When Reality Shifts: Understanding Ontological Shock After Psychedelic Experiences

Posted: June 24, 2025

Psychedelic experiences can be profoundly transformative, often described as some of the most meaningful events in a person’s life. They can open up new perspectives, foster deep emotional insights, and lead to positive changes in well-being. However, for some individuals, these powerful experiences can also bring about significant challenges, particularly when they shake the very foundations of how a person understands reality and their place in it. This phenomenon, sometimes referred to as “ontological shock,” can lead to a period of existential distress and confusion. For those curious about psychedelic psychotherapy but perhaps wary of such intense shifts, understanding ontological shock and how people navigate it can be both educational and reassuring.

What is Ontological Shock?

The word “ontology” refers to the philosophical study of being, or what it means for something to exist and the nature of reality. So, “ontological shock” describes a state where an individual’s fundamental beliefs about reality are suddenly and dramatically challenged, often by a direct experience that doesn’t fit into their previous worldview. A psychedelic experience, by its very nature, can alter consciousness in such a way that the familiar world seems different, and new, sometimes bewildering, concepts about existence, consciousness, and the self can emerge. Imagine living your whole life believing the sky is always blue, and then one day, you experience it as a vibrant, swirling green. This might be a simple analogy, but it hints at the kind of disorientation that can occur when deeply held assumptions about reality are upended. For some, this can be an exciting and expansive experience, leading to new spiritual or philosophical insights. For others, it can be deeply unsettling, leading to feelings of groundlessness, confusion, and anxiety as they struggle to make sense of their new perceptions.

Existential Challenges: When Big Questions Arise

When ontological shock occurs, it often brings with it a host of existential questions – the big questions about life, death, meaning, and purpose. An interview-based study published in the journal PLOS One by Argyri et al. (2025) explored the experiences of 26 people who reported existential distress following psychedelic experiences. Their research identified several common themes of these challenges, providing valuable insight into what this struggle can look like. The study found that participants often experienced a persistent “existential struggle,” marked by confusion about their existence and purpose, and a preoccupation with meaning-making. It wasn’t just a fleeting moment of questioning; it was an ongoing process of trying to reconcile their psychedelic experience with their everyday life and understanding of reality. Some of the key challenges identified included:

Derealization and Questioning Reality: Many participants reported feeling disconnected from reality as they knew it, or as if the world around them wasn’t real. Their psychedelic experience might have presented a different version of reality that felt incredibly authentic, making it hard to return to or trust their ordinary state of consciousness.
Confusion about Self and Identity: Psychedelic experiences can blur the boundaries of the self, leading to questions like “Who am I really?” or “Is my everyday self the ‘real’ me?” This can be particularly challenging if the experience involved a sense of ego dissolution or oneness with the universe.
Preoccupation with Metaphysical Questions: Individuals often found themselves grappling with complex philosophical and spiritual questions about the nature of consciousness, the possibility of an afterlife, or the existence of other dimensions or entities. These weren’t just abstract intellectual exercises; they felt like urgent, personal concerns.
Difficulty Integrating the Experience: A major challenge was trying to make sense of the psychedelic experience and integrate its insights or revelations into their daily lives. If the experience was vastly different from their previous understanding of the world, finding a way to live with this new awareness could be difficult.
Emotional and Functional Impact: The study highlighted that these ontological challenges weren’t just cognitive; they had significant emotional, social, and even bodily impacts. Participants might experience anxiety, depression, social withdrawal, or even physical sensations related to their altered sense of reality.

It’s important to note that these challenges, while difficult, are not necessarily a sign that something has gone wrong with the psychedelic experience itself. Rather, they can be seen as part of a profound process of re-evaluation and growth, a kind of “spiritual emergency” or transformative crisis where old frameworks are breaking down to make way for new understanding.

Navigating the Groundlessness: What Helps?

