19 September 2025
Some people struggle after psychedelics. A new study wants to help.
By: Roman Palitsky, Zainab Salako, Joshua Lipson, Deanna Kaplan
MAPS Bulletin: Volume XXXIV
For many people, psychedelics have been powerfully and beneficially transformative. But as with anything that carries great catalytic potential, some people experience difficulties after taking them. Our team has spent years designing a study of these psychedelic-related challenges. Our goal is to better understand what those challenges are, what predicts them, and how to best support the people going through them. That study has just launched.
What are post-psychedelic challenges?
A question that we often get often is, “What do you mean by post-psychedelic challenges? Are you talking about people who have had a bad trip?” Not exactly. “Bad trips” are important to study, but our focus is more specific. We are interested in people who have had distress or impairment, or have sought help from a family member, friend, or professional, after taking a psychedelic. What we are focused on here the impact: difficulties in the days, weeks, or months after the psychedelic experience is over.
Why study post-psychedelic challenges?
Most people who have taken a psychedelic recognize how powerful they can be. Psychedelics’ capacity as agents of change gives them tremendous promise as mental health treatments. The benefits of psychedelics—for mental health, spiritual and existential renewal, connectedness, and wellbeing—are increasingly recognized and corroborated by scientific research. But these positive findings do not mean that we should be cavalier with psychedelics. When we look to societies that have historically used psychedelics, we find that psychedelics are often treated with great respect and care in those cultural settings. Like any powerful medicine, their capacity for benefit is accompanied by a range of effects. At times, these can involve difficulties that last after the initial effects of the psychedelic have worn off.
If psychedelics continue to become a bigger part of health systems, communities, or people’s spiritual or personal lives, it is vital that we be accountable to those who experience difficulties after taking them. Good stewardship means that as clinicians, scientists, and advocates, we should be prepared to offer support if someone has negative impacts after taking a psychedelic. This is not about raising alarms or decrying “risks.” It is about taking seriously an open secret in the psychedelic ecosystem: sometimes people struggle after taking a psychedelic. And acknowledging that, like anything humans ever do, sometimes things don’t go as planned. We need better tools to support people when that happens, and we need them yesterday.
Scientific and clinical knowledge about post-psychedelic difficulties is nowhere near as advanced as the understanding of psychedelics’ benefits. There have been some excellent studies published in the last several years documenting the existence of challenges, the fact that they can last for months or longer, and that they can impact some of the same domains where we also see psychedelic benefits: spirituality, meaning, mood, and trauma. Unfortunately, a consequence of the biomedical approach to psychedelics—handling them like a pharmacological treatment—is that we have mostly been looking at pharmacological adverse events and safety profiles. These are mainly things that happen during the dosing session itself. However, that focus is extremely limiting. The value of psychedelics is often in positive effects that persist in people’s lives after the acute subjective effects subside. Being able to recognize difficulties during that period is just as important.
What we need to know
What is the nature of post-psychedelic challenges?
This may come as a surprise, but clinical science doesn’t actually have a good answer to this question. Decades ago, people thought that psychedelics could lead to psychosis because some of the effects seemed similar. Although this belief has persisted, there is now some debate about how often psychosis really occurs after taking a psychedelic. Research suggests that in some individuals with genetic vulnerabilities for psychosis, cannabis can be a trigger for early or initial symptomology. However with psychedelics the early data aren’t pointing in that direction. Instead, early data suggest that with psychedelics there may be more risk of manic symptoms. However, even when someone appears to develop what looks like symptoms of a manic episode after taking psychedelics, it is unclear whether this is—and can be successfully treated the same way as—a manic episode that occurs spontaneously, such as in bipolar disorder.
The same issue applies to all kinds of other post-psychedelic difficulties, including depressed mood, anxiety, loss of meaning, post-traumatic stress symptoms, or dissociation. We have very little data about what people who have post-psychedelic difficulties go through, and how these experiences may be similar or different from mental health symptoms that have different catalysts. Understanding what exactly people are going through can help to recognize early signs of difficulties, and to offer support when it’s needed. It can also help to better understand what kinds of support work better for different kinds of people experiencing different kinds of challenges.
What predicts challenges?
