Tripping to Cope: Coping Strategies and Use of Hallucinogens during the COVID-19 Pandemic in Three Cultural Contexts

Round 1

Reviewer 1 Report

The authors present data from an online survey, investigating associations between coping strategies and the use of hallucinogens during COVID-19.

Introduction

·        The authors provide a good overview of different coping styles, coping during COVID-19, and possible points of action of psychedelics. The transition to the actual study, however, is quite short and the reader does not receive information on what the authors were expecting to find (hypotheses). Did authors expect better or worse coping strategies among users of psychedelics? What would be considered as helpful coping strategies in the chosen instruments to assess coping? Which coping strategies should predict hallucinogen use during COVID-19?

Methods

·        Even if the survey was described in a different publication, authors should give some basic information about the survey and its sample also in this publication (e.g., what was the aim of the survey, what were the inclusion and exclusion criteria for participation, etc.). Furthermore, the authors describe a longitudinal study but refer in the description of the survey to another publication that describes a cross-sectional survey, please clarify.

·        Section 2.4: “Participants were asked about their use of hallucinogenic drugs.” What exactly was asked for? In general, it would be helpful for the reader if the authors could provide the survey in the supplement of the article.

·        Section 2.6:

o   Linear regression: Please clarify what was used as the predictor and what was the response variable.

o   GEE: Please clarify the variable “hallucinogenic drug use over time”. Is it correct that it refers to the frequency of psychedelic use during COVID-19 (after baseline)? In table 3 it says “lifetime use of psychedelic drugs”.

Results

·        Table 1:

o   Please clarify the meaning of “partner status”

o   There is a high percentage of participants with mental diseases, especially in the English sample. Could this have affected results?

o   Substance use: what do numbers refer to (e.g., lifetime use, recent use, regular use)?

·        Section 3.1

o   In the text of the second paragraph, it should be noted that results refer to the English sample

o   The results read as if mean differences between the groups were calculated. Please clarify.

·        Section 3.2

o   English sample: the text does not match the table (e.g., “both problem-focused coping strategies were related to lower … GSI scores” à no significant value in table)

Discussion

·        It should be considered to revise the discussion comprehensively. The lack of hypotheses in the introduction makes it difficult for the reader to interpret the results. Do findings indicate more or less helpful coping strategies? Furthermore, some arguments in the discussion are hard to follow or seem too far-fetched for the data presented in the results section. Integration of findings across languages is lacking, and the results of the longitudinal analysis are not discussed.

·        English sample: I do not understand why increased positive emotion processing should be associated with more emotion-focused coping. Has this been shown in previous literature? Similarly, why should acute impairments of cognitive processing during the psychedelic experience result in (generally) decreased problem-focused coping strategies? The last paragraph states that the research “should be interpreted with caution and adequate context should be provided” but it remains somewhat obscure what this means.

·        Spanish sample: The discussion focuses on the comparison of psychedelic and psychotic states, which is interesting, but the initial research question should also be addressed. Furthermore, it seems a little far-fetched to infer from differences between two groups (psychedelic users assessed outside the acute psychedelic state vs. people with schizotypal traits) to differences between the acute psychedelic vs. psychotic state. Similarly, the conclusion that reduced wishful thinking indicates reduced openness to conspiratorial ideologies reaches very far, as the link is established via schizotypal traits that were not assessed in this paper.

·        After the discussion of results from the different cultures, a summary of findings across cultures would be interesting to read.

·        The limitations are very short and do not sufficiently describe how results could be biased.

 

·        The conclusion does not reflect the results presented (e.g., states that no differences were observed between users and non-users).

Author Response

The authors provide a good overview of different coping styles, coping during COVID-19, and possible points of action of psychedelics. The transition to the actual study, however, is quite short and the reader does not receive information on what the authors were expecting to find (hypotheses). Did authors expect better or worse coping strategies among users of psychedelics? What would be considered as helpful coping strategies in the chosen instruments to assess coping? Which coping strategies should predict hallucinogen use during COVID-19?

Thank you for this appreciation. We have modified the second paragraph of page 4 as follows:

However, the exact mechanisms through which this putative protective effect is exerted are still largely unknown. This study represents a first key step towards shedding light on this phenomenon. Appropriate coping strategies during the pandemic, apart from the previous ones mentioned (e.g., acceptance, humor) [20–25], have been described in relation to personal care-based measures, social connectedness, and activity-based measures [55]. Reasonably, we expect hallucinogenic drug users to use those healthier coping strategies to a greater degree than non-users, as this might partially explain their better scores on mental health and well-being during the COVID-19 pandemic [53, 54].  We should not forget that the directionality of these findings is still uncertain, as it is possible that those engaging in positive coping strategies are precisely the individuals who regularly use hallucinogens. 

 

Methods

Even if the survey was described in a different publication, authors should give some basic information about the survey and its sample also in this publication (e.g., what was the aim of the survey, what were the inclusion and exclusion criteria for participation, etc.). Furthermore, the authors describe a longitudinal study but refer in the description of the survey to another publication that describes a cross-sectional survey, please clarify.

Certainly a good point. We have modified the paragraph as follows:

We used data from a previous longitudinal study that was launched through an online survey in April, 2020, with two follow-ups at two and six months after baseline. The main objective of the survey was to collect information about the relationship between the detrimental effects of the COVID-19 pandemic and the use of hallucinogenic drugs. Additionally, other relevant measures were included, such as personality, psychopathology, and coping strategies. The first, cross-sectional results of this study were published, and the methods can be consulted there for more detail [53]. The survey was launched in Spanish, Portuguese, and English, and it reached an international sample. At baseline, 2971 participants were recruited, followed by 1024 subjects at the first follow-up, and 455 subjects for the second one. The same sample was used in the present study.

 

• Section 2.4: “Participants were asked about their use of hallucinogenic drugs.” What exactly was asked for? In general, it would be helpful for the reader if the authors could provide the survey in the supplement of the article.

We will submit the survey in the supplement of the article as suggested.

Additionally, we included the following lines at the end of page 5:

For each of them, participants were asked to select one of the following options: I have not tried it; I have tried it, but I do not regularly consume it; I take it 1 to 2 times every 6 months; I take it between 3 and 5 times every 6 months; I take it more than 6 times every 6 months (at least once per month).

 

• Section 2.6:

o   Linear regression: Please clarify what was used as the predictor and what was the response variable.

We clarified the sentence in the third paragraph of page 6:

Then we ran linear regression to assess baseline associations between each coping mechanism and occasional and regular users of hallucinogenic substances as compared to never-users, using the frequency of hallucinogen use as the predictor variable.

 

o   GEE: Please clarify the variable “hallucinogenic drug use over time”. Is it correct that it refers to the frequency of psychedelic use during COVID-19 (after baseline)? In table 3 it says “lifetime use of psychedelic drugs”.

