Day trip to hell: A mixed methods study of challenging psychedelic experiences

This interview (n=38) and survey (n=319) study identified new themes as part of negative or challenging psychedelic experiences. Specifically, it identified fear (69%) and confusion (62%) to be a larger component than previously recognized, and ego dissolution as less central and sometimes even protective.

Abstract

“Background and aims This article presents a mixed methods study of challenging psychedelic experiences or “bad trips”, with the aim of exploring the nature and characteristics of such experiences. While challenging psychedelic experiences have been studied in previous research, the article posits that the focus of this research has been overly narrow in terms of the characteristics and etiology of these experiences, and that it would be helpful to broaden our understanding of what a challenging psychedelic trip might be and how it affects users.

Methods In the first study, respondents (N = 38) were recruited at various online fora for individual anonymous interviews via private messaging. The Cannabis and Psychedelics User Survey used for the second study was constructed on the basis of the knowledge obtained from interviews, and recruited 319 participants (median age 33; 81% male) from seven different online communities. Respondents were asked to characterize both a typical and their worst psychedelic experience, allowing for comparisons between the two and for regression analyses of associations between challenging experiences and other factors.

Results Both in interviews and in the survey, respondents reported a broader range of characteristics for challenging psychedelic experiences than what has previously been recognized in the research literature. Despite the often dramatic narratives, they were convinced that the experience had positive long-term consequences.

Conclusions The two studies found that challenging psychedelic experiences have a greater thematic range than what has previously been identified. Besides the near ubiquity of fear in these experiences, confusion was also identified as an important aspect. Meditation practice had paradoxical effects on challenging psychedelic experiences, appearing as a fruitful area for further research.”

Author: Peter G. Johnstad

Notes

Psychedelic experiences aren’t all sunshine and unicorns. A small percentage of trips can be classified as ‘bad’ or ‘challenging’. In many studies, it rarely occurs, but one recent study found that 7 out of 40 that used ayahuasca in a traditional environment had negative experiences. Still, for many such an experience is later classified as helping them grow in the long term.

The Challenging Experience Questionnaire finds that grief, fear (of death or going insane), feeling isolated, and a negative experience of ego dissolution are part of such bad trips. Another study finds that those who score high on the personality trait neuroticism, have a higher chance of having challenging experiences.

The current study argues that the definition of bad trips is still too limited. To study this, the researchers conducted interviews with 38 people and did a survey study with 319 more. They found several aspects that were overlooked by other researchers.

The full ‘bad trip’ phenomenology

• The fear of ego dissolution was a smaller part of the experience than previously identified, some interviewees even identified it as a positive aspect of a trip
• Fear was a larger part of the experience, with 69% of participants identifying this as part of their worst trip
• Confusion was identified 62% of the time, a concept not previously included

Gaining new insights into your life is often a large part of a psychedelic trip. It allows a person to take a step back and look at their life from an outsider’s perspective. The current study identified this as an aspect of the bad trips. Or in other words, people didn’t like what they saw from that vantage point.

Still, this study and previous studies find that challenging experiences usually lead to positive outcomes long term. By being confronted with something one rather not sees, a person is able to resolve that problem.

Summary

This article presents a mixed methods study of challenging psychedelic experiences, which found that these experiences have a greater thematic range than what has previously been recognized in the research literature. Meditation practice had paradoxical effects on challenging psychedelic experiences.

INTRODUCTION

Psychedelics are a group of psychoactive drugs with powerful effects on feelings, thought, and perception. Some psychedelics are considered safe and have been used to treat a range of conditions, including depression, anxiety, and substance abuse.

Psychedelics users may experience intense fear when experiencing the dissolution of their ego or self, and this fear may be measured by a rating scale named Dread of Ego Dissolution (DED). However, the DED scale overlooks some categories of challenging experiences, including grief, fear, death, insanity, isolation, physical distress, and paranoia.

Researchers have generally been unable to identify predictors for adverse psychedelic experiences, but Lucas (2005) summarized four rules of common sense for psychedelic trips.

(3) taking them in an over-stimulating environment like a public place; or (4) taking too much (Lucas, 2005, p. 26).

