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

Article · August 2016with504 Reads
DOI: 10.1177/0269881116662634
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.
Journal of Psychopharmacology
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DOI: 10.1177/0269881116662634
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Introduction
Psilocybin, the principal psychoactive component of the
Psilocybe and other genera of mushrooms (Presti and Nichols,
2004), has likely been used for millennia within some cultures
for religious or divinatory purposes (Guzmán, 2008; Metzner,
2004; Stamets, 1996; Wasson, 1980). Of the US population aged
12 years or older, 8.7% (22.9 million people) reported lifetime
use of psilocybin (NSDUH, 2014). In 2004–2005 (the last year
data were available), over half (52%) of those who reported initi-
ating use of a hallucinogen in the past year did so with psilocybin
(NSDUH, 2007).
Although psilocybin has very low physiological toxicity and is
not associated with compulsive drug seeking, it sometimes pro-
duces acute and, more rarely, persisting adverse psychological reac-
tions (Johnson et al., 2008; Tylš et al., 2014). Case reports document
adverse effects of psilocybin in non-research settings, including
short-term distressing psychological symptoms such as fear (Nordic
Council of Ministries, 2009; Riley and Blackman, 2008; van
Amsterdam et al., 2011), individuals putting themselves at risk for
physical harm (Allen et al., 1991; Schwartz and Smith, 1988; van
Amsterdam et al., 2011), seeking medical help (Allen et al., 1991;
Nordic Council of Ministries, 2009; Mowry et al., 2014), and
enduring negative psychological or psychiatric problems (Allen
et al., 1991; Nordic Council of Ministries, 2009; Nielen et al.,
2004). However, the perceived risk of psilocybin-related harm was
found to be very low when evaluated by drug experts (Nutt et al.,
2010; van Amsterdam and van den Brink, 2010) and by experi-
enced drug users (Carhart-Harris and Nutt, 2013), and psilocybin
was ranked as moderately beneficial by experienced drug users
(Carhart-Harris and Nutt, 2013).
Data-reporting systems from emergency rooms and poison
centers also confirm that psilocybin is associated with seeking
medical treatment (DAWN, 2013; Mowry et al., 2014). However,
the incidence of psilocybin toxicity is extremely low relative to
other drugs used non-medically. For instance, in 2011, emer-
gency room mentions of problems with psilocybin alone (83
mentions) were only a very small fraction of mentions for heroin
Survey study of challenging experiences
after ingesting psilocybin mushrooms:
Acute and enduring positive and
negative consequences
Theresa M Carbonaro1, Matthew P Bradstreet1, Frederick S Barrett1,
Katherine A MacLean1, Robert Jesse1,2, Matthew W Johnson1
and Roland R Griffiths1,3
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.
Keywords
Psilocybin, psychedelic, hallucinogen, bad trip, adverse effects, survey, human
1 Department of Psychiatry and Behavioral Sciences, Johns Hopkins
University School of Medicine, Baltimore, MD, USA
2 Council on Spiritual Practices, Baltimore, MD, USA
3 Department of Neuroscience, Johns Hopkins University School of
Medicine, Baltimore, MD, USA
Corresponding author:
Roland Griffiths, Departments of Psychiatry and Neuroscience, Johns
Hopkins University School of Medicine, 5510 Nathan Shock Drive,
Baltimore, MD 21224-6823, USA.
Email: rgriff@jhmi.edu
662634JOP0010.1177/0269881116662634Journal of PsychopharmacologyCarbonaro et al.
research-article2016
Original Paper
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2 Journal of Psychopharmacology
alone (10,309 mentions, 0.81%), cocaine alone (9828, 0.84%),
and marijuana alone (9711, 0.85%) (DAWN, 2013).
The present study was undertaken to characterize challenging
experiences occasioned by psilocybin and the consequences of
such experiences. An internet survey was conducted of a large
international sample of individuals who reported having had a
difficult or challenging experience with psilocybin. Detailed
questions were asked about an individual’s single worst “bad
trip.” Questions addressed demographics, the set and setting con-
ditions in which psilocybin was ingested, as well as any negative
and positive acute and enduring psychological and emotional
consequences of the challenging psilocybin experience.
Methods
Participant recruitment
Participants were recruited primarily via internet advertisements and
email invitation. An internet link to the survey was posted on web-
sites that attract individuals interested in hallucinogens (e.g. Erowid,
Bluelight, Reddit, etc). Information about the survey was also shared
by email with individuals knowledgeable about psychedelic drugs,
and information about the survey spread through online social net-
works. Individuals were recruited who endorsed having had a diffi-
cult or challenging experience after ingesting psilocybin mushrooms
(e.g.Have you had a difficult or challenging experience (i.e., a “bad
trip”) with psilocybin mushrooms? If so, please take the Johns
Hopkins online survey on psilocybin and bad trips”). The link
directed participants to a webpage that described the aims of the
study and provided basic information about study completion.
Participants 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. The Institutional Review Board of the Johns Hopkins
University School of Medicine approved all study procedures.
Survey administration
The survey was designed to take approximately 45 minutes to
complete (not including an optional open-ended written
response), and participants were required to complete the survey
in one sitting. The survey was administered using SurveyMonkey
(www.surveymonkey.com), an online survey and data-collection
software tool with security and privacy features that make it suit-
able for clinical research.
Inclusion criteria
Participants were required to fulfill six inclusion criteria: (1) At
least 18 years old; (2) Read, write, and speak English fluently; (3)
Have taken a dose of psilocybin mushrooms that produced mod-
erate to strong psychoactive effects; (4) After taking psilocybin
mushrooms, “have you ever had a psychologically difficult or
challenging experience (i.e., a bad trip)—that is, have you expe-
rienced significant fear, anxiety, or distress or anything else that
you found psychologically difficult?”; (5) The experience
referred to above (#4) occurred when between 18 and 70 years
old and did not occur in the context of a university or hospital
study; (6) Have not completed this survey previously.
Participants who met the inclusion criteria were directed to the
remaining questions in the survey. In completing the survey, par-
ticipants were instructed to complete the survey items in reference
to their single most psychologically difficult or challenging ses-
sion or experience (worst “bad trip”). Individuals who did not
meet the inclusion criteria were linked to an alternate, shorter ver-
sion of the survey and their data were not used in the analyses. It
was reasoned that this approach would discourage such individu-
als from attempting to take the survey again and providing differ-
ent answers because it would appear to them that they had
completed the survey. Participants were excluded from analysis if
the challenging experience was attributed to the co-consumption
of a substance other than psilocybin or if the open-ended written
comments raised concern about validity of their other responses.
Measures
Demographics. Participants provided basic demographic infor-
mation as described in the results section.
Lifetime hallucinogen use. Participants reported the total
number of different occasions on which they had ingested any of
the following hallucinogens: psilocybin mushrooms, LSD, morn-
ing glory seeds, mescaline, peyote cactus, San Pedro cactus,
DMT, or ayahuasca. They also provided the total number of occa-
sions they used only psilocybin mushrooms. Both questions were
answered on an 8-point categorical scale (1; 2–5; 6–10; 11–20;
21–50; 51–100; 101–300; and more than 300 times). Participants
also reported how old they were when they first and last used
psilocybin mushrooms.
