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Test cohort study

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Exit Survey
 
 

 



“This study is being run at Imperial College London. It requires four measurements assessing individual characteristics and one follow-up measurement. It asks about your previous experiences with drugs and experiences in the upcoming psychedelic session/ceremony/experience. You must be at least 18 years old and have a good understanding of the English language to participate. To participate, you agree to complete five sets of questionnaires at five different time points, of which this one is the first. When clicking “yes”, you will agree with receiving notifications to fill in the remaining four sets of questionnaires at different moments. The moments of these notifications depend on the date of your upcoming psychedelic session/ceremony/experience. The questionnaires can vary in length at each time point. All obtained data is anonymous, no data will be shared that will identify individuals or their responses. You may withdraw from the questionnaire at any time and your data will be discarded; there will be an opportunity to confirm your response at the end of each questionnaire.”
 
 
* Your age:
 
 
 
* Gender:
 
Female
 
Male
 
Other
 
 
 
Highest educational level attained:
 
Left school before age 16 without qualifications
 
Some highschool/GCSE level (in UK)
 
High school diploma/A-level education (in UK)
 
Some university (or equivalent)
 
Bachelor’s degree (or equivalent)
 
Post-graduate degree (e.g. masters or doctorate)
 
 
 
Your previous drug use
Please indicate what substance you have used for at least one time
 
Alcohol
 
GHB
 
Ketamine
 
Cocaine
 
Amphetamine
 
MDMA/Ecstasy
 
LSD
 
DMT
 
Ayahuasca
 
Psilocybin
 
Mescaline
 
Salvia
 
Iboga/Ibogaine
 
Heroin
 
Cannabis
 
Synthetic cannabinoids (New psychoactive substance; NPS, e.g. Black Mamba, Spice)
 
Stimulant-type NPS (e.g. Mephedrone, 4FMP)
 
Hallucinogen-type NPS (e.g. 25I-NBOMe/N-Bomb, 2C-B)

 
 
 
Number of times you have taken classical psychedelic substances (LSD, psilocybin, DMT, ayahuasca, mescaline).
 
Never
 
Only once
 
2-5 times
 
6-10 times
 
11-15 times
 
16-20 times
 
20-25 times
 
26-50 times
 
51-100 times
 
More than 100 times
 
 
 
* Have you ever been diagnosed with one of the following psychiatric illnesses?
 
Major depression disorder
 
Bipolar disorder
 
Schizophrenia
 
Anxiety disorder
 
Substance abuse
 
Hallucinogen persisting perception disorder
 
Obsessive-compulsive disorder
 
Psychotic disorder
 
Depersonalisation/derealisation disorder
 
None of the above

 
 
 
* On what date will your upcoming psychedelic session/ceremony/experience be?
 
 
Can you indicate what your motives are to undergo a psychedelic session/ceremony/experience?
Not at all Slightly Neutral Moderately Very much
* Fun/recreational/party
* Healing/therapeutic/personal growth
* Spiritual experience
* Religious practice
* Curiosity
* Escapism (of emotion)
* Willingness to confront (emotion)
 
 
How do you feel about the long-term outcomes of the upcoming psychedelic experience?
Extremely uncertainEntirely confident
*  
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