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The psychedelic crisis: bad trip
Information on what a bad trip is, how to prepare for good trips, avoid bad trips, deal with bad trips, help others having bad trips, heal after a bad trip and much more.
Are you having a bad trip right now? Click Here for advice.
A psychedelic crisis (often called a bad trip) is a psychedelic experience which is perceived to be negative.
This article aims to give comprehensive information on what to expect and how to handle a psychedelic crisis, both for the tripper and the trip sitter. Additionally, the article will attempt to explicitly convey the nature of the psychedelic crisis in terms of intensity, varied nature of subjective experience and psychological implications. Often, websites which feature information on the psychedelic crisis state that it can be terrifying and horrible. Such statements, while true, do little to convey the nature of the experience, an understanding of which is necessary in order for rational risk assessments to be made.
This article should be considered a work in progress. If something is not included, that does not mean it is considered inaccurate or irrelevant.
Any portion of text which as a whole is indented and has a footnote after it is a direct quote. Click on the footnote if you are interested in the source.
A psychedelic crisis (often called a bad trip) is a psychedelic experience which is perceived to be negative. Typically, then, it involves the onset of emotions such as anxiety, fear, paranoia, revulsion, despair and anger. These emotions are often accompanied by an altered perception of the world and the self, which is often amplified and animated by the hallucinatory effects of psychedelics. Subjectively, the perceived content of a psychedelic crisis is limited only by the imagination. Reports include fear of going insane, being trapped in universe where time is cyclical, alien encounters, seeing the devil, the end of the world, and perceived sudden sexual orientation change. Externally, the behavior of someone undergoing a psychedelic crisis can be equally varied. It can include catatonic states, panic episodes, crying, repeating the words of others, acute hyperactive paranoid states, taking clothes off, and, rarely, violence. A more complete list including some behaviors that can not be described so easily will be included later.
Subjectively, an anxiety or panic attack is commonly what initiates a psychedelic crisis. The feeling is one of dread and fear washing over you. It might be felt physically, like a blanket is covering you, or as if something is squeezing your heart. Symptoms of a panic attack also include difficulty breathing, tightness of chest and sweaty palms.
Some bad trips are worse than others. The following list details some classic symptoms which are indications of bad trips. Each of these symptoms can be mild, moderate or extreme depending on how severe the bad trip is.
Signs that a regular psychedelic crisis is becoming an extreme psychedelic crisis (getting worse):
There is a critical level where the tripper becomes unresponsive to communication. If this occurs, they are very far gone and very possibly they will get a lot worse. Unresponsive means that they don’t show any sign that they know where they are, what they are, or what is happening. It seems likely that this is what occurs when, as the psychiatrist S Grof puts it, the inner world is confused with the outer world, resulting in sensory input data no longer being regarded as such by the tripper, and therefore normal response is not triggered.
There is a tremendous danger of confusing the inner world with the outer world, so you’ll be dealing with your inner realities but at the same time you are not even aware of what’s happening, You perceive a sort of distortion of the world out there. So you can end up in a situation where you’re weakening the resistances, your conscious is becoming more aware, but you’re not really in touch with it properly, you’re not really fully experiencing what’s there, not seeing it for what it is. You get kind of deluded and caught into this.
A sitter is a person (or persons) who are there to help deal with a bad trip if one occurs. Ideally they would be sober because it is a job which when best done requires full attention. The following are some tips for sitters.
Julie Holland is a psychiatrist with extensive experience in dealing with people brought into hospital for a psychedelic crisis. Her approach is as follows
The real way to handle a psychedelic emergency is by listening, being present, and making space for whatever is coming up. The patient is opened up, like never before, and vulnerable to the influence of those around him or her. A patient in a psychedelically induced 'crisis' is in need of empathy and connection, not just reassurance that it will end soon. Primarily what is required is for the patient to debrief, unload, and otherwise try to verbalize their experience, hopefully with a measure of acceptance of the history and compassion for the self.If they are responsive to verbal communication then that is a good sign. Talk to them, but be careful what you ask. Asking them their name can confuse them- Asking their name and date of birth over and over to try and keep them talking, for example, could lead to the tripper starting to think they had been in a car crash, were being questioned by a paramedic, and that they had killed people.
