Q&A: Long-Term Psychological Effects

The psychological impact of psychedelics can be profound. How people process the experience afterward is central to understanding what happened during the experience, how it relates to their lives, and how they can continue to benefit and learn from it.

Mary Cosimano

Mary Cosimano directs guide/facilitator services at the Johns Hopkins University Center for Psychedelic and Consciousness Research, where she is responsible for training and supervising session facilitators. She has conducted more than 450 study sessions. She has also taught in the Psychedelic-Assisted Therapies and Research program at the California Institute of Integral Studies.


BCSP

What is integration?

Mary Cosimano

“Integration is when someone has an experience and then brings it into their daily life. The experience itself is just an experience. Unless they integrate it and change, they go right back to the same way of living. I’ve heard integration defined as weaving the mystical into the practical. I like that, although it’s not always true, because people don’t always have mystical experiences.”


BCSP

Does someone need to be in therapy or part of a group to integrate their experience?

Mary Cosimano

“Certainly some people can and do integrate their experience alone, but they’re more likely to integrate it into a meaningful experience if they have a well-structured program or plan. It can be in a group. It can be with your therapist. It can be with a friend or friends who really know this territory and know you. Of course, if you’re in a clinical trial, that’s part of the protocol. But if you don’t have the intention of integrating it and some kind of a plan, it’s going to be much easier to dismiss your experience and to have problems with things that came up in a difficult session.”


BCSP

When you talk about an integration plan or program, what does that actually look like? What activities might be included in that?

Mary Cosimano

“You want to make it concrete. I can give some examples from prior volunteers. Meditation or a mindfulness practice is a big one. People have done artwork, written poetry, made sculptures. We had one volunteer who would go back to a chunk of clay at different times, think of an experience, and shape it to that. If you listen to music during the experience, going back to that playlist can bring the experience back. Nature is one of the best ways for integration. Everyone has their own way that’s going to work for them. 

In our sessions, we set goals so that they have something to concretely work toward. What are a few ways that you will integrate your experience this week, until we meet again next week? It doesn’t have to be big, it just has to be intentional. They might say, ‘OK, I’m going to meditate for ten minutes three times this week,’ or ‘I’m going to journal every night.'”

“The experience itself is just an experience. Unless they integrate it and change, they go right back to the same way of living.”


BCSP

How long does integration last?

Mary Cosimano

“Integration should last a lifetime. I just talked with somebody who found a book that helped her incorporate something from her session 25 years later. It’s ongoing, and it’s very individual.”


BCSP

How long will the positive or negative feelings that come out of an experience last?

Mary Cosimano

“That’s individual, too. Some people have already integrated them by the end of their session, just on their own, although I still wouldn’t say the work is done. Give yourself time. 

We had one volunteer who traveled so far out in his experiences. They weren’t necessarily difficult, but it was difficult to come back here and make sense of the daily routine of his life. He realized that for him he needed space. It was really hard because he had a family, but he knew he needed it because the experience was so expansive and so difficult to come back from. We met with him more, talked more, and found ways that he could take the time to make sense of it. There’s not one answer. It just depends on you and how you’re integrating it.”


BCSP

How do you manage disappointment? How do you integrate an experience that wasn’t what someone wanted?

Mary Cosimano

“That happens a lot, because people read about others’ experiences and expect the same. Talking about expectations is a huge part of our preparation.  After witnessing experiences for all these years, I believe that your experience is exactly what you were supposed to have at this time in your life to go forward. So it certainly may not be, and often isn’t, the ‘big-lights-all-is-one’ experience, but it’s exactly the area that you needed to work on. People will say that a lot: ‘It wasn’t what I wanted, but it was what I needed. I see that now.'”


BCSP

How can someone hold onto the good feelings or insights they had during their trip?

Mary Cosimano

“It’s just the nature of the experience that a powerful positive feeling is going to dissipate. But the more that you incorporate a new practice into your life, the more that you bring it into your every day. That integration is gradual. It’s the micro steps. It’s understanding that that big experience, that big joy, fun, and beauty, is going to dissipate.”


BCSP

Can a user stop other mental health supports like therapy or SSRIs after taking psychedelics?

Mary Cosimano

“At our center we never say that, because psychedelics aren’t a cure-all. That’s not what we’re looking for them to be. It’s whatever works for you. I think it’s the same as with therapy. Some people will have formal therapy the rest of their life and others will have it for a few months.”

This interview was edited for length and clarity.

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