New study sheds light on which post-psychedelic difficulties last longest and what helps people cope

While psychedelics are gaining attention for their therapeutic potential, some users report lingering psychological difficulties that extend well beyond the immediate effects of the drug. A new study published in the Journal of Psychedelic Studies provides one of the most detailed assessments to date of these long-term challenges, examining their prevalence, severity, duration, and the coping strategies people find most effective. The findings suggest that while anxiety and panic are among the most disruptive, issues like existential struggle and diminished self-esteem tend to last the longest—often persisting for over a year.

Psychedelics like psilocybin, LSD, and ayahuasca have shown promise in treating mental health conditions, but not all outcomes are positive. A significant minority of users report psychological disturbances that linger beyond the acute effects of the drug. Previous studies have found that around 5% to 25% of users experience such issues, and some continue to struggle for months or even years.

These difficulties can include anxiety, perceptual changes, depression, confusion, and existential distress. While many users continue to view their psychedelic experiences positively, researchers have called for a more nuanced understanding of the risks involved and how people recover from negative effects.

“I am part of the Challenging Psychedelic Experiences research team, and we have been exploring adverse reactions to psychedelics across a series of research studies since 2023,” said study author Oliver C. Robinson, an associate professor of psychology at the University of Greenwich.

“While research shows that the majority benefit from the clinical or guided use of psychedelics, a minority have adverse reactions. These emotional or behavioral difficulties have been largely overlooked in research studies that have primarily focused on the average positive effects among users.”

To address this gap, the present study set out to identify which post-psychedelic difficulties are most common, how severe and long-lasting they are, and what strategies help people manage them. The researchers hypothesized that different types of difficulties would vary in severity and duration, and that people would use different coping strategies depending on the nature of the problem.

The study involved an online survey of 159 adults who had experienced psychological difficulties lasting more than one day after using a psychedelic drug between 2 and 10 years ago. Participants were recruited through newsletters, social media, and previous studies. The sample included individuals from North America and Europe, most of whom had high levels of education. Participants were asked to focus on one specific psychedelic experience that had led to lasting challenges and completed detailed assessments of the difficulties they encountered.

Participants reported whether they had experienced any of 11 different types of psychological difficulties, such as anxiety, depression, social disconnection, existential struggle, derealization, and paranoia. They rated the severity of each difficulty on a three-point scale and indicated how long each issue persisted. The researchers also asked participants to select up to two coping strategies that had helped them manage each difficulty. Options ranged from professional therapy and support from friends and family to self-education, meditation, physical activity, and breathing techniques.

The most frequently reported difficulties were social disconnection (72%), anxiety and panic attacks (68%), and existential struggle (65%). More than half of participants also reported depression (61%) and derealization (55%). Less common were paranoia and visual disturbances, each affecting about 21% of the sample.

In terms of severity, anxiety and panic attacks were rated as the most disruptive to daily life, followed by paranoia and difficulty thinking clearly. In contrast, depersonalization, derealization, and visual disturbances were rated as less severe on average. Although many participants experienced these perceptual or dissociative symptoms, they tended to interfere less with daily functioning compared to emotional or cognitive issues.

When looking at duration, existential struggle and diminished self-esteem stood out as the longest-lasting challenges. Both persisted on average for more than 15 months—significantly longer than other issues like anxiety or depression. These findings align with earlier research showing that some individuals find it difficult to integrate profound or disorienting psychedelic experiences, particularly those involving shifts in their worldview or sense of identity.

The findings highlight “that some people who take psychedelics experience disorienting and disruptive difficulties pertaining to emotions, their sense of self or even sense of reality that can last for weeks or months,” Robinson told PsyPost.

The study also revealed which coping strategies were perceived as most helpful for each type of difficulty. Self-education—such as reading or watching videos to better understand one’s experience—was the most frequently cited strategy overall. It was especially helpful for managing existential struggle, social disconnection, derealization, and visual disturbances.

Professional therapy was most commonly used for depression and diminished self-esteem, suggesting that these issues often require more structured support. Support from peers and family was rated as most effective for anxiety and panic attacks, underscoring the importance of interpersonal connection in the recovery process.

“It surprised me that more people find chatting with peers to be effective than chatting with therapists,” Robinson said. “It may be that therapists are not yet well trained to handle the conundrum of working with psychedelics and associated difficulties.”

Some challenges, including depersonalization, sleep problems, and cognitive confusion, did not show strong preferences for specific coping strategies, suggesting that these may be more variable in how people manage them. In general, though, the study found that different problems call for different types of support.

These results have several implications. First, they show that extended difficulties following psychedelic use are not only common but also diverse in form and duration. Second, they suggest that coping with these difficulties is not a one-size-fits-all process. People benefit from a range of strategies, from reading and journaling to therapy and social support. Third, the findings highlight gaps in current systems of care. Many people rely on self-guided learning or informal peer networks rather than professional help, possibly because psychedelic integration is still a niche area within mainstream mental health services.

The researchers acknowledge some limitations. The data were collected retrospectively, which introduces the possibility of memory bias. People may not accurately recall the timeline of their symptoms or what helped them recover. The sample also skewed toward educated individuals from Western countries, which may not reflect the full range of experiences across different cultural or socioeconomic backgrounds.

“This is a sample mainly from the United Kingdom and the United States,” Robinson noted. “In countries where there is a legal psychedelic culture, such as Brazil or Peru, we would expect very different results.”

Future research could address these limitations by tracking individuals in real time, starting before they use psychedelics and following up afterward to assess both short- and long-term outcomes. Cross-cultural studies could also shed light on how different settings, belief systems, and social supports shape the experience and aftermath of psychedelic use. It may also be helpful to explore the biological underpinnings of persistent symptoms, particularly those involving perception or cognition.

“We are currently exploring how individuals who have childhood trauma and then take psychedelics experience the resolution, or exacerbation, of the early trauma,” Robinson said. “We are also involved in a Global Psychedelic Survey that will bring data on how common adverse reactions to psychedelics are.”

“We find that even among people who have difficulties after psychedelic usage, the vast majority retain a favorable view of psychedelics as agents of positive change,” he added. “This shows that perhaps the difficulties relate to issues that, once made conscious, can be resolved to some degree. This process may be distressing, but we see a similar pattern with extended psychotherapy—people tend to get worse before they get better.”

The study, “An investigation into the varieties of extended difficulties following psychedelic drug use: Duration, severity and helpful coping strategies,” was authored by Oliver C. Robinson, Jules Evans, Rosalind G. McAlpine, Eirini K. Argyri, and David Luke.