The strategy of talking to them about what they are experiencing depends on their mental state being responsive. If they are too far gone, this strategy is impossible. Read the section on the extreme psychedelic crisis for further information.
Julie Holland describes her understanding of the nature of the psychedelic crisis:
One thing I noticed during my nine years at the psych ER was how certain patients reminded me of my tripping high school friends. Patients in a manic episode were often describing their thoughts and ideas to me, and many of them spoke to me about religious epiphanies, a felt oneness with the universe, feeling enlightened, everything suddenly made sense. There was this sense of wonder at the universe, a sense of awe, how everything was connected. The boundaries between self and other dissolve.
This may be required if they are thrashing around near something very hard or sharp, or if they are displaying hostile or self-destructive behavior. Remember, physically retraining someone on a bad trip is likely to make them worse and holding someone in the wrong way can easily result in a dislocated shoulder or muscular damage due to over exertion. Try to keep contact time and force to a minimum. For example, steer someone gently but forcibly away from danger, rather than grabbing them and trying to hold them on the floor. See the ambulance section for info on calling an ambulance
Prevention of a psychedelic crisis is dealt with in this section and will include:
These factors are to be relevant to preparation for a psychedelic experience. There is another aspect to prevention which is immediate psychological techniques which are relevant should a psychedelic crisis initiate. This will be dealt with in the 'advice for the tripper' section.
Also, what should be obvious but is nonetheless often the cause of bad trips is getting the dosage wrong or taking a different substance, either mistakenly or due to deceit. It is vital that scales that are accurate enough to properly measure whatever substance is being taken are used. The user must also be confident they have not mistakenly weighed up something else. Although, even with the correct dosage bad trips can still happen. Finally, the mixing up of substances is not as common as misjudging dose but can not only create very intense bad trips but also kill people.
No one can be sure that they are free from the risk of experiencing a psychedelic crisis. The point is frequently made in the literature that even those who are judged to be normal by psychiatrists have been known to experience a psychedelic crisis.
There is no doubt that even apparently well-adjusted persons can be thrown into an acute psychosis requiring days or weeks of hospitalization.
Some of the worst reactions have been in persons, often physicians and other professionals, who appeared stable by ever indicatorThe nature of a psychedelic experience is reflective of the mental state of the individual. Although everyone is at some risk, then, those whose mental states are less stable, either from a diagnosed condition or from negatively perceived life circumstances, will be more at risk, more vulnerable, to an unstable experience.
Harmful aspects of the LSD experience (1967) is a study which suggests this is the case, for 'unstable', 'noncommitted individuals'. It draws the following conclusions:
It may be within the bounds of probability that LSD, alone, is not responsible for the psychiatric disorders here reported. It seems evident that the LSD experience is influenced by the individual's personality, his set and setting
persons functioning in jobs or as students just prior to testing were far less likely to be psychiatrically disturbed by their LSD experiences
LSD in our study is likely to be disruptive for some unstable, noncommitted individuals who take the drug in a setting without medical support and protection.That personality plays a significant part in shaping the experience of the individual, and that therefore those with a current unsuitable mental state are at greater risk is corroborated by another study. Schwartz outlines Klee and Weintraub's findings:
Klee and Weintraub (1959) described four cases of paranoid reactions lasting a few days in 'normal' subjects given LSD. They linked these reactions with the previous personalities and emphasized the need for careful screening and handling of volunteers "since paranoid reactions following LSD may become prolonged" Additionally, if a person has a history of mental illness in their family then they should consider themselves to be at greater risk. Latent mental illnesses can be triggered by a psychedelic crisis. More on this in the "after a bad trip" section.
A final caveat is that previous successful LSD experiences does not mean future sessions will be successful. So, even if you fall under one of these at-extra-risk categories and have used psychedelics without problems, do not consider this to mean anything other than the risk is lower than 100% and so you had a chance to get lucky.
"the events of the LSD-25 sessions could not be predicted on the bases of pre-LSD-25 experience with the patient" There are studies which have given statistical evidence on the rate of psychotic episodes.
Data on 5,000 patients given a total of 25,000 sessions
Cohen's evidence also corroborates the view that individuals suffering from diagnosed conditions are at more risk of having problems with psychedelic drug use.
