This qualitative analysis of Erowid.org experience reports (n=279) examines the temporal structure (organisation of time) of psilocybin experiences, focusing on the 'come-up' and 'come-down' phases. The study finds that the onset phase typically resembles an acute stress reaction with negative feelings. In contrast, the descending phase is characterised by positive feelings similar to post-stress recovery, suggesting a potentially important therapeutic mechanism.
Psychedelic therapy has the potential to become a revolutionary and transdiagnostic mental health treatment, yielding enduring benefits that are often attributed to the experiences that coincide with peak psychedelic effects. However, there may be an underrecognized temporal structure to this process that helps explain why psychedelic and related altered states of consciousness can have an initially distressing but ultimately distress-resolving effect. Here we present a qualitative analysis of the self-reported ‘come-up’ or onset phase, and ‘come-down’ or falling phase, of the psychedelic experience. Focusing on psilocybin or psilocybin-containing mushroom experience reports submitted to Erowid.org, we use phenomenological, thematic content and word frequency analysis to show that the come-up is more often characterized by negatively valenced feeling states that resemble an acute stress reaction, while the come-down phase is more often characterized by positively valenced feeling states of the sort often observed following recovery from illness or resolution of stress. The therapeutic and theoretical relevance of these findings are discussed.
The authors conducted a qualitative analysis of self-reported psilocybin (mushroom) experience reports drawn from Erowid.org using three complementary approaches: phenomenological description, thematic content analysis and word frequency analysis. Phenomenological analysis was used to closely read reports and extract first-person quotations that convey the gestalt of the come-up and come-down phases. Thematic content analysis then coded descriptions of the come-up and come-down to determine the relative frequency of emergent themes. Word frequency analysis was used primarily as a quantitative check on whether words associated with identified themes showed different temporal distributions across a larger set of timestamped reports. The dataset for the thematic/phenomenological work comprised reports explicitly describing the come-up (N = 47) and the come-down (N = 83). Word frequency analysis was conducted on a larger set of timestamped mushroom reports (N = 279) to examine temporal patterns across the experience (for example, words used in the first 60 minutes versus later phases). The authors excluded low-dose reports (defined as less than 0.5 grams of dried mushrooms). Reports were authored by people using psilocybin mushrooms outside controlled clinical settings; the sample therefore reflects self-selected, unstructured narratives rather than data collected in trials. Thematic frequency counts were reported as the proportion of reports in which a theme was mentioned. Word frequency analysis examined usage of anxiety-, nausea- and positive-emotion-related words across time bins to test whether the phenomenological themes generalized to the timestamped sample. The authors emphasised that their approach captures the relative prevalence of topics individuals chose to write about rather than providing epidemiological incidence estimates, and they noted features of the dataset that could affect interpretation (for example, unfiltered co-use of cannabis in some reports and potentially non-random attrition in timestamped reports).
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Andersen, K. A. A., Carhart-Harris, R. L., Nutt, D. J. et al. · Acta Psychiatrica Scandinavica (2020)
Roseman, L., Nutt, D. J., Carhart-Harris, R. L. · Frontiers in Pharmacology (2018)
Yaden, D. B., Griffiths, R. R. · ACS Pharmacology and Translational Science (2020)
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The thematic content analysis found a consistent temporal pattern in how people described the psilocybin mushroom experience. For the come-up phase, commonly reported aversive or challenging themes and their reported prevalence in the analysed sample included nausea (34%), anxiety (28%), restlessness (21%), confusion (17%) and detachment (11%). Physical sensations reported during the come-up included energy rushes (19%), tingling (15%), feeling cold (9%), feeling heavy (9%) and clumsiness or uncoordination (9%). By contrast, the come-down phase was more frequently described with positively valenced themes: feeling pleasant (34%), peaceful (22%), reflective (17%), insightful (17%) and socially enjoyable (16%). The authors also noted that a minority of come-down reports referenced racing thoughts, extra excitability or irritability and ideas of dubious value. Word frequency analysis on the larger timestamped sample (N = 279) supported these temporal trends. Words associated with anxiety and nervousness appeared more often in descriptions of the first 60 minutes after ingestion, while words referring to positive emotional states were used more often in later phases. The authors additionally reported increased references to nausea, confusion, laughter, altered breathing and perceptual distortion during earlier phases of the experience. The visualisations and temporal mappings (figures described in the text) were reported to align with plasma psilocin/5-HT2A receptor occupancy and subjective intensity trajectories known from pharmacology, although the extracted text does not reproduce numerical pharmacokinetic comparisons.
