Have You Had Difficulties After a Trip? The Emory Center for Psychedelics and Spirituality Wants to Hear From You

“To fathom hell or soar angelic.” That is how Humphry Osmond, the psychiatrist who gave us the word “psychedelic,” summed up these compounds in a rhyme he mailed to Aldous Huxley in 1956. The line is remembered for its second half, “just take a pinch of psychedelic.” But Osmond put hell first, and the order was not incidental. His point was that the same substance, at the same dose, could deliver either one, and that nobody could say in advance which a given person would get. Nearly seventy years on, that asymmetry has held. We have learned a great deal about soaring. We know much less about the people who don’t—and least of all about those for whom the difficulty doesn’t end when the drug wears off.

Although the “bad trip” is well-established in psychedelic lore, there is little data about difficulties that persist after the trip. We know they happen. Sometimes the blues don’t go away. Sometimes hope and meaning remain elusive. And, at times, a psychedelic experience is the event that triggers mania, psychosis, and even a hospital stay. Jules Evans has been chronicling the harder end of this spectrum in Ecstatic Integration for years, and the peer-reviewed literature has begun to catch up. In a mixed-methods study of 608 people reporting extended difficulties, Evans and colleagues found that problems persisted for more than a year in roughly a third of them, and for more than three years in a sixth. 

Psychedelic communities often navigate these difficulties the way a small community tiptoes around an open secret: they are not aired in public because they might give the wrong impression of psychedelics, and they are rarely discussed amongst ourselves. Early research gives us a rough sense of scale. In a survey of U.S. adults who had used classic psychedelics, Simonsson and colleagues found that about 9% reported difficulties that impaired their functioning for longer than a day, 3.4% reported challenging or distressing effects lasting longer than a month, and 2.6% sought medical, psychiatric, or psychological help in the days and weeks after their most difficult experience. 

A more recent survey from the same group puts post-acute difficulties at 6.4%, with 1.3% reporting difficulties that lasted more than a year. Set against the roughly 31 million American adults – about 12 percent of us, a figure the RAND Corporation independently arrives at – who have taken psilocybin at least once, a rate like 2.6% works out to something on the order of 800,000 people who have needed professional support after a trip. The cumulative impact of post-psychedelic challenges amounts to a serious psychiatric, spiritual, and ethical issue, one that demands new, intensive focus from the research and clinical community.

Enter the Post-Psychedelic Challenges Study, launched by an international consortium of universities, including Brown University, the University of Melbourne, and the University of North Texas, led by Dr. Roman Palitsky, a faculty member at Emory University. When I saw the opportunity to do a postdoc fellowship focused on this area of research, I jumped at the chance.

The project builds on the work of Dr. Willoughby Britton’s Varieties of Contemplative Experience project, which, despite the serenity of its name, set out to honestly characterize the range of challenges people can encounter when they practice meditation.

The Post-Psychedelic Challenges Study takes the same approach to psychedelics, and we mean something more specific by it than cataloguing adverse effects. We’re trying to establish the clinical footprint of post-psychedelic difficulty: what the symptoms and syndromes actually are, how to characterize them in language a clinician can use, how long they tend to last, and – above all – what contributes to improvement and to thriving on the other side. If you are someone who has struggled after a psychedelic experience, that last question is why this project exists. Right now, a person who turns up in a therapist’s office or an emergency room months after a trip, still not right, meets a field with very little to offer them. We would like to change what is available to that person. The result, which we affectionately call P-Psych, launched in summer 2025 and is setting the standard for this vital line of inquiry.

Who Are We Looking For?

We’re looking for 800 adults, based in either the United States, Canada, or Australia, who have ever experienced difficulties after the acute effects of the psychedelic wore off. Right now, we’re almost 25% of the way there, which means we’ve already fielded the largest dataset to date that deals with these questions in detail. But in order to realize the vision of this project – to change the landscape of psychedelic science – we can use all the help we can get.

The post-psychedelic challenges we’re interested in can include a variety of issues. People have shared with us about negative changes in mood, somatic issues, dissociation, and spiritual and existential struggles. We are especially interested in people who are currently experiencing challenges as a result of recent psychedelic use because there is a focused longitudinal component to our study. For one year, we aim to follow 400 individuals currently experiencing difficulties to understand how these difficulties resolve, for whom, and why. That said, we’ll welcome people who still have a story to tell about the aftermath of a trip they took in 1968! We’re also interested in people whose experience with psychedelics has had a mixed impact on them – which means we also welcome people who have experienced benefits in addition to harms. 

What Do We Mean By Psychedelics?

For this study, we are trying to capture the effects of classic psychedelics (psilocybin/mushrooms, LSD, ayahuasca/DMT, 5-MeO-DMT, or peyote/San Pedro/mescaline), and also some of the compounds that have developed a reputation as psychedelics in the broad sense, including MDMA and ketamine. Because we have to draw some limits around the category of “psychedelics”, and the effects of cannabis are rather unique, we take care to note that cannabis-related experiences do not fall under the scope of our study.

What Are We Trying To Learn?

We’re trying to learn three important things:

1. What is the nature of these difficulties when they are described in the language of clinical science, rather than through anecdote and personal report alone—important as those are? What forms do they take, and which of them tend to travel together?
2. Among people who do experience post-psychedelic challenges, what distinguishes those who improve from those who worsen or stay stuck? What is associated with particularly severe symptoms?
3. What practices, remedies, and supports help?

