Abstract
Background:
The October 7th, 2023, attack at the Nova rave represents an unprecedented scenario in trauma research: A mass casualty event in which most participants were under the influence of psychedelics.
Methods:
Using a mixed-methods phenomenological design, 45 survivors were interviewed. Participants were categorized by substance use: classic psychedelics (n = 24), empathogens (n = 19), and ketamine (n = 2). Data were analyzed within a critical realist framework across three temporal domains: immediate survival, in-event emotional coping, and post-event integration.
Results:
Findings point toward a dissociative phenomenon we name “adaptive psychedelic dissociation,” characterized by a combination of traumatic and psychedelic dissociative features: emotional detachment, derealization and depersonalization, automatic behaviors, and preserved functionality. Participants’ awareness and knowledge about their substance use created an “epistemic container,” which may have facilitated real-time containment of traumatic input while complicating later meaning-making. A neurophenomenological pattern emerged wherein psychedelic subjective effects appeared suppressed during the acute trauma exposure, resurging after the threat was over. Quantitative analysis showed a predominantly positive subjective impact of substance use on immediate survival (75%–79%) and emotional coping (83%–84%) but mixed outcomes in aftermath processing (42%–53% positive and 25%–26% negative).
Conclusions:
Psychedelic-induced dissociation during trauma exposure may confer acute adaptive benefits while causing integration challenges a paradox with significant implications on trauma research. This singular perspective on the psychedelic–trauma interface invites further research into these complex neuropsychological interactions. Psychedelics may serve as epistemological instruments, revealing cognitive processes and unique prisms through which trauma response, psychopathology, resilience, and the adaptive capacities of the human mind under extreme conditions can be re-examined.
Keywords
Introduction
Trauma exposure can fundamentally alter an individual’s psychological well-being, with an estimated 6%–8% of the general population developing post-traumatic stress disorder (PTSD) following severe traumatic events (World Health Organization, 2024). This alteration occurs through mechanisms involving dissociative processes that can either serve as adaptive responses or become pathological, depending on the severity and context of the trauma (Schimmenti, 2017). Individuals demonstrate remarkable variation in trauma processing and resilience (Bonanno et al., 2012; Yehuda et al., 2015), and perhaps consequently, the treatment of trauma-related disorders remains a significant clinical challenge, with conventional approaches showing limited efficacy in addressing this interplay of physiological, cognitive, and emotional responses (Haagen et al., 2015; Krystal et al., 2017). By contrast, recent clinical research has demonstrated promising results when using psychedelic substances, particularly 3,4-methylenedioxymethamphetamine (MDMA), for PTSD treatment (Mitchell et al., 2023). These substances appear to facilitate trauma processing through several mechanisms, including enhanced emotional processing, reduced fear response, and increased psychological flexibility (Krediet et al., 2020). According to the RElaxed Beliefs Under pSychedelics (REBUS) model, psychedelics work by relaxing the precision weighting of high-level priors or beliefs in the brain’s predictive processing hierarchy (Carhart-Harris and Friston, 2019). This relaxation allows bottom-up information to travel more freely up the hierarchy, enabling the revision of previously rigid beliefs and mental models (Millière, 2017).
While popular accounts often highlight ego dissolution as emblematic of psychedelic experiences, in practice, this is not the most common outcome. More typically, psychedelic states involve emotionally intensified experiences in which core ego functions remain intact. Psychedelics can, in some cases, induce what has been described as ego dissolution, a temporary reduction in the usual boundaries between self and environment, often correlated with decreased activity in brain networks associated with self-referential processing (Nour et al., 2016). However, when it does occur, psychedelic-induced ego dissolution differs markedly from the pathological dissociation seen in trauma. It is typically characterized by maintained metacognitive awareness and relative functional capacity, unlike the frightening loss of self-coherence and agency that defines trauma-related dissociation (Millière, 2017; Simon et al., 2025). Recognizing this distinction is crucial to avoid conflating fundamentally different experiential and neurophenomenological states, and to accurately characterize the range of responses that participants reported in our study. The distinction is central to our analysis. We examine how these two altered states, co-occurring and merging into one mixed-dissociative state, influenced survivors’ experiences during and after the traumatic event. One hypothesis is that the psychedelic-induced state of “relaxed beliefs” about the self and the world may have allowed individuals to process traumatic experiences from a more flexible psychological stance while retaining, at the same time, the capacity for adaptive behavior and decision-making.
The October 7th, 2023, attack on the Nova Music Festival in southern Israel represents an unprecedented opportunity to study the interface of psychedelics and trauma from a diametrically opposed angle to the one that is usually approached. The attack targeted approximately 3500 festival attendees and resulted in 378 casualties. Roughly two-thirds of the participants were under the influence of various types of psychedelics, including classic psychedelics (e.g., both lysergic acid diethylamide (LSD) and psilocybin act as serotonin 5-HT2A receptor agonists), empathogens (particularly MDMA a serotonin–norepinephrine–dopamine releasing agent commonly known as “Ecstasy,” i.e., 3,4-methylenedioxymethamphetamine (MMC 3/4)), and dissociatives (ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist), at the moment of the attack (Halperin et al., 2025; Karp Barnir et al., 2025). This devastating event created a naturalistic context for studying trauma responses under the influence of psychedelics. We examined how survivors of the Nova Festival attack understand and describe the relationship between their altered states of consciousness and their traumatic experiences. Our investigation covered three phases: their immediate survival responses during the attack, their psychological processing afterward, and their long-term efforts to make meaning and recover from PTSD. Drawing on the REBUS model and theories of dissociation (Carhart-Harris and Friston, 2019; Schauer and Elbert, 2015), our study examines how psychedelic substances influenced survivors’ experiences across three critical domains: (1) immediate survival response, including decision-making and behavioral adaptations; (2) emotional processing during the traumatic event; and (3) post-event integration and meaning-making. This framework allows us to disentangle the composite dynamics of how altered states interact with trauma processing at different stages. To understand how psychedelics influence trauma responses, we must examine the multiple levels, pharmacological, neural, and psychological, through which these substances operate.
At the pharmacological level, classic psychedelics act primarily as partial agonists at 5-HT2A serotonin receptors, which are densely expressed on layer V pyramidal neurons in higher-order association cortices, including the medial prefrontal cortex and temporoparietal junction (van Elk and Yaden, 2022). Activation of these receptors initiates complex downstream signaling cascades that are hypothesized to promote neuroplastic processes, including increases in brain-derived neurotrophic factor and dendritic spine growth (Aleksandrova and Phillips, 2021; Calder and Hasler, 2023; De Vos et al., 2021). However, most of this evidence remains preclinical, and the translation to therapeutic outcomes in humans is still under investigation. A particularly compelling framework, now supported by empirical evidence, suggests that psychedelics may temporarily reopen critical periods of heightened plasticity, rendering the adult brain more responsive to therapeutic input (Lepow et al., 2021; Nardou et al., 2023). Recent work by Dölen and colleagues has demonstrated this phenomenon across multiple psychedelic compounds, showing that these substances can indeed reopen critical periods for social reward learning in adult mice (Nardou et al., 2023).
At the systems level, psychedelics modulate large-scale brain networks. Neuroimaging studies indicate decreased activity in the default mode network (DMN), which has been associated with ego dissolution (Carhart-Harris et al., 2016), alongside increased global functional connectivity and elevated neural entropy, suggesting a loosening of hierarchical constraints on information processing (Schartner et al., 2017; Tagliazucchi et al., 2016). In parallel, classic psychedelics disrupt thalamic gating, the regulatory mechanism that filters sensory and interoceptive information to the cortex. This disruption can result in a sensory “flooding” of cortical regions, intensifying perception and affect (Vollenweider and Smallridge, 2022). While these effects may facilitate psychological breakthroughs, they also increase vulnerability to destabilization, particularly in contexts of trauma.
These neural effects interact dynamically with psychological and contextual variables. Psychedelics are hypothesized to enhance emotional processing and psychological flexibility through several interrelated mechanisms. One proposed pathway, associated with the REBUS model (Carhart-Harris and Friston, 2019), involves a temporary relaxation of rigid belief structures or self-models, enabling individuals to revise entrenched trauma-related narratives (Davis et al., 2020). Other contributing factors include the increase in signal diversity (Schartner et al., 2017), enhanced inter-network communication (Tagliazucchi et al., 2016), and the critical role of set and setting (Haijen et al., 2018). Taken together, these processes do not point to a single unifying mechanism, but rather to a convergence of neurobiological, psychological, and environmental influences that may, under the right conditions, support therapeutic change.
