Anxiety DisordersDepressive DisordersSafety & Risk ManagementPsilocybin

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

The authors developed and validated the Challenging Experience Questionnaire (CEQ) to characterise acute adverse psychological reactions to psilocybin mushrooms, identifying seven reproducible factors — grief, fear, death, insanity, isolation, physical distress and paranoia. Factor scores correlated with perceived difficulty, meaningfulness, spiritual significance and changes in well‑being, and the factor structure was consistent across gender and prior anxiety or depression, providing a tool for future study of predictors and outcomes of challenging psychedelic experiences.

Authors

  • Roland Griffiths
  • Matthew Johnson
  • Frederick Barrett

Published

Journal of Psychopharmacology
individual Study

Abstract

Acute adverse psychological reactions to classic hallucinogens (“bad trips” or “challenging experiences”), while usually benign with proper screening, preparation, and support in controlled settings, remain a safety concern in uncontrolled settings (such as illicit use contexts). Anecdotal and case reports suggest potential adverse acute symptoms including affective (panic, depressed mood), cognitive (confusion, feelings of losing sanity), and somatic (nausea, heart palpitation) symptoms. Responses to items from several hallucinogen-sensitive questionnaires (Hallucinogen Rating Scale, the States of Consciousness Questionnaire, and the Five-Dimensional Altered States of Consciousness questionnaire) in an Internet survey of challenging experiences with the classic hallucinogen psilocybin were used to construct and validate a Challenging Experience Questionnaire. The stand-alone Challenging Experience Questionnaire was then validated in a separate sample. Seven Challenging Experience Questionnaire factors (grief, fear, death, insanity, isolation, physical distress, and paranoia) provide a phenomenological profile of challenging aspects of experiences with psilocybin. Factor scores were associated with difficulty, meaningfulness, spiritual significance, and change in well-being attributed to the challenging experiences. The factor structure did not differ based on gender or prior struggle with anxiety or depression. The Challenging Experience Questionnaire provides a basis for future investigation of predictors and outcomes of challenging experiences with classic hallucinogens.

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

Introduction

Barrett and colleagues situate this work within the renewed empirical interest in classic psychedelic hallucinogens (for example psilocybin, LSD, mescaline, and DMT) and note that, alongside therapeutic and neuroscientific inquiry into positive and mystical-type effects, acute psychologically adverse reactions—commonly called "bad trips" or challenging experiences—remain a documented phenomenon. Prior clinical and research reports describe a heterogeneous set of acute adverse phenomena that can include affective symptoms (panic, depressed mood), cognitive disturbances (confusion, derealisation, fears of losing sanity), perceptual and delusional phenomena (paranoia, frightening hallucinations), and somatic responses (nausea, sympathetic arousal). Existing widely used scales (for example the Hallucinogen Rating Scale, Dittrich's Altered States of Consciousness questionnaires) capture some of these elements but lack a concise set of subscales specifically designed to parse distinct dimensions of challenging experiences. The present papers aimed to construct and validate a dedicated instrument, the Challenging Experience Questionnaire (CEQ), to measure discrete dimensions of challenging experiences occasioned by psilocybin. Study 1 used secondary analysis of an Internet survey to derive and replicate a factor structure from pooled items taken from the HRS, 5DASC and the States of Consciousness Questionnaire (SOCQ), test factorial invariance across sex and prior psychiatric struggle, and relate CEQ factors to global impact ratings (difficulty, meaningfulness, spiritual significance, and change in well-being). Study 2 then tested the CEQ as a stand-alone 26-item instrument in an independent online sample to replicate the factor structure and validate associations with impact ratings.

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Study Details

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49 cited
A qualitative and quantitative account of patient’s experiences of ketamine and its antidepressant properties

Sumner, R. L., Chacko, E., Mcmillan, R. et al. · Journal of Psychopharmacology (2021)

51 cited
Psychedelic Communitas: Intersubjective experience during psychedelic group sessions predicts enduring changes in psychological wellbeing and social connectedness

Kettner, H., Rosas, F. E., Timmermann, C. et al. · Frontiers in Pharmacology (2021)

157 cited
Naturalistic Use of Mescaline Is Associated with Self-Reported Psychiatric Improvements and Enduring Positive Life Changes

Agin-Liebes, G. I., Lancelotta, R., Uthaug, M. V. et al. · ACS Pharmacology and Translational Science (2021)

Combining Psychedelic and Mindfulness Interventions: Synergies to Inform Clinical Practice

Payne, J. E., Chambers, R., Liknaitzky, P. · ACS Pharmacology and Translational Science (2021)

55 cited
Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice

Palhano-Fontes, F., Gorman, I., Nielson, E. M. et al. · Frontiers in Psychology (2021)

Optimal dosing for psilocybin pharmacotherapy: Considering weight-adjusted and fixed dosing approaches

Garcia-Romeu, A., Barrett, F. S., Carbonaro, T. M. et al. · Journal of Psychopharmacology (2021)

Psychedelic drugs and perception: a narrative review of the first era of research

Aday, J. S., Bloesch, E. K., Wood, J. R. et al. · Reviews In The Neuroscience (2021)

