This qualitative study (n=26) explored existential distress following psychedelic experiences, finding persistent preoccupation with sense-making and confusion about existence and purpose. Participants reported cognitive, emotional, social, bodily, and functional impacts. They managed distress through embodiment practices and social/cognitive normalization.
Psychedelic induced mystical experiences have been largely assumed to drive the therapeutic effects of these substances, which may in part be mediated by changes in metaphysical beliefs. However, there is growing evidence that psychedelic experiences can also trigger long lasting distress and studies of persisting difficulties suggest a high prevalence of ontological challenges (related to the way people understand reality and existence). We conducted semi-structured interviews with 26 people who reported experiencing existential distress following psychedelic experiences. We explored the phenomenology of participants’ difficulties and the ways they navigated them, including what they found helpful and unhelpful in their process. Thematic analysis revealed the kinds of distress that accompanied worldview and identity shifts: persistent preoccupation with making sense of the experience and confusion about their existence and purpose. Along with cognitive difficulties stemming from the ungrounding of their prior frameworks for understanding, participants’ ontologically challenging experiences also had significant emotional, social, bodily, and other functional impact. Participants primarily alleviated their distress through ‘grounding’ practices of embodiment, and the social and cognitive normalization of their experiences. Findings are discussed in the context of the growing field of psychedelic-related difficulties and the challenges of integration.
Psychedelic experiences can produce profound shifts in metaphysical beliefs and identity, and while many studies emphasise therapeutic benefits such as reduced death anxiety and increased meaning, there is growing evidence that a substantial minority of users experience long-lasting difficulties. Earlier research and large surveys have identified persistent ontological challenges—disturbances in how people understand reality and existence—after single or repeated psychedelic episodes, and qualitative analyses commonly report existential confusion, struggles to make sense of experiences, and functional impairment lasting months or longer. The unpredictability of such transformations raises ethical questions about informed consent, and the literature on integration—the process of making sense of and incorporating psychedelic experiences—remains sparse, with little guidance about how to address specific types of prolonged difficulties like ontological shock. Argyri and colleagues set out to explore, in depth, the phenomenology of existential and ontological distress that persists after psychedelic experiences and to identify what participants found helpful or unhelpful when managing these difficulties. Using a retrospective qualitative design nested within a larger mixed-methods project, the study asked three research questions: what are the features of extended existential struggle after psychedelic use, which supports and practices participants found useful or harmful, and how people described integrating the experience and the learnings they carried forward. The authors aimed to fill a gap in understanding how extended ontological disruption is lived and navigated, and to inform integration and support approaches for such difficulties.
Papers cited by this study that are also in Blossom
Breeksema, J. J., Kuin, B. W., Kamphuis, J. et al. · Journal of Psychopharmacology (2022)
Bremler, R., Katati, N., Shergill, P. et al. · Scientific Reports (2023)
Belser, A. B. · Frontiers in Psychology (2022)
Carbonaro, T. M., Bradstreet, M. P., Barrett, F. S. et al. · Journal of Psychopharmacology (2016)
This study formed part of the Challenging Psychedelic Experiences Project, a mixed-methods, multi-country investigation. For the qualitative arm reported here, participants were drawn from an earlier online survey of 608 individuals who reported difficulties lasting more than a day after psychedelic use; 102 of those survey respondents (17%) had indicated an "Existential Struggle" theme in their open-ended answers and were eligible for follow-up. From those who volunteered for interviews, the researchers selected participants purposively on the basis of having described existential-type difficulties. Recruitment channels included social media, a psychology and philosophy newsletter, student email lists and a newspaper advertisement. No financial incentives were offered. Twenty-eight interviews were conducted initially; two transcripts were later excluded because they did not address the study aim, leaving a final sample of 26 participants. Inclusion criteria were age 18 or over, fluency in English, and having experienced post-psychedelic difficulties that negatively affected functioning for more than a day. Interviews were semi-structured, audio-recorded, transcribed via Otter.ai and checked against the recordings by interviewers to ensure accuracy. Three members of the research team (EKA, JE, PM) performed an inductive thematic analysis following the six-stage approach described by Braun and Clarke (familiarisation; coding; theme development; review; definition; reporting). An additional team member (OR) served as a consultant during parts of the analysis. Codes were organised visually on a Miro board and themes were negotiated collaboratively across the analysts. Unlike some thematic reports, the team reported the frequency of themes and subthemes, with frequencies and percentages provided in supplementary materials. Ethical approval was granted by the University of Greenwich Research Ethics Board (Project ID: 21.5.7.20); written informed consent was obtained and participants could withdraw up to two weeks after interview. Transcripts were anonymised and data held securely.