Set and Setting refers to your preparation for your psychedelic experience. Set is your mindset, setting is the physical environment you are in. This chapter will mainly consist of various takes on set and setting by experts.
The nature of the experience depends almost entirely on set and setting. Set denotes the preparation of the individual, including his personality structure and his mood at the time. Setting is physical − the weather, the room's atmosphere; social − feelings of persons present towards one another; and cultural − prevailing views as to what is real. -Timothy Leary & Richard Alpert (Ram dass)
the first and most important thing is to create the right circumstances, a protective environment. And do it in an internalized way. Don’t interact with the external world until you know that you’re back to your ordinary reality testing ... That’s the right set and setting. A lot of it [negative outcomes] can be prevented with the right set and setting. And with the right person being there with you. (S.Grof)
Set and setting have been widely recognized as the two most important factors in undertaking a psychedelic experience. Of these, set has the greatest influence.
Potential causes of a 'bad trip'
If a person is in crisis secondary to a psychedelic substance, here are some of the potential components of what has created that crisis: Choosing a bad setting (or having one befall you) for the experience to take place; being unprepared (poor set); trying to control the altered state instead of letting it have its way with you; and the most important element, I believe: what comes bubbling-up into consciousness courtesy of the catalyst ingested. -Julie Holland
Set includes the contents of the personal unconscious, which is essentially the record of all one's life experience. It also includes one's walls of conditioning, which determine the freedom with which one can move through various vistas. Another important aspect of set consists of one's values, attitudes, and aspirations. These will influence the direction of attention and determine how one will deal with the psychic material encountered.
Setting, or the environment in which the experience takes place, can also greatly influence the experience, since subjects are often very suggestible under psychedelics. Inspiring ritual, a beautiful natural setting, stimulating artwork, and interesting objects to examine can focus one's attention on rewarding areas. Most important of all is an experienced, compassionate guide who is very familiar with the process. His mere presence establishes a stable energy field that helps the subject remain centered. The guide can be very helpful should the subject get stuck in uncomfortable places, and can ask intelligent questions that will help resolve difficulties, as well as suggesting fruitful directions of
exploration that the subject might have otherwise overlooked. The user will also find that simply sharing what is happening with an understanding listener will produce greater clarity and comfort. Finally, a good companion knows that the best guide is one's own inner being, which should not be interfered withunless help is genuinely needed and sought.
One hears a lot about “preparation” for the LSD experience. You may wonder what sort of preparation you should undergo. Actually you have been preparing all your life, and those many years of preparation will outweigh anything you can do in a short time before the session. Being told to prepare for a session is a little like being told to “prepare to meet your Maker” a few hours before you are going to be shot.
If there is any last-minute preparation for the LSD experience, it would be in the nature of refreshing in your mind the things that are dearest and most sacred to you. Don’t plunge into oriental philosophy, unless you are already a lover of it. The psychedelic state is no more eastern than western. Think about the things you care about, the people you love, the things you hope to do with your life. Try to clear your mind of negative emotions — resentments, jealousies. Say something nice to your mother-in-law, or whoever fills that place in your world. A good conscience is the best preparation you can have.
On the technical side, preparation consists in making sure that the physical and social conditions of the session are as they should be. Decide well in advance who is going to participate in the session. You should all know, like and trust one another. The more you have shared of life in common with your session-mates the better. Until you are very experienced you should avoid taking LSD alone, and also avoid two-person sessions. This is especially true for unmarried couples, no matter what their sexual relationship. A two-person session is very difficult, because it puts the whole burden of social interaction on the two people. Talk is difficult on LSD. This is no problem in a group, since the group can sit quietly and nobody will be embarrassed. But in a two-person group a silence becomes awkward. Unhealthy hang-ups on what the other person is thinking and games of Mind Reader result. A relationship can be badly strained when two inexperienced people take LSD together. For your first several sessions stick to three or four member groups. Groups larger than five are to be avoided as to distracting.
If none of you are experienced it is a good idea to have a friend along who does not take any LSD.
note: Psychedelics are used to treat people with such trauma or issues. Taking psychedelics to 'self medicate' for this purpose without the supervision of a medical professional is highly inadvisable.
