Navigating Groundlessness: An interview study on dealing with ontological shock and existential distress following psychedelic experiences

Psychedelic experiences can produce profound shifts in metaphysical beliefs and identity, and while many studies emphasise therapeutic benefits such as reduced death anxiety and increased meaning, there is growing evidence that a substantial minority of users experience long-lasting difficulties. Earlier research and large surveys have identified persistent ontological challenges—disturbances in how people understand reality and existence—after single or repeated psychedelic episodes, and qualitative analyses commonly report existential confusion, struggles to make sense of experiences, and functional impairment lasting months or longer. The unpredictability of such transformations raises ethical questions about informed consent, and the literature on integration—the process of making sense of and incorporating psychedelic experiences—remains sparse, with little guidance about how to address specific types of prolonged difficulties like ontological shock. Argyri and colleagues set out to explore, in depth, the phenomenology of existential and ontological distress that persists after psychedelic experiences and to identify what participants found helpful or unhelpful when managing these difficulties. Using a retrospective qualitative design nested within a larger mixed-methods project, the study asked three research questions: what are the features of extended existential struggle after psychedelic use, which supports and practices participants found useful or harmful, and how people described integrating the experience and the learnings they carried forward. The authors aimed to fill a gap in understanding how extended ontological disruption is lived and navigated, and to inform integration and support approaches for such difficulties.

This study formed part of the Challenging Psychedelic Experiences Project, a mixed-methods, multi-country investigation. For the qualitative arm reported here, participants were drawn from an earlier online survey of 608 individuals who reported difficulties lasting more than a day after psychedelic use; 102 of those survey respondents (17%) had indicated an "Existential Struggle" theme in their open-ended answers and were eligible for follow-up. From those who volunteered for interviews, the researchers selected participants purposively on the basis of having described existential-type difficulties. Recruitment channels included social media, a psychology and philosophy newsletter, student email lists and a newspaper advertisement. No financial incentives were offered. Twenty-eight interviews were conducted initially; two transcripts were later excluded because they did not address the study aim, leaving a final sample of 26 participants. Inclusion criteria were age 18 or over, fluency in English, and having experienced post-psychedelic difficulties that negatively affected functioning for more than a day. Interviews were semi-structured, audio-recorded, transcribed via Otter.ai and checked against the recordings by interviewers to ensure accuracy. Three members of the research team (EKA, JE, PM) performed an inductive thematic analysis following the six-stage approach described by Braun and Clarke (familiarisation; coding; theme development; review; definition; reporting). An additional team member (OR) served as a consultant during parts of the analysis. Codes were organised visually on a Miro board and themes were negotiated collaboratively across the analysts. Unlike some thematic reports, the team reported the frequency of themes and subthemes, with frequencies and percentages provided in supplementary materials. Ethical approval was granted by the University of Greenwich Research Ethics Board (Project ID: 21.5.7.20); written informed consent was obtained and participants could withdraw up to two weeks after interview. Transcripts were anonymised and data held securely.