Many psychedelic practitioners already have some ideas about this. Training for psychedelic facilitators often includes a set of risk factors or rule-outs: unsafe or unpredictable settings, little or no preparation, and certain mental health histories or conditions are on this list. And yet, we simply don’t have in-depth and high-quality data from enough people who have had difficulties to truly understand what roles these factors play. Do some practices (for example, mixing different psychedelics, or mixing psychedelics with another substance) tend to lead to certain difficulties, or to more severe difficulties?
Our study has taken everything we could learn from the research, from clinicians, from underground practitioners, and from people with lived experience of these difficulties. We used this information to create a set of questions about set, setting, compound, and other possible predictors, supplementing this received wisdom with empirical observation. What we learn can help people make informed choices about how they use psychedelics, and to better inform services for those experiencing challenges. It can also help people who provide psychedelic treatments offer care with more information at their fingertips.
What helps?
There are many different, even contradicting, recommendations. To date, few if any of these are backed by scientific evidence. We often hear that integration is crucial for psychedelics. But what do we mean by that? And what approaches to integration are most helpful to someone who is experiencing challenges? Do certain remedies help with specific kinds of challenges? What role do changes in diet or sleep have? Can a second psychedelic experience ever help someone recover from challenges? When is it a good time to see a therapist, and what sort of therapy might help? Should someone consider pharmacological treatment? Are there meditation techniques or therapy modalities that are more helpful than others? And, are any of the recommendations that people are receiving counterproductive and even harmful?
Our study is designed to generate information that can help provide the programs and clinicians who focus on psychedelic-related challenges, and the people going through challenges, with a helpful evidence base.
Post-Psychedelic Challenges Study
Your story matters.
If you have experienced difficulties after taking a psychedelic, you may be eligible to participate in a study sponsored by Emory University. Visit psychedelicchallenges.org to learn more.
Our study in a nutshell
To answer these questions, we are recruiting 800 people who have had post-psychedelic challenges. The only way that we can learn about these difficulties is if people with lived experience are willing to share what it has been like for them.
To be in the study a person must be over 18, speak English, and have experienced distress or impairment, or needed professional support, after taking a psychedelic. By psychedelic, we mean the classic psychedelics (e.g., mushrooms/psilocybin, acid/LSD, DMT, ayahuasca, peyote/San Pedro/mescaline) as well as similar compounds like molly/MDMA, ibogaine, and ketamine (because people many treat it like a psychedelic). We are not including cannabis.
If you are reading this and know someone who might have had difficulties after taking one of these compounds, or someone who is going through difficulties right now, we ask that you share about this study with them.
Here is what the study involves.
The study has several components because not every major question can be answered the same way. Participants will receive compensation for every part of the study they engage in.
• An in-depth survey of post-psychedelic difficulties
The first part of the study is an anonymous, detailed self-report online survey that can be done from home. The survey asks about a person’s background, different aspects of their post-psychedelic difficulties, any remedies that they might have tried, and whether those remedies were helpful. This information will be crucial for understanding the nature of psychedelic-related challenges.
• A longitudinal study to understand 1-year trajectories
We will invite 400 people with recent or ongoing post-psychedelic challenges to participate in a 1-year longitudinal study. Every 2 months we will send an assessment to see what they are experiencing, what remedies they have tried, and whether these have helped. How do people heal, and even grow, from these challenges? Is there anything that makes the challenges worse? This study will provide much-needed answers in real time.
• Interviews
Survey studies can miss a great deal. To help fill those gaps, we are inviting 40 people to tell us in more detail about their experiences. We will invite people with different kinds of experiences, different trajectories, and different outcomes to provide depth and detail for understanding the things that numbers can’t tell us.
• Voice Diaries: in your own words
One of the most important things that we have learned from people who have had post-psychedelic difficulties is how unique and personal their stories can be. For 40 participants, we’ll also have the ability to learn what their experiences are like on a weekly basis, in their own words. Using an app called Fabla, people can securely and privately share about their experience by talking out loud, the way they would share with a friend. We think that this will be some of the most important information we gather because it will provide us with a rich and textured understanding of how difficulties unfold over time, and to learn about the concrete things that make people’s lives easier as they recover.