While I am convinced that one of the great cosmic commands is "Enjoy," there are traps in using these substances purely for recreation. The first is that a person seeking the delights of the senses may find himself overwhelmed by the eruption of repressed unconscious material without knowing how to deal with it. Another danger is that constant pleasure-seeking without giving anything back to life can distort the personality and ultimately produce more discomfort. The safe, sure way to rewarding outcomes with psychedelics is through intelligent, well-informed use.Anecdotal reports suggest that those who use psychedelic drugs for recreational purposes often come to believe that they must be 'respected' as something 'greater'. The process by which they learn this is often, unfortunately, a psychedelic crisis. It is entirely plausible that this is simply due to overuse, however, as often such reports feature frequent usage. Whether the danger of overuse is ultimately a negative psychological reaction due to pleasure seeking or simply due to a reaction to frequent consciousness alteration is not certain.
Is LSD then no fun? Is it not enjoyable? You have heard that it is an ecstatic experience. So it is, or can be. But this is a very different kind of fun from any that you know about, from ordinary recreation or other sorts of drugs. Going into an LSD session with the idea that it will all be a lark, a carefree “high”, is a mistake that leads to some bad session games.Unrealistic expectations:
I do believe that a healthy adult can have a safe and beneficial psychedelic experience, provided he knows what to do and his expectations are not unrealistic. Some of the common unrealistic expectations are: (1) that LSD will cure something; (2) that LSD will give you psychic powers; (3) that you can have a super sex experience on it; (4) that your LSD experience will be like your friend Joe’s, or like some experience you have read about; (5) that it will be like marijuana, only more so; (6) that if you don’t like it you can always take a tranquilizer and shut it off; (7) that LSD will improve your memory or I.Q.
the LSD experience, personal and subjective as it is, is affected more by the individual’s attitudes and behavior than by anything another can do for him.Common wisdom: "do not fight the trip" + "just go with the flow"
This advice can be true or false depending on how it is interpreted.
Not fighting the bad trip does not mean that you shouldn't be trying to get rid of it.
What people mean when they advise that you don't 'fight' the trip is that you shouldn't panic or worry or be tense in your body/mind. You should not in any way give in to the panic impulse. Your body and mind is triggering the natural panic, fight or flight state. You will want to freak out. To scream. To run around. Or even to just worry: to think of disaster, and about how you are going to be fucked up forever. These reactions are not rational, as they will not do any good, and the worries are unfounded. They are just the natural behavioral reactions and thoughts which arise once the panic reaction is triggered.
Objective: To understand that the panic being felt and negative thoughts/ideas/beliefs experienced are nothing more than a product of a negative mindset caused by the panic reaction. If specific anxiety occurs, to transition to general anxiety.
This is the three step calming planStep one: recognition
This is exceptionally important but isn't always easy. This is because it is often some X which is the focus of panic. This X could and often is a thought brought about by the psychedelic state. It could be a fear about something which is or you merely think is happening or could happen.
So, instead of thinking 'I am experiencing a panic reaction!' (general anxiety), which would put you in a position where you realised what was going on such that you know what you need to do (to calm down) you think 'X is happening !' (specific anxiety) In other words, you believe the fear.
There are three ways a bad trip can happen:
1) anxious thought leads to anxiety (specific) which leads to the impulse to freak out.
2) anxiety (general) leads to anxious thought (specific) which leads to the impulse to freak out.
3) Pure anxiety (general) which can be more easily dealt with.
In 1), if a thought leads to anxiety, then it is because the tripper has come to believe something which causes them to fear/worry. This could be that their friends are trying to kill them, that the world is about to end, that the devil is possessing them, and so on. So, this is a case of specific anxiety, where the core of the mindset is 'X negative circumstance is happening'. Anxiety/panic then follows this acquisition of thought.
2) is exactly the same, except that a panic reaction is the initial trigger. This can occur in the psychedelic experience for no apparent or clear reason. Once triggered, the mindset of the tripper will be negative and then the panic/anxiety will try to latch itself onto something. Greater self-awareness and experience with bad trips can lead to the ability to almost 'feel' this happening. The effect is that thoughts will arise in your mind which will be presented as worries/anxieties. They might be that their friends are trying to kill them, that the world is about to end, that the devil is possessing them, and so on. The core of the negative mindset in 2), as in 1), is 'X negative circumstance is happening'.