Questions about the session experience. After participants
had chosen their session (i.e. their worst “bad trip”), they were
asked questions about the estimated dose of psilocybin con-
sumed, the set and setting conditions in which the session
occurred, the duration of the difficult experience, strategies
attempted and that helped to stop the experience, and acute nega-
tive consequences of the experience. As with laboratory studies
of psilocybin (Griffiths et al., 2006, 2011), the phenomenology of
the psilocybin experience was assessed using three question-
naires: Hallucinogen Rating Scale (HRS) (Strassman et al.,
1994); Mystical Experience Questionnaire – 30 item version
(MEQ30) which is part of the States of Consciousness Question-
naire (Barrett et al., 2015; Griffiths et al., 2006; MacLean et al.,
2011); and selected subscales from the 5D-ASC (Studerus et al.,
2010). Data analyzed for this report were the six subscales of the
HRS (expressed as raw scores) and the total and four subscales of
the MEQ30 (expressed as percentages of maximum possible
scores). A participant was designated as having had a “complete”
mystical experience if scores on each of the four subscales of the
MEQ30 were 60% or higher. The results from other questions
and subscales will be reported elsewhere.
Qualitative ratings of the psilocybin experience. Participants
were instructed to answer four questions according to “how you
feel now about your chosen psilocybin session” and to “retrospec-
tively evaluate your experiences during your psilocybin session in
the context of your full life experience.” The questions were as
follows: (1) How psychologically difficult or challenging was the
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Carbonaro et al. 3
experience? (2) How personally meaningful was the experience?
(3) Indicate the degree to which the experience was spiritually
significant to you; and (4) Do you believe that the experience and
your contemplation of that experience have led to a change in
your current sense of personal well-being or life satisfaction? The
response options for all four questions are shown in Figure 1.
Negative psychological or emotional experiences before and
after the experience. Participants answered questions about the
occurrence, duration, and severity of the negative psychological or
emotional experiences of fear, paranoia, anxiety, depression, and
“other” that they may have experienced at any time before the
challenging experience occurred. Participants also answered a
similar set of questions about these same types of negative psycho-
logical experiences if they occurred after the challenging experi-
ence and were attributed to the challenging psilocybin experience.
Open-ended written comments. Participants were offered an
optional opportunity to provide a written description of their psi-
locybin experience.
Statistical analysis
Descriptive statistics (percentages, mean, median, range, and
standard error of the mean) were used to characterize the responses
to questions and the subscale scores of the questionnaires. Pearson
correlations were used to analyze the associations among partici-
pant ratings of the degree of difficulty of the challenging experi-
ence, the duration of the challenging experience, personal
meaning, spiritual significance, and enduring change in well-
being. Multiple regression analysis was used to further explore the
relative roles of duration of difficult experience and the degree of
difficulty of the experience on the ratings of personal meaning,
spiritual significance, and enduring change in well-being. Pearson
correlations were also used to analyze the association of difficulty
and duration of difficulty of the psilocybin experience to dose
(weight of dried mushrooms consumed and HRS item referring to
approximate dose), setting conditions, age at time of the psilocy-
bin experience, past hallucinogen experience, use of cannabis and
use of another mood-altering drug (including cannabis, but
excluding nicotine) immediately before or during the session, and
endorsement of putting self or others at risk for physical harm.
Binary logistic regression (odds ratios) were used to analyze the
associations of setting conditions, use of cannabis and the use of
another mood-altering drug (including cannabis, but excluding
nicotine) immediately before or during the session to endorsement
of putting self or others at risk for physical harm. The percentage
of participants reporting negative psychological and emotional
symptoms as well as the percentage seeking treatment for such
symptoms before and after the chosen psilocybin session was
assessed. Rates of endorsing these experiences were analyzed by
z-tests to compare independent proportions.
Results
Survey completion
During recruitment (January–July, 2013), 5850 individuals began
the survey. Of these, 1074 were excluded because they did not
meet the inclusion criteria; 92 were excluded because partici-
pants reported that the experience was attributed to the co-con-
sumption of a substance other than psilocybin or because the
open-ended written comments raised concern about validity of
their other responses. Some 2691 were excluded because they did
not complete the survey, with 91% of these failing to complete
half of the survey questions. Thus 1993 individuals provided use-
able data. Of these, 70% found the survey link on a website, 7%
received the survey link as a part of an email distribution list, and
13% heard of the survey by word of mouth. The median time to
complete the survey was 59 minutes. A written response in the
open-ended comment section was provided by 83% of
participants.
Participant characteristics
Table 1 presents participants’ reported characteristics. Participants
were, on average 29.8 years of age. The majority were male
(78%), White (89%), had a college or graduate degree (51%).
Most participants (93%) had used psilocybin more than two times
in their life (median = 6–10 times) and had used hallucinogens
more than 10 times in their life (59%) (median = 11–20 times). At
the time of the survey, daily use of cannabis, tobacco, and alcohol
were reported by 38%, 27%, and 11% of the group, respectively.
Participants were, on average 23.3 years of age at the time of
their chosen session (Table 1), which occurred on average 6.5
years before completing the survey. Median number of uses of
psilocybin before their chosen session was 2–5 times. Of the
respondents, 16% had not used psilocybin at all before their cho-
sen session and for 10% of the total sample, the chosen session
was the first time they had used any hallucinogen.
The challenging psilocybin session
Some 84% and 16% of participants, respectively, reported taking
dried and fresh mushrooms. Of those who reported knowing the
weight of the mushrooms consumed, the median reported weight
of dried psilocybin mushrooms was 4 g (n = 1203 respondents),
and the median weight of fresh mushrooms was 21–30 g (n =
148). Of the participants, 68% endorsed having taken a moder-
ately high or high dose of psilocybin; 36% reported that they
were attempting to take a larger than usual dose of psilocybin for
the session.
During the session, participants reported being alone (25%) or
in the company of one person (24%), with a few people (39%), in
a small to medium size group (9%), or a large gathering (4%).
The majority of participants indicated that their emotional state
before taking psilocybin (76%), the physical comfort and safety
of the surroundings (76%), and the social support and trust for
others during the session (65%) were conducive to having a posi-
tive experience. Only 25% had a “guide” or “sitter” present dur-
ing the session and only 2.7% had a trusted and sober guide
present who was experienced in supporting psychedelic sessions.
Some 53% and 19%, respectively, reported using cannabis or
alcohol immediately before or during their chosen challenging
psilocybin session. Fifty-nine percent reported having had a seri-
ous intention (psychological or spiritual exploration) for their
session; 73% covered or closed their eyes for some length of time
during the session (median = 10–30 minutes).
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4 Journal of Psychopharmacology
Figure 2 shows the distribution of durations of the psycho-
logically difficult portion of the experience; 31% percent
reported the duration to be 1 hour or less, with 25% and 40%
reporting the duration to be 1 to 2 hours and 2 hours or longer,
respectively.
Qualitative ratings of the psilocybin
experience
As shown in Figure 1, the majority of participants (62%)
considered the experience to be among the top 10 most psycho-
logically difficult or challenging experiences of their lives
(Figure 1, sum of among top 10, among top five and single
most), with 39% rating it as among the top five including sin-
gle most and 11% rating to be the single most. Despite this
psychological challenge, 34% and 31% rated this same session
to be among the top five including single most personally
meaningful and spiritually significant, respectively (Figure 1),
experiences of their lives, with 6.2% and 8.6%, respectively,
rating it to be the single most personally meaningful and spiritu-
ally significant of their lives. Although most of the participants
(76%) reported that experiences during the psilocybin session
led to increases in current well-being and life satisfaction, 8%
reported that the chosen challenging experience resulted in a
decrease in their sense of well-being or life satisfaction
(slightly or greater) (Figure 1). A substantial majority of par-
ticipants (84%) rated that they benefited from the challenging
portions of their sessions. Almost half (46%) endorsed that
they would want to repeat their chosen session and all that had
happened in it, including the difficult or challenging portions
of the session.