We modified the sentence as follows:

“the use of hallucinogens over time (users/non-users),”

 

Results

• Table 1:

o   Please clarify the meaning of “partner status”

In the updated version of the tables it can be read

“% of participants with a partner”

 

o   There is a high percentage of participants with mental diseases, especially in the English sample. Could this have affected results?

Certainly a good point. We included some lines in the end of paragraph 3, page 8:

Another important point to consider in the case of English speakers is that a high percentage (37.4%) reported having mental disorders. This could affect the results obtained in terms of coping strategies and the way in which individuals deal with the experiences elicited by hallucinogenic drugs.  

 

o   Substance use: what do numbers refer to (e.g., lifetime use, recent use, regular use)?

Thanks, now this heading is as follows:

Substance use; N (%) of users

• Section 3.1

o   In the text of the second paragraph, it should be noted that results refer to the English sample

Thanks for noting that. We have included in the beginning of the first sentence:

“In the case of English speakers, linear regressions”

 

o   The results read as if mean differences between the groups were calculated. Please clarify.

We have included the following sentence in paragraph 3, page 7:

Among the Spanish speakers, regular users of hallucinogens scored significantly lower, as informed by ANOVA, than non-users on the wishful thinking scale.

 

• Section 3.2

o   English sample: the text does not match the table (e.g., “both problem-focused coping strategies were related to lower … GSI scores” à no significant value in table)

The sentence has been rewritten as:

whereas both problem-focused strategies were associated with lower general health and only problem-focused disengagement with a lower GSI score.

 

Discussion

• It should be considered to revise the discussion comprehensively. The lack of hypotheses in the introduction makes it difficult for the reader to interpret the results. Do findings indicate more or less helpful coping strategies? Furthermore, some arguments in the discussion are hard to follow or seem too far-fetched for the data presented in the results section. Integration of findings across languages is lacking, and the results of the longitudinal analysis are not discussed.

According to the reviewer, we included in the introduction our initial hypotheses, especially in the following sentence:

“Reasonably, we expect hallucinogenic drug users to use those healthier coping strategies to a greater degree than non-users, as this might partially explain their better scores on mental health and well-being during the COVID-19 pandemic”

Thus, we consider that now the results could be better understood.

However, clear patterns in our results were not observed, and we state this in the following lines (paragraph 4, page 9):

“A diffuse pattern of adaptive coping strategies adopted by hallucinogen users can be observed. The frequency at which hallucinogen users used most of the coping strategies was equal to non-users, with the exception of wishful thinking, which they were less engaged with”

Or in the same paragraph:

“However, in the present study, we were unable to find strong relationships between coping strategies and hallucinogenic drug use.”

So we cannot conclude, unfortunately, that more or less helpful coping strategies were used by users of hallucinogens. We did our best when delineating the results, connecting them with related topics in order to offer a wider background. But this is an example of negative results obtained while doing research. They are not surprising nor confirm the main hypothesis, but should be still published, since after that paper it would be more appropriate for researchers looking for the underlying psychological mechanisms that seems to protect users of hallucinogens in front of social stressors to look other variables not related with coping strategies.

Additionally, we made a number of corrections taking into account the commentary of the reviewer. Regarding the potential far-fetched arguments, we deleted this paragraph, mainly because of the far-fetched suggestion highlighted in yellow:

“In relation to the previous point, the number of conspiracy and “negationist” theories surrounding COVID-19 has been remarkable [92, 93]. This ideology might be linked to enhanced scores in wishful thinking, as schizotypal traits have been associated with wishful thinking and the belief in conspiracy theories. Thus, this study suggests that people who regularly use hallucinogens are not open to conspiratorial ideologies, but further studies should explore relationships between followers of conspiracy theories, schizotypal traits, and the use of hallucinogens.”

The following sentence: “might constitute strong evidence supporting” (first paragraph of page 9) has been rewritten as “might constitute preliminary evidence supporting”

We have included some words in order to clarify in the first lines of paragraph 2 of page 10:

“A diffuse pattern of adaptive coping strategies adopted by hallucinogen users can be observed. The frequency at which hallucinogen users used most of the coping strategies was equal to non-users across the three cultures, with the exception of wishful thinking in Spanish speakers”

Lastly, as suggested by the reviewer, we extend the discussion regarding the longitudinal analyses, adding the following paragraphs at page 9:

“Regarding the longitudinal analyses, in the English questionnaire the use of emotion-focused coping strategies was associated with poorer general health and higher scores on the GSI, indicating a greater presence of psychopathology according to the study assessments, and also with a less frequent use of hallucinogens. In contrast, the use of problem-focused strategies was associated with better general health and GSI scores, except for the specific scale of problem-focused engagement in the latter, and with more frequent use of hallucinogens. It should be noted that it has been generally stated in the literature that problem- and emotion-focused strategies are difficult to discriminate, as they may be used simultaneously and constitute parts of the whole coping process [92]. Thus, the following discussion about our findings should not be interpreted dichotomously. There is likely a mix of problem/emotion orientation in most cases, although a clearer trend can occasionally be drawn. The results observed are consistent with previous findings, as some research reported that emotion-oriented strategies may be less adaptive in the long-term than problem-oriented ones [93]. Nonetheless, the stressor that activates such strategies is also important. For instance, people diagnosed with chronic illnesses tend to adopt emotion-focused strategies [94, 95], since problem-focused ones are intended to intervene in the problem, but in the case of suffering diseases without a cure it is common to ascribe them to uncontrollable factors.

Among Spanish speakers, positive coping strategies (e.g., cognitive restructuring, social support) were associated with better general health and GSI scores, whereas negative strategies (e.g., self-criticism, social withdrawal, wishful thinking) were related to worse general health and GSI scores. This is in line with a robust body of research about coping strategies [96].

In the case of Portuguese speakers, the trend is also similar to the one observed in the literature [96]. The use of strategies like acceptance of responsibility and escape-avoidance were related to poorer general health and GSI scores, while using strategies like problem solving and social support was related to better scores at both measures according to the study assessments.

 

• English sample: I do not understand why increased positive emotion processing should be associated with more emotion-focused coping. Has this been shown in previous literature? Similarly, why should acute impairments of cognitive processing during the psychedelic experience result in (generally) decreased problem-focused coping strategies? The last paragraph states that the research “should be interpreted with caution and adequate context should be provided” but it remains somewhat obscure what this means.

Regarding the first part of the commentary, we rewrote a bit the following sentence:

“Thus, emotion-focused strategies might be more feasible among these subjects because of the positive bias in emotional processing, and then turning the emotional processing “easier”.”

