This survey study (n=1993) found that in naturalistic (non-laboratory studies) setting, the single worst difficult experience (‘bad trips’) was associated with acute negative effects (aggression, physical harm) and long-term negative (3 cases of both suicide attempt and enduring psychotic symptoms) and positive (increase in well-being) outcomes.
Abstract
“Acute and enduring adverse effects of psilocybin have been reported anecdotally, but have not been well characterized. For this study, 1993 individuals (mean age 30 yrs; 78% male) completed an online survey about their single most psychologically difficult or challenging experience (worst “bad trip”) after consuming psilocybin mushrooms. Thirty-nine percent rated it among the top five most challenging experiences of his/her lifetime. Eleven percent put self or others at risk of physical harm; factors increasing the likelihood of risk included estimated dose, duration and difficulty of the experience, and absence of physical comfort and social support. Of the respondents, 2.6% behaved in a physically aggressive or violent manner and 2.7% received medical help. Of those whose experience occurred >1 year before, 7.6% sought treatment for enduring psychological symptoms. Three cases appeared associated with onset of enduring psychotic symptoms and three cases with attempted suicide. Multiple regression analysis showed the degree of difficulty was positively associated, and duration was negatively associated, with enduring increases in well-being. The difficulty of experience was positively associated with dose. Despite difficulties, 84% endorsed benefiting from the experience. The incidence of risky behavior or enduring psychological distress is extremely low when psilocybin is given in laboratory studies to screened, prepared, and supported participants.”
Authors: Theresa M. Carbonaro, Matthew P. Bradstreet, Frederick S. Barrett, Katherine A. MacLean, Robert Jesse, Matthew W. Johnson & Roland R. Griffiths
Notes
“Despite these difficulties, it is notable that 84% of respondents reported having benefited from the experience, with 76% reporting increased well-being or life satisfaction attributed to the experience. Some 60% of respondents considered their experience to be among the top 10 most psychologically personally meaningful experiences of their lives, while 34% and 31% reported the experience in the top five most personally meaningful and spiritually significant, respectively.”
This ties back into earlier research by Griffiths et al (2006) which identified that in their study 67% of participants rated the experience (30mg/70kg of psilocybin) as one of the top five (or top) experience in their lives.
Summary
Psilocybin has been reported to cause acute and enduring adverse effects, but have not been well characterized. In this study, 1993 individuals completed an online survey about their single most psychologically difficult or challenging experience after consuming psilocybin mushrooms.
Introduction
Psilocybin, the principal psychoactive component of mushrooms, has likely been used for millennia for religious or divinatory purposes. Over half of people who reported using a hallucinogen in the past year did so with psilocybin.
Although psilocybin has very low physiological toxicity and is not associated with compulsive drug seeking, it can sometimes produce acute and persisting adverse psychological reactions. However, the perceived risk of psilocybin-related harm was found to be very low when evaluated by drug experts and experienced drug users.
Psilocybin use is associated with seeking medical treatment, but the incidence of psilocybin toxicity is extremely low relative to other drugs used non-medically.
A study was conducted of individuals who had experienced a challenging experience with psilocybin. The study asked about the psychological and emotional consequences of the experience.
Participant recruitment
Participants were recruited via internet advertisements and email invitation. They were informed that study participation was anonymous, they could choose to stop answering questions at any time, and if they did not complete the survey their specific responses would not be used.
Survey administration
The survey was administered using SurveyMonkey, an online survey and data-collection software tool, and took approximately 45 minutes to complete.
Inclusion criteria
Participants were required to fulfill six criteria to participate: be at least 18 years old, read, write, and speak English fluently, have taken psilocybin mushrooms, and not have completed this survey previously.
Participants were instructed to answer questions in reference to their single most psychologically difficult or challenging session or experience. Those who did not meet the inclusion criteria were linked to an alternate, shorter version of the survey.
Participants reported how many times they had used psilocybin mushrooms, LSD, morning glory seeds, mescaline, peyote cactus, San Pedro cactus, DMT, or ayahuasca over the course of their lifetime.
The phenomenology of the psilocybin experience was assessed using three questionnaires: the Hallucinogen Rating Scale (HRS), Mystical Experience Questionnaire – 30 item version (MEQ30), and selected subscales from the 5D-ASC.
Participants were asked to rate the experience of taking psilocybin on four different scales: psychologically difficult, personally meaningful, spiritually significant, and change in current sense of personal well-being or life satisfaction.
Participants answered questions about the occurrence, duration, and severity of negative psychological experiences that they may have experienced before and after the challenging experience.
Statistical analysis
Descriptive statistics, Pearson correlations, multiple regression analysis, and the role of duration of challenging experience in determining personal meaning, spiritual significance, and enduring change in well-being were used. Pearson correlations were used to analyze the associations between dose, setting conditions, age at time of the psilocybin experience, past hallucinogen experience, use of cannabis and use of another mood-altering drug immediately before or during the session, and endorsement of putting self or others at risk for physical harm.
Survey completion
During recruitment, 5850 individuals began the survey. Of these, 1074 were excluded because they did not meet the inclusion criteria, 92 were excluded because they did not complete the survey, and 1993 individuals provided useable data.
Participant characteristics
Participants were mostly male, White, and had a college or graduate degree. Most had used psilocybin more than two times in their life and had used hallucinogens more than 10 times in their life.
Participants were on average 23.3 years old, had used psilocybin 2 – 5 times before their chosen session, and 10% had used no hallucinogens before their chosen session.
