Written by Tommaso Barba
Tommaso is a PhD candidate at the Centre for Psychedelic Research at Imperial College London

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Psychedelic substances like psilocybin, a compound derived from certain mushroom species, have gained traction in recent years for their potential therapeutic benefits in treating mental health conditions such as depression, anxiety, and PTSD. However, these substances often elicit profound and challenging experiences, colloquially referred to as "bad trips." Despite their discomfort, these experiences may offer opportunities for psychological growth. This article delves into how challenging psychedelic experiences, when properly supported, can serve as catalysts for profound personal transformation.

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A Personal Account

A participant testimony in a psilocybin clinical trial posted on YouTube described her experience as a last resort to address longstanding mental health struggles. Born in Scotland to a mixed-race, mixed-faith family, she grew up nurtured by her father, a marine engineer and amateur astronomer, and her mother, a history teacher specialising in religious, moral, and philosophical studies. This upbringing fostered her love for science, nature, philosophy, and art, as well as an ability to hold complex and sometimes contradictory ideas. However, despite this rich foundation, she struggled with undiagnosed neurodivergence, low self-esteem, and poor mental health, which often manifested as patterns of burnout and self-doubt.

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“The psilocybin session was a ‘hurricane’ that dismantled my coping mechanisms. I confronted a visceral representation of my mental illness, amplifying feelings of futility,” she recounted. For years, she had masked her struggles by presenting a carefully constructed façade of agreeability, an act that eroded her sense of self and left her feeling hollow. "Nearly 30 years of mental problems were dumped on me in one go. It was hell, but it showed me the true shape of the parts of me that had been damaged beyond recognition." She likened her mental state to a top-of-the-range Ferrari with a permanently engaged handbrake, functional but always on the verge of breaking down under strain. The psilocybin session ripped away her mask, leaving her to confront the painful reality of her condition. "It wasn’t just the depression; it was the violence I had been doing to myself by ignoring my needs and allowing parts of me to suffer," she shared.

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Despite the distress, the experience proved transformative. "The session wasn’t a cure, but it made me realise I can’t go on like this alone. I need help, and acknowledging that was a huge step," she said. The process forced her to begin a journey of self-compassion, recognising that her depression, once viewed as an adversary, was a part of her that had been silenced and needed justice, not suppression. Though the aftermath of the session was challenging, she emerged with profound insights and a renewed commitment to healing. "I would do it all again," she concluded, emphasising the treatment’s potential to catalyse profound psychological growth even through discomfort.

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Understanding Challenging Psychedelic Experiences

Research by Carbonaro et al. (2016) provides a comprehensive analysis of challenging psychedelic experiences. The study surveyed 1,993 individuals about their most psychologically difficult experience with psilocybin, revealing insights into the multifaceted nature of these events. Notably, 39% of respondents rated their challenging experience among the top five most difficult events of their lives, yet an overwhelming 84% also reported deriving lasting benefits.

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Key findings included:
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• Acute risks: 11% of participants reported behaviours that put themselves or others at risk during the experience. Higher doses, inadequate preparation, and lack of social support were found to increase the likelihood of such risks. Participants who had experienced greater distress often cited the absence of supportive guides or safe settings as significant contributors to their challenges.‍
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• Duration and intensity: On average, the most challenging aspects of the experiences lasted several hours, but the psychological effects could linger for weeks. For some, these effects included distressing memories or heightened emotional sensitivity. 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. However, participants frequently reported that the intensity of the experience directly correlated with the depth of their eventual breakthroughs.
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Figure 1. Duration of challenging psychedelic experiences

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• Enduring psychological impacts: While 7.6% of participants sought professional help for lingering symptoms such as anxiety or depression, the majority experienced profound personal growth, with 84% reporting that they benefited from the experience. An interesting insight emerged, suggesting that individuals who faced the most intense difficulties were often the ones who reported the greatest increases in well-being, provided they received adequate support during and after the experience.

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These findings underscore the transformative potential of navigating emotional hardship. Many participants described feeling a sense of rebirth or renewal, with newfound insights leading to long-term behavioural and emotional improvements.

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Figure 2. Characteristics of challenging psychedelic experiences

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The study highlights that preparation and integration are crucial to achieving these outcomes. Strategies such as setting clear intentions, engaging in mindfulness practices, and seeking professional guidance can increase the likelihood of positive results. By contrast, individuals who lacked these supports often struggled to process their experiences, underscoring the importance of support frameworks for psychedelic use.