Different classes of psychedelic substances likely exert distinct effects on trauma processing. Research has shown that dissociative states induced by substances like MDMA differ from trauma-induced dissociation. While trauma-related dissociation often involves memory fragmentation and impaired information processing (Bedard-Gilligan et al., 2012; Ehlers and Clark, 2000; Granieri et al., 2018; van der Kolk and Fisler, 1995), MDMA-induced dissociative states are characterized by feelings of depersonalization and derealization while maintaining cognitive function (Puxty et al., 2017). Classic psychedelics (e.g., LSD, psilocybin) cause alterations in perception, emotional processing, and memory encoding in unique ways (Cameron et al., 2023; Vargas et al., 2023). Understanding these substance-specific effects is crucial for interpreting how different psychedelics might modulate trauma responses across varied temporal domains, including acute threat, emotional coping, and post-event integration.
Building on these theoretical foundations, our study examines how psychedelic use shaped survivors’ subjective experiences of trauma during and in the aftermath of the traumatic event. While neurobiological and pharmacological models offer valuable insights into the mechanisms of psychedelic action, they cannot fully capture the lived, embodied, and meaning-laden dimensions of these experiences. Adopting a phenomenological perspective, we sought to explore how participants perceived, navigated, and interpreted the convergence of psychedelic influence and life-threatening danger. The study design enables us to closely attend to the immediacy and complexity of their accounts, focusing on how shifts in perception, emotional processing, and sense of self unfold across the immediate, emotional, and integrative phases of the trauma response. In doing so, we aim to illuminate psychedelics and trauma’s interface, hoping to both challenge and expand current understandings of the field and psychological resilience in general.
Method
Research design
This study employs a mixed-methods, phenomenologically informed qualitative approach within a critical realist framework to examine the experiences of Nova Festival survivors under psychedelic influence during the October 7, 2023, attack. This design acknowledges both the neurobiological processes triggered by psychedelics and the subjective, context-shaped meaning-making in trauma (Cassell et al., 2018; Willis, 2022). While informed by phenomenological principles, our approach diverges from classical Husserlian phenomenology, instead seeking to systematically describe and analyze subjective experiences in a reproducible manner (McMillan et al., 2023). This methodology aligns with our aim to understand both the immediate and mid-term impact of psychedelic substances on trauma experience and processing and is consistent with recent qualitative research in psychedelic therapy (Breeksema et al., 2020).
We conducted semi-structured interviews using open-ended “how” questions designed to elicit rich, first-person accounts of participants’ lived experiences, following phenomenologically informed qualitative methods (Høffding and Martiny, 2016; McMillan et al., 2023; Metastasio et al., 2025). This approach prioritizes participants’ own descriptions and conceptualizations while maintaining systematic inquiry protocols that enhance the reproducibility of findings.
Participants and recruitment
The study includes 45 participants (25 males and 20 females) who survived the attack while being under the influence of a psychedelic drug (any 5-HT2A agonist hallucinogen or entactogen) and who sought psychiatric care for post-traumatic stress symptoms. This sample size was determined not by statistical power calculations, but by adherence to phenomenological principles, which seek depth of experiential understanding and thematic saturation (Martiny et al., 2021). Participants were recruited through the “Lev Batuach” (Safe Heart) NGO, which provides therapy for survivors under the supervision of the Israeli Trauma Coalition. The study received approval from the Institutional Review Board of Bar Ilan University, Ramat Gan, Israel.
Inclusion criteria required participants to be (1) present at the Nova Festival during the attack, (2) under the influence of psychedelic substances at the time of the attack, (3) seeking psychiatric care for post-traumatic stress symptoms, (4) able to provide informed consent, and (5) fluent in Hebrew. Exclusion criteria included (1) acute psychosis or severe psychiatric destabilization, (2) inability to identify the substance that was used, (3) severe physical injuries impacting interview participation, and (4) current substance dependency requiring immediate intervention. No financial compensation was provided to the participants.
Development of the research questionnaire and data collection
The questionnaire was developed collaboratively and sequentially, drawing on our research team’s clinical complementary expertise and collective experience. As a phenomenological study examining individuals’ lived experiences, we needed a tool to capture the rich, multifaceted nature of the participants’ experiences while remaining sensitive to the traumatic context in which they lived. The semi-structured format was deliberately chosen to provide a consistent framework across interviews while allowing flexibility to explore unique aspects of each participant’s experience. The semi-structured interview protocol covered participants’ immediate experiences during the attack, their subsequent meaning-making and integration of the substance effects (including altered perceptions of time/memory), and the development of supportive coping mechanisms. These topics were organized into three broad domains: (1) immediate survival impact, (2) emotional and psychological responses during the event (including the influence of psychedelics), and (3) post-event trauma integration and recovery challenges. Semi-structured, in-depth interviews were conducted between November 2023 and January 2024. The interviews were conducted in Hebrew by licensed, trauma-informed clinicians with expertise in both trauma therapy and psychedelic integration. Audio and video recordings were made with participant consent and were transcribed verbatim. The interviews lasted between 42 and 118 minutes. The participants were asked about the use and influence of specific substances, but not about the impact of marijuana and alcohol consumption. All participants provided informed consent after receiving detailed information about the study’s purposes and procedures.
Data analysis
The analysis followed a systematic qualitative approach, using MAXQDA software developed by VERBI GmbH for data organization and analysis. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted following established methodological steps: familiarization with the data, open and inductive coding, development of a coding framework, identification and refinement of themes, and interpretation in relation to the research questions and theoretical framework (Braun and Clarke, 2006).
Our analytical approach maintained what Høffding and Martiny (2016) refer to as “performative consistency,” ensuring alignment between our phenomenological framework, data collection methods, and analytical procedures. Two complete readings of all the transcripts were conducted to familiarize the initial audience with the data. Then, the transcripts were imported into MAXQDA for detailed coding and analysis. Initial codes were generated independently by two researchers and subsequently compared to ensure inter-rater reliability and minimize analytical bias.
The coding process, designed to fracture, conceptualize, and integrate data to form a theory (Strauss and Corbin, 1998), began with a third reading of each transcript. During this phase, sentences and paragraphs were categorized into three primary temporal domains: immediate survival impact, emotional coping during the event, and aftermath processing. Within these domains, text was coded to capture participants’ experiences of substance effects, mainly focusing on (1) reported impacts on survival behaviors and decision-making; (2) emotional and psychological responses during the attack; (3) drug-related dissociation mechanisms, which were later termed “adaptive psychedelic dissociation” (APD); (4) post-event processing and integration challenges; and (5) the role of substances as perceived by the survivors.
Codes were systematically grouped into thematic categories through iterative team discussions, with theme boundaries refined through constant comparative analysis across cases. We employed the constant comparison method (Glaser and Strauss, 2017) to ensure analytic rigor by continuously juxtaposing newly coded material with existing data, allowing for the refinement of categories as new meanings emerged. This process enabled a systematic comparison of themes across participants to identify both convergent patterns and meaningful variations in subjective experiences while also guiding our assessment of thematic saturation.
Quantitative patterns were derived from coding frequencies by systematically analyzing the coded interview data. The analysis examined the distribution of effects across three substance categories: classic psychedelics, empathogens, and ketamine. Responses were classified and quantified for each substance category and temporal domain based on reported beneficial effects, challenges, and neutral impacts. It should be noted that these quantitative elements were employed not as an end in themselves but to identify patterns in the phenomenological data that might not be immediately apparent through thematic analysis alone. The analytical process employed the constant comparison method to ensure systematic evaluation of patterns while maintaining methodological rigor through iterative coding and analysis procedures.
Final themes were interpreted within our critical realist framework, connecting participants’ subjective reports to existing literature while maintaining clear distinctions between descriptive findings and theoretical interpretations. Two researchers participated in coding and theme development to enhance credibility and minimize bias. This analytic procedure is consistent with recent calls for systematic and comprehensive qualitative research in psychedelic-assisted psychotherapy (Breeksema et al., 2020; McMillan et al., 2023; Metastasio et al., 2025). Our approach provides a methodologically sound bridge between participants’ lived experiences and scientific understanding of psychedelic-assisted trauma processing, ensuring both analytical rigor and reproducibility.