Table 2 shows correlations among the four measures of
qualitative effects described above and the duration of difficult
experience. The duration correlated positively (r = 0.30) with
the overall degree of difficulty of the experience, but nega-
tively or less robustly with the meaningfulness, spiritual sig-
nificance, or enduring changes in well-being. Interestingly, the
degree of difficulty of the experience correlated positively with
the degree of personal meaning (r = 0.41), with less robust but
significant correlations with spiritual significance and enduring
well-being. Finally, spiritual significance correlated robustly
with personal meaning, and enduring change in well-being cor-
related robustly with both personal meaning and spiritual sig-
nificance. Table 3 shows the results of multiple regression
analysis regressing participant ratings of personal meaning,
spiritual significance, and enduring change in well-being on
degree of difficulty and the duration of the psychologically
Figure 1. Distributions of ratings in response to four questions about how the participant felt in retrospect about their experiences in the context
of their full life experience (N = 1993). Bars show percentage of total participants that endorsed each category.
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Carbonaro et al. 5
Table 1. Participant characteristics (N = 1993).a
Numerical variable
Age at time of survey (years) M = 29.8 (18–79)
Age of first psilocybin use (years) M = 19.9 (12–65)
Age of last psilocybin use (years) M = 26.1 (18–66)
Age of chosen psilocybin session (years) M = 23.3 (18–66)
Lifetime hallucinogen use (times) Med = 11–20 (1–300 or more)
Lifetime psilocybin use (times) Med = 6–10 (1–300 or more)
Categorical variable
Gender 78% male, 22% female
Education 17% graduate degree, 8% some graduate school, 26% college degree, 36% some college, 11%
high school diploma, 2% some high school
Race 89% White, 1.3% American Indian, 1.2% Asian, 0.3% Black or African American, 1.7% some
other race
Hispanic or Latino 93% No, 6% Yes
Current marital status 50% single, 30% in a committed relationship (not married), 15% married, 4%, divorced, 1%
widowed
Current household income (USD) 18% <10K, 26% 10–30K, 25% 30–60K, 14% 60–90K, 14% 90–200K, 3% > 200K
Current country of residenceb66% US, 8% Canada, 7% UK, 3.4% Australia, 1.9% Sweden, 1.8% Germany, 1.6% Netherlands,
1% Norway
Current daily drug use 38% cannabis, 27% tobacco, 11% alcohol, 2.8% prescription stimulants, 2.1% benzodiazepines,
1.7% opioids, 0.4% synthetic cannabinoids, 0.2% methamphetamine, 0.1% cocaine
a
The table presents descriptive statistics for demographic variables (N = 1993). Numerical variables are reported as mean (M) or median (Med) values with range in paren-
theses. Categorical variables are reported as percentage of respondents that endorsed each category. Percentages do not sum to 100 because some questions include a
“prefer not to answer” option.
bApproximately 48 additional countries of residence (not listed) were represented by 15 or fewer participants each.
Figure 2. Distribution of participant-rated durations of challenging experiences (N = 1993). Bars show percentage of total participants that
endorsed each category.
challenging experience after taking psilocybin. These data
show a consistent pattern of effects, with personal meaning,
spiritual significance, and increases in well-being all positively
and significantly related to difficulty of experience. In con-
trast, all three of these outcome measures are significantly
negatively related to the duration of the difficulty of the
experience.
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 assessed by weight of dried mush-
rooms consumed, and estimated dose (from a question on the
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6 Journal of Psychopharmacology
HRS), both significantly positively correlated with degree
of difficulty and duration of difficult experience. Emotional
state before ingesting psilocybin mushrooms, physical comfort
of setting, and social support present during the session were
significantly negatively correlated with degree of difficulty
and duration of difficult experience. Having a guide present
was significantly negatively correlated with duration of diffi-
cult experience, but not with degree of difficulty. The use of
Table 2. Pearson correlations (r) examining relationships among participant ratings of duration of difficult experience, difficulty of experience,
personal meaning, spiritual significance, and enduring increased well-being.1
Duration of difficult
of experience
Difficulty of
experience
Personally
meaningful
Spiritually
significant
Enduring change
in well-being
Duration of difficulty of experience X
Difficulty of experience 0.30**** X
Personally meaningful ns 0.41**** X
Spiritually significance 0.14**** 0.20**** 0.58**** X
Enduring change in well-being30.18**** 0.11**** 0.39**** 0.46**** X
1Data analyzed are from those respondents who endorsed knowing the length of their difficult or challenging experience (n = 1897).
2Asterisks indicate significance level (*p < 0.05, **p < 0.01, ***p < 0.001; ****p < 0.0001); ns = not significant;
3Positive scores indicate increased well-being.
Table 3. Multiple regression analysis regressing participant ratings of personal meaning, spiritual significance, and enduring increased well-being on
degree of difficulty and the duration of the psychologically challenging experience after taking psilocybin.1
Dependent variable Adjusted R2Predictors Estimate SE t p
Personal meaningful (Scored from 1 to 8) 0.2 (Intercept) 5.53 0.03 162.86 <0.0001
difficulty 0.49 0.02 21.72 <0.0001
duration 0.23 0.03 8.36 <0.0001
Spiritual significance (Scored from 1 to 6) 0.084 (Intercept) 3.33 0.04 92.69 <0.0001
difficulty 0.28 0.02 11.69 <0.0001
duration 0.27 0.03 9.49 <0.0001
Enduring change in well-being (Scored 3 to +3) 0.061 (Intercept) 1.44 0.03 51.97 <0.0001
difficulty 0.16 0.02 7.82 <0.0001
duration 0.25 0.02 10.00 <0.0001
1Data analyzed are from those respondents who endorsed knowing the length of their difficult or challenging experience (n = 1897).
Table 4. Pearson correlations (r) examining the relationship of dose, setting conditions, use of another mood-altering drug, age, and past
hallucinogen experience to difficulty and duration of difficulty of the psilocybin session.1,2,3
Difficulty of experience Duration of difficult experience
Weight of dried mushrooms (g) .110*** .107***
Estimated dose4 .181*** .069**
Emotional state before ingestion .052* .087***
Physical comfort of setting .068** .074***
Social support during the session .085*** .146***
Guide present ns .092***
Cannabis use before or during session .057* ns
Any drug use before or during session5.072** ns
Age .062** ns
Past hallucinogen experience6.054* ns
1
Data are analyzed are from those participants who endorsed knowing the length of their difficult or challenging experience (n = 1897). n = 1151 for data with weight of
dried mushrooms because not everyone used dried mushrooms and not everyone knew the weight of the consumed mushrooms.
2 Point by serial correlations were used for emotional support, physical comfort, social support, guide present, cannabis use before or during session, and any drug use
before or during session because these data are dichotomous.
3Asterisks indicate significance level (*p < 0.05, **p < 0.01, ***p < 0.001); ns = not significant.
