PONE-D-24-20547Navigating Groundlessness: An interview study on dealing with ontological shock and existential distress following psychedelic experiencesPLOS ONE

Dear Dr. Ketzitzidou Argyri,

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: N/A

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This qualitative article deals with the experience of psychedelic use and outcomes in non therapeutic settings.

It was an interesting read, thought provoking and engaging in terms of experiences (non helpful experiences follwoign use was less interesting to me for some reason).

That being said, I felt that there was not a proficient lit. framework for discussing the types of effects of psychedelics on the human brain and especially the information processes that occur. Before discussing on page 2 “The process of making sense of and learning from psychedelic experiences, particularly those that are challenging, is commonly described as ‘integration’ [28,29], It would makes sense to write about information processing and how psychedelics affect this process (integration would be an outcome of information processing, of altering of consciousness and reworking of past concepts in ones mind following the experience).

The concept of ontological shock was put forward, but this shock is just one outcome altered information processing in the brain. I feel that processing models should be central in this discussion, especially since questions of being (ontological discourse- participants were recruited to share their experiences of "Existential Struggle,") were not the only experiences that were described by participants.

in other words, many of the experiences related to in the article by participants were not merely related to metaphysical beliefs but rather extreme experiences which were encoded as a threat to the individual, and this does not come out in the opening set up of the article.

What this article is inavertedly describing, in my eyes, is mainly overwhelming traumatic experiences/encoding within the psychedelic experience,

Note that some authors have offered (eg) that “It is possible that HPPD represents a form of traumatic anxiety disorder akin to PTSD [21, 25] or a form of health anxiety [26] triggered by the residual symptoms of the psychedelic experience.“

this logic can be put forward towards all the “residual” symptoms such as those described here are related to trauma related encoding, and not ontological issues.

https://doi.org/10.1371%2Fjournal.pone.0293349

BTW, In that study, 40% of the sample thought that a childhood trauma was implicated in experiencing post-psychedelic difficulties, which seems in line with what was described in this present article, regarding the pre-conditions of individuals participating in the study who may have been more likely to have adverse life experiences or a period of stress before the psychedelic experience, and thereby more prone to a traumatic reaction to the drug.

The “existential concerns” put forward here can easily be clustered under PTSD-like symptoms: and I therefore suggest trauma be taken more into consideration.

“Existential concern. For 9 individuals, this existential concern involved Perceived physical or ego death (death related - Criteria A in PTSD). The theme Overwhelming responsibility (thematically related to Guilt in EMDR therapy- Cognition and mood symptoms in PTSD) was conveyed by 7 of the participants. Experiences echoing a sense of Meaninglessness or emptiness (Again, Cognition and mood symptoms) were shared by 5 individuals. The final theme under this existential umbrella referred to Solipsistic isolation or Aloneness (again, - Cognition and mood symptoms),

To sum, trauma, information processing or consciousness models are lacking, in my eyes and provide a better framework, even if the ontological aspect is the main game.

Alternatively if existential struggle is indeed the sole the focus of this paper then more effort should be out into a conceptual model related to such a concept, and not just one paragraph on ontological shock (This is not my area of expertise, and more writing on the topic would be necessary).

See for example- some papers that are relevant .

Carhart-Harris R., Leech R., Hellyer P., Shanahan M., Feilding A., Tagliazucchi E., et al.. (2014b). The entropic brain: a theory of conscious states informed by neuroimaging research with psychedelic drugs. Front. Hum. Neurosci. 8:20. 10.3389/fnhum.2014.00020

Froese T. (2015). The ritualised mind alteration hypothesis of the origins and evolution of the symbolic human mind. Rock Art Res. 32, 90–97.

Gallimore A. (2015). Restructuring consciousness –the psychedelic state in light of integrated information theory. Front. Hum. Neurosci. 12:346 10.3389/fnhum.2015.00346

More in the - ITT

https://pubmed.ncbi.nlm.nih.gov/24811198/

see this for relevant in formation in ITT, effects of psychedelic, brain effects

https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2015.00346/full

(related to sexual abuse) Information processing of trauma. This can be an alternative framework, where the psychedelic experience can be regarded as an experience, which is not properly encoded in the brain, causing a posttraumatic reaction (as indicated in the paper)- then using this as a framework to describe how our brain means of make meaning of experiences.