In 1), The fear is caused by the negative mindset which in turn is caused by the panic reaction.
In 2), the thought which leads to anxiety is dreamed up, induced by the hyper-suggestibility of the psychedelic state.
In both these cases, the consequence is specific anxiety - anxiety about a specific thing. You think "oh shit, this terrible thing is happening ! (aliens/devils/murdering friends, etc)" and this sets you down the path for increases in anxiety. The path for opposing anxiety begins with the recognition that you are simply experiencing an anxiety reaction and that is all that is going on. Your mindset is negative and so you are thinking negative thoughts. This recognition is essential.
The fear, then, is not about the real world and so is not rational as it can not be fear of any real danger. What the fear is of, then, is not actually important. This realisation is important in making the move from specific anxiety to general anxiety. The content of a trip, when anxiety is involved, can be disregarded, then, as irrational. So, if you suddenly find yourself worrying that you are going insane, that you will never stop tripping, that you are communicating with the devil, then these thoughts, whatever their content, can be dismissed as irrational, and rather than thinking 'X negative circumstance is happening!', such as, for example, 'I will never stop tripping!', you will, once successfully realising the irrational nature of the fear, think 'I am having a panic reaction!'. I repeat this, because of its importance.
The bad trip will now consist of 3), pure anxiety.
Step two: CalmingObjective: to reduce or completely get rid of anxiety
Focusing on breathing, and on keeping breathing slow and steady is effective and can be done by anyone. Direct your entire consciousness on the feeling of slowly breathing in and out, noticing every sensation. Notice the progression of sensation involved, and focus on the expectation of the next particular sensation. This drops your heart rate, and focuses your mind on calmness rather than the perceived negative aspects of the experience. You will calm down.
The pain and anxiety will not go away instantly. If you begin this but don't notice as much change as you would like, do not let yourself worry that it is not working. You need to realise that the anxiety will try to latch onto anything which you could worry about. When negative thoughts and worries do arise, you must ignore them and not believe them. It is your focus and attention on the fear and anxiety which causes it to rise.
Keep this thought in mind: I can not actually be harmed here. It feels horrible, but that is temporary and cannot hurt me. Nothing bad can actually happen.
Do not expect the anxiety, fear and pain to go away instantly. If it does, great, but if all you can manage is to stop it escalating or lower it then that is still a good achievement. Spend some more time calming yourself, remembering to focus on your breathing. This forces your body to calm down. It is your body which is responsible for your mental pain and only once the body has relaxed can the mind begin to relax.
Do not allow your muscles to be tensed
Do not whimper or speak with a shaky voice
Try not to shiver or shake (this is related to muscle tension)
Do not have a pained or anxious facial expression
It may take some time, but go through the routine in your mind- focus on the breathing, then think about your body, is anything not relaxed? The mind will follow.
Now say out loud "I feel fine". Say it like you mean it. Say it without your voice shaking. Keep trying until you manage it. Take deep breaths in between attempts. Understand that you can do this. And even if you can't, it really doesn't matter anyway- anxiety feels horrible but it can't harm you. So there really is nothing to worry about. This realisation will help you. It can seem like a lot of hard work is ahead of you and the fact that you have no real choice in the matter can be frightening, but know this: No one in your position has ever failed to come back from this.
Step three: new mental focus/distractionObjective: to perform an activity which engages the mind in a simple way
Once the initial panic has been overcome like this, get up, change your scene. do something which concentrates the mind in an easy way, like watching a film or tv show you have seen many times before. Ignore thoughts which might pop into your mind like 'you are pretending to be ok right now.. but really everything is HORRIBLE JESUSCHRIST WHAT THE FUCK IS HAPPENING'
This takes some conscious effort. So, 'going with the trip', which is the commonly expressed wisdom is completely misleading, because the natural reaction your mind wants to take is panic. You have to take control of the experience.