4Estimated dose was rated on a scale from 1 (low) to 4 (high) in the Hallucinogen Rating Scale (HRS).
5Use of another mood-altering drug (excluding nicotine) immediately before or during the session.
6Number of occasions of past use of psilocybin-like classic hallucinogens.
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Carbonaro et al. 7
cannabis and/or another mood-altering drug (excluding nico-
tine) immediately before or during the session, age at the time
of the experience, and past hallucinogen experience were sig-
nificantly negatively correlated with difficulty of experience,
but not with duration of difficult experience.
Endorsement of putting self or others
at risk of physical harm: Relationship of
dose, setting conditions, difficulty and
duration of difficulty of experience, use of
another mood-altering drug, age, and past
hallucinogen experience
Endorsement of putting self or others at risk for physical harm
was positively correlated with estimated dose (from a question
on the HRS) (r = 0.071, p < 0.01), degree of difficulty of experi-
ence (r = 0.154, p < 0.001), and duration of difficult experience
(r = 0.157, p < 0.001). Furthermore, endorsement of putting self
or others at risk for physical harm was less likely in those who
also endorsed that the physical comfort of the setting (odds ratio
= 0.562, p < 0.001, 95% CI [0.416, 0.760]) and the social support
during the session (odds ratio = 0.657, p = 0.004, 95% CI [0.493–
0.875]). Endorsement of risk of physical harm was not signifi-
cantly associated with the weight of dried mushrooms, age, past
hallucinogen experience, emotional state before ingestion, use of
cannabis, or use of a mood-altering drug (excluding nicotine).
Hallucinogen Rating Scale and Mystical
Experience Questionnaire 30
The mean (SEM) for all 1993 participants for the six subscales of
the HRS were: Intensity, 2.62 (0.01); Somaesthesia, 1.64 (0.02),
Affect, 1.89 (0.01), Perception, 2.54 (0.02), Cognition, 2.30 (0.02),
Volition, 2.02 (0.02). The means (SEM) for the subscales and total
scores on the MEQ30 were: Mystical 45.35 (0.65), Positive Mood
50.74 (0.61), Transcendence of Time and Space 52.56 (0.53),
Ineffability 69.24 (0.58), and Total Score 50.26 (0.54). The per-
centage of participants who fulfilled criteria for having had a
“complete” mystical experience on the MEQ30 was 20.5%.
Strategies for alleviating the challenging
experience
The majority of participants reported that the social support and
trust for others physically present (65%), physical comfort and
safety of surroundings (75%), and emotional state (76%) before
taking psilocybin was conducive to having a positive experi-
ence. Most participants (91%) reported trying to stop the chal-
lenging experience. As shown with the gray bars in Figure 3,
participants tried a wide range of different strategies to attempt
to stop the experience. Most participants reported trying to calm
their mind (69%) or change location (63%). Some 33–40% tried
to stop the experience by shifting their body, changing the
music or social environment, or asking for help from a friend.
About 25% smoked cannabis or changed their environment in
other ways, with a minority reporting drinking alcohol (5%) or
taking another drug (3%). The striped bars in Figure 3 show the
percentage of participants who indicated that the specific
strategy helped to substantially stop the challenging experience.
Comparison of the gray and striped bars indicates that all strate-
gies were only modestly effective (i.e. on average, striped bars
are 57% as long as gray bars).
Risks and problems during the experience
Of the 1993 respondents, 10.7% reported putting themselves or
others at risk of physical harm, 2.6% reported behaving in a
physically aggressive or violent manner towards themselves or
others, and 2.7% reported getting help at a hospital or emergency
department during the chosen occasion.
Suicidality
Two research staff members independently reviewed all open-
ended textual responses to identify instances in which changes in
suicidal thoughts or behavior were attributed to acute or enduring
effects of the challenging experience. This review provided evi-
dence of both increased suicidality (five cases) and decreased
suicidality (six cases). More specifically, one individual, who had
pre-existing anxiety, depression and suicidal planning, reported
purposely attempting suicide by overdosing with benzodiaz-
epines and, subsequently, awakening in an intensive care medical
unit. Another respondent reported unsuccessfully trying to shoot
himself in the head. A third respondent reported that pre-existing
serious depression was exacerbated by the psilocybin experience
and later resulted in a suicide attempt. Two other individuals
reported salient suicidal thoughts during their psilocybin experi-
ence. In contrast, six respondents reported that pre-existing sui-
cidal thoughts (including depression in five cases) fully remitted
after their psilocybin experience.
Enduring negative psychological and
emotional experiences
To meaningfully assess enduring effects, data from participants
whose session occurred at least 1 year before completing the sur-
vey were analyzed (n = 1339). Of the participants, 19.3%
endorsed that they had sought treatment for at least one of five
negative psychological symptoms: fear (F), anxiety (A), depres-
sion (D), paranoia (P), and “other” (O) before their chosen ses-
sion and which they did not attribute to having taken psilocybin
or some other hallucinogen. After the challenging session, 24%
of these 1339 participants reported experiencing one or more of
these symptoms that lasted 1 week or longer and that the partici-
pant attributed to the chosen psilocybin session (F = 13%, A =
16%, D = 12%, P = 9%, O = 12%). The majority of those report-
ing symptoms (65%) reported more than one symptom. Some
10% of the 1339 participants reported psychological symptom(s)
lasting 12 months after the challenging session, and 7.6%
sought professional treatment for the symptom(s) after the cho-
sen session (F = 3.4%, A = 4.6%, D = 4.8%, P = 1.8%, O = 3%).
Of those who sought professional treatment after the session, 28
(2.1% of the 1339) reported no previous symptoms or treatment.
Those that sought treatment before the challenging experience
were significantly more likely to seek treatment afterwards
(14.3% with vs. 6% without prior treatment histories; p < 0.001;
z = 4.37). All of these findings based on the subset of 1339
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8 Journal of Psychopharmacology
participants were similar to those that occurred in the total par-
ticipant sample.
Inspection of data and review of open-ended comments doc-
umented three cases in which the challenging experience with
psilocybin was reported to be associated with the onset of
enduring and impairing psychotic symptoms. All three were
White males who were 18 to 21 years old at the time of the
experience, which had occurred 3 to 20 years before the survey.
None of the three reported having psychotic symptoms before
the experience. In their open-ended written comments about
their symptoms the first individual described auditory halluci-
nations (hearing voices) and paranoia. The second described
severe depersonalization, very disturbing visual hallucinations,
and extreme confusion. This individual subsequently started
taking unspecified antipsychotic drugs and later received a
diagnosis of schizophrenia. The third individual reported para-
noia, agoraphobia, severe social withdrawal, mental confusion,
and also reported that he had received diagnoses of bipolar dis-
order and post-traumatic stress disorder.
Discussion
This survey documents that psychologically difficult experi-
ences after taking psilocybin mushrooms can be associated with
acute adverse effects and enduring psychological problems as
well as enduring benefits. Almost 2000 participants, who were
on average 30 years old when they took the survey, met inclu-
sion criteria and completed the survey on the basis of their sin-
gle most psychologically difficult or challenging experience
(worst “bad trip”) after taking psilocybin mushrooms. Of these
respondents, 39% rated the experience as among the top five
(including single most) most challenging experiences of their
lifetime, 11% reported putting themselves or others at risk of
physical harm, 2.6% reported behaving in a physically aggres-
sive or violent manner, and 2.7% reported getting medical help
during the occasion. Of those whose session occurred at least 1
year earlier, 7.6% reported that they sought treatment for one or
more psychological symptom they attributed to the challenging
psilocybin experience. Three cases appeared associated with
Figure 3. Percentage of participants endorsing specific strategies that they reported using to attempt to stop the challenging experience
(gray bars) (N = 1993) and that they reported having helped substantially to stop the challenging experience (striped bars) (N = 1993). Of the
participants 9.1% reported doing nothing to try to stop the experience. The bars sum to more than 100% because most participants (52%) endorsed
trying more than one strategy.