The authors interpret their findings as supporting the view that the psilocybin mushroom come-up often resembles an aversive, illness-like or acute stress reaction, whereas the come-down often resembles relief or recovery. They suggest this temporal structure may be therapeutically relevant: an anxiogenic onset and stress-hormone release early in the experience could shape the emotional intensity and memorability of the peak and contribute to later insights or emotional breakthroughs. The authors link this idea to prior suggestions that an acute stress response elicited by psychedelics may be part of the mechanism of therapeutic change, and they note phenomenological parallels with psycholytic psychotherapy traditions that encourage exploration of symbolic material during drug-augmented sessions. The paper also situates the results within broader theoretical proposals that psychedelic-like experiences (hallucinations, spiritual experiences) can be elicited by stress-induced activation of 5-HT2A receptors. The authors reference a model in which transient, stress-related psychotomimetic states may be adaptive and energising, promoting learning and reengagement, while repeated sensitisation could increase risk of psychosis. They further draw parallels between initial anxiogenic effects of psychedelics and early side effects of SSRIs, proposing that initial 5-HT2A activation might be anxiogenic while subsequent downregulation contributes to antidepressant effects. The authors acknowledge multiple limitations. Their focus on psilocybin mushrooms limits generalisability to other classic psychedelics, routes of administration or clinical contexts. Reports came from uncontrolled, self-selected submissions to Erowid, and approximately half of submitted reports are not published on the site, which may bias the sample. Cannabis co-use was common and was not excluded in all reports, which could have potentiated effects. Their exclusion of low-dose reports (<0.5 g) and the unstructured nature of narrative reports mean the analysis cannot provide population-level incidence estimates; it captures only the relative prevalence of themes that authors chose to mention. The authors also raise the possibility of non-random attrition in timestamped reports (for example, that people with more pleasant come-downs might be more likely to continue time-stamping), but report a preliminary review that did not support this concern. Word frequency analyses and visualisations are presented as supportive, secondary evidence rather than the primary basis for conclusions. For future research, the authors recommend hypothesis-driven work in controlled contexts, development of questionnaires and observational methods to quantify the temporal trajectory of come-up and come-down themes, examination of context-dependency (clinical versus recreational settings), investigation of different administration routes and other psychedelic compounds, and theoretical synthesis that integrates their findings with alternative frameworks.
The authors conclude that their qualitative analysis provides initial evidence that the psilocybin mushroom come-up is often experienced as an aversive or stress-like state while the come-down is more often experienced as relief or recovery. They present this study as an important first step in parsing the temporal trajectory of psychedelic experiences and suggest the approach could motivate more formal hypothesis testing and further research into therapeutic mechanisms.
This study uses phenomenological, thematic content and word frequency analysis to examine the psychedelic mushroom come-up and come-down. The phenomenological analysis allows for a careful examination of subjective experience, and here provides a rich source of first-person quotes to convey a gestalt or holistic sense of how individuals experience and describe the psilocybin mushroom come-up and come-down. Thematic content analysisallows us to code descriptions of the come-up and come-down and determine the relative frequency of themes emerging from our initial phenomenological analysis and subsequent word frequency analysis. Word frequency analysis allows us to test whether words associated with various themes are used with different frequencies when describing different phases of the psychedelic experience. We use word frequency analysis primarily to check whether themes emerging from our phenomenological and thematic content analysis of the come-up (N = 47) and come-down (N = 83) map onto a larger set of timestamped reports (N = 279, see below) which generally do not include explicit reference to the come-up or come-down. While less informative, word frequency analysis helps protect against possible interpretative biases.