Quality assurance and validation methods
Multiple validation strategies were employed to ensure internal and external phenomenological consistency (Høffding and Martiny, 2016). The interview protocols underwent rigorous pilot testing with three participants, enabling crucial refinements in temporal domain exploration. Data saturation was systematically evaluated using the constant comparison method, where each newly coded interview was continuously compared with previously coded ones to identify whether new themes emerged. This iterative process enabled the researcher to determine whether additional interviews were providing novel information or merely repeating existing themes. Interviews continued until theme saturation was achieved, specifically when no new themes emerged across three consecutive interviews. To ensure methodological rigor, preliminary findings were subjected to expert review by a multidisciplinary panel comprising specialists in sociology, psychology, and psychedelic studies. Further validation was obtained through peer engagement when initial preliminary findings were published in “Hebrew Psychology” (Simon, 2025). The broader professional clinical community provided feedback and commentary in this peer-reviewed, online professional publication.
Ethical considerations
This study received approval from the Institutional Review Board of Bar-Ilan University.
Considering the sensitive nature of the study and the participants’ vulnerable state following the attack, comprehensive ethical safeguards were implemented. These measures included immediate access to psychological support, ongoing supervision for the research team, and strict confidentiality protocols. The research followed the ethical guidelines for trauma research established by the International Society for Traumatic Stress Studies. When necessary, wellness checks were conducted 24 hours after the interview, and additional support was offered.
Reflexivity and researcher characteristics
An interdisciplinary team with specialisms in psychedelic studies, social work, psychology, psychiatry, and philosophy devised the design of this study. Two researchers analyzed the data: an interdisciplinary academic specializing in the intersection of psychedelic studies, trauma, and phenomenology (Analyst 1), and a social worker specializing in qualitative methods and mixed methods (Analyst 2). They were followed by a psychiatrist and researcher specializing in psychedelics (Analyst 3) and a psychedelic harm-reduction specialist who specializes in phenomenological analysis (Analyst 4). The interactive dialogical approach involved data analysis and a series of mutually influential interactions between analysts. During the analysis process, there were 10 scheduled discussions were held among team members, during which intrapersonal and interpersonal reflexive deliberations and potential sources of bias were discussed to maximize transparency and accuracy. Through this collaborative process, the team co-developed a parsimonious and transferable thematic scheme that integrated the knowledge and analytic strengths of all four members.
Results
Overview of findings
The analysis of interviews with 45 Nova Festival survivors reveals distinct patterns regarding how different psychedelic substances influenced participants’ experiences across three temporal phases: the immediate survival response, emotional processing during the event, and aftermath integration. The findings suggest that psychedelic substances played a multifaceted role in participants’ reactions to the traumatic event, with both adaptive and maladaptive elements emerging across substance categories and temporal domains. Through a systematic analysis of participants’ accounts across temporal domains, we identify a previously undocumented dissociative phenomenon that we name “adaptive psychedelic dissociation” (APD), and that aligns with and extends the predictions of the REBUS model. APD reflects a unique state of superimposed dissociative states provoked by psychedelics and trauma, characterized by emotional detachment and altered perception coexisting with high functional awareness (Table 1).
Thematic findings.
Substance use distribution and characteristics
The sample comprised users of classic psychedelics (n = 24, e.g., LSD, psilocybin, mescaline); empathogen-type stimulants (n = 19, primarily MDMA, commonly known as Ecstasy, and related cathinones 3-MMC/4-MMC); and ketamine (n = 2). Most participants described intentionally planning the timing of their substance use, not necessarily in terms of precise dosing, but rather in relation to the setting, atmosphere, and symbolic significance of the moment, often aiming to align the onset of effects with the approaching sunrise.
Thematic findings
Immediate impact on survival behaviors
Across substance categories, participants predominantly reported that substances aided rather than hindered their survival efforts. Among classic psychedelic users, 75% reported beneficial effects on survival behaviors, while only 4.17% indicated increased challenges. The remaining participants reported no effect (12.5%) or were uncertain about the impact (8.34%). In the empathogen group, 78.95% of participants reported beneficial effects on survival behaviors, and only 5.26% noted any negative impact. An additional 5.26% experienced both supportive and challenging effects, indicating a nuanced impact profile. The ketamine group (n = 2) unanimously reported no effect on survival-related behaviors; however, the small sample size limits the generalizability of these findings. We differentiate between classic psychedelics and empathogens because they work through different mechanisms: classic psychedelics primarily act as 5-HT2A receptor agonists, while empathogens like MDMA increase serotonin, dopamine, and norepinephrine release rather than directly activating the 5-HT2A pathway.
The thematic analysis shows how substances influenced decision-making during the crisis. Many participants described a state facilitating rapid, instinctive responses without cognitive interference. As one survivor who consumed Ecstasy (a pill usually containing MDMA and other stimulants) explained: “It felt like everything was faster, at higher speeds, sharper, more decisive in the moment, without overthinking and sinking into things and overthinking.” The altered state enabled what one participant who used psilocybin mushrooms described as automatic decision-making: “It helped me in the decisions. Not in the decisions, in the action itself. Like, not thinking, just doing.”
The stimulant properties of certain substances emerged as beneficial in the survival context. One participant articulated this clearly: “Because it was Ecstasy and stimulants, I managed to run for at least 5 or 6 hours. Not continuously, but I managed to run a lot. And I know I wouldn’t have been able to move without it. I know how my body reacts in extreme situations, and I would have just frozen.” An LSD user stated: “I’m certain that if half of us hadn’t taken something, first of all, we wouldn’t have had the strength to run. We wouldn’t have had the energy. I have friends who walked for 6 hours; they were running. There’s no chance in the world, absolutely no chance, that a person without some drug would have been that hyperactive.” When asked if the LSD she consumed helped her save herself, she replied: “It helped me. I ran like a crazy person. Like a crazy person.”
This perspective was further emphasized by another participant who reflected on how these substances affected not just physical abilities but also emotional priorities during the crisis: “They [Ecstasy and substances sold as MMC-3/-4] had a huge impact on this escape, physically. Physically and mentally. To disconnect for a moment and focus purely on what needs to be done, and not on looking for everyone and escaping with everyone, and being the caring person that you are, like you’ve always been, then suddenly you . . . I was very selfish, very selfish. Like focusing purely on myself and purely on my escape, and so was everyone else who was there.”
This can be seen as a radical shift in selfhood under extreme threat, mediated by the altered state induced by the substances. The experience of “disconnecting” may reflect a temporary suspension of habitual identity, the caring, relational self, giving way to a survival-oriented mode of being focused solely on self-preservation. Notably, it provided what we term an “epistemic container,” a contextual frame that allowed the participant to suspend their usual caring role and focus on personal survival and will be explore further in the discussion section. This moment illustrates a collapse of inter-subjective priorities, where emotional and moral frameworks are set aside in favor of instinctive action. The altered state appears to facilitate this functional narrowing of consciousness, enabling rapid decisions while distancing the participants from their usual self-understanding. This illustrates a core dimension of what we have termed APD, emotional detachment paired with maintained functionality, while also revealing the existential dissonance that follows such shifts in self-perception.
Emotional coping during the event
The data show a strong pattern of substances facilitating emotional regulation during the traumatic event. Across all substance categories, participants predominantly reported beneficial effects on their emotional state during the attack. Among classic psychedelic users, 83.33% indicated positive emotional coping effects, with only 8.33% reporting increased challenges. The remaining participants reported uncertainty about the impact (8.33%). The empathogen group showed similar results, with 84.21% reporting beneficial effects on emotional coping, though with a different pattern of negative responses (15.79% reporting no effect rather than increased challenges). Both ketamine users reported a positive impact on emotional coping, though again, the small sample size warrants caution in interpretation.