What counts as having successfully dealt with a psychedelic crisis is not necessarily a complete turnaround of a perceived negative experience into an enjoyable experience. If all you can manage is to reduce the initial panic into a steady level of moderate anxiety, then that is still a serious achievement. The strategy then is simply to wait until the drug effects have completely warn off and you are tired enough to sleep. Make sure you are tired enough, and don't necessarily lie down with the expectation of falling asleep. It might not happen, in which case you should not be worried, but accept that you need to wait longer. Just lie down and rest. If you manage to sleep, great, if not, you were keeping relaxed, which was great as well. Increases of anxiety can occur during this period, but are normal and if you keep the attitude described towards it then you will be fine.
Remember that the goal with all anxious thoughts "X is happening" is to stop believing the fear, and think instead "I am having a panic reaction !"
Some anxious thoughts are particularly difficult. Here are some examples:
"I am going insane !"
This is a very common anxious thought and it is particularly difficult to dismiss because when you think it, the anxiety increases, perhaps the visual hallucinations change in a sinister way (see here for interesting discussion on that), and you essentially feel worse. The problem is that this 'feeling worse' is easily mistaken for 'feeling insane' - it is mistaken for evidence that it is true that the person is going insane. Again the only advice is to try to breath slowly, remember this paragraph and remember that it is a mistake and untrue to think that. Ignore thoughts which might surface to make you more unsure, like "but I'm not a psychiatrist!" or "what if I suddenly black out now, and wake up having killed people". All thoughts must be taken as equally irrational. It might help some people to think "ok, even if I am insane, I can deal with that when I am sober. For now, I will just wait and breath slowly".
"The anxiety keeps escalating, if things keep getting worse then very soon it will be far too intense to handle !"
This fear can be terrifying, almost like seeing the instruments of torture which you know are about to be used on you. Again, you have to just remember that it is your actual fear of escalation which is causing the escalation. You can stop it from getting worse. If you can dismiss the feeling, then you can refer back to this success if the feeling ever arises again, and draw confidence from it. Distract yourself, and then 5 minutes or so later, think to yourself about how you thought you were going to get far worse for sure, and how you were wrong about that.
More info on malleability
It is often an experience of interest to the person experiencing a psychedelic crisis to note how malleable their feelings and emotions are. Focusing the mind to be positive often results in the experience becoming positive. A natural extension of this is to introspectively analyse the actual feelings involved and wonder if they are actually positive or even enjoyable.
introspective question when perceiving negativity: Am I actually having a positive experience, rather than a negative one?
Answering "Yes" can then lead to "But then what was I worrying about before?". This can reinforce the idea that there must have been something to worry about. The difficulty to overcome is in understanding that anxiety need not have a rational cause.
People experiencing this mental osscilation caused by the the interplay between higher and lower levels of psychological confidence and greater and lesser degrees of psychological control have varied reactions. Commonly, they alternate between laughing and crying at a disturbingly rapid rate. Ultimately, however, this is a learning experience in familiarity with the aspects of the causal structure of emotional states.
Find out what the time is, and work out when the various milestones of a trip are, such as the end of the peak, and the comedown. This will ground you in reality and give you an idea of when to expect the trip to end.
Here is a graph which represents the level of effects of the LSD over time:
If you have a trip sitter, talk about what you are feeling, and be open.
Once you say to yourself that you are not enjoying the experience, you are in danger of a panic reaction. There is no turning away from the experience. You look down at your hands, and you see them morphing and weaving, you close your eyes and you see fractal CEVs and odd bodily sensations become more pronounced. It is helpful to focus the mind on something, like a movie or TV show that you have seen many times before and is easy on the mind.
This section deals with some drugs that can be used to help deal with a psychedelic crisis.
Drugs should not be forced on people who are having a psychedelic crisis. Not only are you almost certainly likely to fail, the act will likely make them far worse. Any position you might have been in to help them is immediately forfeit when they no longer trust you. This includes trying to hide pills in food.
Of this section, only the benzodiazepines subsection is complete.