Thematic analysis of 26 interviews produced 11 overarching sections of findings describing participants' contexts, the acute psychedelic episodes, the nature of extended difficulties, coping strategies and outcomes. Participants frequently described turbulent or transitional life circumstances prior to the index experience: 9 reported healing/self-exploration, 12 were in highly transitional phases, and 12 described turbulent or stressful periods; only two reported no significant prior difficulties. Intentions for using psychedelics varied: curiosity/exploration (9), seeking fun (7), healing (6), self-development (5), seeking clarity on life decisions (5), positive prior experience (5), and spiritual aims (2). One participant reported an unintentional DMT exposure. Acute experiences were often aversive: 12 participants characterised their trip as traumatic, and 16 conveyed existential concern. Expressions of fear were common (16 participants, 62%), including anxiety or terror (11, 42%) and paranoia (7, 27%). Other acute features included overwhelm, sensory overload and aggressive reactions in a minority. Many described exiting the trip feeling shaken, fragile or physically exhausted. Interviewees reported major and sometimes prolonged worldview and identity shifts that could be bewildering, with cases ranging from conversion to religious life to dramatic changes in spiritual orientation. All participants experienced some form of ontological shock or existential confusion. Extended difficulties encompassed existential crisis and despair (10 participants), cognitive and behavioural disruptions affecting daily functioning (12), severe impacts on work or study (11), attentional problems and disorientation, and somatic problems including sleep disruption and nightmares (ten participants described somatic issues; seven reported nightmares). Twelve participants explicitly framed the experience as traumatic, and 15 reported flashbacks or re-experiencing phenomena. Identified triggers for reactivation included meditation, breathwork, further substance use, conversations about psychedelics, and sleep-related triggers. Regarding coping, 22 of 26 participants reported using grounding practices that helped reduce cognitive preoccupation; examples included body-oriented practices, simple attention-focusing techniques (e.g. counting), and various forms of meditation—though meditation functioned as both helpful and as a trigger for some individuals. Social and cognitive normalisation—finding interpretive frameworks or communities that validated the experience—was also commonly reported as beneficial. By contrast, lack of support and understanding was widely described as unhelpful (18 participants), including absence of community, dismissive or fear-provoking spiritual interpretations from others (eight participants), and insufficient integration support from guides (three participants). Participants recommended cautious use, better preparation, journeying with informed or experienced companions, and dedicating time for integration; some advocated legalisation or decriminalisation to improve access to support. Concerns about psychedelic culture and public narratives were raised by 12 participants, who cited underestimation of harms (8), harmful elements within psychedelic-associated communities such as spiritual narcissism (4), risks of co-dependency or abuse by self-styled authorities (3), and commercialisation (2). Despite the difficulties, many participants reported positive outcomes: 14 described self-development or spiritual growth, three reported improved mental health or full recovery, and ten stated they were content with their integration. Participants' models of integration varied, from an ongoing, never-complete process to successful bridging between mystical experiences and ordinary life.