Thematic analysis of 26 interviews produced 11 overarching sections of findings describing participants' contexts, the acute psychedelic episodes, the nature of extended difficulties, coping strategies and outcomes. Participants frequently described turbulent or transitional life circumstances prior to the index experience: 9 reported healing/self-exploration, 12 were in highly transitional phases, and 12 described turbulent or stressful periods; only two reported no significant prior difficulties. Intentions for using psychedelics varied: curiosity/exploration (9), seeking fun (7), healing (6), self-development (5), seeking clarity on life decisions (5), positive prior experience (5), and spiritual aims (2). One participant reported an unintentional DMT exposure. Acute experiences were often aversive: 12 participants characterised their trip as traumatic, and 16 conveyed existential concern. Expressions of fear were common (16 participants, 62%), including anxiety or terror (11, 42%) and paranoia (7, 27%). Other acute features included overwhelm, sensory overload and aggressive reactions in a minority. Many described exiting the trip feeling shaken, fragile or physically exhausted. Interviewees reported major and sometimes prolonged worldview and identity shifts that could be bewildering, with cases ranging from conversion to religious life to dramatic changes in spiritual orientation. All participants experienced some form of ontological shock or existential confusion. Extended difficulties encompassed existential crisis and despair (10 participants), cognitive and behavioural disruptions affecting daily functioning (12), severe impacts on work or study (11), attentional problems and disorientation, and somatic problems including sleep disruption and nightmares (ten participants described somatic issues; seven reported nightmares). Twelve participants explicitly framed the experience as traumatic, and 15 reported flashbacks or re-experiencing phenomena. Identified triggers for reactivation included meditation, breathwork, further substance use, conversations about psychedelics, and sleep-related triggers. Regarding coping, 22 of 26 participants reported using grounding practices that helped reduce cognitive preoccupation; examples included body-oriented practices, simple attention-focusing techniques (e.g. counting), and various forms of meditation—though meditation functioned as both helpful and as a trigger for some individuals. Social and cognitive normalisation—finding interpretive frameworks or communities that validated the experience—was also commonly reported as beneficial. By contrast, lack of support and understanding was widely described as unhelpful (18 participants), including absence of community, dismissive or fear-provoking spiritual interpretations from others (eight participants), and insufficient integration support from guides (three participants). Participants recommended cautious use, better preparation, journeying with informed or experienced companions, and dedicating time for integration; some advocated legalisation or decriminalisation to improve access to support. Concerns about psychedelic culture and public narratives were raised by 12 participants, who cited underestimation of harms (8), harmful elements within psychedelic-associated communities such as spiritual narcissism (4), risks of co-dependency or abuse by self-styled authorities (3), and commercialisation (2). Despite the difficulties, many participants reported positive outcomes: 14 described self-development or spiritual growth, three reported improved mental health or full recovery, and ten stated they were content with their integration. Participants' models of integration varied, from an ongoing, never-complete process to successful bridging between mystical experiences and ordinary life.

Argyri and colleagues interpret their findings as evidence that psychedelic-induced ontological shock can produce profound cognitive, emotional and social "ungrounding" that precipitates sustained existential confusion and functional disruption. The study illustrates that such ontological challenges often involve core existential themes—death, meaninglessness, responsibility and aloneness—and can present with PTSD-like features including re-experiencing and functional impairment. The authors situate these accounts in existing theories: increased psychological entropy (uncertainty) during psychedelic states may destabilise prior belief structures, which in turn can permit therapeutic recalibration when psychological and social resources are sufficient, but may produce prolonged distress when those resources are lacking. The findings highlight grounding as a central recovery mechanism: somatic and embodiment practices, attention-focused techniques, and social normalisation helped participants re-anchor themselves and reduce obsessive meaning-searching. Interpersonal validation, community belonging and adoption of interpretive frameworks (religious, spiritual or scientific) were reported to aid recovery, though the authors note that some cultural or community responses—particularly spiritually dogmatic or bypassing approaches—can be counterproductive and may exacerbate vulnerability or dependence on authority. The researchers reflect on clinical implications cautiously, suggesting that trauma-focused interventions (for example EMDR) may have utility when PTSD-like symptoms predominate, and that integration support should address metaphysical and existential questions rather than only symptom reduction. They underscore debates about informed consent and the ethical responsibilities of guides and therapists to prepare people for possible metaphysical shifts, while acknowledging contrasting recommendations in the field about whether therapists should offer a "menu" of belief frameworks or support person-driven meaning-making. Limitations acknowledged by the authors include the predominantly Western, English-speaking sample, which restricts cultural generalisability and may overrepresent experiences in contexts lacking communal frameworks for absorbing ontological shock. The retrospective design and purposive sampling of individuals who reported existential difficulties mean prevalence estimates cannot be derived from this study. Future research directions proposed include cross-cultural comparisons, investigations into aetiological and vulnerability factors, the prevalence and timelines of ontological difficulties among psychedelic users, and systematic evaluation of which communal structures and integration supports are protective versus harmful.

The study concludes that psychedelic-induced ontological shock can lead to prolonged cognitive, emotional and social ungrounding, producing existential confusion and functional impairment for some individuals. Participants most commonly navigated these difficulties through grounding strategies—bodily and somatic practices, attentional techniques—and through social normalisation and adoption of meaning-making frameworks. Integration following ontological challenge is framed as a process of rebuilding stable 'ground' after dissolution of prior worldviews. The authors suggest that improved availability of supportive structures during and after psychedelic experiences, and nuanced attention to cultural and interpersonal factors, may help people recover from or avoid protracted ontological distress.