Thematic content analysis of descriptions of the come-up and come-down revealed that individuals are more likely to experience aversive feelings in the come-up such as nausea (34%), anxiety (28%), restlessness (21%), confusion (17%), detachment (11%) as well as other physical sensations such as energy rushes (19%), tingling (15%), feeling cold (9%), heavy (9%) or uncoordinated (9%). Alternatively, the come-down is more likely to be described as a pleasant (34%), peaceful (22%), reflective (17%), insightful (17%) and socially enjoyable experience (16%). See Fig.directly below. Word frequency analysis confirmed that words referring to anxiety and nervousness were used more often to describe the first 60 min of the mushroom experience, while words referring to positive emotional states were used more often to describe the latter phases of the mushroom experience. Increased reference to nausea, confusion, laughter, breathing Fig.| Percentage of timestamped reports that reference the come-up ('come-up', 'come-up', 'coming up') and come-down ('come-down', 'comedown', 'coming down') at given timepoints. Despite low percentages of timestamped reports that explicitly reference the come-up and come-down, the graph maps well onto first-person accounts, as well as the temporal relationships between plasma psilocin levels, 5-HT2AR occupancies, and subjective intensity ratings after psilocybin ingestion. and distortion also characterizes descriptions of earlier phases of the mushroom experience. See Figs. 4 and 5 directly below.
Our results support the hypothesis that the come-up phase of a psilocybin mushroom experience (and likely other classic psychedelic experiences) can resemble an aversive illness-like state and that the come-down can resemble a state of relief. See Fig.below for a visual summary of our results. We will now discuss how our results may be relevant to the therapeutic mechanism of action (MoA) of psychedelics, as well as the idea that naturally occurring psychedelic-like experiences, such as hallucinations and spiritual experiences, are elicited by stress. First let us address therapeutic considerations. The psychedelic mushroom come-up described above specifically resembles an acute stress reactionwhich is relevant to but not isolated to illness-like states and symptoms. Feelings of anxiety, irritability and excitement, energy coursing through the body, attention to heartbeat and breathing, numbness, nausea and detachment are common symptoms of a stress reaction or disorder and are associated with the release of stress hormones and adrenaline. Psychedelics have been shown to elicit release of stress hormones and acutely increase anxiety-like behaviors in rodents, a process which is positively associated with post-acute anxiolytic effects. Some scholars also suggest that an acute stress response may contribute to the therapeutic effects of psychedelic agents. De Wit and colleagues, for example, ask whether the acute stress response elicited by psychedelics is a result of the powerful subjective psychedelic experience and/or shapes the emotional intensity and memorability of the psychedelic experience. Our qualitative analysis suggests that the acute stress response elicited by psychedelics begins prior to peak psychedelic subjective effects but does appear to shape the emotional content and insights that occur during the peak and come-down of the psychedelic experience. For example, the unique subjective experience of emotional breakthroughor psychological rebirth following an acute period of challenge or distress might exert therapeutic influences on individuals' views towards illness and healing. In some reports, we noticed that fears, as objects of attention, were first elicited by aversive emotional states, but then drastically reinterpreted as negative emotions gave way to positive emotions. Consider the following passage. "That fear, it turned out, was a fear of fanatical Islam. I realize I had been harboring a deep fear of radical Islam for some time, to the point of bordering on feelings of hatred. I had been rationalizing it and quietly suppressing it and not dealing with it. In that state, the shock of finding that fear was very intense and sad, and it appeared within my subconscious as a tangled messy ball of black yarn-like strings, all bound up and tense and chaotic. I had to let it go, I had to surrender to love. I decided in that moment the only way forward was to love Islam and all Muslims as well, and forget fears of the future, and not to generalize.". Above we glimpse a psychotherapeutic process uniquely relevant to the temporal trajectory of the psychedelic experience (and related spiritual experiences). First, one may experience anxiety or fear, followed by visualizations or symbolic representations of fears. Subsequently, feelings of fear subside, leaving one to reinterpret objects of fear from an unusually nonreactive, accepting and even loving perspective. Certainly, this process can occur outside contexts of psychedelic use. However, the fact that psychedelics can elicit this trajectory in an amplified, short-duration and controlled manner is of immense therapeutic import. Note here that there is a tradition of psychoanalytic therapy conducted with low