In a psilocybin study by Studerus et al. (2012), high drug dose, being placed in a PET scanner, and emotional excitability were found to be predictors for difficult experiences, and in an online survey by Carbonaro et al. (2016), cannabis use decreased the difficulty of the challenging trip. Besides dosage and drug combinations, factors related to set and setting also had a significant impact on the difficulty of the experience. Mature and experienced users were generally better able to deal with the experience.

It seems that set and setting are important for the outcome of a psychedelic trip, but precautions in this regard do not guarantee against adverse reactions.

The characteristics, etiology, and consequences of challenging psychedelic experiences remain unclear, but fear of death or insanity accompanying states of ego dissolution seems to play a central role. Set and setting are important, but not decisive, and consequences seem largely benign.

METHOD

In two phases of study, 38 current or past psychedelics users were interviewed about their experiences. These interviews touched upon the subject of challenging trips, and 12 participants were recruited specifically on the basis of their reports of challenging psychedelic experiences posted on Internet discussion fora.

The study was designed in conformity with Norwegian Social Science Data Services ethical guidelines and used asynchronous and Internet-mediated interviews to collect data. Participants were encouraged to interact with the interviewer via anonymized email or messaging that protected their identity from the researcher.

The Cannabis and Psychedelics User Survey was constructed on the basis of the interview study and tested on 18 volunteers. It was made generally available online via SurveyXact from April to September 2019 for self-selected participation.

Participants were recruited from seven communities: www.shroomery.org, www.dmt-nexus.me, www.bluelight.org, the Facebook page for Portland Psychedelic Society, the Reddit group r/Psychedelics, the Norwegian Association for Safer Drug Policy, and an informal group of psychedelics users in Bergen, Norway.

Measures

The Cannabis and Psychedelics User Survey included basic demographic questions relating to age, gender, education, work status, and relationship status, as well as questions about participants’ usage history and/or present use of cannabis and psychedelic drugs of the 2C family.

The Cannabis and Psychedelics User Survey used a version of Gosling, Rentfrow, Swann’s (2003) Ten-Item Personality Inventory (TIPI) and a modified version of Nicholson, Soane, Fenton-O’Creevy, and Willman’s (2005) Risk Taking Index (RTI) to measure personality traits.

Statistical analysis

An ordinal regression analysis was used to predict the difficulty of a challenging psychedelic experience. Eight negative items were added together and a range of predictor variables was assessed to determine the impact of these variables on the additive variable.

While controlling for commonly used demographic covariates, the overall risk taking score, the Big Five personality traits, the six personality traits, the years of cannabis experience, the lifetime number of use occasions, and the social environment in which the respondent most commonly used their chosen psychedelic were all significant. Data was analyzed with IBM SPSS Statistics 25. An ordinal regression model and a linear regression model were used to analyze the impact of the respondents’ worst psychedelic experience on their long-term consequences.

Participant characteristics

The study included 30 participants, 28 male and 2 female, with a median age of mid-30s. They were employed in retailing, education, music teaching, journalism, industrial services, IT consulting, carpentry, investment client support, and as a hospital worker.

Types of challenging psychedelic experiences

Respondents reported a broad range of challenging psychedelic experiences, which may have been the product of several converging themes.

One common form of challenging experience involved unpleasant insights about one’s life. However, some users described apparent insights that were actually delusionary, turning minor issues into huge problems.

Social paranoia is a common aspect of challenging psychedelic experiences. It involves thoughts that other people do not like, accept, or approve of the user.

Psychedelics can cause users to see threatening visions, such as insects crawling on walls and angry faces in pictures.

Participants in the study worked to integrate challenging experiences, and claimed to benefit from them in the long run. Some reported seeing evil or malicious entities, while others reported experiencing alterations to other senses than vision.

Psychedelics may enhance or stimulate certain aspects of cognition and perception, but the enhancement effect can be uncomfortably strong, leading to states of mental and sensory overload.

He noticed that 15 seconds had passed since he laid down, and calmed himself, and did not have any lasting complications.

Psychedelics dissolve the sense of having a separate self, and users who experience fear of ego death often resist the process.

After using cannabis, one user reported feeling protected by ego loss, and another reported understanding his true identity as a kind of spiritual force that was only playing at being “himself”.

Psychedelics users report fears of mental and physical damage, including losing old memories and brain damage.

Some psychedelic experiences were so intense that users feared they would never be able to go back to the person they were before the experience.

