SuicidalityAdolescentsSchizophreniaSet & SettingPsilocybin

Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences

In an online survey of 1,993 people about their worst "bad trip" on psilocybin mushrooms, most (84%) reported some benefit but a minority experienced acute harms (11% put themselves or others at risk, 2.6% were aggressive, 2.7% sought medical help) and 7.6% of episodes older than one year led to treatment for persistent psychological symptoms (including three apparent new psychoses and three suicide attempts). Higher estimated dose, greater subjective difficulty and lack of physical comfort or social support predicted acute risk, degree of difficulty was positively associated with enduring increases in well‑being while duration was negatively associated, and harms were much rarer in well‑controlled laboratory settings.

Authors

  • Roland Griffiths
  • Matthew Johnson
  • Frederick Barrett

Published

Journal of Psychopharmacology
individual Study

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 degree of difficulty was positively associated, and duration was negatively associated, with enduring increases in well-being. 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.

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Research Summary of 'Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences'

Introduction

Psilocybin, the principal psychoactive compound in Psilocybe and related mushrooms, has a long history of use in certain cultural and religious contexts. Previous literature indicates that psilocybin has low physiological toxicity and low addictive potential, but it can occasion acute distressing psychological reactions and, more rarely, persisting adverse psychiatric outcomes. Emergency-department and poison-centre data show that medical presentations involving psilocybin are uncommon relative to many other drugs, yet case reports and anecdotal evidence document instances of short-term fear, risk-taking behaviour, and longer-term psychiatric problems following non‑clinical use. This study set out to characterise psychologically difficult or challenging experiences—commonly described as “bad trips”—following ingestion of psilocybin mushrooms. Carbonaro and colleagues conducted a large anonymous internet survey asking respondents to report in detail on a single worst challenging psilocybin session, including demographics, set and setting, dose and duration, acute and enduring negative and positive consequences, and use of strategies to alleviate the experience. The aim was to quantify the nature, acute harms, and longer-term outcomes of difficult psilocybin experiences occurring outside laboratory contexts and to examine factors associated with increased risk of harm.

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212 cited
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Psychedelics and virtual reality: parallels and applications

Aday, J. S., Davoli, C. C., Bloesch, E. K. · Therapeutic Advances in Psychopharmacology (2020)

Mystical Experiences in Retrospective Reports of First Times Using a Psychedelic in Finland

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Ethics and ego dissolution: the case of psilocybin

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Chronic pain and psychedelics: a review and proposed mechanism of action

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101 cited
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Self-reported negative outcomes of psilocybin users: A quantitative textual analysis

Bienemann, B., Ruschel, N. S., Campos, M. L. et al. · PLOS ONE (2020)

57 cited
Reported effects of psychedelic use on those with low well-being given various emotional contexts

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Characterization and prediction of acute and sustained response to psychedelic psilocybin in a mindfulness group retreat

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126 cited
Narrative identity, rationality, and microdosing classic psychedelics

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Emotional breakthrough and psychedelics: validation of the emotional breakthrough inventory

Roseman, L., Haijen, E. C. H. M., Idialu-Ikato, K. et al. · Journal of Psychopharmacology (2019)

Psychedelic microdosing benefits and challenges: an empirical codebook

Anderson, T., Petranker, R., Christopher, A. et al. · Harm Reduction Journal (2019)

Replication and extension of a model predicting response to psilocybin

Russ, S. L., Carhart-Harris, R. L., Maruyama, G. et al. · Psychopharmacology (2019)

55 cited
Psychedelic drugs-a new era in psychiatry?

Nutt, D. J. · Dialogues in Clinical Neuroscience (2019)

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Survey of subjective “God encounter experiences”: Comparisons among naturally occurring experiences and those occasioned by the classic psychedelics psilocybin, LSD, ayahuasca, or DMT

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171 cited
5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT) used in a naturalistic group setting is associated with unintended improvements in depression and anxiety

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113 cited
Microdosing psychedelics: personality, mental health, and creativity differences in microdosers

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142 cited
Psychiatry might need some psychedelic therapy

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Richards, W. A., Garcia-Romeu, A. · International Review of Psychiatry (2018)

Predicting responses to psychedelics: a prospective study

Haijen, E. C. H. M., Kaelen, M., Roseman, L. et al. · Frontiers in Pharmacology (2018)

339 cited
Increased amygdala responses to emotional faces after psilocybin for treatment-resistant depression