doses of psychedelicsreferred to as psycholytic therapythat actively encourages patients to engage with symbolic representations of 'subconscious' conflicts or fears. The current findings may also provide additional insights into the antidepressant mechanism of action (MoA) of psychedelics, and perhaps how this MoA relates to other antidepressant treatments. For example, aversive feelings in the come-up overlap to some extent with the adverse side effects of serotonin selective reuptake inhibitor (SSRI) antidepressants; side effects that may occur before therapeutic effects are noticed. Initial activation of 5-HT2ARs may therefore be anxiogenic in both cases, while rapid or chronic downregulation of 5-HT2AR signaling, respectively, might contribute to the antidepressant effects of both types of serotonergic antidepressant. In addition to being therapeutically relevant, our findings also support the idea that naturally occurring psychedelic-like experiences, such as hallucinations and spiritual experiences, may be elicited by stress-induced activation of 5-HT2ARs. Indeed, the impetus for this study comes from recent theoretical attempts to reconcile psychedelics, as therapeutic agents, with a broader psychotomimetic perspective. Brouwer and colleaguespropose that transient endogenous psychotomimetic compensation elicited by illness, injury, social threat or loss, depression, anxiety or panic is often neuroprotective and energizing, and promotes learning and behavioral reengagement, while psychotomimetic sensitization over time in response to recurrent intense stress or repeated drug use can sensitize an individual to psychotic disorder. According to this theory, the phenomenological trajectory of a psychedelic experience might mimic the trajectory of naturally occurring psychedelic-like (eg spiritual, psychotic, and near-death) experiences facilitated by stress, in which feelings of lethargy, anxiety, detachment, confusion, pain and panic precede visionary/hallucinatory phenomena and increased mental energy. We note above that a minority of come-downs are characterized by racing thoughts, extra excitability or irritability, and ideas of dubious value (see also Supplementary Note 2; 2G), which may reflect a particular sensitivity to the energizing effects of psychedelics and possibly a predisposition to mania or psychosis. We refer the reader to Brouwer et al.for further explanations and implications of the model. There are, of course, other potential implications of our findings, and ties to prior research and other theoretical frameworks, that we cannot adequately elaborate on here. Therefore, in addition to suggesting specific directions for future research based on the limitations of the current study (see below), we also encourage theoretical efforts to synthesize the findings and frameworks mentioned here with other perspectives on psychedelics. Now turning to some limitations of our study. The choice to focus exclusively on psilocybin mushroom experiences limits our ability to extrapolate to other classic psychedelics; however, it was motivated by clinical interest in psilocybin, and a desire to privilege rich descriptions over a broader scope. Focusing specifically on textual descriptions of the mushroom come-up and come-down likewise provided us with an easily manageable number of reports, allowing us to carefully read and extract quotes from the text at our discretion, without fear of misrepresenting our sample. The large number of mushroom reports available at Erowid.org also provided an adequate sample size of timestamped reports (N = 279) for conducting a meaningful word frequency analysis. Word frequency analysis and visualization (Figs.and) increased our confidence in the generalizability of our qualitative analysis. One possible limitation of the current study, and indeed a critique that is often levied against qualitative analyses, is that a priori assumptions lead to biases in interpretating data. We acknowledge this limitation and encourage interested readers to explore the primary source material at Erowid's Experience Vaults (), as well as to reflect upon their own experiences and ask whether they resonate with our interpretations. Good phenomenological research is characterized verisimilitudethe appearance of being true or realand the value of the current analysis will age accordingly. An a priori focus on illness and relief-related themes is, in our view, more of a strength than a limitation, as post hoc identification of meaningful themes presents an opportunity for bias and error inherent in the search for explanations. Moreover, formulating clear hypotheses allowed us to question whether emergent themes fit with our preconceived notions. One finding that challenged us in this regard; laughter was more commonly referenced in descriptions of the come-up than in descriptions of the comedown. A quick review of background literature, however, helped make sense of this association. While laughter may indicate a positive emotional state, it is also associated with anxiety and uncertainty, and a signaling of 'playfulness' or 'non-threat' to others during arousing or potentially uncomfortable, uncertain or threatening scenarios. Uncertainty is an expected feature of