The challenging psilocybin session
Some 84% of participants reported taking dried and fresh mushrooms, and 36% reported attempting to take a larger than usual dose of psilocybin for the session.
During the session, participants reported being alone, with one person, with a few people, in a small to medium size group, or a large gathering, and 76% indicated that their emotional state before taking psilocybin was conducive to having a positive experience.
Qualitative ratings of the psilocybin experience
As shown in Figure 1, the majority of participants considered the psilocybin experience to be among the top 10 most psychologically difficult or challenging experiences of their lives, but most also considered it to be among the top five most personally meaningful and spiritually significant experiences of their lives.
Table 2 shows that the duration of a psychologically challenging experience was positively correlated with the overall degree of difficulty, but negatively or less robustly with the meaningfulness, spiritual significance, or enduring changes in well-being.
Difficulty and duration of difficulty of the psilocybin experience: Relationship of dose, setting conditions, use of another mood-altering drug, age, and past hallucinogen experience
As shown in Table 4, dose, estimated dose, emotional state, physical comfort of setting, social support, and having a guide present were all positively correlated with degree of difficulty and duration of difficult experience.
Endorsement of putting self or others at risk for physical harm was positively correlated with estimated dose, degree of difficulty of experience, and duration of difficult experience. It was less likely in those who also endorsed the physical comfort of the setting.
Hallucinogen Rating Scale and Mystical Experience Questionnaire 30
The mean scores for 1993 participants on the HRS were 2.62 (0.01), 1.64 (0.02), Affect, 1.89 (0.02), Perception, 2.54 (0.02), Cognition, 2.30 (0.02), Volition, 2.02 (0.02), and 50.26 (0.54) for the MEQ30.
Strategies for alleviating the challenging experience
Participants reported that their social support and trust for others, physical comfort and safety of surroundings, and emotional state were conducive to having a positive experience. Most participants tried to stop the challenging experience by changing location, calm their mind, or changing the music or social environment.
Risks and problems during the experience
Two research staff members reviewed all open-ended textual responses to identify instances in which changes in suicidal thoughts or behavior were attributed to the challenging experience. They found evidence of both increased suicidality (five cases) and decreased suicidality (six cases).
Enduring negative psychological and emotional experiences
Data from 1339 participants who took psilocybin at least 1 year before completing the survey were analyzed. Of those who reported psychological symptoms, 19.3% had sought treatment for at least one of five negative psychological symptoms before their chosen session and 24% reported experiencing one or more of these symptoms after the challenging session.
Three cases were reported in which White males who were 18 to 21 years old at the time of the experience reported enduring and impairing psychotic symptoms. All three reported having received diagnoses of bipolar disorder and post-traumatic stress disorder.
Discussion
In a survey of 2000 participants, 39% rated their worst experience after taking psilocybin mushrooms as among the top five most challenging experiences of their lifetime, 11% reported putting themselves or others at risk of physical harm, and 2.6% reported getting medical help during the occasion.
Despite difficulties, most respondents reported benefiting from the experience, and 60% considered it to be among the top 10 most personally meaningful experiences of their lives.
The degree of difficulty of a psychedelic experience was positively and significantly related to the attribution of enduring personal meaning, spiritual significance, and increased life satisfaction. The duration of the psychedelic experience was negatively related to personal meaning, spiritual significance, and increased well-being.
Dose of dried mushrooms consumed and estimated dose positively correlated with degree of difficulty.
In the present study, those who reported having been treated for psychological symptoms before their challenging session were more likely to seek treatment for psychological symptoms that they attributed to the session.
The present survey documents nontrivial rates of both acute problems and enduring problems with psilocybin use, which may be related to the protective effects of lifetime psilocybin exposure on psychological distress and suicidality.
The rates and severity of acute and enduring problems shown in the survey are notably higher than those observed in laboratory research studies involving administration of high doses of psilocybin to carefully screened, well-prepared, and closely monitored volunteers. Although no volunteer has been physically harmed during sessions, three instances in which a participant’s disorientation during a session might have put them or staff members at risk were reported. We changed our session management procedures to strongly emphasize that volunteers remain on the couch throughout the session. Three volunteers reported negative symptoms after a psilocybin session, but all three reported that the symptoms resolved after a few sessions with an experienced psychotherapist.
The rates of acute and enduring problems reported in the survey compared with the controlled laboratory studies may be due to several factors, including the absence of psychological screening and unknown psychological preparation for psilocybin ingestion.
The current survey was an anonymous internet survey and the rate of non-completion was high. However, 83% of respondents took the time to write open-ended comments about their challenging experience at the end of the survey.
The survey was limited to people who endorsed having had a challenging experience after psilocybin, and the sample was biased toward individuals with current favorable interest in psychedelic drugs.
The median reported dose of dried psilocybin mushrooms taken in the survey was 4 g, with most respondents reporting having taken dried mushrooms rather than fresh. The mean HRS intensity subscale score was 2.62, and the mean MEQ30 total score was 50.3, with 21% fulfilling criteria for a “complete” mystical experience.
This survey of almost 2000 people showed that psychologically difficult experiences after taking psilocybin mushrooms can include acute psychological distress, dangerous behavior, and enduring psychological problems. However, the risks of these effects are extremely low in laboratory studies with carefully screened, well-prepared participants.
Figure 3.
Participants in a study endorsed different strategies to try to stop a challenging experience after taking psilocybin, and most endorsed trying more than one strategy.
Study details
Participants
1993