We agree with the reviewer regarding the next sentence, so we deleted the following lines:

“In that sense, research has shown that the acute administration of hallucinogens impairs cognitive processing [78, 79] (although this is less evident in experienced users [80]), which, again, contradicts the results obtained in this study that made no distinction between acute, subacute, and long-term effects.”

Regarding the point about the last paragraph, these lines have been rewritten in a clearer way:

“In conclusion, this preliminary research focusing on coping strategies should be interpreted with caution, considering the complexities associated with emotional/cognitive performance and their connections to predominant coping strategies”

 

• Spanish sample: The discussion focuses on the comparison of psychedelic and psychotic states, which is interesting, but the initial research question should also be addressed. Furthermore, it seems a little far-fetched to infer from differences between two groups (psychedelic users assessed outside the acute psychedelic state vs. people with schizotypal traits) to differences between the acute psychedelic vs. psychotic state. Similarly, the conclusion that reduced wishful thinking indicates reduced openness to conspiratorial ideologies reaches very far, as the link is established via schizotypal traits that were not assessed in this paper.

We completely agree with the reviewer, and actually the last part of the commentary has been already addressed due to a previous commentary, deleting the part of conspiracy.

The discussion on psychotic/psychedelics was included not only because it is interesting (we truly think it is!), but also because it was the only significant result obtained in the Spanish speakers, so it is challenging for us to discuss more results since stating that no differences were found is the only basically needed.

 

• After the discussion of results from the different cultures, a summary of findings across cultures would be interesting to read.

As stated earlier, the results can be summarized as has been already done in the following lines:

“A diffuse pattern of adaptive coping strategies adopted by hallucinogen users can be observed. The frequency at which hallucinogen users used most of the coping strategies was equal to non-users, with the exception of wishful thinking, which they were less engaged with”

 “However, in the present study, we were unable to find strong relationships between coping strategies and hallucinogenic drug use.”

As unfortunately no more significant results were found.

 

• The limitations are very short and do not sufficiently describe how results could be biased.

The following lines have been included:

“Furthermore, there were some crucial differences between the samples from different cultures (e.g., a higher presence of mental disorders among the English speakers) that could have affected our results.”

 

• The conclusion does not reflect the results presented (e.g., states that no differences were observed between users and non-users).

The conclusions have been rewritten as follows:

“When comparing hallucinogenic drug users and non-users, two main findings were observed: the former used problem-focused coping strategies more often and used the strategy based on wishful thinking less often. Besides these findings, users of hallucinogens were not found to differ from non-users in other coping strategies. This suggests that coping strategies are only a marginal factor distinguishing hallucinogen users from non-users in terms of explaining the better scores obtained by the former in mental health and well-being in studies assessing the impact of the COVID-19 pandemic. The overall pattern of coping strategies adopted by hallucinogen users and the specific case regarding wishful thinking contributes evidence to support the hypothesis that hallucinogens and the hallucinations they induce strongly differ from psychotic states. These findings have strong implications for research involving the use of hallucinogens as a model for psychosis.”

 

Note that the final paragraph of the abstract has been modified according to the new inclusions:

“Further research should take into account that coping strategies are only marginally associated with hallucinogenic drug use. Other underlying mechanisms that might explain the better adjustment of users of hallucinogens to pandemics should be explored.”

Author Response File: Author Response.docx

Reviewer 2 Report

Thank you for a very interesting read. This study has explored an under-researched area of how the Covid-19 pandemic has affected individuals and the role of hallucinogens in coping with the stresses it has caused, and is still causing.

The writing style is easy to follow and the standard of English is excellent. Some minor changes are suggested.

Appropriate methods and research instruments were employed. However, I would like a little more detail about recruitment (and its limitations) and how long the questionnaire took to complete.

A clearly presented and argued description and interpretation of results.

Good use of tables and appropriate statistical analyses.

The Discussion is focused and based on the results.

The conclusions are solid and sensible.

Queries and comments are in the attached file.

Well done.

Comments for author File: Comments.pdf

Author Response

Thank you for a very interesting read. This study has explored an under-researched area of how the Covid-19 pandemic has affected individuals and the role of hallucinogens in coping with the stresses it has caused, and is still causing.

The writing style is easy to follow and the standard of English is excellent. Some minor changes are suggested.

Appropriate methods and research instruments were employed. However, I would like a little more detail about recruitment (and its limitations) and how long the questionnaire took to complete.

In Methods, beginning of page 5, the following lines were included:

“Through snowball sampling, questionnaires were disseminated among direct contacts and through social media. The questionnaire was also shared on the websites of the Mental Health Post-graduate Program of the Ribeirão Preto Medical School at the University of São Paulo, in the scientific journal Archives of Clinical Psychiatry, and on websites offering information about psychedelics and cannabis (Lasdrogas.info, Cannabis Magazine, social media pages of ICEERS, and local community websites). The three versions of the questionnaire remained open for a period of six weeks. The survey took 20-30 minutes to complete.”

Regarding the limitations of recruitment method, we have included this sentence in the limitations section:

“Lastly, online questionnaires have their own limitations in terms of reliability. In that regard, having disseminated the survey through the networks of our organization could have also biased the profile of participants towards hallucinogenic drug users.”

 

A clearly presented and argued description and interpretation of results.

 

Good use of tables and appropriate statistical analyses.

 

The Discussion is focused and based on the results.

 

The conclusions are solid and sensible.

 

Queries and comments are in the attached file.

 

Well done.

Thank you so much.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Thank you for the revision of the manuscript. However, some points are still open. In particular, the presentation of results is still not clean (e.g., some results in the text do not match the table) and the summary of results in the discussion does (in certain parts) not match the results presented in the results section. This should be revised before publication. (New comments in green).

 The authors provide a good overview of different coping styles, coping during COVID-19, and possible points of action of psychedelics. The transition to the actual study, however, is quite short and the reader does not receive information on what the authors were expecting to find (hypotheses). Did authors expect better or worse coping strategies among users of psychedelics? What would be considered as helpful coping strategies in the chosen instruments to assess coping? Which coping strategies should predict hallucinogen use during COVID-19?

Thank you for this appreciation. We have modified the second paragraph of page 4 as follows:

However, the exact mechanisms through which this putative protective effect is exerted are still largely unknown. This study represents a first key step towards shedding light on this phenomenon. Appropriate coping strategies during the pandemic, apart from the previous ones mentioned (e.g., acceptance, humor) [20–25], have been described in relation to personal care-based measures, social connectedness, and activity-based measures [55]. Reasonably, we expect hallucinogenic drug users to use those healthier coping strategies to a greater degree than non-users, as this might partially explain their better scores on mental health and well-being during the COVID-19 pandemic [53, 54].  We should not forget that the directionality of these findings is still uncertain, as it is possible that those engaging in positive coping strategies are precisely the individuals who regularly use hallucinogens. 