Argyri and colleagues interpret their findings as evidence that psychedelic-induced ontological shock can produce profound cognitive, emotional and social "ungrounding" that precipitates sustained existential confusion and functional disruption. The study illustrates that such ontological challenges often involve core existential themes—death, meaninglessness, responsibility and aloneness—and can present with PTSD-like features including re-experiencing and functional impairment. The authors situate these accounts in existing theories: increased psychological entropy (uncertainty) during psychedelic states may destabilise prior belief structures, which in turn can permit therapeutic recalibration when psychological and social resources are sufficient, but may produce prolonged distress when those resources are lacking. The findings highlight grounding as a central recovery mechanism: somatic and embodiment practices, attention-focused techniques, and social normalisation helped participants re-anchor themselves and reduce obsessive meaning-searching. Interpersonal validation, community belonging and adoption of interpretive frameworks (religious, spiritual or scientific) were reported to aid recovery, though the authors note that some cultural or community responses—particularly spiritually dogmatic or bypassing approaches—can be counterproductive and may exacerbate vulnerability or dependence on authority. The researchers reflect on clinical implications cautiously, suggesting that trauma-focused interventions (for example EMDR) may have utility when PTSD-like symptoms predominate, and that integration support should address metaphysical and existential questions rather than only symptom reduction. They underscore debates about informed consent and the ethical responsibilities of guides and therapists to prepare people for possible metaphysical shifts, while acknowledging contrasting recommendations in the field about whether therapists should offer a "menu" of belief frameworks or support person-driven meaning-making. Limitations acknowledged by the authors include the predominantly Western, English-speaking sample, which restricts cultural generalisability and may overrepresent experiences in contexts lacking communal frameworks for absorbing ontological shock. The retrospective design and purposive sampling of individuals who reported existential difficulties mean prevalence estimates cannot be derived from this study. Future research directions proposed include cross-cultural comparisons, investigations into aetiological and vulnerability factors, the prevalence and timelines of ontological difficulties among psychedelic users, and systematic evaluation of which communal structures and integration supports are protective versus harmful.
The study concludes that psychedelic-induced ontological shock can lead to prolonged cognitive, emotional and social ungrounding, producing existential confusion and functional impairment for some individuals. Participants most commonly navigated these difficulties through grounding strategies—bodily and somatic practices, attentional techniques—and through social normalisation and adoption of meaning-making frameworks. Integration following ontological challenge is framed as a process of rebuilding stable 'ground' after dissolution of prior worldviews. The authors suggest that improved availability of supportive structures during and after psychedelic experiences, and nuanced attention to cultural and interpersonal factors, may help people recover from or avoid protracted ontological distress.
Three members of the research team (EKA, JE, PM) carried out a thematic analysis of interviews, with a predominantly inductive approach to theme creation. One research team member (OR) acted as an additional consultant during specific phases of the analysis. Themes and subthemes were regularly discussed between the three researchers throughout the analysis stage to ensure appropriate categorisation of codes, ensuring that theme development was consensual and collaborative. We followed the six stages of thematic analysis as outlined inguide ('Familiarising yourself with the dataset; Generating initial codes; Searching for themes; Reviewing themes; Defining and naming themes; Producing the report'). All interviews were analysed individually prior to cross-case themes being developed, and codes were collated on a Miro online whiteboard for visualising code clusters that could be developed into themes. One difference from Braun and Clarke's approach to reporting a thematic analysis and the method employed within this study, is that we report the frequency of themes, rather than using less precise quantifiers such as "many participants" or "some participants". We do so because we are of the view that it enhances transparency and rigour of reporting to report the more accurate information; all frequencies and percentages appear in the table of themes and subthemes in Supplementary Materials.