The research by Argyri et al. (2025) didn’t just focus on the challenges; it also explored how people managed to alleviate their distress and what they found helpful in their process. This is where the reassurance for those uncertain about psychedelic therapy lies. Even when these profound existential questions arise, there are ways to navigate them. The primary way participants found relief was through “grounding.” This involved practices that helped them reconnect with their bodies, their everyday lives, and a sense of stability. Grounding can take many forms:

Embodiment Practices: Activities like yoga, tai chi, mindful breathing, spending time in nature, or even simple physical exercise helped people feel more present in their bodies and connected to the physical world. When your sense of reality feels shaky, anchoring yourself in physical sensations can be very helpful.
Social Connection and Normalization: Talking to others who had similar experiences, or to understanding friends, family, or therapists, was crucial. Realizing they weren’t alone in their struggles and that their experiences, while unusual, weren’t necessarily a sign of madness, helped to normalize what they were going through. Finding communities or support groups where these topics can be openly discussed can be invaluable.
Cognitive Re-framing and Meaning-Making: While the initial confusion could be distressing, over time, many participants found ways to make new meaning from their experiences. This might involve developing a new spiritual framework, engaging with philosophical texts, or simply learning to live with a greater sense of mystery and uncertainty. The process of actively trying to understand and integrate the experience, rather than just being overwhelmed by it, was key.
Professional Support: For some, working with a therapist or counselor experienced in psychedelic integration was very beneficial. These professionals can provide a safe space to explore challenging experiences, offer tools for grounding and coping, and help individuals make sense of their ontological shifts in a constructive way.

Psychedelics as “Pivotal Mental States”

The authors of the PLOS One study suggest that psychedelic experiences can act as “pivotal mental states.” This means they can be turning points that facilitate transformative learning processes, challenging and expanding the ways individuals make meaning. While this process can be destabilizing in the short term, it can also lead to significant personal growth, a more nuanced understanding of life, and a deeper sense of purpose in the long run. For someone considering psychedelic psychotherapy, it’s important to be aware that profound shifts in perspective are possible. The goal of the therapy isn’t to cause distress, but to facilitate healing and insight. However, because these substances can open up such deep levels of consciousness, encountering challenging existential questions is a possibility.

Reassurance and Preparation

Knowing that ontological shock and existential challenges can occur, and more importantly, that there are ways to navigate them, can be reassuring. Here are a few things to keep in mind:

It’s Not Uncommon: Experiencing a shift in your understanding of reality after a profound psychedelic experience is not an indication that you are “going crazy.” It’s a known phenomenon that many people navigate.
Preparation is Key: Good psychedelic therapy involves thorough preparation. This includes discussing your current beliefs, your intentions for the experience, and any fears or concerns you might have. Understanding the range of possible experiences, including challenging ones, can help you feel more prepared if they arise.
Integration is Crucial: The period after a psychedelic experience is just as important as the experience itself. This is when the work of making sense of what happened, integrating insights, and grounding oneself takes place. Reputable psychedelic therapy programs place a strong emphasis on integration support.
Support Systems Matter: Having supportive people to talk to, whether it’s therapists, friends, family, or peer support groups, can make a huge difference in navigating any existential challenges.

Psychedelic psychotherapy holds great promise for healing and personal growth. Part of that growth can sometimes involve confronting and re-evaluating our most fundamental beliefs. While the idea of “ontological shock” might sound intimidating, it can also be viewed as an invitation to a deeper, more authentic understanding of ourselves and the universe. With proper preparation, support, and a commitment to integration, these profound experiences can ultimately lead to a richer and more meaningful life, even if the journey involves navigating some groundlessness along the way.

Disclaimer: Psychedelic Assisted Psychotherapy has not been approved by any regulatory agencies in the United States, and the safety and efficacy are still not formally established at the time of this writing.

References

Argyri, E. K., Evans, J., Luke, D., Michael, P., Michelle, K., Rohani-Shukla, C., Suseelan, S., Prideaux, E., McAlpine, R., Murphy-Beiner, A., & Robinson, O. C. (2025). Navigating groundlessness: An interview study on dealing with ontological shock and existential distress following psychedelic experiences. PLOS One, 20(5), e0322501. https://doi.org/10.1371/journal.pone.0322501