A return of scenes from the past. A sudden insight, or understanding. A feeling of peace or pleasantness. A feeling of happiness, or joy. A sense of harmony or unity with the universe. Confrontation with a brilliant light. The senses feel more vivid. An awareness of things going on elsewhere, as if by extrasensory perception (ESP). Experiencing scenes from the future. A feeling of being separated from the body. Experiencing a different, unearthly world. Encountering a mystical being or presence, or hearing an unidentifiable voice. Seeing deceased or religious spirits. Coming to a border, or point of no return. In a study published in The Lancet van Lommel and colleagues list ten elements of the NDE: Awareness of being dead. Positive emotions. Out of body experience. Moving through a tunnel. Communication with light. Observation of colours. Observation of a celestial landscape. Meeting with deceased persons. Life review. Presence of border. After-effects According to sources the NDE is associated with a number of after-effects, or life changing effects. The effects, which are often summarized by researchers, include a number of value, attitude and belief changes that reflect profound changes in personality, and a new outlook on life and death, human relations, and spirituality. Many of the effects are considered to be positive or beneficial. van Lommel and colleagues conducted a "longitudinal follow-up research into transformational processes after NDEs" and found a "long-lasting transformational effect of the experience". However, not all after-effects are beneficial. The negative effects can be very large and prevalent. The literature describes cases of NDE where changes in attitudes and behaviour can lead to distress, psychosocial, spiritual and physiological problems. The negative effects of NDE often have to do with adjustment to the new situation following a near-death experience, and the issues that comes with reintegration into ordinary life. According to Bruce Greyson, those who experienced NDE may also have difficulty maintaining relationships due to the fear of rejection or being ridiculed when discussing the events that occurred during the NDE. This fear of being judged or ridiculed also causes a problem when needing to talk to a professional. Some NDErs have received negative reactions from professionals, thereby discouraging many who are in need of help to seek it, which is essentially where the fear of sharing the experience with others originated from. Consequently, many NDErs find great difficulty in sharing the experience of NDE and how it