Thanks for clarification.

Methods

Even if the survey was described in a different publication, authors should give some basic information about the survey and its sample also in this publication (e.g., what was the aim of the survey, what were the inclusion and exclusion criteria for participation, etc.). Furthermore, the authors describe a longitudinal study but refer in the description of the survey to another publication that describes a cross-sectional survey, please clarify.

Certainly a good point. We have modified the paragraph as follows:

We used data from a previous longitudinal study that was launched through an online survey in April, 2020, with two follow-ups at two and six months after baseline. The main objective of the survey was to collect information about the relationship between the detrimental effects of the COVID-19 pandemic and the use of hallucinogenic drugs. Additionally, other relevant measures were included, such as personality, psychopathology, and coping strategies. The first, cross-sectional results of this study were published, and the methods can be consulted there for more detail [53]. The survey was launched in Spanish, Portuguese, and English, and it reached an international sample. At baseline, 2971 participants were recruited, followed by 1024 subjects at the first follow-up, and 455 subjects for the second one. The same sample was used in the present study.

Ok, thank you for providing extra information.

 

 

·        Section 2.4: “Participants were asked about their use of hallucinogenic drugs.” What exactly was asked for? In general, it would be helpful for the reader if the authors could provide the survey in the supplement of the article.

We will submit the survey in the supplement of the article as suggested.

Additionally, we included the following lines at the end of page 5:

For each of them, participants were asked to select one of the following options: I have not tried it; I have tried it, but I do not regularly consume it; I take it 1 to 2 times every 6 months; I take it between 3 and 5 times every 6 months; I take it more than 6 times every 6 months (at least once per month).

Ok, thank you. The supplement should be referred to in the text of the manuscript.

·        Section 2.6:

o   Linear regression: Please clarify what was used as the predictor and what was the response variable.

We clarified the sentence in the third paragraph of page 6:

Then we ran linear regression to assess baseline associations between each coping mechanism and occasional and regular users of hallucinogenic substances as compared to never-users, using the frequency of hallucinogen use as the predictor variable.

Thanks for clarification.

o   GEE: Please clarify the variable “hallucinogenic drug use over time”. Is it correct that it refers to the frequency of psychedelic use during COVID-19 (after baseline)? In table 3 it says “lifetime use of psychedelic drugs”.

We modified the sentence as follows:

“the use of hallucinogens over time (users/non-users),”

Thank you but this does not yet clarify what period “use over time” refers to. If I understand the idea of the paper correctly, baseline coping strategies were used to predict psychedelic use after baseline (=use during pandemic). However, in the heading of table 3 it says “lifetime use of psychedelic drugs” which suggests to me that baseline values of coping strategies were used to predict life-time use of psychedelics. 

Results

·        Table 1:

o   Please clarify the meaning of “partner status”

In the updated version of the tables it can be read

“% of participants with a partner”

Thank you. However, in the current version that I received, it still reads “partner status”.

o   There is a high percentage of participants with mental diseases, especially in the English sample. Could this have affected results?

Certainly a good point. We included some lines in the end of paragraph 3, page 8:

Another important point to consider in the case of English speakers is that a high percentage (37.4%) reported having mental disorders. This could affect the results obtained in terms of coping strategies and the way in which individuals deal with the experiences elicited by hallucinogenic drugs.  

Ok, thanks.

o   Substance use: what do numbers refer to (e.g., lifetime use, recent use, regular use)?

Thanks, now this heading is as follows:

Substance use; N (%) of users

Thank you. However, it is still not clear to the reader what reference frame this relates to (e.g., are numbers indicating life-time use of the respective substance, or use in the past month, etc.)

·        Section 3.1

o   In the text of the second paragraph, it should be noted that results refer to the English sample

Thanks for noting that. We have included in the beginning of the first sentence:

“In the case of English speakers, linear regressions”

Ok.

o   The results read as if mean differences between the groups were calculated. Please clarify.

We have included the following sentence in paragraph 3, page 7:

Among the Spanish speakers, regular users of hallucinogens scored significantly lower, as informed by ANOVA, than non-users on the wishful thinking scale.

Thank you. I asked because according to the method section result represenation of a linear regression is expected by the reader (although results will be identical).

·        Section 3.2

o   English sample: the text does not match the table (e.g., “both problem-focused coping strategies were related to lower … GSI scores” à no significant value in table)

The sentence has been rewritten as:

whereas both problem-focused strategies were associated with lower general health and only problem-focused disengagement with a lower GSI score.

Thank you. However, if I understand the data correctly, the text still doesn’t match the results presented in the table (e.g., problem-focused disengagement GSI p-value of 0.004 and also emotion-focused engagement GSI p-value of 0.04 are higher than the p-value of 0.003 that was set in the method section). The text should be closely checked if the results are presented correctly.

Discussion

·        It should be considered to revise the discussion comprehensively. The lack of hypotheses in the introduction makes it difficult for the reader to interpret the results. Do findings indicate more or less helpful coping strategies? Furthermore, some arguments in the discussion are hard to follow or seem too far-fetched for the data presented in the results section. Integration of findings across languages is lacking, and the results of the longitudinal analysis are not discussed.

According to the reviewer, we included in the introduction our initial hypotheses, especially in the following sentence:

“Reasonably, we expect hallucinogenic drug users to use those healthier coping strategies to a greater degree than non-users, as this might partially explain their better scores on mental health and well-being during the COVID-19 pandemic”

Thus, we consider that now the results could be better understood.

Yes, that was helpful, thank you.

However, clear patterns in our results were not observed, and we state this in the following lines (paragraph 4, page 9):

“A diffuse pattern of adaptive coping strategies adopted by hallucinogen users can be observed. The frequency at which hallucinogen users used most of the coping strategies was equal to non-users, with the exception of wishful thinking, which they were less engaged with”

The results section also reports significant changes in problem-focused engagement and disengagement.

Or in the same paragraph:

“However, in the present study, we were unable to find strong relationships between coping strategies and hallucinogenic drug use.”

The results section reports relationships between hallucinogenic drug use and problem-focused engagement/disengagement, emotional experience, and wishful thinking.

So we cannot conclude, unfortunately, that more or less helpful coping strategies were used by users of hallucinogens. We did our best when delineating the results, connecting them with related topics in order to offer a wider background. But this is an example of negative results obtained while doing research. They are not surprising nor confirm the main hypothesis, but should be still published, since after that paper it would be more appropriate for researchers looking for the underlying psychological mechanisms that seems to protect users of hallucinogens in front of social stressors to look other variables not related with coping strategies.