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What happens when things go wrong? Findings from Evans et al. (2023)

A recent study by Evans et al. (2023) extended our understanding of the potential challenges associated with psychedelic use by focusing on the long-term difficulties experienced by participants. The mixed-methods study gathered data from 608 individuals who reported extended adverse experiences following the use of psychedelics. Findings revealed that the most common difficulties included anxiety, existential struggles, social disconnection, depersonalisation, and derealisation. Remarkably, for one-third of the participants, these challenges persisted for over a year, and for one-sixth, they lasted more than three years.

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The study identified several predictors of prolonged difficulties. Participants who had no knowledge of the dose or drug type, or who took psychedelics in unguided settings, were more likely to experience extended challenges. Additionally, those who reported more severe acute difficulties during their psychedelic experience were more likely to face enduring impacts. Guided settings, with experienced facilitators and structured integration support, were associated with shorter durations of difficulties and a narrower range of adverse effects.

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Qualitative data from the study shed light on the emotional and existential struggles faced by participants. One individual described feeling "completely untethered from reality," while another shared, "The overwhelming anxiety persisted, making me question everything I knew about myself and the world around me." Such accounts highlight the profound and often isolating nature of these experiences, as well as the importance of robust post-experience integration support.

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How long can the challenges last?

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Figure 3. Duration of psychological challenges after a psychedelic experience in 608 individuals reporting long term difficulties

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Evans et al. emphasised the need for harm reduction strategies, including better education about dose and substance, increased access to guided settings, and the development of integration frameworks. They concluded that while psychedelics hold therapeutic potential, their use requires careful preparation, monitoring, and follow-up to minimise risks and support those who experience long-term difficulties.

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Mechanisms of growth Following challenging psychedelic experiences

The potential for challenging psychedelic experiences to foster psychological growth hinges on the concepts of emotional breakthrough and cognitive reappraisal. Wood et al. (2024) highlighted strategies individuals employ to navigate difficult experiences, identifying three primary coping mechanisms:

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1. Acceptance and Reappraisal: Embracing the experience rather than resisting it. Participants frequently reported moments of surrender as pivotal to their transformation. For instance, one participant shared, "I realised fighting it made the experience worse. When I stopped resisting, the fear melted away, and I could see the lessons hidden within the pain." Reappraisal often involved reframing distressing emotions as valuable insights, enabling individuals to find meaning in their struggles.
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2. Sensory Regulation and Physical Interaction: Engaging the senses or the body to stay grounded was frequently cited as a stabilising mechanism during challenging experiences. Participants often utilised tactile strategies, such as holding onto soft or familiar objects, to anchor themselves. For example, one individual noted, "At one point, I clutched a blanket tightly, and it grounded me in a way I didn’t think was possible." Others turned to sensory inputs like focusing on the rhythm of their breathing or immersing themselves in natural environments. One respondent shared, "The sound of birdsong during my experience reminded me of life’s beauty, even amidst the chaos." Music also played a pivotal role for many, with curated playlists providing a sense of continuity and emotional resonance. "The music felt like a guide," explained one participant, "helping me navigate through the most turbulent parts of my journey." These grounding techniques not only provided immediate relief but also facilitated emotional breakthroughs by creating moments of safety within the intensity of the experience. 
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3. Social Support and Disclosure: Seeking comfort or sharing the experience with others often played a pivotal role in the integration process. Participants highlighted the importance of forming connections through group discussions, therapy sessions, or even informal conversations with friends. These interactions provided emotional validation and helped participants process their experiences more effectively. One individual noted, "Sharing my experience in a safe group setting allowed me to hear different perspectives, which reframed the intensity of what I went through as something valuable." Another participant shared how disclosing their journey to a trusted friend brought a sense of relief and acceptance: "It felt like I was finally seen for who I truly am." Social support often extended beyond the immediate aftermath, with structured peer groups and long-term integration communities playing a crucial role in fostering sustained psychological growth.
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Acceptance and reappraisal strategies were particularly associated with emotional breakthroughs, moments of catharsis that allow individuals to process repressed emotions and achieve new insights. One participant from Wood’s study described the pivotal nature of this process: “Meditating earlier helped me observe my thoughts and not fight them. This allowed me to view the issue from different angles.” The study further found that participants who accessed deep emotional layers often emerged with increased self-compassion and a clearer understanding of their values.

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Figure 4. Usefulness of different strategies attempted to navigate challenging psychedelic experiences 

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How to learn from challenging trips? The importance of shaping narratives 

The work of Gashi et al. (2021) explored how individuals narratively transform challenging psychedelic experiences into valuable life lessons. Drawing on qualitative interviews with 50 Norwegian users of psychedelics, the study revealed that storytelling plays a pivotal role in integrating these experiences. Participants often reframed their so-called "bad trips" as opportunities for growth, describing them as "necessary" journeys that provided profound existential and emotional insights.