Thematic analysis shows how different substances influenced emotional processing during the event. MDMA’s empathogenic properties offered unexpected emotional support, as one participant described: “MDMA is a substance that induces a sense of unity, creating a feeling that everyone is with you and you’re part of something larger. This significantly helped me feel less isolated despite being alone in this ordeal.” While some substances appeared to aid emotional regulation, others created more complex experiential layers. A participant who consumed psilocybin mushrooms experienced a unique form of dissociative guidance: “You’re connected to this channel that’s simply . . . you’re not there, it’s not you. It’s like when you take a mushroom, then the mushroom—you’re letting an entity into your brain and giving it space to do things.”
Many survivors experienced a surreal detachment from reality that appeared to buffer the immediate emotional overwhelming, describing the events as if watching a film or game. One participant who consumed MDMA vividly described: “I feel like I’m above the situation, like I’m watching some movie from the side, and I’m not part of the event. I feel sorry for the other people who were there. I don’t understand that it’s happening.”
The stark contrast between a state of celebration and the horrifying emerging reality created a profound cognitive dissonance, as illustrated by an LSD user who reported: “I just see fireworks exploding. That’s it. And I’m into those fireworks. After a whole minute of looking at the fireworks and getting excited about them, my partner told me: ‘No, honey, it’s Iron Dome’ (the Israeli air defense system), and I saw and understood that there was a possibility it’s Iron Dome, but I refuse to believe it within myself.”
While potentially dangerous in a threat situation, this initial confusional state appears to have quickly given way to more adaptive responses for most participants. The transition from confusion to functional response varied across substance categories, with one ketamine user reporting more persistent challenges: “trapped in a nightmare . . . drowning in a sea of terror without being able to move or react. Fortunately, they took me away [the friends]; I wouldn’t have managed to escape alone.”
Despite this intense experience, the participant maintained that the ketamine did not impair his survival capabilities and may have provided emotional buffering during the traumatic event, a counterintuitive finding we will explore further in the discussion section.
APD: A potential protective mechanism
Out of the 45 participants, 93.33% (n = 42) reported experiences characterized by dissociative features during the event, using terms such as “disconnected,” “detached,” “outside myself,” and “emotionally numb” to describe their states, etc. For example, one participant stated they felt “completely disconnected from what was happening around me,” while another described “watching me escape like I wasn’t there.” These dissociative phenomena, as defined by participants, appeared to function as emotional buffers that isolated them psychologically from the full impact of the traumatic experience during their escape. Through the thematic analysis of participants’ accounts across temporal domains, we identified a previously undocumented dissociative phenomenon that we termed APD, which aligns with and extends the predictions of the REBUS model. Analysis of the interviews suggests five distinct characteristics of APD, which together form the adaptive dissociative phenomenon: (1) emotional detachment, (2) derealization and depersonalization, (3) altered memory formation, (4) Instinctual actions, and (5) optimistic detachment.
Emotional detachment (observed in 80.95% of participants): Most survivors described a profound separation from emotional reactions that would typically dominate such situations. As one participant who consumed ketamine explained: “I wasn’t hysterical at all. Instead, I was very operational.” This emotional buffering appeared to facilitate practical responses to the crisis. One participant who consumed MDMA (Ecstasy) explained: “You’re simply detached from the situation, and you don’t start crying, you don’t get stressed, you don’t . . . you understand that right now, you need to escape.”
Derealization and depersonalization (observed in 61.90% of participants): Many survivors experienced a surreal detachment from reality, describing the events as watching a film or game. One participant who consumed LSD and MDMA described it through a video game lens: “I felt like I was in a computer game: like everything around me was a station I needed to pass through, like finishing getting organized, getting into the car, getting out of there.” Another participant who consumed LSD perceived reality as a play or movie, suggesting a fundamental disconnection where reality no longer felt real. “The sharpness and everything were like really blooming and glowing and breathing to me, and I felt like when I was running, I was running inside like a movie, like I was inside like . . . inside a play or something.” While derealization involves detaching oneself from one’s surroundings, depersonalization manifests as a disconnection from one’s body and actions. A few participants reported this experience. One who consumed psilocybin described it as “being like a fly on the wall that just sees everything and has no control over what’s happening.” Another MMC-3/-4 user noted: “At that moment, I felt that I had no control over my body at all, that any little thing you’d tell me to do, I would just do it.” Another participant who consumed LSD described a feeling of estrangement from himself during the terror attack, “It didn’t seem like David [talking about himself—pseudonym] was there. It seemed like someone was there who is . . . who is like completely . . . I don’t know; in short, it didn’t feel like it was me.”
Altered memory formation (observed in 19.05% of participants): Participants reported protective gaps in memory, as illustrated by one who consumed MDMA, who stated: “I didn’t remember it until a month and a half later, that situation where he was shot behind me.” Some viewed this memory alteration as beneficial, creating a psychological buffer against traumatic memories. For example, another participant explains how being on LSD helps her in the way she remembers things. “I saw things I shouldn’t have seen and wouldn’t want to see. But my state of mind at that moment was . . . was in a place, I think, better than if I hadn’t been on acid. I think my memory of that day without acid would have been maybe a little more difficult, more anxious.”
Instinctual actions (observed in 47.62% of participants): The state enabled rapid, instinctive responses without cognitive interference. As one survivor who consumed MDMA explained: “That haziness helped me . . . if I hadn’t been under the influence, I could have stopped for a moment to try to understand: where am I, what am I. I didn’t think. I just acted. It released something there.” When one of the participants was asked how the MDMA substances helped him, he described: “I think it [MDMA] helped me a lot, both at that moment to act on complete autopilot, like some machine, and even today when I’m like . . . I feel less frightened to talk about these things or tell them because I feel somewhat detached from them.” The lack of cognitive interference also allowed thoughts to flow freely and associativity in the mind without “getting stuck” on fear-inducing or anxiety-provoking elements. As one participant described, “So I just get into these thoughts with myself like: how is it logical that the bullets don’t penetrate the windshield? I don’t know. All kinds of thoughts like these are like . . . I don’t know how to tell you if I would have thought of them if I wasn’t on acid.” Another participant described how this cognitive state provided him with unusual, creative ideas that he would not have conceived without the influence of LSD. These ideas ultimately proved helpful during the crisis: “We reached a point where there was a barrier of Hamas militants, and we saw birds flying, a flock of birds flying toward the direction we came from. And then we said: birds flee from noise, and if they escape in the opposite direction, we should also turn around. This was the LSD effect.”
Optimistic detachment (observed in 11.90% of participants): Despite the dire circumstances, some participants reported an inexplicable sense of security and optimism. One participant who consumed LSD described: “I had a very, very deep feeling that everything would be okay, with lots and lots of anxiety and fear and worry, but I had a feeling that it would be okay, that I needed to trust my instincts and my intuitions and just continue, not stop for a moment.” Another participant who also consumed LSD described the feeling of calmness that the substance provided him: “It allowed me to look at it from a more . . . more relaxed perspective. Okay, more . . . I would say even less logical. It gave me some place of faith that things would be okay, which I think sustained me.”
The unique interaction between psychedelic states and extreme stress seems to have created a distinct form of psychological protection that both aided immediate survival and posed challenges for later integration, as we will discuss in the following sections. An analysis of participant narratives revealed that APD was most clearly present in those who expressed both the beneficial emotional detachment they felt during the attack and their subsequent difficulty reconciling this subjective experience with the objective horror of the situation. This pattern emerged consistently in our data, indicating a potential relationship between the protective mechanism of APD during trauma and later integration challenges (Figure 1 and Table 2).
Segmentation of APD features.
Features of Adaptive Psychedelic Dissociation.
Suppression of psychedelic effects during stress response and resurgence after reaching safety
The interaction between acute stress and psychedelic effects became particularly evident among those who had consumed LSD. Several participants reported that the direct influence of the substance diminished during the most life-threatening moments. One described this experience: “I couldn’t feel the effects at all at that moment, honestly. It was like a complete shutdown of the trip. The adrenaline completely took over; it became the dominant force.” The unique interplay between natural fight-or-flight responses and psychedelic effects became evident during the attack. One participant described how the surge of adrenaline seemed to counteract the typically debilitating effects of psilocybin mushrooms, allowing for unexpected functional capacity: “At some point, I think the adrenaline overpowered the mushrooms. That’s why we were also able to function more substantially because mushrooms are typically a substance that significantly reduces functionality. So fortunately, because we didn’t take much, I think the adrenaline surpassed the effect of the mushrooms.”