Additionally, we made a number of corrections taking into account the commentary of the reviewer. Regarding the potential far-fetched arguments, we deleted this paragraph, mainly because of the far-fetched suggestion highlighted in yellow:

“In relation to the previous point, the number of conspiracy and “negationist” theories surrounding COVID-19 has been remarkable [92, 93]. This ideology might be linked to enhanced scores in wishful thinking, as schizotypal traits have been associated with wishful thinking and the belief in conspiracy theories. Thus, this study suggests that people who regularly use hallucinogens are not open to conspiratorial ideologies, but further studies should explore relationships between followers of conspiracy theories, schizotypal traits, and the use of hallucinogens.”

Ok, thanks.

The following sentence: “might constitute strong evidence supporting” (first paragraph of page 9) has been rewritten as “might constitute preliminary evidence supporting”

We have included some words in order to clarify in the first lines of paragraph 2 of page 10:

“A diffuse pattern of adaptive coping strategies adopted by hallucinogen users can be observed. The frequency at which hallucinogen users used most of the coping strategies was equal to non-users across the three cultures, with the exception of wishful thinking in Spanish speakers”

See above. The results section also reports significant changes in problem-focused engagement and disengagement?

Lastly, as suggested by the reviewer, we extend the discussion regarding the longitudinal analyses, adding the following paragraphs at page 9:

“Regarding the longitudinal analyses, in the English questionnaire the use of emotion-focused coping strategies was associated with poorer general health and higher scores on the GSI, indicating a greater presence of psychopathology according to the study assessments, and also with a less frequent use of hallucinogens.

If I understand it correctly, this was not reported in the results section

 In contrast, the use of problem-focused strategies was associated with better general health and GSI scores, except for the specific scale of problem-focused engagement in the latter, and with more frequent use of hallucinogens. It should be noted that it has been generally stated in the literature that problem- and emotion-focused strategies are difficult to discriminate, as they may be used simultaneously and constitute parts of the whole coping process [92]. Thus, the following discussion about our findings should not be interpreted dichotomously. There is likely a mix of problem/emotion orientation in most cases, although a clearer trend can occasionally be drawn. The results observed are consistent with previous findings, as some research reported that emotion-oriented strategies may be less adaptive in the long-term than problem-oriented ones [93]. Nonetheless, the stressor that activates such strategies is also important. For instance, people diagnosed with chronic illnesses tend to adopt emotion-focused strategies [94, 95], since problem-focused ones are intended to intervene in the problem, but in the case of suffering diseases without a cure it is common to ascribe them to uncontrollable factors.

Among Spanish speakers, positive coping strategies (e.g., cognitive restructuring, social support) were associated with better general health and GSI scores, whereas negative strategies (e.g., self-criticism, social withdrawal, wishful thinking) were related to worse general health and GSI scores. This is in line with a robust body of research about coping strategies [96].

In the case of Portuguese speakers, the trend is also similar to the one observed in the literature [96]. The use of strategies like acceptance of responsibility and escape-avoidance were related to poorer general health and GSI scores, while using strategies like problem solving and social support was related to better scores at both measures according to the study assessments.

The finding that no association between coping style and psychedelic use was observed for the Spanish and Portuguese sample should also be named in the summary.

·        English sample: I do not understand why increased positive emotion processing should be associated with more emotion-focused coping. Has this been shown in previous literature? Similarly, why should acute impairments of cognitive processing during the psychedelic experience result in (generally) decreased problem-focused coping strategies? The last paragraph states that the research “should be interpreted with caution and adequate context should be provided” but it remains somewhat obscure what this means.

Regarding the first part of the commentary, we rewrote a bit the following sentence:

“Thus, emotion-focused strategies might be more feasible among these subjects because of the positive bias in emotional processing, and then turning the emotional processing “easier”.”

We agree with the reviewer regarding the next sentence, so we deleted the following lines:

“In that sense, research has shown that the acute administration of hallucinogens impairs cognitive processing [78, 79] (although this is less evident in experienced users [80]), which, again, contradicts the results obtained in this study that made no distinction between acute, subacute, and long-term effects.”

Regarding the point about the last paragraph, these lines have been rewritten in a clearer way:

“In conclusion, this preliminary research focusing on coping strategies should be interpreted with caution, considering the complexities associated with emotional/cognitive performance and their connections to predominant coping strategies”

 

·        Spanish sample: The discussion focuses on the comparison of psychedelic and psychotic states, which is interesting, but the initial research question should also be addressed. Furthermore, it seems a little far-fetched to infer from differences between two groups (psychedelic users assessed outside the acute psychedelic state vs. people with schizotypal traits) to differences between the acute psychedelic vs. psychotic state. Similarly, the conclusion that reduced wishful thinking indicates reduced openness to conspiratorial ideologies reaches very far, as the link is established via schizotypal traits that were not assessed in this paper.

We completely agree with the reviewer, and actually the last part of the commentary has been already addressed due to a previous commentary, deleting the part of conspiracy.

The discussion on psychotic/psychedelics was included not only because it is interesting (we truly think it is!), but also because it was the only significant result obtained in the Spanish speakers, so it is challenging for us to discuss more results since stating that no differences were found is the only basically needed.

Ok, I understand although I still find it difficult to infer from differences between two groups (psychedelic users assessed outside the acute psychedelic state vs. people with schizotypal traits) to differences between the acute psychedelic vs. psychotic state. But, of course, it is up to the authors to discuss it.

·        After the discussion of results from the different cultures, a summary of findings across cultures would be interesting to read.

As stated earlier, the results can be summarized as has been already done in the following lines:

“A diffuse pattern of adaptive coping strategies adopted by hallucinogen users can be observed. The frequency at which hallucinogen users used most of the coping strategies was equal to non-users, with the exception of wishful thinking, which they were less engaged with”

See above, also problem-focused engagement/disengagement?

 “However, in the present study, we were unable to find strong relationships between coping strategies and hallucinogenic drug use.”

See above, the results section reports relationships between hallucinogenic drug use and problem-focused engagement/disengagement, emotional experience, and wishful thinking.

As unfortunately no more significant results were found.

 

·        The limitations are very short and do not sufficiently describe how results could be biased.

The following lines have been included:

“Furthermore, there were some crucial differences between the samples from different cultures (e.g., a higher presence of mental disorders among the English speakers) that could have affected our results.”

·        The conclusion does not reflect the results presented (e.g., states that no differences were observed between users and non-users).