Previous studies have noted that psychedelics can lead to major shifts in identity and metaphysical beliefs. This study is the first to explore what it is like to go through challenges that accompany such shifts, and what helps navigate persisting existential confusion. Our participants went through sometimes dramatic identity and belief shifts. Several described becoming obsessed with the meaning of their psychedelic experience, and eventually had to let go of their need for answers. In all cases participants struggled with ontological insecurity; their psychedelic experiences overwhelmed their ability to make sense, and this caused severe distress. Participants described psychedelic experiences of ontological shock (supernatural, religious and spiritual experiences) coupled with core existential concerns (death, meaninglessness, responsibility, and aloneness). Stanislavhas theorised that the ongoing distress that can follow psychedelic experiences arises from the unresolved confrontation with one's existential limits. The 'no-exit' situations identified by Grof also emerged as themes in our participants' accounts. The ontologically challenging nature of the experience was evidenced in participants' accounts of feeling fear, anxiety and confusion during the trip, and exiting it feeling overwhelmed, shaken and exhausted. The therapeutic benefits of psychedelics are theorised to be driven by increases in entropya measure of uncertainty-that shift individuals' reliance on their prior beliefs. This destabilising mechanism allows for a recalibration of cognitive structures, enabling the re-evaluation of previously rigid mental models. However, when individuals lack adequate psychological or social resources, this increase in uncertainty can lead to distressmanifesting as confusion and difficulty accommodating the ungrounding of established worldviews. The ensuing overwhelming sense of responsibility for meaning-making results in a sensation of 'groundlessness'. This feeling of groundlessness, according to, reflects the central underlying principle of cognition. Termed the 'foundationless foundation,' it describes how humans, in a state of inherent uncertainty, enact and continuously reconstruct a world of meaning around them. Therefore, the dissolution of prior meaning frameworks under the influence of psychedelics can be seen as a direct encounter with this fundamental cognitive uncertainty. While such experiences underscore the sense of losing one's cognitive 'ground,' they also open avenues for exploring new existential territories. However, it is beyond the scope and aims of this study to delve into theological discussions of an ultimate ground, as proposed by thinkers like, which might provide a metaphysical counterpoint to this existential uncertainty. As Rodríguez Arce and Winkelman (2021) argue, psychedelic experiences can trigger ontological shock that reflects in a loss of cognitive structuring and prior meaning frameworks. This risk may be especially pronounced in secularised contexts, where larger, communal meaning structures such as religion have largely dissolved. In contrast, traditional psychedelic use within ritualised social contexts provides protective resources by offering a controlled environment and frameworks for integrating the experience. The process of navigating ontological shock, as well as the loss and reconstruction of cognitive structures, may be heavily influenced by the availability of cultural resources alongside individual psychological resilience. According to, people subconsciously avoid the anxiety associated with the uncertainty of groundlessness by either adopting a rigid adaptation to life or transferring their freedom to ordering systems beyond their control. This need for order may relate to our participants' sometimes obsessive preoccupation with making sense of the experience and in turn to what the OCD International Foundation described as an 'Existential and Philosophical OCD' subtype. Little research exists to-date about the distinct phenomenology and treatment of existential OCD, althoughhad previously discussed evidence on the association between OCD symptom severity and the core existential concerns put forward by Yalom: death, freedom, isolation and meaninglessness, also seen in some of our participants' experiences. A few participants noted their prior 'questioning disposition' as a potential aetiological factor for their existential difficulties but the intersection of such factors and cultural frameworks are yet to be studied. In line with evidence frominterview study, many participants described their experience as traumatic, with their lasting difficulties aligning significantly with DSM-5 criteria for PTSD.suggested that individuals remain stuck in a liminal state after a challenging trip, where the encountered material may resurface in various forms. Interviewees reported triggers that reignited their challenging psychedelic state, related to reminders of the trip's content or shifts into altered states of consciousness, such as falling asleep or meditating, when their vulnerability was heightened. Participants also experienced disruptions in daily life and work, including severe sleep disturbancespreviously identified in studies as a common adverse effect of psychedelic use. Using trauma-focused therapies, like EMDR to process the psychedelic experience as a traumatic memory, may help resolve PTSD-like symptoms during the integration period (Raine-. Almost all participants mentioned navigating their difficulties through the use of practices and support that helped them 'ground'; 'come back to [their] body' and let go of cognitive preoccupations about their experience. Notably, some participants described how cognitively distancing themselves from their experience helped them move on from troubled mindstates. Meditation was reported as helpful in cases where it aimed at focussing attention outside the self but as unhelpful when focused inwards leading participants to become further 'stuck in [their] head'. These findings, along with