The arrival home marked a significant psychological transition for survivors, characterized by an initial period of emotional numbness followed by profound realization. Many described an inability to process what had occurred until they reached a state of safety. One participant who consumed LSD recounted: “Until we got home, brother, we didn’t understand . . . We didn’t grasp what we’d been through. I think I didn’t have any emotion . . . in those moments, there was no emotion; it wasn’t functioning. It was instinct, I think, until reaching safety. “This numbness gave way to emotional release upon entering a secure environment.” Another participant who consumed LSD described when she returned home: “Only when I truly returned home and hugged my mother and the children did I start crying and breaking down . . . until then, I was disconnected. I didn’t understand what was happening.” This pattern aligns with the adaptive nature of APD, where emotional processing was temporarily suspended to enable survival responses.
Beyond the psychological transition, a distinct phenomenon emerged among LSD users: the return of psychedelic effects that had been suppressed during the attack. Once safety was reached and the immediate physiological threat subsided, the effects of the substance returned, sometimes with overwhelming intensity. Many described how the transition to safety triggered a resurgence of the trip’s intensity, suggesting a complex neurobiological interaction between stress responses and psychedelic states. As one participant explained: “When we got to the house, I suddenly felt like I could let go of the insane fight mode I had been in. And that’s when the looping thoughts started, and I also started having visuals.” Another participant echoed this pattern: “The next acid peak, I only felt it once I was home. When I got home, I went ‘pff’, like I took everything off.”
This phenomenon might hint that the body’s stress response may have temporarily overridden or masked the psychedelic effects, which re-emerged once the immediate threat was removed. Another described how the LSD (acid) intensified as he processed the unfolding reality: “Then I turned on the television and realized everything that was happening, and that’s really when I started crying. I went into such a dark place from the acid at that moment, I didn’t think it was possible to experience darkness that profound.”
Yet, another participant reflected: “It was like I felt that for a moment, everything just stopped, calmed down, we weren’t being chased anymore. But then I suddenly felt the effects slightly returning . . . the influence, the effects were returning to me.”
This might suggest that during extreme danger, the body’s “fight or flight” response could prioritize survival, temporarily suppressing altered states of consciousness induced by psychedelics or other drugs.
These accounts reinforce the hypothesis that neurochemical systems operate in a dynamic hierarchy, with survival mechanisms taking precedence during acute danger (Raut et al., 2020). The phenomenon represents, for instance, a departure from the usual experience with psychedelic mushrooms, where cognitive and motor impairment are common, suggesting that extreme survival situations may temporarily alter how psychoactive substances affect the body and mind. The delayed resurgence of psychedelic effects upon reaching safety could mean that the body’s stress response may act as a temporary inhibitor, only allowing the full spectrum of altered consciousness to return once the immediate threat is removed.
Aftermath processing and integration
The mid-term impact of substance use during the traumatic event revealed more complicated and varied patterns compared to the immediate effects. Among classic psychedelic users, 41.66% reported beneficial effects on aftermath processing, while 25% indicated increased challenges, another 25% reported no impact, and 8.34% did not answer. The empathogen group showed somewhat more positive outcomes, with 52.63% reporting beneficial effects on aftermath processing, though 26.32% still indicated increased challenges. In this group, 10.53% reported both positive and negative impacts on the aftermath processing, suggesting a more nuanced long-term integration process. The remaining participants reported no effect (5.26%) or were uncertain about the impact (5.26%). In the ketamine group, responses were evenly split between increased challenges and no effect.
The thematic analysis revealed four primary thematic findings in the aftermath processing: fear of delayed trauma, the duality of dissociation and processing dissonance coping, community support, and temporal distortions.
The fear of delayed trauma: The fear of delayed trauma emerged as a significant concern among survivors. This manifested as anxiety about repressed memories surfacing unexpectedly later in life. One participant who consumed LSD expressed this anxiety metaphorically: “Sometimes it really scares me that it will eventually come up. It’s like a coin that hasn’t dropped yet.” This reflects concerns about delayed trauma processing that may be complicated by the dissociative effects experienced during the event.
The duality of dissociation: We use the term “duality of dissociation” to describe the ambivalent nature of dissociative responses among participants, experienced as both a protective buffer during the traumatic event and a source of emotional or cognitive dissonance in its aftermath. This dual function captures how dissociation served to shield individuals from overwhelming emotions and perceptions in the moment while complicating their ability to process later or make sense of what occurred. Some participants viewed this dissociation as beneficial, as it helped obscure distressing memories or sensory details. As one participant who consumed MDMA articulated: “It did help because supposedly, since I was on drugs, in hindsight, there are many vaguer things. They’re not with me in my daily life.” However, others described this same dissociative distance as a barrier to integration. One participant who consumed LSD and MDMA elaborated: “I think that feeling detached from the situation helped me process what I saw and the harder things, like the bodies and various horrors. But . . . it created a very strong dissonance in processing the experience.” This dissociative dissonance manifested further in what could be termed a reality-experience disconnect, involving participants’ struggle to reconcile their emotional state during the event with the horror of the objective reality. As one survivor recounted, “I didn’t feel bad during the event. And how can that be so disconnected from the reality that was so painful and so detached, like, they were slaughtering us and raping us and kidnapping us and mutilating our bodies, and like desecrating us, how could I feel that I was okay there?”
Community support: Community support emerged as a crucial protective factor in healing. Survivors who connected with others who shared similar experiences reported reduced feelings of isolation, guilt, and shame. When asked what helped during the attack, one participant who consumed LSD described: “First of all, I wasn’t alone; I was with my partner during the entire time. I believe we helped each other throughout, even without knowing it.” Another participant who consumed MDMA described: “The fact that I went through this with my husband, and we both live in the same house and understand each other, makes it easier. I went through this with all my friends it makes it easier. If I need to escape to someone, I know I’ll find someone who understands me.” This collective processing appeared to validate survivors’ experiences and normalize their reactions, creating space for more adaptive coping strategies.
An additional concerning pattern emerged regarding post-event substance use. Some participants developed a relationship between feelings of vitality and safety and continued psychoactive substance use, to the extent that the non-ordinary states these substances induce became the primary accessible “safe space” following the event. As one participant who consumed MDMA (Ecstasy) reflected: “I think the fact that I was on drugs today is not helping me. Today, it’s holding me back, if not even . . . because it’s the only thing that feels good and safe.” This suggests potential complications for recovery when substances become entangled with trauma processing mechanisms.
Discussion
Our findings reveal a temporal arc in how psychedelic substances influenced participants’ trauma experiences across the three phases described above. To enhance conceptual clarity regarding key constructs used throughout this analysis, we distinguish between several related but distinct phenomena. According to structural dissociation theory, dissociation is a disruption in the standard integration of consciousness, memory, identity, emotion, perception, or motor control (Holmes et al., 2005; Nijenhuis and van der Hart et al., 2011). It manifests in two forms: a detachment-type dissociation, which is an altered state of consciousness involving a subjective feeling of being separated from one’s current experience, and a compartmentalization-type dissociation, which is the loss of voluntary control over functions that would typically be under conscious control. Ego dissolution, a phenomenon distinct from clinical dissociation, involves the temporary reduction of boundaries between self and environment during psychedelic experiences, correlating with decreased DMN activity while preserving metacognitive awareness, a qualitatively different experience from trauma-induced dissociation’s fragmentation and loss of self-coherence (Millière, 2017; Nour et al., 2016). Emotional detachment, as we observed in participants, represents a specific form of detachment-type dissociation involving conscious distancing from affective responses while maintaining cognitive clarity and decision-making capacity. Within this framework, our proposed concept of APD emerges as a hybrid phenomenon. It incorporates detachment-type features, especially emotional distancing and altered perception, while paradoxically preserving the volitional control usually lost in compartmentalization-type dissociation. This unique dissociative profile enabled functional survival responses during the acute trauma.