The conclusions have been rewritten as follows:

“When comparing hallucinogenic drug users and non-users, two main findings were observed: the former used problem-focused coping strategies more often and used the strategy based on wishful thinking less often. Besides these findings, users of hallucinogens were not found to differ from non-users in other coping strategies. This suggests that coping strategies are only a marginal factor distinguishing hallucinogen users from non-users in terms of explaining the better scores obtained by the former in mental health and well-being in studies assessing the impact of the COVID-19 pandemic. The overall pattern of coping strategies adopted by hallucinogen users and the specific case regarding wishful thinking contributes evidence to support the hypothesis that hallucinogens and the hallucinations they induce strongly differ from psychotic states. These findings have strong implications for research involving the use of hallucinogens as a model for psychosis.”

 

Note that the final paragraph of the abstract has been modified according to the new inclusions:

“Further research should take into account that coping strategies are only marginally associated with hallucinogenic drug use. Other underlying mechanisms that might explain the better adjustment of users of hallucinogens to pandemics should be explored.”

 

Author Response

Rebuttal letter #2

 

Thank you for the revision of the manuscript. However, some points are still open. In particular, the presentation of results is still not clean (e.g., some results in the text do not match the table) and the summary of results in the discussion does (in certain parts) not match the results presented in the results section. This should be revised before publication. (New comments in green).

The authors provide a good overview of different coping styles, coping during COVID-19, and possible points of action of psychedelics. The transition to the actual study, however, is quite short and the reader does not receive information on what the authors were expecting to find (hypotheses). Did authors expect better or worse coping strategies among users of psychedelics? What would be considered as helpful coping strategies in the chosen instruments to assess coping? Which coping strategies should predict hallucinogen use during COVID-19?

Thank you for this appreciation. We have modified the second paragraph of page 4 as follows:

However, the exact mechanisms through which this putative protective effect is exerted are still largely unknown. This study represents a first key step towards shedding light on this phenomenon. Appropriate coping strategies during the pandemic, apart from the previous ones mentioned (e.g., acceptance, humor) [20–25], have been described in relation to personal care-based measures, social connectedness, and activity-based measures [55]. Reasonably, we expect hallucinogenic drug users to use those healthier coping strategies to a greater degree than non-users, as this might partially explain their better scores on mental health and well-being during the COVID-19 pandemic [53, 54].  We should not forget that the directionality of these findings is still uncertain, as it is possible that those engaging in positive coping strategies are precisely the individuals who regularly use hallucinogens. 

Thanks for clarification.

 

Methods

Even if the survey was described in a different publication, authors should give some basic information about the survey and its sample also in this publication (e.g., what was the aim of the survey, what were the inclusion and exclusion criteria for participation, etc.). Furthermore, the authors describe a longitudinal study but refer in the description of the survey to another publication that describes a cross-sectional survey, please clarify.

Certainly a good point. We have modified the paragraph as follows:

We used data from a previous longitudinal study that was launched through an online survey in April, 2020, with two follow-ups at two and six months after baseline. The main objective of the survey was to collect information about the relationship between the detrimental effects of the COVID-19 pandemic and the use of hallucinogenic drugs. Additionally, other relevant measures were included, such as personality, psychopathology, and coping strategies. The first, cross-sectional results of this study were published, and the methods can be consulted there for more detail [53]. The survey was launched in Spanish, Portuguese, and English, and it reached an international sample. At baseline, 2971 participants were recruited, followed by 1024 subjects at the first follow-up, and 455 subjects for the second one. The same sample was used in the present study.

Ok, thank you for providing extra information.

 

 

• Section 2.4: “Participants were asked about their use of hallucinogenic drugs.” What exactly was asked for? In general, it would be helpful for the reader if the authors could provide the survey in the supplement of the article.

We will submit the survey in the supplement of the article as suggested.

Additionally, we included the following lines at the end of page 5:

For each of them, participants were asked to select one of the following options: I have not tried it; I have tried it, but I do not regularly consume it; I take it 1 to 2 times every 6 months; I take it between 3 and 5 times every 6 months; I take it more than 6 times every 6 months (at least once per month).

Ok, thank you. The supplement should be referred to in the text of the manuscript.

We now refer to the supplement on page 3 in the Samples alinea.

• Section 2.6:

o   Linear regression: Please clarify what was used as the predictor and what was the response variable.

We clarified the sentence in the third paragraph of page 6:

Then we ran linear regression to assess baseline associations between each coping mechanism and occasional and regular users of hallucinogenic substances as compared to never-users, using the frequency of hallucinogen use as the predictor variable.

Thanks for clarification.

o   GEE: Please clarify the variable “hallucinogenic drug use over time”. Is it correct that it refers to the frequency of psychedelic use during COVID-19 (after baseline)? In table 3 it says “lifetime use of psychedelic drugs”.

We modified the sentence as follows:

“the use of hallucinogens over time (users/non-users),”

Thank you but this does not yet clarify what period “use over time” refers to. If I understand the idea of the paper correctly, baseline coping strategies were used to predict psychedelic use after baseline (=use during pandemic). However, in the heading of table 3 it says “lifetime use of psychedelic drugs” which suggests to me that baseline values of coping strategies were used to predict life-time use of psychedelics. 

At the baseline measurement, the term ‘lifetime use of psychedelics’ indeed means at any time during their life. However, at the follow-up measurements, the potential new cases of use would only indicate use of psychedelics during the pandemic. Unfortunately, we did not measure the amount that persons used during the follow-up, only whether they used any substance or not. A more specific question was whether they used more or less as compared to the previous time point, but this would still not specify the exact frequency.

We now added the following sentences to the Methods parts on page 4:

“Participants were asked about their lifetime use of hallucinogenic drugs… During the follow-up measurements, we did not ask the specific frequency, so only re-coded each participant as user of hallucinogenic drugs (yes/no).

Results

• Table 1:

o   Please clarify the meaning of “partner status”

In the updated version of the tables it can be read

“% of participants with a partner”

Thank you. However, in the current version that I received, it still reads “partner status”.

Now we adjusted this version, and the reviewer can now see % of participants with a partner. We added the following on page 4:

“For each participant, we recorded whether participants have a partner (yes/no).”

Also in Table 1, we added “having a partner”.

o   There is a high percentage of participants with mental diseases, especially in the English sample. Could this have affected results?

Certainly a good point. We included some lines in the end of paragraph 3, page 8:

Another important point to consider in the case of English speakers is that a high percentage (37.4%) reported having mental disorders. This could affect the results obtained in terms of coping strategies and the way in which individuals deal with the experiences elicited by hallucinogenic drugs.  

Ok, thanks.

o   Substance use: what do numbers refer to (e.g., lifetime use, recent use, regular use)?

Thanks, now this heading is as follows:

Substance use; N (%) of users

Thank you. However, it is still not clear to the reader what reference frame this relates to (e.g., are numbers indicating life-time use of the respective substance, or use in the past month, etc.)

We refer to substance use as the lifetime use of psychedelic substances.