reports of obsessive preoccupation suggest a cognitive overload that individuals attach significance to, but lack resources to navigate. The special role of 'grounding' for our participants can be understood through literature on trauma recovery where its understood to help stabilise one's emotional state and bring focus back from dissociated states to one's body and the present moment (Van der Kolk, 2015). Dissociation is an adaptive response that compartmentalises overwhelming experiences, storing memories in isolated fragments (O'Shea. Grounding can reorient the person back to the present moment when dissociation arises and as such aid integration of the overwhelming experience. Some participants found relief in simply reframing their experience as an inner-state rather than an ultimate truth about the universe. Others described engaging with structured ways of making sense. This was sometimes completely self-driven, such as through journaling and consciously breaking down the experience in small parts to process day by day. In many cases it was the adoption of established spiritual, religious or scientific frameworks that provided a new structure for making sense. Notably the framing of 'spiritual emergence' was found particularly helpful coupled with the notion that psychedelic-induced difficulties have significance and are part of a process of spiritual growth. A previous study on ayahuasca integration also highlighted the value of interpretive frameworks. Explanatory systems, such as religious, scientific or spiritual framings provide normative explanations for unusual experiences. The normalisation of this otherwise confusing and isolating experience seemed to play an important role in participants' recovery whether through finding resonance in established frameworks, hearing about how others have suffered through similar challenges or speaking to friends and loved ones about their own challenges. Interpersonal support was also often found through reaching out to community or finding a new community where psychedelic experience could be talked about openly. The elements of feeling seen, heard, believed and understood were mentioned as crucial to recovery. Connection with others and a like-minded community as a beneficial aid to integration was also a core finding in Cowley-Court et al.'s study on ayahuasca integration (2023) as well as our team's prior survey. Some participants, however, were disturbed by elements of psychedelic-associated cultures which have a spirituality-focus but often promote spiritual bypassingor separatist feelings of grandiosity based on a sense of spiritual superiority. Interpersonal support which prevents the person from critically evaluating and coming to their own meaning can cause further harm. We also asked participants for their lived-experience-informed learnings for the field. They noted the need for increasing awareness of harms but also of the potential to overcome challenging psychedelic experiences, in order to give hope to others who find themselves in their shoes. A need for structures that enable sharing and offer support during and after psychedelic experiences was identified, along with legalisation and decriminalisation policy changes to enable this. Participants' concerns reflected current wider debates in the field; the underestimation of harms and the commercialisation of psychedelics were discussed in relation to the indiscriminate hype that has characterised narratives around the reemergence of psychedelic research. Participants identified several factors as unhelpful in managing their existential struggles. While many found relief in spiritual frameworks, in other cases spiritual interpretations felt forced and instilled further fear. Attempts to escape through further substance use, including with cannabis, proved counterproductive for participants, as did an obsessive search for intellectual answers. Some participants found that revisiting the experience through additional psychedelic journeys allowed them to overcome the challenge, while others reported that these experiences were unhelpful or even harmful.have previously suggested, based on a series of personal accounts, that individuals experiencing spiritual emergencies may benefit from revisiting altered states, but only after a significant period of time has passed and they feel more resilient and better able to cope. Wide-ranging changes in metaphysical beliefs and associated challenges raise questions about the feasibility of obtaining informed consent prior to psychedelic experienceand the role of guides and facilitators in assisting the adoption of interpretive frameworks. Sjöstedt-Hughes (2023) has argued for the importance of guiding people to explore metaphysical beliefs in psychedelic integration, suggesting that therapists provide a 'menu' of different beliefs . In response, Cheung and Yaden (2024) advocated for supporting a meaning-making process driven by the individuals themselves. Notwithstanding, existential and spiritual elements appear to be crucial for psychedelic integration (Bathje et al., 2022a;. It is important to note that many participants reported positive outcomes from navigating the challenges of their psychedelic experiences, including improved mental health, selfdevelopment and psychological growth. These findings align with notions of post-traumatic growthand narrative theories suggesting identity crises can trigger psychological transformation. A period of self-questioning following a difficult or traumatic event can catalyse the formation of a new sense of self, emerging with increased psychological maturity. Nearly half of the interviewees reflected on their increased compassion, appreciation of human connection, and motivation to support others linking these changes to their new understanding of themselves as part of the world; the commonality in human suffering, and alleviating their isolation through connection. Increased prosociality has also previously been linked to psychedelic useand proposed as a key factor in facilitating wellbeing.
