Ontologically Challenging Psychedelic Experiences: Considerations for Managing Associated Distress

Dec 2, 2025Current topics in behavioral neurosciences

Difficult Psychedelic Experiences and How to Handle the Resulting Distress

AI simplified

Psychedelic Science on OpenScience ↗PubMed ↗DOI ↗

Abstract

Psychedelic experiences may lead to ontologically challenging experiences (OCPEs) that disrupt a person's sense of self and reality.

OCPEs could cause lasting feelings of ontological instability and existential distress for some individuals.
For others, OCPEs may provide opportunities for personal growth and therapeutic benefits when they feel supported.
Grounding techniques and cognitive reframing may help individuals recover and integrate their experiences.
Ethical considerations include the importance of preparation and support tailored to address ontological disruptions.
There is a need for more research to develop effective practices in psychedelic therapy and harm reduction.

AI simplified

Psychedelic substances have been increasingly recognised for their potential in treating various mental health conditions, yet they can also induce what we call ontologically challenging psychedelic experiences (OCPEs), a concept developed in our research to describe experiences that profoundly disrupt an individual's sense of self, reality, and existence. We present OCPEs not as a diagnostic category but as a phenomenological and harm reduction perspective on certain destabilising psychedelic experiences.While some individuals integrate OCPEs with ease, others struggle with ontological instability, existential distress, and impairments that persist long after acute effects. Importantly, ontological challenges are not always negative: for many, when they feel adequately resourced, they form part of the therapeutic mechanism and are a valued opportunity for personal development and growth. Drawing on our qualitative studies alongside other psychological research, we examine the phenomenology of OCPEs and their challenging aftermath, as well as strategies that may help facilitate recovery and integration. Grounding techniques, cognitive (re)framing, and supportive structures are discussed as potentially beneficial approaches and resources.Finally, we outline ethical and practical implications for clinical and harm reduction practice. We highlight the limits of informed consent in psychedelic therapy and argue for the value of preparation and post-experience support that is attuned to ontological disruptions. As empirical evidence remains limited, further research is needed to refine best practices. The development of an ethically responsible approach, informed by the phenomenology of OCPEs, can help maximise benefits of psychedelic substances while minimising long-term harm.

Full Text

Full text is available at the source.

View full text ↗

Ontologically Challenging Psychedelic Experiences: Considerations for Managing Associated Distress

Abstract

Full Text

You found one interesting study. We’ll send the next 7.

what lands in your inbox each week:

Recent issues from the psychedelic science brief

Abstract

Full Text

Related papers

You found one interesting study. We’ll send the next 7.

what lands in your inbox each week:

Recent issues from the psychedelic science brief