• Section 3.1

o   In the text of the second paragraph, it should be noted that results refer to the English sample

Thanks for noting that. We have included in the beginning of the first sentence:

“In the case of English speakers, linear regressions”

Ok.

o   The results read as if mean differences between the groups were calculated. Please clarify.

We have included the following sentence in paragraph 3, page 7:

Among the Spanish speakers, regular users of hallucinogens scored significantly lower, as informed by ANOVA, than non-users on the wishful thinking scale.

Thank you. I asked because according to the method section result represenation of a linear regression is expected by the reader (although results will be identical).

We have now included the following sentence in paragraph 3, page 6, as we indeed did a linear regression instead of ANOVA in Table 2:

“Among the Spanish speakers, regular users of hallucinogens scored significantly lower, as informed by linear regression, than non-users on the wishful thinking scale.”

• 
  Section 3.2

o   English sample: the text does not match the table (e.g., “both problem-focused coping strategies were related to lower … GSI scores” à no significant value in table)

The sentence has been rewritten as:

whereas both problem-focused strategies were associated with lower general health and only problem-focused disengagement with a lower GSI score.

Thank you. However, if I understand the data correctly, the text still doesn’t match the results presented in the table (e.g., problem-focused disengagement GSI p-value of 0.004 and also emotion-focused engagement GSI p-value of 0.04 are higher than the p-value of 0.003 that was set in the method section). The text should be closely checked if the results are presented correctly.

Thank you for this comment. We checked the text carefully and compared it to the results in the Tables. It seems a writing mistake.

In section 3.2 we now adjusted the paragraph:

“According to data collected using the English questionnaire, both emotion-focused coping strategies were related to lower general health, and only emotion-focused disengagement was associated to higher GSI scores, whereas problem-focused strategies were only associated with better scores in general health in the case of problem-focused disengagement. Regarding hallucinogenic drug use, both scales of problem-focused strategies were associated with a higher use of these drugs.”

 

Discussion

• It should be considered to revise the discussion comprehensively. The lack of hypotheses in the introduction makes it difficult for the reader to interpret the results. Do findings indicate more or less helpful coping strategies? Furthermore, some arguments in the discussion are hard to follow or seem too far-fetched for the data presented in the results section. Integration of findings across languages is lacking, and the results of the longitudinal analysis are not discussed.

According to the reviewer, we included in the introduction our initial hypotheses, especially in the following sentence:

“Reasonably, we expect hallucinogenic drug users to use those healthier coping strategies to a greater degree than non-users, as this might partially explain their better scores on mental health and well-being during the COVID-19 pandemic”

Thus, we consider that now the results could be better understood.

Yes, that was helpful, thank you.

 

However, clear patterns in our results were not observed, and we state this in the following lines (paragraph 4, page 9):

“A diffuse pattern of adaptive coping strategies adopted by hallucinogen users can be observed. The frequency at which hallucinogen users used most of the coping strategies was equal to non-users, with the exception of wishful thinking, which they were less engaged with”

The results section also reports significant changes in problem-focused engagement and disengagement.

The 3^rd paragraph on page 10 focuses on the coping strategies in the English speakers, and here we discuss the associations between problem-focused coping and more regular hallucinogen use at baseline (reported in Table 2).

But on the last paragraph on page 10 we now adjusted this sentence:

“A diffuse pattern of adaptive coping strategies adopted by hallucinogen users can be observed. The frequency at which hallucinogen users used most of the coping strategies was equal to non-users across the three cultures, with the exception of problem-focused coping in English speakers and wishful thinking in Spanish speakers.”

Or in the same paragraph:

“However, in the present study, we were unable to find strong relationships between coping strategies and hallucinogenic drug use.”

The results section reports relationships between hallucinogenic drug use and problem-focused engagement/disengagement, emotional experience, and wishful thinking.

We now adjusted this text into:

“However, in the present study, we found significant associations between problem-focused coping (English speakers) and emotional experience and wishful thinking (Spanish speakers) and hallucinogenic drug use over time.”

So we cannot conclude, unfortunately, that more or less helpful coping strategies were used by users of hallucinogens. We did our best when delineating the results, connecting them with related topics in order to offer a wider background. But this is an example of negative results obtained while doing research. They are not surprising nor confirm the main hypothesis, but should be still published, since after that paper it would be more appropriate for researchers looking for the underlying psychological mechanisms that seems to protect users of hallucinogens in front of social stressors to look other variables not related with coping strategies.

Additionally, we made a number of corrections taking into account the commentary of the reviewer. Regarding the potential far-fetched arguments, we deleted this paragraph, mainly because of the far-fetched suggestion highlighted in yellow:

“In relation to the previous point, the number of conspiracy and “negationist” theories surrounding COVID-19 has been remarkable [92, 93]. This ideology might be linked to enhanced scores in wishful thinking, as schizotypal traits have been associated with wishful thinking and the belief in conspiracy theories. Thus, this study suggests that people who regularly use hallucinogens are not open to conspiratorial ideologies, but further studies should explore relationships between followers of conspiracy theories, schizotypal traits, and the use of hallucinogens.”

Ok, thanks.

The following sentence: “might constitute strong evidence supporting” (first paragraph of page 9) has been rewritten as “might constitute preliminary evidence supporting”

We have included some words in order to clarify in the first lines of paragraph 2 of page 10:

“A diffuse pattern of adaptive coping strategies adopted by hallucinogen users can be observed. The frequency at which hallucinogen users used most of the coping strategies was equal to non-users across the three cultures, with the exception of wishful thinking in Spanish speakers”

See above. The results section also reports significant changes in problem-focused engagement and disengagement?

As we answered above, we now adjusted this sentence into:

“A diffuse pattern of adaptive coping strategies adopted by hallucinogen users can be observed. The frequency at which hallucinogen users used most of the coping strategies was equal to non-users across the three cultures, with the exception of problem-focused coping in English speakers and wishful thinking in Spanish speakers.”

Lastly, as suggested by the reviewer, we extend the discussion regarding the longitudinal analyses, adding the following paragraphs at page 9:

“Regarding the longitudinal analyses, in the English questionnaire the use of emotion-focused coping strategies was associated with poorer general health and higher scores on the GSI, indicating a greater presence of psychopathology according to the study assessments, and also with a less frequent use of hallucinogens.

If I understand it correctly, this was not reported in the results section

We now adjusted this sentence into:

“Regarding the longitudinal analyses, in the English questionnaire the use of emo-tion-focused coping strategies was associated with poorer general health and higher scores on the GSI, indicating a greater presence of psychopathology according to the study assessments, and also with a less frequent use of hallucinogens.”