Create a free account to open full-text PDFs.
Carhart-Harris, R. L., Chandaria, S., Erritzoe, D. E. et al. · Neuropharmacology (2023)
Carhart-Harris, R. L., Friston, K. J. · Pharmacological Reviews (2019)
Chenhall, R., Sarris, J., Bouso, J. C. et al. · Psychoactives (2023)
Davis, A. K., Barrett, F. S., Griffiths, R. R. · Journal of Contextual Behavioral Science (2020)
Davis, A. K., Clifton, J. M., Weaver, E. G. et al. · Journal of Psychopharmacology (2020)
Devenot, N., Seale-Feldman, A., Smith, E. et al. · Kennedy Institute of Ethics Journal (2022)
Evans, J. · Frontiers in Psychology (2023)
Evans, J., Robinson, O., Ketzitzidou-Argyri, E. et al. · PLOS ONE (2023)
Gashi, L., Sandberg, S., Pedersen, W. · International Journal of Drug Policy (2021)
Palhano-Fontes, F., Gorman, I., Nielson, E. M. et al. · Frontiers in Psychology (2021)
Greń, J., Tylš, F., Lasocik, M. et al. · Frontiers in Psychology (2023)
Grob, C. S., Danforth, A. L., Chopra, G. S. et al. · JAMA Psychiatry (2011)
Grof, S., Goodman, L. E., Richards, W. A. · Pharmacopsychiatry (1973)
Hartogsohn, I. · Journal of Psychopharmacology (2016)
Hartogsohn, I. · Frontiers in Human Neuroscience (2018)
Kopra, E., Ferris, J. A., Winstock, A. R. et al. · Journal of Psychopharmacology (2023)
Goodman, L. E., Grof, S., Kurland, A. A. et al. · Journal of Death and Dying (1972)
Kvam, T-M., Uthaug, M. V., Andersen, K. A. A. et al. · Frontiers in Psychiatry (2023)
Lewis, S. E. · AnthroSource (2008)
Lutkajtis, A., Evans, J. · Journal of Psychedelic Studies (2023)
Mollaahmetoglu, O. M., Keeler, J., Ashbullby, K. J. et al. · Frontiers in Psychiatry (2021)
Moreton, S. G., Szalla, L., Menzies, R. E. et al. · Psychopharmacology (2019)
Morton, E., Sakai, K., Ashtari, A. et al. · Journal of Psychopharmacology (2022)
Nayak, S., Griffiths, R. R. · Frontiers in Psychology (2022)
Nayak, S., Singh, M., Yaden, D. B. et al. · Journal of Psychopharmacology (2022)
Ona, G., Bouso, J. C. · Neuroscience and Biobehavioral Reviews (2020)
Rodríguez Arce, J. M., Winkelman, M. J. · Frontiers in Psychology (2021)
Rucker, J. J., Marwood, L., Ajantaival, R. L. J. et al. · Journal of Psychopharmacology (2022)
Simonsson, O., Goldberg, S. B., Chambers, R. et al. · Psychopharmacology (2023)
Sjöstedt-Hughes, P. · Frontiers in Psychology (2023)
Smith, W. R., Sisti, D. · Journal of Medical Ethics (2020)
Timmermann, C., Kettner, H., Letheby, C. et al. · Scientific Reports (2021)
Papers in Blossom that reference this study
Simon, G., Tadmor, N., Evans, J. et al. · Research Square (2026)
Oliver, C. R., Luke, D., Evans, J. et al. · Research Square (2026)
Dourron, H. M., Bradley, M. K., Copes, H. et al. · International Journal of Mental Health and Addiction (2026)
McAlpine, R., Kamboj, S. K. · Scientific Reports (2024)