The interplay between psychedelic states and acute stress responses created a complex neuropsychological environment that defies straightforward explanation. However, survivors’ accounts revealed consistent patterns in how they believed psychedelics shaped their experiences during and after the attack. From these accounts, two interrelated mechanisms emerged. The first is what we term APD. This dissociative state is characterized by emotional detachment, altered memory formation, derealization, and depersonalization, as well as a paradoxical combination of instinctual action and euphoric detachment, all of which occur without a loss of situational awareness or decision-making capacity. While these features resonate with clinical dissociation, they also include responses more akin to a narrowing of consciousness, a functional compression of cognitive processing that is often observed under extreme overload. Some participants appeared to operate within a narrowed attentional bandwidth, enabling rapid, survival-oriented actions while mitigating emotional interference. This distinction is essential. While some responses reflect classical dissociative phenomena, others align more closely with acute stress-induced narrowing of attention. We view both as elements of a dynamic, adaptive response, neither wholly pathological nor entirely under volitional control.
Psychedelic substances may have helped mediate this unique state of simultaneous disconnection and hyperawareness, enabling individuals to cope with extreme danger while shielding themselves from affective overwhelm.
The second mechanism, which we conceptualize as an epistemic container, refers not to a pharmacological effect per se, but to the interpretive frameworks participants brought to the experience. Survivors often relied on their knowledge of the substances they had ingested to make sense of what was happening, interpreting even extreme perceptual distortions or emotional blunting as part of the drug experience. This epistemic framing appeared to provide psychological containment and a degree of cognitive organization amid traumatic chaos. The REBUS model may offer a neurobiological explanation (relaxed high-level priors) for psychedelic effects; however, our findings highlight the importance of participants’ interpretive frameworks. Survivors’ preexisting knowledge and expectations about the drugs shaped how they made sense of perceptual distortions and emotional blunting during the trauma, helping them psychologically contain overwhelming input. In other words, beyond neuro-computational mechanisms, cultural, experiential, and contextual factors significantly informed participants’ ability to navigate and interpret their traumatic reality under the influence of psychedelics.
The neurobiological interaction between the stress response and psychedelic effects represents another critical dimension of this research. Psychedelics are known to disrupt DMN functioning and modulate affective processing. At the same time, acute trauma triggers a cascade of stress-related neurochemicals that can override or interact with these alterations in unpredictable ways. This interaction may reflect a hierarchical reorganization of consciousness, where survival imperatives dominate even in pharmacologically altered states.
Our findings thus highlight a paradox: mechanisms that provided immediate protection during trauma, such as dissociation, narrowing of consciousness, or euphoric detachment, may later complicate integration and narrative reconstruction. Given that peritraumatic responses are crucial predictors of trauma trajectories, understanding these altered-state mechanisms may offer new insights into both the therapeutic potential and psychological risks of psychedelics during trauma exposure. These findings may inform future research on trauma interventions and help shape ethical, clinical, and harm-reduction frameworks for working with psychedelic experiences in high-risk contexts.
APD: Theoretical implications and possible mechanisms
The APD phenomenon we observed appears to differ from traditional trauma-induced dissociation in its immediate function, yet shares key characteristics such as emotional detachment, altered perception of time, and compartmentalization of experience. Unlike involuntary dissociative states commonly associated with PTSD, APD appears to have facilitated strategic emotional regulation, enabling rapid decision-making and reducing immediate emotional overwhelm while maintaining functional awareness. This distinction is significant when viewed through the lens of evolutionary-based defense mechanisms. Schauer and Elbert (2015) propose a “defense cascade” model, where dissociation represents an adaptive survival response, particularly when an organism faces an overwhelming threat with no escape route. Their model outlines six fear responses that escalate as danger proximity increases: freeze, flight, fight, fright, flag, and faint. Our findings argue that psychedelic substances may modulate this defense cascade in unique ways, potentially enabling individuals to maintain situational awareness and decision-making capacities (typically associated with earlier stages of the cascade) while experiencing protective dissociative features (typically associated with later stages). Traditional trauma-induced dissociation, particularly the “flag” and “faint” stages described by Schauer and Elbert, involves complete disconnection from reality, functional sensory deafferentation, motor paralysis, and speech inhibition, dramatically impairing adaptive functioning (Schalinski et al., 2015). By contrast, APD appeared to enable emotional regulation while preserving functional awareness and action capabilities.
To place APD within established dissociation frameworks, it is necessary to differentiate between detachment-type and compartmentalization-type dissociation (Brown, 2006; Holmes et al., 2005). Detachment-type dissociation involves disconnection from reality, emotions, or bodily sensations (depersonalization, derealization, emotional numbing). In contrast, compartmentalization-type dissociation refers to loss of voluntary control over usually controllable mental processes (dissociative amnesia, conversion symptoms). What we observed might reflect a fundamental reorganization of neural engagement patterns associated with psychedelics, resulting in a unique hybrid dissociative state.
While classic psychedelics typically produce widespread increases in neural connectivity across limbic and sensory networks, trauma-exposed populations during acute stress show selective enhancement of emotional processing circuits, specifically amygdala-medial prefrontal cortex connectivity, with significantly reduced visual-perceptual phenomena. This neuroadaptive profile aligns with the Research Domain Criteria framework’s focus on negative valence systems (Kelly et al., 2021). It also mirrors clinical observations of trauma survivors’ preference for using psychedelics to regulate emotions.
APD seems to include features of detachment-type dissociation (emotional numbing, derealization) while paradoxically keeping the volitional control usually affected in compartmentalization-type dissociation. This sets APD apart from the Psychedelic Iatrogenic Structural Dissociation described by Elfrink and Bergin (2025), where psychedelics can disrupt the balance between daily functioning and trauma-related reactions, causing destabilization. By contrast, APD is a temporarily adaptive reorganization that maintains functional ability during acute trauma.
To understand this pattern, we propose APD as a trauma-specific adaptation characterized by selectively channeling psychedelic effects through emotional processing networks while preserving perceptual stability and executive control. This concept fills a theoretical gap, as current frameworks inadequately represent trauma-related changes in psychedelic responses (Halberstadt, 2015; Kelly et al., 2021). For instance, APD might reduce perceptual disinhibition that contributes to conditions like HPPD by preferentially engaging limbic rather than visual processing networks. However, trauma histories also increase the risk of delayed dissociative complications. Careful screening, longitudinal neuroimaging, and psychometric validation using established dissociation measures (e.g., Detachment and Compartmentalization Inventory) are essential for understanding the mechanisms and clinical applications of APD.
The REBUS model provides another explanatory framework for understanding APD (Carhart-Harris and Friston, 2019). According to this model, psychedelics reduce the precision weighting of high-level priors or beliefs in the brain’s predictive processing hierarchy. This relaxation of prior beliefs may have enabled participants to maintain metacognitive awareness while experiencing altered perceptions of the traumatic event. Neurobiologically, psychedelics suppress the DMN, correlating with ego dissolution experiences while increasing neural entropy and connectivity diversity (Carhart-Harris et al., 2016; van Elk and Yaden, 2022). These neural changes may help explain participants’ seemingly paradoxical combination of emotional detachment and functional awareness.
Unlike the complete parasympathetic dominance seen in later stages of the defense cascade (Schauer and Elbert, 2015), APD may represent a state where parasympathetic and sympathetic systems achieve a functional balance, sufficient parasympathetic activation to moderate emotional overwhelm while maintaining enough sympathetic activation to enable adaptive behavioral responses. This aligns with our participants’ reports of emotional distancing and preservation of action capabilities, contrasting with the findings of Sierra et al. (2002), who observed decreased heart rate and autonomic responses during traditional dissociative states.
Several complementary frameworks may explain the neurobiological mechanisms underlying APD. At the pharmacological level, classic psychedelics act primarily through 5-HT₂ₐ serotonin receptors, which are densely distributed in cortical layer five pyramidal neurons and higher-order association areas (van Elk and Yaden, 2022). This receptor activity likely modulates fear response pathways, mainly through serotonin’s role in reducing amygdala hyperactivity while enhancing cognitive flexibility (Ben-Zion et al., 2018; Bocchio et al., 2016; Matias et al., 2017). The improved cognitive flexibility observed in APD aligns with research on thalamic dysfunction in PTSD and dissociation. Bremner et al. (1999) and Lanius et al. (2001, 2003) have shown altered thalamic sensory processing in dissociative states. While standard trauma-induced dissociation typically results in “functional sensory deafferentation,” where incoming stimuli fail to reach beyond the gates in the spinal cord and thalamus (Krystal, 1995), our participants reported a more nuanced perceptual alteration, and sensory information was perceived but emotionally modulated. This may represent a unique form of threat processing where psychedelics create what we term an “epistemic container” that moderates emotional response without completely blocking perceptual processing.