This will contribute to general knowledge, of course. But that isn’t what drives the work. We’re clinicians, and the reason we want to understand the shape these difficulties can take is so that the field can build real ways to help the people living inside them—before and after potentially destabilizing psychedelic experiences.

Right now, the evidence base around what predicts post-psychedelic challenges, and what predicts an effective recovery from them, is sorely lacking. While underground practitioners can sometimes speak to these issues from intuition and experience, a dramatic increase in interest in psychedelics for healing and other purposes underscores the pressing need for high-quality data.

What Does Our Study Involve?

First of all, we make sure to schedule a real, live conversation with anyone who signs up to express interest in our study. This gives us a chance to get to know the human behind the story, and gives people who’ve experienced post-psychedelic challenges a chance to know the humans behind the research.

Then, anyone who qualifies gets invited to take one big, comprehensive survey that asks about their history with psychedelics, the nature of the experience that led to difficulties for them, the full range of challenges they’ve experienced, and whether those challenges are ongoing. We also ask about what they think any challenges they’ve experienced are about, why they believe they happened, as well as what remedies, therapies, or lifestyle changes may have helped them move through the difficulties. Throughout the survey, there are plenty of chances for participants to offer open-ended responses that give voice to their experience in their own words.

In addition, anyone who began experiencing post-psychedelic difficulties within the past year, and whose challenges are still ongoing, may be eligible to enroll in a year-long follow-up portion of the study, where we check in every two months to ask about whether the difficulties have subsided, gotten worse, or stayed the same, whether your interpretation of them has changed, and whether you’ve sought any new help or found new ways of coping with them.

Some portion of participants will also be invited to check in with us weekly through a cutting-edge voice-diary app called Fabla, which gives us a window into how people are feeling and functioning in their everyday lives, including but not limited to their experience of post-psychedelic challenges. We’ll also invite a small subset of study participants back for a longer, more in-depth interview about their story with post-psychedelic challenges, because there are some things that quantitative analyses of survey data can’t fully capture: the nuances of an individual narrative and themes we didn’t think to ask about.

We’d also be remiss not to mention that participation in all parts of our study is compensated.

Why Study the Dark Side? Do We Have a Problem with Psychedelics?

Not at all. At the Emory Center for Psychedelics and Spirituality, our raison d’etre is finding ways to understand the role of psychedelics in spiritual health across the lifespan, and harnessing insights from the field of spiritual health to help support richer, more therapeutically effective psychedelic experiences. Crucially, we think that any attempt to integrate psychedelics into our cultures of spiritual practice and healing requires honesty and nuance about both the upsides and downsides of psychedelics. While we see this as a strong, non-negotiable matter of research ethics, there’s also a simple, pragmatic piece to it: when advocates for psychedelics paper over the gnarlier stories of psychedelics and their effects, the general public loses trust in their vision for normalization.

Holding space in the discussion for both the benefits and the risks is a real challenge, but it isn’t unique to psychedelics. Several decades after their approval by the FDA, and in the wake of their large-scale uptake in the treatment of depression and anxiety, people continue to debate the balance of benefit and risk from SSRIs. There is near-consensus that benzodiazepines and opioids, while sometimes medically necessary, carry significant risks of dependency, withdrawal, and overdose. Even medical interventions considered generally benign by the public, such as anesthesia, hip replacements, and tonsillectomies, cannot be said to have a perfectly spotless risk-benefit calculus.

While it’s understandable to be concerned that too much talk of risk and side effects could scare off people who would likely benefit from these interventions, the greater danger is in depriving adults of the chance to make a balanced, honest assessment for themselves.

Even beyond the realms of mental health and medicine, it is worth remembering that many activities we think of as vital to a good life, such as driving, are not without built-in risk.

It’s not our study’s intention to measure the baseline riskiness of psychedelics; after all, we are specifically recruiting people who have experienced challenges after psychedelics, rather than randomly sampling people who have taken a psychedelic. However, it may be interesting to one day assess how risky it is to take psychedelics, compared to other activities that mainstream society currently deems legally or morally acceptable, like driving or running marathons. It’s worth noting, though, that our study is comparing difficulties after psychedelics to difficulties after meditation. Despite looking very different from the outside, one exogenous and fraught with historical stigma, the other endogenous and seen as largely benign, might these two consciousness-changing technologies overlap in their risk profiles?

A New Chapter in Psychedelic Research Needs You.

We believe that the Post-Psychedelic Challenges Study, which at nearly 200 participants to date represents the largest dataset of its kind, marks a new chapter in the science of psychedelic experience, as it happens in the wild and continues to reverberate through people’s lives. The field has come very far in the study of how psychedelics work at the molecular level, how they affect the brain, and the kinds of experiences they tend to produce. But the longer, wider arc of real-world impacts has gotten relatively short shrift. We’re here to change that. And because there isn’t one single “psychedelic experience”, the only way to advance our knowledge of real-world psychedelic experiences and their after-effects, both good and bad, is to talk to as many psychonauts as possible.

If your psychedelic story includes difficulties that lasted beyond the trip – be they physical, emotional, or spiritual and existential – the team at Emory would love to invite you to a conversation. It may just change the way we talk about psychedelics.

Josh Lipson is a psychologist and postdoctoral fellow at the Emory Center for Psychedelics and Spirituality.