This respondent’s dangerous insight was forgotten upon returning to his usual state of consciousness. He felt that this was because he had not gone through a process of ego dissolution.

In cases of accidental overdosing, the fear of mental and physical damage often occurred along with distressing bodily sensations.

Another respondent drank a self-made tea based on Mimosa tenuiflora and P. harmala and described entering a void of uncaring eternity.

After smoking a joint with his friends and taking a large dose of Psilocybin mushrooms, a fourth respondent experienced a psychotic episode that also involved a feeling of eternal damnation.

Finding the way back

Psychedelic users share their difficult experiences on an online forum, where they get feedback from people who have been in a similar situation. This helps them to integrate the experience and move on with their lives.

Respondents who underwent especially high-intensity experiences often talked to a partner or family member to help them calm down, and some also pleaded for help at online discussion fora.

Participant characteristics

The survey was completed by 213 participants, of which 106 opted out. The typical participant was a male aged 32 with some university education, unmarried and childless but with a partner, situated in North America.

The most commonly chosen psychedelic drug was psilocybin, followed by LSD and DMT. Participants reported moderate usage patterns, with the median participant having had between 1 and 10 use occasions over the past 12 months.

Characteristics of challenging psychedelic experiences

Participants reported significant differences between their worst and a typical experience with their chosen psychedelic drug on 23 of 24 characteristics, with the only exception being ego death or dissolution.

Ordinal regression was used to assess the impact of a range of predictor variables on two indicators of experiential difficulty: absolute difficulty and relative difficulty. Age, education, female gender, emotional stability, meditation practice, and escapist motivation all contributed to decrease the difficulty of a challenging psychedelic experience. The regression model for relative difficulty was somewhat weaker, but it was congruent with the first model in that female gender, education and the personality trait Emotional stability reduced the difficulty of the experience, while the number of lifetime use occasions increased difficulty.

DISCUSSION

This study indicated that challenging psychedelic experiences have a greater thematic range than previous research has indicated, and that consequences are generally positive.

The survey data showed that ego dissolution was an important aspect of many challenging psychedelic experiences, but it was by no means a defining characteristic. Furthermore, the types of challenging psychedelic experiences in this study seemed to have a greater range and variation than the seven categories identified by Barrett et al. (2016). Barrett et al.’s (2016) model of insanity includes experiences with loneliness and social isolation, but not with existential isolation. This category seems somewhat underdefined, however, since it also includes experiences with dread of ego dissolution, fear of brain damage, and an actual psychotic break.

Fear was ubiquitous in these narratives, and was regarded as a defining characteristic of challenging psychedelic experiences.

The survey data indicates that fear was the most endorsed characteristic for respondents’ worst psychedelic experience, and that fear could probably serve as an operationalized indicator of such experiences.

The survey data supports Barrett et al.’s (2016) categories of social isolation and grief as important aspects of challenging psychedelic experiences. Furthermore, 32% of respondents indicated that their worst experience included ego dissolution, which was significantly correlated with fear.

Barrett et al.’s (2016) survey identified confusion as an important characteristic of respondents’ worst psychedelic trip, and this characteristic was significantly correlated with the indicator for ego dissolution. Furthermore, anger or hate, regrettable behavior towards others, and violent behavior were all significantly correlated.

Psychedelic experiences often involved hard insights into one’s life, which may be relevant for the positive therapeutic effect from psychedelic experiences on issues of substance dependence. However, some respondents also found themselves obsessing over minor life issues during psychedelic trips.

The employment of meditation skills in order to overcome challenging psychedelic experiences was widespread among interviewees, and the regression model for the absolute difficulty of a challenging psychedelic experience found that a meditation practice was actually associated with a more difficult experience.

Factors relating to set and setting were not as important in these studies as we would perhaps expect. The most salient factor was set, and there was no clear link between a negative mind-state before the psychedelic session and the emergence of challenging material during the session.

The majority of participants in these studies found that their challenging psychedelic experience resulted in positive long-term consequences. A small minority of 4% pointed out negative consequences, however.

This explorative study recruited participants via online psychedelic communities, and they had to self-select for participation. The study may have excluded some psychedelics users, and the sample may therefore be biased towards positive results.

CONCLUSION

These explorative studies identified paradoxical effects from meditation practices on the difficulty of challenging psychedelic experiences, and identified fear as the most common aspect of such experiences.