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Carbonaro et al. 9
onset of enduring and impairing psychotic symptoms and three
cases with attempted suicide.
Despite these difficulties, it is notable that 84% of respond-
ents 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 expe-
rience 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 meaning-
ful and spiritually significant, respectively.
The distributions of the degree of difficulty and the degree of
personal meaningfulness (Figure 1, top row) were strikingly sim-
ilar. Furthermore, correlation and multiple regression analyses
showed that the degree of difficulty of the experience was posi-
tively and significantly related to the attribution of enduring per-
sonal meaning, spiritual significance, and increased life
satisfaction. These counterintuitive findings are consistent with
clinical observations of psychedelic psychotherapists who have
reported that, during a psychedelic session, the resolution of psy-
chologically challenging experiences may result in attribution of
meaning, spiritual significance, and increased life satisfaction
(Richards, 2015), sometimes described as catharsis. Challenging
experiences are not necessary for positive therapeutic outcomes.
Whether some challenging experiences can have facilitative or
detrimental effects on therapeutic outcome has not been scientifi-
cally explored.
The duration of the challenging experience was positively
related to the degree of difficulty of the experience and negatively
related to personal meaning, spiritual significance, and enduring
increased well-being. From the perspective of maximizing mean-
ing, spiritual significance, and enduring well-being, this finding
suggests that therapeutic interventions during a challenging expe-
rience should be preferentially aimed at reducing the duration
rather than the peak difficulty of the challenging experience.
Dose assessed by weight of dried mushrooms consumed and
estimated dose (from a question on the HRS) positively corre-
lated with degree of difficulty (r = 0.11 and 0.18). This finding is
consistent with laboratory studies showing that the frequency of
challenging experiences increase at higher psilocybin doses
(Griffiths et al., 2011; Studerus et al., 2012).
In the present study, respondents who reported having been
treated for psychological symptoms before their challenging ses-
sion were more than twice as likely than those with no treatment
history to subsequently seek treatment for psychological symp-
toms that they attributed to the session (14.3% vs. 6%). This find-
ing suggests alternative interpretations. First, those with treatment
histories may be less reluctant to seek out professional treatment
or may have better access to treatment services. Second, it is pos-
sible that those with treatment histories are more vulnerable to
enduring adverse effects of psilocybin.
The present survey documents nontrivial rates of both acute
problems (e.g. 11% putting themselves or others at risk for
physical harm during the session) and enduring problems (e.g.
7.6% seeking professional help for negative psychological
symptoms lasting >1 year). These rates are likely much higher
than the expected population rates of problems with a single
exposure to psilocybin because survey participants completed
the survey based on their worst “bad trip”, with participants
reporting a median of 6–10 prior psilocybin experiences. More
relevant to understanding associations between psilocybin use
and treatment-seeking for psychological problems, a population
survey has indicated protective effects of lifetime psilocybin
exposure and psychological distress and suicidality (Hendricks
et al., 2015).
The rates and severity of both acute and enduring problems
shown in the survey are notably higher than those we and others
have observed in laboratory research studies involving adminis-
tration of high doses of psilocybin to carefully screened, well-
prepared, and closely monitored volunteers (e.g. Griffiths et al.,
2006, 2008, 2011; Johnson et al., 2014; Studerus et al., 2010). At
Johns Hopkins, we adhere to our published guidelines for safe
administration of classic hallucinogens (Johnson et al., 2008).
Since initiating psilocybin research in 2000, we have adminis-
tered psilocybin doses of 20 mg/70 kg or higher to about 250 vol-
unteers in more than 380 sessions (as of May 2016). Although no
volunteer has been physically harmed during sessions, there were
three instances (0.9%) in which a participant’s disorientation dur-
ing a session might have put them or staff members at risk if
appropriate supervision had not been provided: (1) a volunteer
decided to stand up and engage in expressive movements; (2) a
volunteer moved from the couch to the floor while vigorously
moving legs and arms in an erratic fashion; and (3) a volunteer
became confused and disoriented when in the restroom. In
response to these instances, we changed our session management
procedures to strongly emphasize to both volunteers and session
staff the instruction and intention that volunteers remain on the
couch throughout the session when not engaged in a specific task
or using the restroom. When volunteers need to go to the restroom,
they walk to the restroom with the staff member at their side.
When in the restroom, the door remains unlocked and slightly ajar
with a staff member of the same gender remaining immediately
outside of the door and in intermittent (about 1 minute intervals)
verbal contact with the volunteer. With regard to post-session
negative symptoms, we have had three cases (0.9%) in which vol-
unteers reported physical or psychological symptoms within sev-
eral days to a week after a psilocybin session. In the first case, 1
week after a session the volunteer reported feeling anxious after
experiencing physical symptoms consistent with a heart attack.
An evaluation at an emergency department found no abnormal
signs. The volunteer was offered a further medical consultation
that the volunteer declined as unnecessary. In the second case, the
volunteer reported a range of symptoms that were ultimately diag-
nosed as hyperthyroidism. In the third case, the volunteer reported
that the psilocybin session experience was dominated by negative
emotions such as sadness and fear. After the session, the volunteer
reported periods of intermittent depressed mood. The volunteer
declined our offer to meet with a psychologist, but, instead, sought
out a spiritual counselor. At a 5-month follow-up visit, the volun-
teer reported that the symptoms had resolved. This low rate of
enduring psychological symptoms in laboratory studies is also
consistent with a summary of such effects from 110 psilocybin
research participants from another laboratory (Studerus et al.,
2011). In that report, seven participants endorsed negative changes
in psychological well-being, but only one participant (0.9%)
reported a level of distress sufficient for him to contact the
researchers. Those symptoms resolved after a few sessions with
an experienced psychotherapist.
Many factors likely contribute to the higher rates of acute and
enduring problems reported in the survey compared with the con-
trolled laboratory studies. In addition to the probable absence of
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10 Journal of Psychopharmacology
psychological screening and unknown psychological preparation
for psilocybin ingestion, only 2.1% of survey respondents
reported taking psilocybin under conditions that are usually
achieved in laboratory settings (i.e. a conducive emotional state
before administration, physical comfort and safety, social support
and trust of others, and the presence of a sober, trusted guide who
is experienced in supporting psychedelic experiences). Some
36% of survey respondents indicated they took a larger than
usual dose of psilocybin and 53% reported using cannabis before
or during the session. Cannabis use before or during the session
was slightly negatively correlated with difficulty of experience,
but had no effect on the duration of the difficult experience or the
likelihood of putting themselves or others at risk of physical
harm. Twenty-six percent of participants who tried to stop the
challenging aspect of the psilocybin session reported using can-
nabis to try to do so. Of those, 50% reported that it helped sub-
stantially. It is noteworthy, however, that in optional open-ended
textual responses at the end of the survey several volunteers
spontaneously commented that the use of cannabis significantly
exacerbated their challenging experience.