First, some perspectives on using sedative/anti-psychotics to help deal with a bad trip:
You see they can’t get you “off” LSD before it runs its natural course. Asking your friends to bring you down is as practical as asking your fellow passengers on a transatlantic jet to stop the plane and let you off in mid-flight. I don’t advise stocking so-called “antidotes”. These are hardly ever effective when taken by mouth. To terminate a session prematurely requires massive doses of a sedative given by injection, and amateurs are not in a position to provide this. Taking a tranquilizer or sedative orally can do more harm than good, by to pin your hopes on being brought down — hopes which are not fulfilled, and which keep you in your bind of fighting the experience. Once you have started an LSD session you have got to go all the way through it, come hell or high water. If you can’t make up your mind to do this beforehand, don’t start.This quote argues against the use of 'antidotes' however it seems that the author's concern is that people will pin their hopes on a complete cessation of the experience. If people's attitude is, instead, that they want the experience to be easier, then they will not fall into this trap.
Some argue that forcibly interrupting bad trips can have a negative psychological impact and that therefore people should be left to work their way out of it and the experience will be ultimately rewarding.
The consensus seems to be that while this may be true of a regular psychedelic crisis, there is a point where the situation becomes unsalvageable. S Grof emphasises this point:
S Grof, in answer to this question: "With that standard reaction of assuming brain dysfunction, the approach of orthodox psychiatry is to administer major tranquilizers. What effect do you see this as having on the person who is going through these non-ordinary experiences?"
Well basically if you have a situation where the unconscious opens on a very deep level and these contents start surfacing, and it becomes uncomfortable and you apply tranquilizers at this point, it tends to sort of freeze the process mainly, and effectively prevent a kind of a resolution of this. This is the same in psychedelic states. The worst thing that you can do to people having a bad trip is to give them tranquilizers because many of the so called bad trips, if they are properly handled, are supported while it’s happening, you know so they cannot do anything to themselves or to others while this is happening, then in most instances they end with radical breakthroughs. The state itself is very unpleasant for the person who is clearing a very difficult aspect of themselves, so if it’s allowed to run it can be completed and integrated, it will be a major healing event. And if you apply tranquilizers you might reach a situation where it’s too late, it’s too close to the surface and too much is happening, you will not be able to really push it back deep enough into the unconscious. And so you might have to keep people on maintenance doses, and every time you start reducing the dosage that stuff will be coming back. So you kind of freeze it. You prevent effective resolution. And of course people are on tranquilizers for many years and you’re running the risk of side effects, irreversible neurological damage, actual addiction to some tranquilizers.
Benzodiazepine type drugs will diminish anxiety and sedate people on very bad trips. They are the drugs most likely to be administered by hospital staff.
Dosage for extremely bad trips (assuming no other depressant type drugs have been taken):
Diazepam (Vallium): 10-30mg
Alprazolam (Xanax): 1-3mg
Etizolam - 1-3mg
Start low and increase dosage if necessary. Of these three, etizolam may be best because it has the fastest onset.
The amount you decide to dose should be proportional to how bad you are feeling. If you are experiencing mild anxiety, take a dose on the lower end of the scale. If you are freaking out or really worried that you will soon freak out, a higher dose is better. Etizolam is probably the best sedative to take because it has the fastest onset.
anxiolytics can be used to 'successfully terminate' 'panic reactions' without 'subsequent discernible untoward effects'.
For acute bad trips (which usually amount to an anxiety reaction), the most knowledgeable psychiatrist I know uses only anxiolytic (eg Valium, Ativan) drugs.This advice is clearly only intended by the authors to pertain to administration by a medical professional.
Trip Abort using a potent selective 5htp(2a) antagonist
*Note: It also may or may not be legal to administer medication to another person in your country. If they happen to have an allergic reaction to the medication, then you will be responsible for injuring them and this may result in a law suit against you.
The consensus seems to be that hospitalisation is only necessary if the person has specific medical problems which could be exacerbated by their state, or if the drugs used and therefore drug interactions/dangers are not known. Calling an ambulance is also recommended if the person is dangerously psychotic and could prove a danger to themselves or others then.
Instant transfer of the individual to a psychiatric facility in the middle of the LSD experience is not only unnecessary, but represents a dangerous and harmful practice. It disregards the fact that the LSD state is self-limiting; in most instances, a dramatic negative experience if properly handled will result in a beneficial resolution and the subject will not need any further treatment. The "emergency transfer" to a psychiatric facility, particularly if it involves an ambulance, creates an atmosphere of danger and urgency that contributes considerable additional trauma for a person who is already extremely sensitized by the psychedelic state and the painful emotional crisis. The same is true of the admission procedure in the psychiatric facility and the atmosphere of the locked ward which is the final destination of many psychedelic casualties. S GrofFurther points to consider:
Although the above points are reasons not to call an ambulance, it will be stated once more that it is absolutely the necessary course of action if the person is in physical danger. Again: If you do not know the person, and therefore do not know their medical history, the side of caution must be erred on. The same applies if the drugs taken are unknown.