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One key theme was the concept of "narrative work," where individuals processed their experiences by constructing coherent stories that made sense of the chaos. For many, this narrative reconstruction helped them draw symbolic boundaries between themselves as knowledgeable, experienced users and those who approached psychedelics without proper preparation or respect. Gashi et al. observed that this process not only allowed users to integrate their experiences into their self-identity but also reduced the stigma surrounding challenging psychedelic experiences by emphasising their transformative potential.

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As one participant noted, "The bad trips are what give you the most insights. They show you the sides of yourself you've tried to diminish—the parts most important to understand." This perspective highlights the therapeutic potential of reframing challenges as integral steps in personal development, rather than as failures or missteps.

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Integration Challenges

While the acute phase of a challenging psychedelic experience often garners attention, the integration period.when individuals attempt to make sense of and apply their insights, is equally critical. The participant from the clinical trial described significant difficulties in this phase: “Without proper integration and support, the journey can feel isolating and incomplete.”

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Wood et al. (2024) similarly emphasised that the absence of structured support can hinder the benefits of challenging experiences. Integration practices such as therapy, journaling, and group discussions help individuals contextualise their experiences and translate them into actionable changes in their lives. The study noted that participants who engaged in structured integration reported significantly higher levels of sustained well-being and personal growth compared to those who did not.

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Set and Setting: The importance of Preparation

The “set and setting”, a person’s mindset and the physical/social environment during a psychedelic experience, play a pivotal role in shaping outcomes. Carbonaro et al. (2017) noted that challenging experiences were less likely to lead to enduring distress when participants had access to physical comfort and social support. Conversely, chaotic or unsafe environments increased the likelihood of adverse outcomes.

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Proper preparation can also mitigate fear-based challenges. Techniques drawn from therapies like Acceptance and Commitment Therapy (ACT) can equip individuals with mindfulness and acceptance strategies, fostering psychological flexibility (Wolff et al., 2020). Participants in Wood’s study who practiced intentional acceptance during their sessions reported greater emotional breakthroughs and more enduring positive changes.

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Additionally, pre-session preparation often involves setting clear intentions, addressing unresolved anxieties, and establishing trust with facilitators. These practices create a psychological foundation that helps participants navigate difficult emotional terrain more effectively.

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Risks and ethical considerations

Despite their therapeutic potential, psychedelics are not without risks. A minority of individuals in the Carbonaro study reported enduring negative effects, including psychotic symptoms and exacerbated mental health issues. These cases highlight the need for careful screening of participants, especially those with pre-existing psychiatric conditions, and underscore the importance of professional guidance. Moreover, the use of psychedelics in non-clinical settings raises ethical concerns. Unregulated use can expose individuals to unsafe environments, increasing the risk of harm. Advocates argue for the importance of legal, supervised settings where medical and psychological support is readily available. Efforts are underway to standardise protocols and create accessible frameworks for safe use, including ongoing trials exploring optimal dosages, session structures, and integration models.

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Moving Forward

Challenging psychedelic experiences represent a paradoxical avenue for psychological growth. As the participant’s story illustrates, profound discomfort can serve as a gateway to self-understanding and healing, but only when supported by careful preparation, safe environments, and robust integration practices. Future research should continue exploring how to optimise these experiences, balancing their risks and rewards to harness their full therapeutic potential.

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In her own words, “I’m past just wanting to feel good; I want to feel better. These treatments have the potential to heal, not just perform short-term damage control.” Her journey reminds us that transformation often lies on the other side of discomfort, waiting to be realised through courage, support, and intentional effort.

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References
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1. Carbonaro, T. M. et al. Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences. J. Psychopharmacol. 30, 1268–1278 (2016).

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2. Gashi, L., Sandberg, S. & Pedersen, W. Making ‘bad trips’ good: How users of psychedelics narratively transform challenging trips into valuable experiences. Int. J. Drug Policy 87, 102997 (2021).

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3. Wolff, M. et al. Learning to let go: A cognitive-behavioral model of how psychedelic therapy promotes acceptance. Front. Psychiatr. 11, 5 (2020).

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4. Wood, M.J., McAlpine, R.G. & Kamboj, S.K. Strategies for resolving challenging psychedelic experiences: insights from a mixed-methods study. Sci Rep 14, 28817 (2024). https://doi.org/10.1038/s41598-024-79931-w

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5. Evans, J., Robinson, O. C., Argyri, E. K., Suseelan, S., Murphy-Beiner, A., McAlpine, R., Luke, D., Michelle, K., Prideaux, E., & Mastinu, A. Extended difficulties following the use of psychedelic drugs: A mixed methods study. PLoS One 18, e0293349 (2023).

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