Several limitations of the current survey should be noted. As
an anonymous internet survey, we cannot know if respondents
were truthful in completing the survey. Furthermore, the rate of
non-completion was high. However, respondents were not paid
for their participation and completing the survey took about an
hour on average. Furthermore, 83% of respondents took the time
to write open-ended comments about their challenging experience
at the end of the survey, and many spontaneously expressed their
interest in and gratitude for having had the opportunity to com-
plete the survey. Another limitation is that respondent population
was not diverse: 78% were male, 89% were White, and 87% had
at least some college education. On the other hand, this lack of
diversity may accurately reflect the population of psychedelic
users.
Two additional factors limit the generalizability of the find-
ings. First, only people who endorsed having had a challenging
experience after psilocybin completed the survey. Therefore it is
not possible to estimate the prevalence of such experiences after
a single psilocybin exposure or after multiple psilocybin expo-
sures. Second, because recruiting for the survey was primarily
conducted via psychedelic-focused internet media, the partici-
pant sample was likely biased toward individuals with current
favorable interest in psychedelic drugs. As such, the survey may
have underestimated the severity of negative effects because
individuals who had severe negative effects would be less likely
to have heard about the survey.
The current study did not address hallucinogen persisting per-
ception disorder, which is an uncommon DSM-5 psychiatric dis-
order characterized by clinically significant distress in response
to the re-experiencing of hallucinogen-like perceptual symptoms
after a period of normalcy following a psychedelic drug experi-
ence (Baggott et al., 2011; Halpern and Pope, 2003).
The median reported dose of dried psilocybin mushrooms
taken in the survey was 4 g, with most respondents (84%) report-
ing having taken dried mushrooms rather than fresh. Although
there is wide variation in psilocybin and psilocin content both
within and across different species of psilocybin-containing
mushrooms (Beug and Bigwood, 1982; Bigwood and Beug,
1982), we estimate that 4 g of typically available dried mush-
rooms (P. cubensis) delivers the approximate psychoactive
equivalent to 25 mg of psilocybin (Bigwood and Beug, 1982;
Michael Beug, personal communication, 10 September 2015;
Stamets, 1996). A 25 mg dose of psilocybin is in the moderate to
high range of doses we have administered in our previous labo-
ratory studies (Griffiths et al., 2006, 2011). In the survey, the
mean score on the HRS Intensity subscale was 2.62 (out of a
maximum possible of 4.25), which is quite similar to the mean
score of 2.64 at 20 mg/70 kg in a laboratory study (Griffiths
et al., 2011). The mean total score from the MEQ30 in the survey
was 50.3, with 21% of participants fulfilling criteria for a “com-
plete” mystical experience. Comparable values in a laboratory
study of 20 mg/70 kg were considerably higher (mean total
score 70.0 and 61% complete mystical experience) (Barrett
et al., 2015), which is consistent with the fact that survey partici-
pants were reporting on the most challenging psilocybin experi-
ence of their life.
In conclusion, 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. Factors contrib-
uting to the increased likelihood of putting self or others at risk of
physical harm included the magnitude of the estimated psilocy-
bin dose, the degree of difficulty of the experience, the duration
of the difficult experience, and the absence of physical comfort
and social support during the experience. Epidemiological data
indicate that rates of adverse effects after psilocybin are very low
relative to adverse effects after other psychoactive drugs.
However, the findings from this survey affirm concerns about
taking psilocybin in uncontrolled environments. With increasing
research exploring possible therapeutic uses of psilocybin (Grob
et al., 2011, 2013; Johnson et al., 2014), it is important to note
that risks of dangerous behavior or enduring psychological prob-
lems are extremely low in laboratory studies of psilocybin with
carefully screened, well-prepared participants who are supported
during and after psilocybin administration.
Acknowledgements
We thank the many anonymous survey respondents who generously gave
their time and effort to complete this survey. We also thank Earth and Fire
from www.erowid.org for their generous assistance in facilitating survey
recruitment.
Contributors
RRG, MPB, MWJ, KAM, and RJ developed the survey. TMC, MPB, and
FSB performed data analysis. All authors took part in the interpretation of
the data. TMC and RRG drafted the manuscript, and all authors provided
comments on the manuscript.
Declaration of Conflicting Interest
The authors declared the following potential conflicts of interest with
respect to the research, authorship, and/or publication of this article: RRG
is a member of the Board of Directors of the Heffter Research Institute.
RJ is convener of the Council on Spiritual Practices.
Funding
The authors disclosed receipt of the following financial support for the
research, authorship, and/or publication of this article: This research was
supported by NIH grants RO1DA03889 and 5T32 DA007209 and grants
from the Council on Spiritual Practices and the Heffter Research Institute.
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Carbonaro et al. 11
References
Allen JW, Merlin MD and Jansen KL (1991) An ethnomycological
review of psychoactive agarics in Australia and New Zealand. J Psy-
choactive Drugs 23: 39–69.
Baggott MJ, Coyle JR, Erowid E, et al. (2011) Abnormal visual experi-
ences in individuals with histories of hallucinogen use: A Web-based
questionnaire. Drug Alcohol Depend 114: 61–67.
Barrett FS, Johnson MW and Griffiths RR (2015) Validation of the
revised Mystical Experience Questionnaire in experimental sessions
with psilocybin. J Psychopharmacol 29: 1182–1190.
Beug MW and Bigwood J (1982) Psilocybin and psilocin levels in twenty
species from seven genera of wild mushrooms in the pacific north-
west, USA. J Enthopharmacol 5: 271–285.
Bigwood J and Beug MW (1982) Variation of psilocybin and psilocin
levels with repeated flushes (harvests) of mature sporocarps of psilo-
cybe cubensis (Earle) Singer. J Enthopharmacol 5: 287–291.
Carhart-Harris RL and Nutt DJ (2013) Experienced drug users assess the
relative harms and benefits of drugs: A Web-based survey. J Psycho-
active Drugs 45: 322–328.
DAWN, Drug Abuse Warning Network (2013) 2011: National Estimates
of Drug-Related Emergency Department Visits. HHS Publication
No. (SMA) 13–4760, DAWN Series D-39. Rockville, MD: Sub-
stance Abuse and Mental Health Services Administration.
Griffiths RR, Richards WA, McCann U, et al. (2006) Psilocybin can
occasion mystical-type experiences having substantial and sustained
personal meaning and spiritual significance. Psychopharmacology
187: 268–283.
Griffiths RR, Richards WA, Johnson MW, et al. (2008) Mystical-type
experiences occasioned by psilocybin mediate the attribution of per-
sonal meaning and spiritual significance 14 months later. J Psycho-
pharmacol 22: 621–632.
Griffiths RR, Johnson MW, Richards WA, et al. (2011) Psilocybin occa-
sioned mystical-type experiences: Immediate and persisting dose-
related effects. Psychopharmacology 218: 649–665.
Grob CS, Bossis AP and Griffiths RR (2013) Use of the classic hallu-
cinogen psilocybin for treatment of existential distress associated
with cancer. In: Carr BJ and Steel J (eds) Psychological Aspects
of Cancer. New York: Springer Sciences + Business Media, LLC,
pp.291–308.
Grob CS, Danforth AL, Chopra GS, et al. (2011) Pilot study of psilocybin
treatment for anxiety in patients with advanced-stage cancer. Arch
Gen Psychiatry 68: 71–78.