Development of the Psychological Insight Questionnaire among a sample of people who have consumed psilocybin or LSD

Davis, A. K., Streeter Barrett, F., Griffiths, R. R. et al. · Journal of Psychopharmacology (2021)

108 cited
Making “bad trips” good: How users of psychedelics narratively transform challenging trips into valuable experiences

Gashi, L., Sandberg, S., Pedersen, W. · International Journal of Drug Policy (2021)

Set and Setting: A Randomized Study of Different Musical Genres in Supporting Psychedelic Therapy

Strickland, J. C., Garcia-Romeu, A., Johnson, M. W. · ACS Pharmacology and Translational Science (2020)

People of color in North America report improvements in racial trauma and mental health symptoms following psychedelic experiences

Williams, T. M., Davis, A. K., Xin, Y. et al. · Drugs Education Prevention and Policy (2020)

Acute and subacute psychoactive effects of Kambô, the secretion of the Amazonian Giant Maki Frog (Phyllomedusa bicolor): retrospective reports

Schmidt, T. T., Reiche, S., Hage, L. T. et al. · Scientific Reports (2020)

9 cited
Psilocybin-Assisted Group Therapy and Attachment: Observed Reduction in Attachment Anxiety and Influences of Attachment Insecurity on the Psilocybin Experience

Stauffer, C., Anderson, B. T., Ortigo, K. M. et al. · ACS Pharmacology and Translational Science (2020)

51 cited
Pivotal Mental States

Brouwer, A., Carhart-Harris, R. L. · Journal of Psychopharmacology (2020)

Psilocybin-assisted group therapy for demoralized older long-term AIDS survivor men: An open-label safety and feasibility pilot study

Anderson, B. T., Danforth, A. L., Daroff, R. et al. · EClinicalMedicine (2020)

212 cited
Psilocybin acutely alters the functional connectivity of the claustrum with brain networks that support perception, memory, and attention

Barrett, F. S., Krimmel, S. R., Griffiths, R. R. et al. · NeuroImage (2020)

Psychedelic Treatments for Psychiatric Disorders: A Systematic Review and Thematic Synthesis of Patient Experiences in Qualitative Studies

Breeksema, J. J., Niemeijer, A. R., Krediet, E. et al. · CNS Drugs (2020)

Use of Benefit Enhancement Strategies among 5-Methoxy-N,N-Dimethyltryptamine (5-MeO-DMT) Users: Associations with Mystical, Challenging, and Enduring Effects

Lancelotta, R., Davis, A. K. · Journal of Psychoactive Drugs (2020)

Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance

Wolff, M., Evens, R., Mertens, L. J. et al. · Frontiers in Psychiatry (2020)

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
Long-term follow-up of psilocybin-assisted psychotherapy for psychiatric and existential distress in patients with life-threatening cancer

Agin-Liebes, G. I., Malone, T., Yalch, M. M. et al. · Journal of Psychopharmacology (2020)

292 cited
Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety

Davis, A. K., Barrett, F. S., Griffiths, R. R. · Journal of Contextual Behavioral Science (2020)

The use of the psychological flexibility model to support psychedelic assisted therapy

Watts, R., Luoma, J. B. · Journal of Contextual Behavioral Science (2020)

From Egoism to Ecoism: Psychedelics Increase Nature Relatedness in a State-Mediated and Context-Dependent Manner

Kettner, H., Gandy, S., Haijen, E. C. H. M. et al. · International Journal of Environmental Research and Public Health (2019)

131 cited
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)

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

Griffiths, R. R., Hurwitz, E. S., Davis, A. K. et al. · PLOS ONE (2019)

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

Davis, A. K., So, S., Lancelotta, R. et al. · The American Journal of Drug and Alcohol Abuse (2019)

113 cited
States and traits related to the quality and consequences of psychedelic experiences

Russ, S. L., Carhart-Harris, R. L., Maruyama, G. et al. · Psychology of Consciousness Theory Research and Practice (2019)

Current perspectives on psychedelic therapy: use of serotonergic hallucinogens in clinical interventions

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

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

143 cited
Psychedelics and music: neuroscience and therapeutic implications

Barrett, F. S., Preller, K. H., Kaelen, M. · International Review of Psychiatry (2018)

Double-blind comparison of the two hallucinogens psilocybin and dextromethorphan: effects on cognition

Barrett, F. S., Carbonaro, T. M., Hurwitz, E. et al. · Psychopharmacology (2018)

78 cited
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
The epidemiology of 5-methoxy- N, N-dimethyltryptamine (5-MeO-DMT) use: Benefits, consequences, patterns of use, subjective effects, and reasons for consumption

Davis, A. K., Barsuglia, J. P., Lancelotta, R. et al. · Journal of Psychopharmacology (2018)

Integrating Psychedelic Medicines and Psychiatry: Theory and Methods of a Model Clinic

Sloshower, J. A. · Plant Medicines Healing and Psychedelic Science (2018)

The Use of Salvia divinorum from a Mazatec Perspective

Maqueda, A. E. · Plant Medicines Healing and Psychedelic Science (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)

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
Serotonin and brain function: a tale of two receptors

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

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