The Psychedelic Experience and Effect on Mental Health (All questions are optional)
Multiple Choice Survey: The Psychedelic Experience and Effects on Mental Health (about 10 minutes to complete)
This survey is intended to understand the relationship between the benefits and challenges of using psychedelics and their lasting effects felt after their use.
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Information About the Survey
Anonymity: no names or personal identifiable information will be collected, including emails, phone numbers, location or residence, or ip/computer information.
Multiple choice questions ask to rank the intensity of the positive and negative experiences during their psychedelic experience as well as rating the intensity, length of effects, the overall benefits and challenges of the effects after the dose and asks for any mental or physical health conditions.
Writing prompt answers are meant to gather specific examples of changes in perception, behaviors, habits, interpersonal relationships and relationships with oneself and whether psychedelics have had a positive or negative impact on mental health or physical disorders.
Which psychedelic(s) used is being referred to for this survey?
When was your last use of this psychedelic?  
Clear selection
How was this experience dosed?  
Clear selection
Approximately how long were changes in mood or perception sustained after the psychedelic experience?  
Clear selection
Do you struggle with any mental health condition(s)? What struggles do you face?
What are a few day-to-day challenges you experience? If you would prefer not to say or it is not applicable, please type "N/A"
Do you struggle with any physical health condition(s)? What struggles do you face?
What are a few day-to-day challenges you experience? If you would prefer not to say or it is not applicable, please type "N/A"
Physical Sensations and Mental Changes
Physical sensations may include vision, taste, touch, smell, hearing, balance or body position, or pain.
Mental experiences may include conscious thought, awareness, perception, behavior, comprehension, reasoning or any other similar conceptual/mental experience.
Rate the intensity of any benefits or challenges that occurred *during* your psychedelic experience.  
Very Strong
Strong
Moderate
Slight
Neutral
Mental benefits
Positive Physical Sensations
Mental Challenges
Negative Physical Sensations
Clear selection
General positive mood changes experienced *during* your psychedelic experience.  
Strong Increase
Moderate Increase
No Change
Moderate Decrease
Strong Decrease
Positive Mood
Positive Cognitions
Self-worth
Radical Acceptance
Euphoria
Clear selection
General negative mood changes experienced *during* your psychedelic experience.  
Strong Increase
Moderate Increase
No Change
Moderate Decrease
Strong Decrease
Negative Mood
Negative Cognitions
Anxiety
Existential Dread
Depression
Clear selection
Rate the change in your perception and behaviors (if any).  
Strong Positive Change
Moderate Positive Change
No Change
Moderate Negative Change
Strong Negative Change
Self-perception
Perception of World
Interpersonal Relationships (With others)
Self-care
Change in Negative Habits (i.e. smoking, procrastination, or any other poor habits)
Change in Positive Habits (i.e. exercise, work ethic, or any other beneficial habits)
Clear selection
General positive mood changes experienced *after* your psychedelic experience.  
Strong Increase
Moderate Increase
No Change
Moderate Decrease
Strong Decrease
Positive Mood
Positive Cognitions
Self-worth
Radical Acceptance
Euphoria
Clear selection
General negative mood changes experienced *after* your psychedelic experience.  
Strong Increase
Moderate Increase
No Change
Moderate Decrease
Strong Decrease
Negative Mood
Negative Cognitions
Anxiety
Existential Dread
Depression
Clear selection
Rate the magnitude of any lasting effects on mood or perception felt *after* the initial psychedelic experience (if any).  
How strongly were these effects felt?
Clear selection
How likely are you to continue the use of psychedelics? 
Clear selection
Why or why not?
How likely are you to recommend the use of psychedelics to someone else?  
Clear selection
Why or why not?
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