The interaction between psychedelic states and extreme stress appears to have created a unique form of psychological protection that both facilitated immediate survival and created challenges for later integration. While APD enabled functional survival responses during the acute phase, many participants later reported difficulty integrating these dissociative experiences into a coherent trauma narrative. This parallels the integration challenges seen in traditional dissociative responses (van der Kolk, 1994) and potentially complicates long-term trauma processing. This might suggest an essential paradox in how psychedelic substances influence trauma processing: mechanisms that provide immediate protective benefits during acute trauma exposure may simultaneously create unique challenges for long-term integration and meaning-making. This tension between immediate adaptive response and long-term processing challenges represents a critical area for future research, particularly in developing interventions that can address the unique needs of individuals who experience trauma while in altered states of consciousness.
The epistemic container: Substance knowledge as a coping resource
Our quantitative findings present a consistent pattern of positive substance-effect attribution across all categories, particularly in immediate survival (75%–78.95%) and emotional coping (83.33%–84.21%). The creation of coherent and digestible narratives following trauma has been identified as a crucial component of recovery and psychological adaptation (Janoff-Bulman, 2010; Park, 2010). Research shows that survivors’ ability to construct meaningful interpretations of their traumatic experiences significantly influences their post-traumatic adjustment and psychological well-being (Neimeyer, 2006). This meaning-making process helps restore a sense of coherence and predictability to survivors’ worldviews, which have been shattered by the traumatic event (Janoff-Bulman and Frantz, 1997). Thus, beyond the direct pharmacological effects, our analysis found that participants’ knowledge of the substances they had consumed played a crucial role in their coping responses. The substances appeared to serve what we conceptualize as an “epistemic container,” a cognitive framework through which survivors experienced the substances’ effects and interpreted and understood them in a way that enabled containment, moderation, and organization of the traumatic reality.
Importantly, the epistemic container also acts as a boundary that isolates otherwise disruptive cognitive and emotional dissonances, those experiences that threaten to overwhelm or fragment the self. During trauma, the psychedelic state may amplify perceptual and emotional distortions, but the subject’s prior knowledge of the substance allows for a form of interpretive bracketing. This boundary-making ability makes extreme states understandable and psychologically manageable, even when they deviate significantly from normal experience.
The epistemic container concept was distilled from philosophical theory about knowledge acquisition expressly through psychedelics and is framed into this unique situation involving acute trauma; this is to create a framework for understanding how these experiences are processed. Letheby (2016) argues that psychedelic states possess what he terms “epistemic innocence.” Even when they involve misrepresentation, they can still yield “significant and otherwise unavailable epistemic benefits” (Letheby, 2016: 31). The epistemic container functions as this innocently imperfect cognitive framework. It provided the survivors with a structured way to interpret overwhelming experiences, attribute unusual behaviors or capacities to substance influence, and maintained a degree of metacognitive distance that protects against trauma.
According to Letheby (2016), psychedelic states can yield both “direct benefits, in the form of knowledge gained during the psychedelic experience itself; and indirect benefits, in the form of improved epistemic functionality after the psychedelic experience” (Letheby, 2016: 34). Similarly, the epistemic container provided immediate cognitive resources during the trauma while potentially supporting later meaning-making processes. It creates what Frise (2024) might call an “observer perspective” on one’s own experiences, a metacognitive position that “minimizes ‘emotional arousal’ and spares one of the ‘horror of reliving’ the traumatic event” (Frise, 2024: 4). Both the psychedelic state and the experience of acute trauma can be understood as “states of exception,” breaks in the continuity of ordinary consciousness and agency. This rupture in the flow of subjectivity produces both danger and opportunity: danger of psychic fragmentation, and opportunity for protective distancing or insight. The epistemic container plays a central role in navigating this threshold condition, offering a symbolic and cognitive anchor amidst experiential disintegration. For instance, some participants attributed agency to the substance they consumed, reflecting what Letheby and Mattu (2022) identified as a standard feature of psychedelic experiences: users often adopt “a consistent metaphysical worldview: an idealistic monism with a pantheistic flavor” (Letheby and Mattu, 2022: 169). While this interpretation may involve misrepresentation, it nonetheless provides meaningful cognitive scaffolding during extreme circumstances.
Another example pertains to participants’ understanding of the stimulant properties of certain substances, which many identified as a crucial factor in their ability to run and flee for extended periods. This illustrates what Letheby (2016: 33) describes as gaining direct knowledge of “the potential of one’s mind and the contingency of one’s sense of self.” The epistemic container provides access to embodied knowledge that becomes crucial for survival; the participant’s understanding of the substance’s effects creates a framework for interpreting and utilizing their physical capacities in otherwise inaccessible ways. This example highlights a critical dual mechanism at work: the stimulants function physiologically by enhancing the body’s physical capabilities and stamina, and psychologically, as the participant’s awareness of these effects enables a metacognitive framework that helps overcome potential freeze responses. This speaks to what might be termed “state and substance competence”, a participant’s embodied and cognitive familiarity with both the altered state and its pharmacological profile. Such competence may modulate the degree to which individuals can remain oriented, utilize their capacities, and avoid panic in the face of extreme circumstances. Although our study did not explicitly measure this variable, the narratives suggest that prior knowledge and somatic literacy may play a significant role in mediating both dissociative responses and agency under threat. In other words, the substances provide the biological capacity for sustained flight and create a psychological assurance that such capacity exists, thereby preventing the paralysis that might otherwise occur in traumatic situations. This interplay between biochemical effects and knowledge of those effects illustrates how substance-mediated experiences can simultaneously operate on multiple levels of embodied cognition in crisis contexts.
The integration paradox: Immediate protection versus long-term processing
The integration paradox demonstrates the temporal complexity of substance-mediated trauma experiences. While psychedelics may have provided immediate cognitive and emotional buffers during acute trauma, these protective mechanisms subsequently created unique challenges for memory consolidation and trauma processing. Fernández (2015) explores the potential benefits of memory distortion, arguing that some distorted memories can benefit the subject despite memory not functioning correctly. He discusses both epistemic and adaptive benefits of certain types of distorted memories, such as observer memories and fabricated memories. This perspective aligns with broader discussions about cognitive processes that may have costs and benefits in different contexts (Blackwell and Munakata, 2014; Schacter et al., 2011). It is worth noting that other researchers have critiqued Fernández’s examples and reasoning. While his general claim, that specific memory distortions, such as observer memories or fabricated recollections, may serve adaptive or epistemically beneficial functions, is theoretically appealing, Otgaar et al. (2015) raise several concerns. First, they question the general plausibility of the epistemic benefits of false memories. Second, they highlight a lack of clarity in Fernández’s reasoning and definition of what constitutes a benefit. Third, they warn that accepting false memories as beneficial might undermine the value placed on memory accuracy, particularly in sensitive contexts such as legal proceedings or therapeutic practice.
In our case, the dissociative experience created profound cognitive dissonance for many participants, particularly in reconciling their emotional state during the event with the objective horror of the situation. This cognitive dissonance represents what Bortolotti (2015) might characterize as a tension between “psychological benefits” and “epistemic functionality.” She notes that cognitive states departing from perfect accuracy can sometimes “prevent epistemic catastrophe” in crisis (Bortolotti, 2015: 495). However, these states may later require reconciliation with more accurate representations of reality. Many participants expressed ambivalence about this dissociative mechanism, specifically voicing apprehension about the possibility of suppressed memories emerging unexpectedly later in life. This fear reflects what McCarroll (2018) identifies as the relationship between memory perspective and emotional processing. Survivors intuitively recognize that the substance-facilitated protective mechanisms may have created what McCarroll calls a “phenomenal distancing” from traumatic content (McCarroll, 2018: 184). While this distancing served a crucial, protective function during acute trauma, it now creates uncertainty about unprocessed emotional content that might emerge later.
APD, while serving as a protective mechanism, created challenges in processing the trauma. This duality echoes Millière (2017), who describes the double-edged nature of ego-dissolution experiences, which can relieve negative self-related processing. Still, they may also complicate the integration of experiences into one’s autobiographical narrative. The protective detachment that substances facilitated now creates challenges for trauma integration. The state that allowed witnessing horrific scenes without overwhelming emotional collapse now creates a dissonance between the remembered experience and its emotional significance.