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Awe: a putative mechanism underlying the effects of classic psychedelic-assisted psychotherapy

Hendricks, P. S. · International Review of Psychiatry (2018)

143 cited
DMT models the near-death experience

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Positive psychology in the investigation of psychedelics and entactogens: A critical review

Jungaberle, H., Thal, S., Zeuch, A. et al. · Neuropharmacology (2018)

DARK Classics in Chemical Neuroscience: Psilocybin

Geiger, H. A., Wurst, M. G., Daniels, R. N. · ACS Chemical Neuroscience (2018)

High dose psilocybin is associated with positive subjective effects in healthy volunteers

Nicholas, C. R., Henriquez, K. M., Gassman, M. C. et al. · Journal of Psychopharmacology (2018)

61 cited
Psychedelic therapy for smoking cessation: Qualitative analysis of participant accounts

Noorani, T., Garcia-Romeu, A., Swift, T. C. et al. · Journal of Psychopharmacology (2018)

The abuse potential of medical psilocybin according to the 8 factors of the Controlled Substances Act

Johnson, M. W., Griffiths, R. R., Hendricks, P. S. et al. · Neuropharmacology (2018)

The psychedelic debriefing in alcohol dependence treatment: illustrating key change phenomena through qualitative content analysis of clinical sessions

Kraehenmann, R., Nielson, E. M., May, D. G. et al. · Frontiers in Pharmacology (2018)

Psychedelics and the essential importance of context

Carhart-Harris, R. L., Roseman, L., Haijen, E. C. H. M. et al. · Journal of Psychopharmacology (2018)

Quality of acute psychedelic experience predicts therapeutic efficacy of psilocybin for treatment-resistant depression

Roseman, L., Nutt, D. J., Carhart-Harris, R. L. · Frontiers in Pharmacology (2018)

The relationships of classic psychedelic use with criminal behavior in the United States adult population

Hendricks, P. S., Crawford, M. S., Cropsey, K. L. et al. · Journal of Psychopharmacology (2017)

Neuroticism is associated with challenging experiences with psilocybin mushrooms

Barrett, F. S., Johnson, M. W., Griffiths, R. R. · Personality and Individual Differences (2017)

78 cited
Long-lasting subjective effects of LSD in normal subjects

Schmid, Y., Liechti, M. E. · Psychopharmacology (2017)

Serotonin and brain function: a tale of two receptors

Carhart-Harris, R. L., Nutt, D. J. · Journal of Psychopharmacology (2017)

Lifetime experience with (classic) psychedelics predicts pro-environmental behavior through an increase in nature relatedness

Forstmann, M., Sagioglou, C. · Journal of Psychopharmacology (2017)

134 cited
Cancer at the dinner table: experiences of psilocybin-assisted psychotherapy for the treatment of cancer-related distress

Swift, T. C., Belser, A. B., Agin-Liebes, G. et al. · Journal of Humanistic Psychology (2017)

130 cited
Anxiety, panic, and hopelessness during and after ritual ayahuasca intake in a woman with generalized anxiety disorder: A case report

Dos Santos, R. G., Osório, F. L., Crippa, J. A. et al. · Journal of Psychedelic Studies (2017)

6 cited
5-HT2A Agonists: A Novel Therapy for Functional Neurological Disorders?

Bryson, A., Carter, O., Norman, T. et al. · International Journal of Neuropsychopharmacology (2017)

18 cited
Phenomenology, Structure, and Dynamic of Psychedelic States

Preller, K. H., Vollenweider, F. X. · Behavioral Neurobiology of Psychedelic Drugs (2016)

Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: A randomized controlled trial

Ross, S., Bossis, A. P., Guss, J. et al. · Journal of Psychopharmacology (2016)

The Challenging Experience Questionnaire: Characterization of challenging experiences with psilocybin mushrooms

Barrett, F. S., Bradstreet, M. P., Leoutsakos, J. M. S. et al. · Journal of Psychopharmacology (2016)

New World Tryptamine Hallucinogens and the Neuroscience of Ayahuasca

McKenna, D., Riba, J. · Current Topics in Behavioral Neurosciences (2016)

Serotonergic Hallucinogen-Induced Visual Perceptual Alterations

Kometer, M., Vollenweider, F. X. · Behavioral Neurobiology of Psychedelic Drugs (2016)

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Survey study of challenging experiences after... — Research Summary & Context | Blossom