EMDR theory discusses this in AIP terms, see F. Shapiro 2018 EMDR textbook, or an older trauma information model related to sexual abuse-

10.1016/0145-2134(93)90007-r

Page and Paragraph, additional comments

1 1 There are different types of uses of these substances, for instance- recreational, professional therapeutic, non professional therapeutic, what is meant by “use” ,- is there difference in the literature, because these participants were recreational self users (even if it was for self development intentions)

1 1 physicalism , non-physicalist beliefs – should give a context, definition, example.

1 2 Use a word other than trigger which may have a negative connotation.

2 2 Integration- define it in this context, find a conceptual model for integration (may be related to previous statement on information processing). for instance, Dan Seigel writes extensively around this issue, and it is interesting to understand how the different fields that he speaks about are related to psych. experiences.

7 Different nationalities, relate to this?

Life context- brain primed for turbulence, as stated above.

10 3 When describing experiences, add percentages not just numbers

10+ Was there a theme of bodily reactions/sensations? Described in exiting, does it have a space in itself even though these are commonly stated as a type of effect. The body is missing in this article.

22 last Self education is actually part of cognitive practices, mentioned before perhaps branch them together and differentiate between the two types (based on external information)

30 core existential concerns (death, meaninglessness, responsibility, and aloneness)= seem more like traumatic symptoms related to cluster 4- as I said above.

28 “ Self development and spiritual growth “ can be related to the concept of posttraumatic growth .

Using trauma-focused therapies, like EMDR to process the psychedelic experience as a traumatic memory, may help resolve PTSD-like symptoms during the integration period [71].

I agree.

Discussion was built better, but following a conceptual framework for the lit review, I would reorganize.

Reviewer #2: Overall Evaluation: The topic of the article is important and suitable for publication.

Introduction:

1) Please provide more detailed information on the types of psychedelic substances. Clarify the inclusion of cannabis (in the table for Cora & Don) and MDMA (for Ida), and explain why these are considered psychedelics.

2) Please expand on the ‘renaissance’ in psychedelic research.

3) While the research emphasizes the potential shortcomings and harms of psychedelic substances, the introduction should also briefly address the benefits that have contributed to the resurgence of interest in psychedelic research in recent years.

Method:

1) Include the reflexive aspect and researcher characteristics in the methodology, particularly in relation to their connection with psychedelic substances.

Table 1:

1) Age at Interview: For Aaron, the age range is listed as 45-55. If this is an estimation, please indicate that it is an assessment.

2) Inconsistencies in Age- Please correct these inconsistencies: Georgia is listed as 55 at the interview but 56 at the psychedelic experience. Similarly, Jessie is listed as 35 at the interview but 36 at the psychedelic experience. Chris is listed as 27 at the interview but 34 at the psychedelic experience.

3) For Youssef and Cora: The age ranges for their interviews and psychedelic experiences are unclear. Please clarify.

4) What substance is "Rape" (for Jessie)? Please provide clarification.

5) In the “Substance/s taken” column, does this indicate that the participants experienced difficulties after taking the listed psychedelic substances? For Aaron, you mention "different trips"—did he encounter difficulties during all of them? This needs clarification. And for Beth, is the reference to polysubstance use in one event? Similar clarification is needed for Cal and Clara.

Figures 1 and 2:

1) Figures 1 and 2 are somewhat blurry and difficult to read; please address this issue.

2) Titles should be added to the figures. Within the article text, include placeholders like “[Figure 1 insert here]” and “[Figure 2 insert here]” where appropriate.

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Reviewer #1: No

Reviewer #2: No

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

PONE-D-24-20547R1

Dear Dr. Ketzitzidou Argyri,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Most suggested changes were made.

One additional change that shpuld be made:

Just as traumatic experiences can lead to posttraumatic stress disorder (PTSD), post-traumatic growth (PTG), (Add: or both + a citation.)

Reviewer #2: After reviewing the revised manuscript and considering the authors' responses to my previous comments, I find that all concerns and suggestions have been adequately addressed to my satisfaction. The authors have made the necessary revisions, improving the clarity, and adding reflexive aspects and researcher characteristics in the methodology.

Given these improvements, I recommend accepting the manuscript for publication.

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Reviewer #1: No

Reviewer #2: No

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