A complex relationship emerged between feelings of vitality and safety and the use of psychoactive substances, to the extent that these substances became the only accessible, safe space during and following the event. This dynamic sometimes leads to intensive substance use patterns that may not necessarily facilitate recovery from the traumatic event. This pattern highlights what Smith and Sisti (2021) might characterize as the ethical dimensions of psychoactive substance use in trauma contexts. The epistemological mechanisms that protected trauma have transformed into persistent coping strategies that may “blur ethical boundaries” between adaptive and maladaptive responses (Smith and Sisti, 2021: 3). What once served as protection now functions as a barrier to recovery; the substance has become both a safe harbor and an obstacle. This pattern illustrates the core of the integration paradox: mechanisms that protected consciousness during trauma may later impede the integration processes needed for recovery. Together, these findings invite a reconceptualization of trauma processing under altered states of consciousness, not merely as a deviation from normative response but as a distinct experiential and neuropsychological pathway requiring novel frameworks of understanding.
Conclusion, limitations, and future research
Given the inherently revelatory nature of psychedelic substances, both in terms of their effects on the human mind and their broader existential implications, this subject resists simplistic or reductive conclusions. Yet often, quantitative scientific research exhibits a troubling tendency to collapse the phenomenological richness of altered states into mechanistic narratives of receptor binding and symptom reduction, as if the profound reorganization of self that occurs during those experiences could be adequately captured through correlational designs and outcomes, while ignoring the undeniable role of social mechanisms and the set and setting play in the unfolding of the psychedelic experience. Accordingly, the interpretations offered here should be cautiously approached and viewed within their proper epistemological and methodological context. Before addressing the limitations of this study, we wish to underscore that this article represents only one version of a narrative, a narrative constructed by a small group of researchers attempting, with as much accuracy and sincerity as possible, to articulate the stories that survivors themselves are telling and retelling (a dynamic we refer to as an epistemic container). In this sense, the article presents a mediated account shaped by what we have termed “psychedelic adaptive dissociation” and the “integration paradox.”
Although the study prioritizes a phenomenological approach over statistical generalizability, we recognize several significant methodological limitations. First, the study is subject to survivor bias: it includes only individuals who lived through the traumatic event, excluding those, approximately 10%, who did not survive, thereby limiting the completeness of the data on how substances may have influenced survival. Second, participant self-selection may have skewed the sample toward individuals who were in a relatively more stable mental-emotional condition; those experiencing acute grief or psychological crisis may have been less likely to participate. Third, the retrospective nature of trauma reporting presents inherent challenges. Psychedelic substances, when taken in proximity to trauma, may influence how memories are encoded, retained, and recalled, particularly through state-dependent memory effects. In addition, processes such as cognitive dissonance may shape how participants reinterpret their substance use in light of their survival, potentially reframing the experience to reconcile existential or moral tensions.
Further methodological limitations include the uneven distribution of participants across substance categories, with only two individuals reporting ketamine use, thereby limiting meaningful cross-substance comparisons. Lastly, it is essential to acknowledge that minute and seemingly incidental decisions may have significantly influenced survival outcomes in the chaotic and rapidly unfolding conditions of the attack. As such, participants’ retrospective interpretations of the role psychedelics played in their survival may be deeply colored by the existential and narrative demands of making sense of extraordinary experiences. Moreover, as participants were under both extreme stress and psychedelic influence, their narrative reconstructions may involve post-hoc reframing, shaped not only by memory limitations but also by the need to create coherence or meaning in the aftermath. This interpretive limitation is inherent to retrospective phenomenological inquiry, particularly when examining experiences that occurred during altered states of consciousness. While our analysis focused on participants’ subjective sense-making processes rather than objective event reconstruction, we acknowledge that reported APD characteristics may reflect both lived experience and subsequent narrative integration efforts.
Nevertheless, consistent with the principles of phenomenological inquiry, these limitations are not viewed as methodological flaws but as intrinsic to exploring lived experience, particularly in the context of traumatic and altered states of consciousness (Martiny et al., 2021).
Future directions
Future research should continue to explore the complex interface between psychedelic experiences and trauma, with particular attention to its dialectical characteristics.
One must acknowledge the opposition between the two dissociative states: the shutting down of experience and emotions during trauma exposure, as a consequence of fear, versus the opening to new experience and emotions as a consequence of courage during psychedelic experience. Also, one must recognize that the psychedelic-induced meta-awareness may be due, or at least associated with, the redistribution of neural activity and neurogenesis, which stands in stark contrast to the repetitive, rigid clinical patterns characteristic of PTSD psychopathology in general. Continued inquiry in this field may yield more profound insights into the mind’s adaptive capacities and vulnerabilities, positioning psychedelics not merely as therapeutic tools but as epistemological instruments, illuminating the very structures of human consciousness. Clinically, the APD model could inform trauma-informed psychedelic therapy practices in several key ways. Therapeutic dosing protocols might be adjusted to optimize the protective dissociative window while avoiding overwhelming fragmentation. Therapists could develop enhanced containment strategies that recognize APD as potentially adaptive rather than pathological, adjusting their interventions accordingly. The model also emphasizes the importance of careful emotional pacing during sessions, enabling clients to transition in and out of dissociative states as needed, thereby promoting psychological safety. Integration of trauma-informed care frameworks could guide practitioners in distinguishing when dissociative responses serve protective functions versus when they signal therapeutic overwhelm.
To empirically examine APD, future studies should use multiple complementary methods. Empirical studies could include trauma-analog paradigms, such as VR-based threat induction or stress-triggered autobiographical recall, combined with low or moderate doses of psychedelics to assess their impact on dissociative responses. Standardized scales (e.g., CADSS, MEQ30) and functional neuroimaging techniques (fMRI, MEG) could help identify APD’s unique neural signatures compared to both pathological trauma-related dissociation and non-drug-induced altered states.
Longitudinal studies in psychedelic-assisted therapy for PTSD could examine whether APD-like states that occur during dosing sessions predict better emotional regulation or make therapeutic integration more difficult. Comparing interviews with trauma survivors who did not use psychedelics during their experiences would provide important baseline data. These follow-up assessments would clarify both the immediate protective effects of APD and the long-term challenges of integrating it, while also testing APD as a factor that influences treatment outcomes.
In this sense, future research may not only aim to understand psychedelics better but also to understand psychopathology through them, reframing psychedelic experiences as a lens through which the dynamic, sometimes fragmented, nature of the human mind can be more fully grasped.
Footnotes
Acknowledgements
The authors wish to express their gratitude to those who made this project possible. First, we thank the management and early volunteers of SafeHeart NGO (Igal Tartakovsky, Tal Zagursky, Karina Dessau, Reut Plonsker, Yair Grynbaum, Irit Hacmun, Roy Salomon, Stephanie Cohen, Shiran Maor, and Efrat Atun) for their tireless efforts to ensure treatment for the survivors. We appreciate all the SafeHeart volunteers, clinicians, and research teams. We also thank Ofir Tenenbaum, Sachar Iczkovits, Racheli Regev, Yoav Cohen, and Dr. Ziv Ben-Zion, Dr. Shlomo Guzmen-Carmeli, and Prof. Michal Pagis for reviewing, giving feedback, and helping us finalize this paper. Finally, we extend our deepest gratitude to the extraordinary survivors of the festival, who entrusted us with their stories and made a tremendous effort to help others even in such difficult times.
Ethical considerations
This study received approval from the Institutional Review Board of Bar-Ilan University.
Consent to participate
All participants provided informed consent, which was recorded and filmed for the study.
Consent for publication
Informed consent for publication of identifying information was obtained from all individual participants.
Author contributions
This study and interviews were designed and conducted by GS. Thematic analysis was done by MG-B and GS. The manuscript was drafted by GS. All authors contributed to interpreting and writing the study results and revised and approved the manuscript for intellectual content.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data availability statement
The data supporting this study’s findings are not publicly available due to medical confidentiality requirements, the sensitive nature of participant information, and data protection regulations. Data may be made accessible upon request and after consultation with the data management officers from Bar-Ilan University or by contacting the corresponding author.