Taking challenges seriously without losing the plot
Finding a balanced way to think about harms is difficult even in mainstream treatments. It is all too easy to become polarized when we talk about post-psychedelic challenges. Are psychedelics safe or risky? Are post-psychedelic challenges adverse events, or are they part of a healing process? Should we be for or against psychedelics? These either/or binaries are not helpful, nor are they realistic ways to deal with psychedelics. Most things we do in life carry some risk. Many of our best medicines have adverse event profiles—think of live-saving chemotherapies, for example. The potential for risk doesn’t mean we should lock ourselves away from the world or never take a drug with a side effect. It does mean that we should know what these effects are and how to help people who are experiencing them.
There are already some good ways for thinking about the possibility of post-psychedelic challenges: one way is by looking to something as ordinary as exercise. Exercise is widely known to be good for the body and for mental health. People who exercise live longer. But it also carries some risk. For every 1000 hours of running there are between 2.5 and 33 running-related injuries. Experienced runners get fewer injuries, novices get more. If you’re a runner (for those who run 1 hour per week, 1000 hours is about 19 years of running), chances are that you’ve had an injury at some point. And yes, some of that has to do with experience and know-how: the experienced runners who do everything right get injured less—and yet they still get injured from time to time. When someone is injured what we need to be able to do is to recognize the problem, decide if it needs treatment, and figure out when they are ready to get back on the road. Someone with a torn ligament shouldn’t be told to just keep running. They need rehab, sometimes even surgery. Then again, not every sore muscle has to take you out of the race.
This kind of approach is something we’re missing in psychedelics. When people have persisting challenges after taking a psychedelic, we often don’t know what the problem is, whether it requires intervention, or what kind of support will be most helpful. Sometimes the answer is time, and sometimes healing takes something more. There’s a lot of lore and wisdom out there, but it’s often contradictory and it doesn’t always make sense. We think that what we learn from this study will help people navigate those difficult moments. If psychedelics come to play a larger role in our society, it is important that we rise to the responsibility that represents.
Roman Palitsky, MDiv, PhD
Roman Palitsky, MDiv, PhD, is Assistant Professor of Psychiatry and Behavioral Sciences and Director of Research Projects in Spiritual Health at Emory University, and he is faculty in the Emory Center for Psychedelics and Spirituality. His research applies a biopsychosocial-spiritual approach to improving behavioral interventions by ensuring that the treatments we offer are responsive to care seekers’ cultural needs and strengths. His work in psychedelic treatment research reflects these commitments by seeking to make psychedelic therapies rigorous, effective, and accountable to the many patient populations who might benefit from them, and to support those care seekers who may experience adverse effects.
Zainab Salako
Zainab Salako is a Clinical Research Coordinator with the Lab for Existential Behavioral Medicine at Emory Spiritual Health. She graduated from Emory University in 2024 with a degree in Psychology, where she developed an interest in the intersections of mental health, spirituality, and culture. In her current role, she supports research on spirituality, mental health, and psychedelics, including clinical trials and measure development. Her research interests focus on how religious and spiritual frameworks influence mental health outcomes, symptom presentation, and treatment experiences across culturally and religiously diverse populations. She plans to pursue doctoral training in clinical psychology.
Josh Lipson, PhD
Josh Lipson, PhD, is a recent graduate of Columbia University’s clinical psychology doctoral program, and an incoming postdoctoral fellow at the Emory Center for Psychedelics and Spirituality. His dissertation research focused on psychosocial, spiritual, and mood-related predictors of psychedelic experiences and their downstream effects. Over the last several years, he has clinically trained in a range of both acute and long-term inpatient psychiatric settings in New York City. He brings perspectives from both these threads of experience to the study of post-psychedelic challenges and adverse effects. He has also completed Sitting and Integration Training with the Zendo Project.
Deanna M. Kaplan, PhD
Deanna M. Kaplan, PhD, is a licensed clinical psychologist and Assistant Professor in the Department of Family and Preventive Medicine at Emory University School of Medicine. Dr. Kaplan has over a decade of experience using wearable and smartphone-based technologies to study the real-world daily dynamics of biopsychosocial-spiritual health. She is the creator and Scientific Director of Fabla, a smartphone app that securely collects voice diaries from participants in research—a tool that she developed specifically for capturing patient narratives in clinical trials of psychedelic-assisted therapy. As faculty in the Emory Center for Psychedelics and Spirituality, she is a co-investigator on four funded trials of psychedelic-assisted therapies, spanning psilocybin, LSD, and ketamine.
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