Guzmán G (2008) Hallucinogenic mushrooms in Mexico: An overview.
Economic Botany 62: 404–412.
Hendricks PS, Johnson MW and Griffiths RR (2015) Psilocybin, psycho-
logical distress, and suicidality. J Psychopharmacol 29: 1041–1043.
Halpern JH and Pope HG, Jr (2003) Hallucinogen persisting perception
disorder: What do we know after 50 years? Drug Alcohol Depend
69: 109–119.
Johnson MW, Richards WA and Griffiths RR (2008) Human hallu-
cinogen research: Guidelines for safety. J Psychopharmacol 22:
603–620.
Johnson MW, Garcia-Romeu A, Cosimano MP, et al. (2014) Pilot study
of the 5-HT2AR agonist psilocybin in the treatment of tobacco
addiction. J Psychopharmacol 28: 983–992.
MacLean KA, Johnson MW and Griffiths RR (2011) Mystical experi-
ences occasioned by the hallucinogen psilocybin lead to increases
in the personality domain of openness. J Psychopharmacol 25:
1453–1461.
Metzner R (2004) Teonanacatl: Sacred Mushroom of Visions. El Verano,
CA: Four Trees Press.
Mowry JB, Spyker DA, Cantilena LR, Jr, et al. (2014) 2013 Annual
Report of the American Association of Poison Control Centers'
National Poison Data System (NPDS): 31st Annual Report. Clin
Toxicol 52: 1032–1283.
Nielen RJ, van der Heijden FM, Tuinier S, et al. (2004) Khat and mush-
rooms associated with psychosis. World J Biol Psychiatry 5: 49–53.
Nordic Council of Ministers (2009) Occurrence and use of hallucino-
genic mushrooms containing psilocybin alkaloids. Copenhagen:
TemaNord.
NSDUH, National Survey on Drug Use and Health (2007) The NSDUH
Report: Patterns of Hallucinogen Use and Initiation: 2004 and
2005. Rockville, MD: Substance Abuse and Mental Health Services
Administration, Office of Applied Studies.
NSDUH, National Survey on Drug Use and Health (2014) Detailed
tables for 2013 National Survey on Drug Use and Health. Rockville,
MD: Center for Behavioral Health Statistics and Quality, Substance
Abuse and Mental Health Services Administration.
Nutt DJ, King LA and Phillips LD (2010) Drug harms in the UK: A mul-
ticriteria decision analysis. Lancet 376: 1558–1565.
Presti DE and Nichols DE (2004) Biochemistry and neuropharmacology
of psilocybin mushrooms. In: Metzner R and Darling DC (eds.) Teo-
nanacatl. El Verano, CA: Four Trees Press, pp.89–108.
Richards WA (2015). Sacred Knowledge: Psychedelics and Religious
Experience. New York: Columbia University Press.
Riley SC and Blackman G (2008) Between prohibitions: Patterns and
meanings of magic mushroom use in the UK. Subst Use Misuse 43:
55–71.
Schwartz RH and Smith DE (1988) Hallucinogenic mushrooms. Clin
Pediatr 27: 70–73.
Stamets P (1996) Psilocybin Mushrooms of the World: An Identification
Guide. Berkeley, CA: Ten Speed.
Strassman RJ, Qualls CR, Uhlenhuth EH, et al. (1994) Dose-response
study of N,N-dimethyltryptamine in humans. II. Subjective effects
and preliminary results of a new rating scale. Arch Gen Psychiatry
51: 98–108.
Studerus E, Gamma A and Vollenweider FX (2010) Psychometric evalu-
ation of the altered states of consciousness rating scale (OAV). PLoS
One 5: e12412.
Studerus E, Kometer M, Hasler F, et al. (2011) Acute, subacute and long-
term subjective effects of psilocybin in healthy humans: A pooled
analysis of experimental studies. J Psychopharmacol 25: 1434–1452.
Studerus E, Gamma A, Kometer M, et al. (2012) Prediction of psilocybin
response in healthy volunteers. PLoS One 7: e30800.
Tylš F, Páleníček T and Horáček J (2014) Psilocybin – summary of
knowledge and new perspectives. Eur Neuropsychopharmacol 24:
342–356.
van Amsterdam J, Opperhuizen A and van den Brink W (2011) Harm
potential of magic mushroom use: A review. Regul Toxicol Phar-
macol 59: 423–429.
van Amsterdam J and van den Brink W (2010) Ranking of drugs: A more
balanced risk-assessment. Lancet 376: 1524–1525.
Wasson RG (1980). The Wondrous Mushroom: Mycolatry in Meso-
America. New York: McGraw-Hill.
at JOHNS HOPKINS UNIVERSITY on August 31, 2016jop.sagepub.comDownloaded from
    • We note however that respondents regarded even these negative experiences as valuable from a spiritual perspective. This agrees with the finding in Carbonaro et al.'s (2016) survey of bad trips, where 84% of respondents claimed to benefit from the bad trip experience. The causes, characteristics, and consequences of bad trips remain understudied.
    [Show description] [Hide description] DESCRIPTION: This study attempts to gain insight into the life worlds of users of entheogenic drugs, and thereby to broaden our understanding of a clandestine and little known spiritual phenomenon. It obtains evidence of spiritually motivated entheogen users who maintain that such use is of benefit to their life and health, and identifies a range of characteristics for their spirituality. Respondents were recruited at several Internet fora for individual email-mediated interviews (n = 11) or group interviews in public discussion threads (n = 15). They were predominantly adult males with stable jobs and living conditions and extensive entheogen experience. Respondents tended to follow a pattern of infrequent and often well-planned entheogen sessions, which, when successful, were characterized by insight into self, relations, and world; inner visions; feelings of peace, joy, and love; and occasional Maslovian peak experiences involving ego death and contact or unity with transcendent forces. Adverse experiences (“bad trips”) did also occur, but participants emphasized the long-term value even of such experiences, and indeed the long-term consequences of entheogenic experiences as regard healing and personal growth were often presented as the most important reason for entheogen use. Entheogenic spirituality may therefore be regarded as a developmental journey with two interacting phases, where brief, intense, and infrequent entheogenic sessions nourish, and are nourished by, a daily life focused on the integration of spiritual experience and insight into everyday activities.
    Full-text · Working Paper · Aug 2017 · Journal of Humanistic Psychology
    • Adverse reactions to these drugs can be classified along a temporalseverity-frequency continuum, from acute, short-lived reactions, involving anxiety, fear, panic, or psychotic symptoms (a " bad trip " ), which are the most common adverse reactions and are often fairly benign, to subacute and chronic maladaptive/dysfunctional reactions with anxiety or psychotic features, which are less common but may carry a poor prognosis (Carbonaro et al., 2016;Cohen, 1960;Strassman, 1984). However, hallucinogen-related disorders (i.e., acute or prolonged reactions with anxiety, depressive, or psychotic features) are generally thought to have low incidence, low persistence, and high rates of recovery (American PsychiatricAssociation, 2013;Carbonaro et al., 2016;Cohen, 1960;Hendricks, Thorne, Clark, Coombs, & Johnson, 2015;Johansen & Krebs, 2015;Krebs & Johansen, 2013;Strassman, 1984), and population studies suggest that hallucinogen use could be associated with improved mental health (Hendricks et al., 2015;Johansen & Krebs, 2015;Krebs & Johansen, 2013). Similarly, observational studies suggest that long-term ayahuasca use is not associated with increased psychopathology, cognitive deficits, or personality disorders (dosSantos, Balthazar, et al., 2016), with only few reports describing adverse psychiatric reactions (dosSantos, Balthazar, et al., 2016;dos Santos & Strassman, 2008; Lima & T ´ ofoli, 2011; Szmulewicz, Valerio, & Smith, 2015).
