Negative Experiences with Psychedelics Linked to Stressful Environments, Other Risk Factors

A recent study on negative outcomes from using psychedelics identified several potential risk factors for bad trips.
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A new study by researchers at Imperial College London has found that stressful environments and other risk factors were associated with negative experiences with psychedelics, reaffirming the notion that set and setting play significant roles in positive experiences with drugs such as psilocybin, LSD and MDMA. The study, which was recently published in the peer-reviewed journal Scientific Reports, gives new insight into the potential negative outcomes of using psychedelics in a clinical setting to treat serious mental health conditions.

Over the past several years, psychedelic drugs have received renewed interest in their potential to treat mental health conditions including post-traumatic stress disorder, treatment-resistant depression, severe anxiety and substance misuse disorders. Research is lacking, however, that focuses specifically on the possible negative outcomes of using psychedelic drugs such as acutely challenging experiences commonly referred to as “bad trips.”

Study author Rebecka Bremler of Imperial College London’s Centre for Psychedelic Research told PsyPost that there was “a lack of research into this topic – at least when we started the project in 2021. There was (is) all of this amazing research on psychedelics’ positive effects on mental health, and some on acute challenging experiences (‘bad trips’) with psychedelics and what may contribute to them, but not so much on long-term negative psychological responses (which is what we focused on here).”

“We wanted to find what may be potential risk factors for having these experiences, but also for people who had had them to be heard,” Bremler added. “The latter was one of the reasons why we included extended participants’ quotes in the article: to tell it in their own words as much as possible.”

To conduct the study, the team of researchers identified potential participants by reaching out to individuals and forums interested in psychedelics on social media platforms including Reddit and Twitter. Participants who reported negative psychological symptoms lasting more than 72 after using psychedelics including LSD, psilocybin (found in magic mushrooms), ayahuasca, 5-MeO-DMT, mescaline and MDMA were selected as potential candidates for the research.

The initial phase of the study consisted of an online survey that was available between November 2021 and April 2022. After providing consent, respondents were asked a series of questions about their experience with psychedelics.

Of the 84 respondents who began it, 32 completed the entire initial survey, which included the Challenging Experience Questionnaire (CEQ) to measure the intensity of any negative experiences while using psychedelic drugs. A smaller group of participants was then selected for more detailed interviews by the researchers.

A total of 15 of the 20 participants contacted for further interviews, including a mix of ages and genders, completed the process. The loosely structured interviews were conducted by mental health professionals, who further explored the participants’ experience using psychedelics. 

The participants scored higher than average scores on the CEQ, indicating more severe challenging experiences. The most commonly reported symptoms were anxiety and panic. 

The published study includes detailed accounts culled from the interviews to illustrate the challenging experiences. Many of the participants, especially those who had taken classic psychedelics such as LSD, characterized the acute psychedelic experiences as negative or frightening.

Study Cites Risk Factors for ‘Bad Trips’

The researchers also explored the potential risk factors that may be associated with negative psychedelic experiences. Significant factors included the dose and purity of the drug taken, the frequency of use before the negative experience, personal and family mental history and the use of other substances. 

The researchers also identified the environment in which the psychedelic drug was taken as a key factor associated with negative experiences, adding further credence to the idea that set and setting play crucial roles in positive outcomes with psychedelics. Stressful or unsafe environments, negative expectations and a lack of social support during and after the psychedelic experience were all associated with negative outcomes. 

“The potential risk factors that we identified based on the interviews were very similar to what previous research has found to be risk factors for having a challenging acute experience or ‘bad trip,’” Bremler explained. “All but one participant who had used a classic psychedelic also talked about having a difficult acute psychedelic experience, and then what they described as something similar to a trauma response in the following weeks, months or even years.”

“We know from previous research that psychedelics make us more sensitive to our environment – both external and internal (internal meaning, for example, mental health, previous life experiences, or even our mood that day),” she continued. “So, it makes sense that there’s a potential to have lasting negative effects on mental health, just as it can have positive effects.”

The researchers noted limitations of the study, including relying on self-reported data about the experiences and possible inaccuracies in reporting previous drug use. The authors also called for continued research, including comprehensive studies with larger sample sizes and a diverse group of participants, to study the long-term effects of psychedelics.

“Important remaining questions to address would, for example, be to further investigate the potential risk factors that we found here,” Bremler said. “There’s so much more to research in this field, and this ‘other’ side of psychedelics is just as important to know more about as the positive side — especially as psychedelic treatment becomes legal.”

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