In contrast, the use of problem-focused strategies was associated with better general health and GSI scores, except for the specific scale of problem-focused engagement in the latter, and with more frequent use of hallucinogens. It should be noted that it has been generally stated in the literature that problem- and emotion-focused strategies are difficult to discriminate, as they may be used simultaneously and constitute parts of the whole coping process [92]. Thus, the following discussion about our findings should not be interpreted dichotomously. There is likely a mix of problem/emotion orientation in most cases, although a clearer trend can occasionally be drawn. The results observed are consistent with previous findings, as some research reported that emotion-oriented strategies may be less adaptive in the long-term than problem-oriented ones [93]. Nonetheless, the stressor that activates such strategies is also important. For instance, people diagnosed with chronic illnesses tend to adopt emotion-focused strategies [94, 95], since problem-focused ones are intended to intervene in the problem, but in the case of suffering diseases without a cure it is common to ascribe them to uncontrollable factors.

Among Spanish speakers, positive coping strategies (e.g., cognitive restructuring, social support) were associated with better general health and GSI scores, whereas negative strategies (e.g., self-criticism, social withdrawal, wishful thinking) were related to worse general health and GSI scores. This is in line with a robust body of research about coping strategies [96].

In the case of Portuguese speakers, the trend is also similar to the one observed in the literature [96]. The use of strategies like acceptance of responsibility and escape-avoidance were related to poorer general health and GSI scores, while using strategies like problem solving and social support was related to better scores at both measures according to the study assessments.

The finding that no association between coping style and psychedelic use was observed for the Spanish and Portuguese sample should also be named in the summary.

We thank the reviewer for this suggestion. These paragraphs mostly mention the associations between coping and stress-measures. However, in the last paragraph on page 10, where we discuss the associations with the use of hallucinogens, we added the following sentence:

“None of the coping strategies was associated to hallucinogens use in the longitudinal analyses.”

• English sample: I do not understand why increased positive emotion processing should be associated with more emotion-focused coping. Has this been shown in previous literature? Similarly, why should acute impairments of cognitive processing during the psychedelic experience result in (generally) decreased problem-focused coping strategies? The last paragraph states that the research “should be interpreted with caution and adequate context should be provided” but it remains somewhat obscure what this means.

Regarding the first part of the commentary, we rewrote a bit the following sentence:

“Thus, emotion-focused strategies might be more feasible among these subjects because of the positive bias in emotional processing, and then turning the emotional processing “easier”.”

We agree with the reviewer regarding the next sentence, so we deleted the following lines:

“In that sense, research has shown that the acute administration of hallucinogens impairs cognitive processing [78, 79] (although this is less evident in experienced users [80]), which, again, contradicts the results obtained in this study that made no distinction between acute, subacute, and long-term effects.”

Regarding the point about the last paragraph, these lines have been rewritten in a clearer way:

“In conclusion, this preliminary research focusing on coping strategies should be interpreted with caution, considering the complexities associated with emotional/cognitive performance and their connections to predominant coping strategies”

 

• Spanish sample: The discussion focuses on the comparison of psychedelic and psychotic states, which is interesting, but the initial research question should also be addressed. Furthermore, it seems a little far-fetched to infer from differences between two groups (psychedelic users assessed outside the acute psychedelic state vs. people with schizotypal traits) to differences between the acute psychedelic vs. psychotic state. Similarly, the conclusion that reduced wishful thinking indicates reduced openness to conspiratorial ideologies reaches very far, as the link is established via schizotypal traits that were not assessed in this paper.

We completely agree with the reviewer, and actually the last part of the commentary has been already addressed due to a previous commentary, deleting the part of conspiracy.

The discussion on psychotic/psychedelics was included not only because it is interesting (we truly think it is!), but also because it was the only significant result obtained in the Spanish speakers, so it is challenging for us to discuss more results since stating that no differences were found is the only basically needed.

Ok, I understand although I still find it difficult to infer from differences between two groups (psychedelic users assessed outside the acute psychedelic state vs. people with schizotypal traits) to differences between the acute psychedelic vs. psychotic state. But, of course, it is up to the authors to discuss it.

We agree that this comparison is less relevant in the Abstract and the Conclusions as we did not exactly measure schizotypal traits nor the psychotic state, but in our opinion still be discussed in the rest of the Discussion. Therefore, we deleted this part in the Abstract, and the Conclusions.

• After the discussion of results from the different cultures, a summary of findings across cultures would be interesting to read.

As stated earlier, the results can be summarized as has been already done in the following lines:

“A diffuse pattern of adaptive coping strategies adopted by hallucinogen users can be observed. The frequency at which hallucinogen users used most of the coping strategies was equal to non-users, with the exception of wishful thinking, which they were less engaged with”

See above, also problem-focused engagement/disengagement?

As we answered above, we now adjusted this sentence into:

“A diffuse pattern of adaptive coping strategies adopted by hallucinogen users can be observed. The frequency at which hallucinogen users used most of the coping strategies was equal to non-users across the three cultures, with the exception of problem-focused coping in English speakers and wishful thinking in Spanish speakers.”

 “However, in the present study, we were unable to find strong relationships between coping strategies and hallucinogenic drug use.”

See above, the results section reports relationships between hallucinogenic drug use and problem-focused engagement/disengagement, emotional experience, and wishful thinking.

As we mentioned above, we adjusted this text into:

“However, in the present study, we found significant associations between problem-focused coping (English speakers) and emotional experience and wishful thinking (Spanish speakers) and hallucinogenic drug use over time.”

As unfortunately no more significant results were found.

 

• The limitations are very short and do not sufficiently describe how results could be biased.

The following lines have been included:

“Furthermore, there were some crucial differences between the samples from different cultures (e.g., a higher presence of mental disorders among the English speakers) that could have affected our results.”

• The conclusion does not reflect the results presented (e.g., states that no differences were observed between users and non-users).

The conclusions have been rewritten as follows:

“When comparing hallucinogenic drug users and non-users, two main findings were observed: the former used problem-focused coping strategies more often and used the strategy based on wishful thinking less often. Besides these findings, users of hallucinogens were not found to differ from non-users in other coping strategies. This suggests that coping strategies are only a marginal factor distinguishing hallucinogen users from non-users in terms of explaining the better scores obtained by the former in mental health and well-being in studies assessing the impact of the COVID-19 pandemic. The overall pattern of coping strategies adopted by hallucinogen users and the specific case regarding wishful thinking contributes evidence to support the hypothesis that hallucinogens and the hallucinations they induce strongly differ from psychotic states. These findings have strong implications for research involving the use of hallucinogens as a model for psychosis.”

 

Note that the final paragraph of the abstract has been modified according to the new inclusions:

“Further research should take into account that coping strategies are only marginally associated with hallucinogenic drug use. Other underlying mechanisms that might explain the better adjustment of users of hallucinogens to pandemics should be explored.”

 

Author Response File: Author Response.docx