    [Show abstract] [Hide abstract] ABSTRACT: Background and aims: Ayahuasca is a dimethyltryptamine- and β-carboline-rich hallucinogenic beverage traditionally used by indigenous groups of Northwest Amazonian for ritual and therapeutic purposes. Animal and human studies suggest that ayahuasca has antidepressant and anxiolytic potentials and has a good safety profile. However, anxiety-like reactions may also occur after ayahuasca intake, although they are rare. Methods: Case report. Results: Here, we describe a case of a non-medicated, symptom-free young female with generalized anxiety disorder, who experienced intense anxiety, panic, and hopelessness during and for 3 days after participating in an ayahuasca ritual. The symptoms appeared in the first hours after ayahuasca intake and were gradually reducing in the following hours/days, but were intense enough to cause significant suffering to her, who needed to seek psychiatric help and restarted pharmacological treatment. Conclusions: Although “bad/horror trips” with anxiety features may occur during the acute effects of ayahuasca and other hallucinogens, to the best of our knowledge, this is the first report of a subacute/prolonged anxiety-like reaction to this substance. Ayahuasca should be used with caution in people with a history of anxiety disorders.
    Full-text · Article · Apr 2017
    • It is possible that one might report having experienced ego dissolution (e.g., might endorse items from the EDI including " All notion of self and identity dissolved away " , " I lost all sense of ego " , " I felt far less absorbed by my own issues and concerns " , and " I experienced a [dissolution or disintegration] of my 'self' or ego " ) under the effects of anesthesia (e.g., propofol), but this experience would not include other dimensions of mystical experience described by Stace or included in either the MEQ30 or Hood Mysticism Scale. Further, some psychedelic experiences of ego dissolution are psychologically challenging, are devoid of positive affect, and may have enduring negative psychological effects (Carbonaro et al. 2016). As constructed, the EDI will not differentiate such experiences from mystical-type experiences.
    [Show abstract] [Hide abstract] ABSTRACT: This chapter begins with a brief review of descriptions and definitions of mystical-type experiences and the historical connection between classic hallucinogens and mystical experiences. The chapter then explores the empirical literature on experiences with classic hallucinogens in which claims about mystical or religious experiences have been made. A psychometrically validated questionnaire is described for the reliable measurement of mystical-type experiences occasioned by classic hallucinogens. Controlled laboratory studies show that under double-blind conditions that provide significant controls for expectancy bias, psilocybin can occasion complete mystical experiences in the majority of people studied. These effects are dose-dependent, specific to psilocybin compared to placebo or a psychoactive control substance, and have enduring impact on the moods, attitudes, and behaviors of participants as assessed by self-report of participants and ratings by community observers. Other studies suggest that enduring personal meaning in healthy volunteers and therapeutic outcomes in patients, including reduction and cessation of substance abuse behaviors and reduction of anxiety and depression in patients with a life-threatening cancer diagnosis, are related to the occurrence of mystical experiences during drug sessions. The final sections of the chapter draw parallels in human neuroscience research between the neural bases of experiences with classic hallucinogens and the neural bases of meditative practices for which claims of mystical-type experience are sometimes made. From these parallels, a functional neural model of mystical experience is proposed, based on changes in the default mode network of the brain that have been observed after the administration of classic hallucinogens and during meditation practices for which mystical-type claims have been made.
    Full-text · Chapter · Mar 2017
  • [Show abstract] [Hide abstract] 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.
    Full-text · Article · Nov 2016
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Clinically significant anxiety and depression are common in patients with cancer, and are associated with poor psychiatric and medical outcomes. Historical and recent research suggests a role for psilocybin to treat cancer-related anxiety and depression. Methods: In this double-blind, placebo-controlled, crossover trial, 29 patients with cancer-related anxiety and depression were randomly assigned and received treatment with single-dose psilocybin (0.3 mg/kg) or niacin, both in conjunction with psychotherapy. The primary outcomes were anxiety and depression assessed between groups prior to the crossover at 7 weeks. Results: Prior to the crossover, psilocybin produced immediate, substantial, and sustained improvements in anxiety and depression and led to decreases in cancer-related demoralization and hopelessness, improved spiritual wellbeing, and increased quality of life. At the 6.5-month follow-up, psilocybin was associated with enduring anxiolytic and anti-depressant effects (approximately 60-80% of participants continued with clinically significant reductions in depression or anxiety), sustained benefits in existential distress and quality of life, as well as improved attitudes towards death. The psilocybin-induced mystical experience mediated the therapeutic effect of psilocybin on anxiety and depression. Conclusions: In conjunction with psychotherapy, single moderate-dose psilocybin produced rapid, robust and enduring anxiolytic and anti-depressant effects in patients with cancer-related psychological distress. Trial Registration: ClinicalTrials.gov Identifier: NCT00957359.
    Full-text · Article · Dec 2016
  • [Show abstract] [Hide abstract] ABSTRACT: Recent randomized controlled trials of psilocybin-assisted psychotherapy for patients with cancer suggest that this treatment results in large-magnitude reductions in anxiety and depression as well as improvements in attitudes toward disease progression and death, quality of life, and spirituality. To better understand these findings, we sought to identify psychological mechanisms of action using qualitative methods to study patient experiences in psilocybin-assisted psychotherapy. Semistructured interviews were conducted with 13 adult participants with clinically elevated anxiety associated with a cancer diagnosis who received a single dose of psilocybin under close clinical supervision. Transcribed interviews were analyzed using interpretative phenomenological analysis, which resulted in 10 themes, focused specifically on cancer, death and dying, and healing narratives. Participants spoke to the anxiety and trauma related to cancer, and perceived lack of available emotional support. Participants described the immersive and distressing effects of the psilocybin session, which led to reconciliations with death, an acknowledgment of cancer’s place in life, and emotional uncoupling from cancer. Participants made spiritual or religious interpretations of their experience, and the psilocybin therapy helped facilitate a felt reconnection to life, a reclaiming of presence, and greater confidence in the face of cancer recurrence. Implications for theory and clinical treatment are discussed.
    Article · Jun 2017
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October 2015 · Journal of Psychopharmacology · Impact Factor: 3.59
The 30-item revised Mystical Experience Questionnaire (MEQ30) was previously developed within an online survey of mystical-type experiences occasioned by psilocybin-containing mushrooms. The rated experiences occurred on average eight years before completion of the questionnaire. The current paper validates the MEQ30 using data from experimental studies with controlled doses of psilocybin.... [Show full abstract]
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December 2016 · Journal of Psychopharmacology · Impact Factor: 3.59
Cancer patients often develop chronic, clinically significant symptoms of depression and anxiety. Previous studies suggest that psilocybin may decrease depression and anxiety in cancer patients. The effects of psilocybin were studied in 51 cancer patients with life-threatening diagnoses and symptoms of depression and/or anxiety. This randomized, double-blind, cross-over trial investigated the... [Show full abstract]
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