the onset of psychedelic experiences and fits with theoretical propositions that psychedelics increase brain entropyand lead to a temporary relaxation of priors. Future research is still needed to ascertain whether the trajectory of the mushroom experience reported here is generalizable to psychedelic experiences that occur in clinical contexts, that are elicited by different routes of administration (smoked, insufflated, intravenous), or are elicited by psychedelics other than mushrooms and/or psilocybin. While we expect some variability regarding these factors, note a similar trajectory in the first LSD experience ever recorded. Albert Hofmann writes… [Come-up] "4/19/43 16:20: 0.5 cc of 1/2 promil aqueous solution of diethylamide tartrate orally = 0.25 mg tartrate. Taken diluted with about 10 cc water. Tasteless. 17:00: Beginning dizziness, feeling of anxiety, visual distortions, symptoms of ataxia, desire to laugh." (p. 19). [Peak] [Experience with demon] (p. 20). [Come-down] "Slowly I returned from a weird, unfamiliar world to my reassuring everyday reality. The horror softened and gave way to a feeling of great fortune and immense gratitude; more normal perceptions and thoughts returned, and I became more confident that the danger of insanity was decidedly past. Now, little by little, I could begin to enjoy the unprecedented colors and plays of shapes that persisted behind my closed eyes" (p. 21). Questions regarding the context-dependency of psychedelic experiences are another key matter for future research. The reports analyzed here were written by people using psilocybin mushrooms outside of controlled settingsand some of our findings may not translate to clinical or experimental contexts. For example, individuals might be less likely to mention paralysis or immobility during the come-up or express "socially inappropriate" reactions like uncontrolled laughter, when lying on a couch in a clinical trial or in a therapist's office. Likewise, concentration difficulties, perceptual distortions and social discomfort may be more noticeable in contexts that require concentration, perceptual acuity and social interaction. Our findings may also not be generalizable to all psychedelic users. Individuals motivated to submit their mushroom experience reports to Erowid.org may differ in some general ways from other populations of users (eg in level of education), just as the demographic and psychological characteristics of individuals in clinical trials may differ from the average psychedelic user. Note also that roughly half of all experience reports submitted to Erowid are not published (see methods). This could affect the generalizability of our findings as well. Relating to variables unique to our sample, the use of cannabis appeared very common in conjunction with the use of psychedelics. Additionally, our search criteria did not filter out some reports in which cannabis was, or was likely to have been, used. Cannabis has been shown to potentiate the psychedelic experience, albeit in a non-linear dose-dependent wayand so might also influence descriptions of the mushroom come-up and come-down as described here. The choice to exclude low-dose experience reports (less than 0.5 grams of dried mushrooms) is another potential limitation/oversight of the current study. Another set of limitations applies to the analysis of unstructured experience reports. Our analysis does not capture what percentage of individuals experienced nausea or anxiety during the come-up, or what percentage of individuals felt content during the come-down. We were only able to capture the relative prevalence of themes that individuals chose to write about. The advantage of this method, of course, is that researchers do not impose expectations on individuals reporting their experiences. Nevertheless, the development of questionnaires and observational methods for assessing the frequency of these themes in experimental trials is a promising area for future research. Another potential area of concern is non-random attrition of reporting as the experience progressed, particularly in our sample of timestamped reports. It is possible, for example, that positively valenced come-downs, as captured by word frequency analysis, better represent the experiences of individuals who continued to keep track of time. In turn, perhaps these individuals had more pleasant trips in general, including during the comeup. However, a preliminary review of the come-ups experienced by these authors did not bear out this concern. Moreover, word frequency analysis and derivative visuals (Figs.and) are, in our opinion, of secondary importance, and merely supportive of our primary phenomenological and thematic content analyses. A qualitative analysis of the psilocybin mushroom come-up and come-down is an important first step in describing the temporal trajectory of the mushroom experience. To our knowledge, little research has parsed the psychedelic come-up or come-down and likened it to an aversive/challenging state and recovery from it. Our approach could therefore inspire future work on this theme, including more formal hypothesis testing. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. 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