The aftermath of a psychedelic crisis refers to the mental state of the user once the drug effects has worn off.
Having a psychedelic crisis, even an extreme one, is not a sign of an 'unstable' personality or mind:
Some of the worst reactions have been in persons, often physicians and other professionals, who appeared stable by ever indicator .Lingering mental issues do not mean that an actual psychosis has been induced. Cohen observed that complications can be psychotic or non-psychotic:
I) Psychotic disordersThe list of non-psychotic reactions covers a wide range of complications. On reading it, a user can be reassured that even having severe anxiety, for example, is not indicative of psychosis. Feelings of impending doom, worrying about your mental state and so on are all normal. If after the users experience they are having complications then being diagnosed by a medical professional is advised.
There is a feature of phenomenon of the common fear of psychological damage which needs to be explained. Anxiety can emerge, for example, as anxiety about being insane. It is very important to realize that this anxiety is not evidence of anything other than being anxious. The mistake so often made is to confuse these absolutely normal non-psychotic feelings of anxiety for an actual psychotic reaction.
A person feels bad because they have been traumatised by what they experienced during the bad trip- they feel things like anxiety but then they make the crucial mistake of taking this feeling of anxiety to be evidence of a permanent psychosis. If they feel anxiety over the idea that they have gone insane, they will mistake this feeling of anxiety for the insanity they worry they have- or if they worry that they are being 'controlled' by evil demons or alien computers, they will take the anxiety they feel as evidence for the feeling of being controlled. This mistake is very often made. The effect of this mistake is, of course, to increase and perpetuate the anxiety which in turn fuels the person's belief that they are psychotic. The person needs to understand this mistake and accept that it is ok and normal to feel anxiety, worry and even emotionally exhausted, drained, weak or just negative in general.
In reality, all that is happening is that they are experiencing perfectly normal anxiety, identified by Cohen as non-psychotic. This is no different to the trauma someone might feel after they have been in a car accident, been attacked or even after being cheated on in a relationship. These symptoms will go away in time, but a person can make it much worse for themselves if they start to make this mistake of believing the symptoms are evidence of anything other than having had a significantly negative experience which resulted in normal temporary residual trauma.
The non-psychotic symptoms are what most people experience after a bad trip. The medical consensus is that psychedelics can give rise to short term complications, including psychosis, but does not cause permanent psychosis. It is thought, however, that psychedelics can trigger mental disorders in individuals who have latent conditions.
I do not believe that any psychedelic ordinarily "causes" a major psychiatric disorder ... I would hasten to point out that psychedelics (as well as many other classes of drugs) DO have the potential to facilitate the emergence of an underlying psychiatric or emotional problems which may never have previously manifested themselves, just as crises later in life tend to resurrect earlier unresolved issues including buried trauma.
There are cases of people taken LSD or other psychedelics and it's precipitated a long lasting psychiatric disorder like schizophrenia. The consensus in the literature seems to be that that doesn't happen in people who are not pre-disposed to the illness. That is, someone who would have developed schizophrenia or the illness in any case' - David E. Nichols Ultimately, the user needs to be diagnosed by a medical professional. The user can be reassured, however, that the chance that a latent problem has been triggered is very small, and that it is perfectly normal for normal people to have complications during the aftermath of a psychedelic crisis, which will fade.
A final and important point is that after any bad trip, though especially one which lead to lingering psychological issues, the user must not take any psychedelic drugs at all. This includes cannabis. Cannabis could cause flashbacks where you partly re-experience your bad trip again. That would delay your healing. It's difficult to put a time frame on how long this abstinence should go on for. Ideally the user will be able to judge for themselves.
If the bad trip was extremely bad, and the lingering mental issues were severe and took 3-4 months to go away, the user should seriously consider not taking psychedelic drugs for at least a year. A moderate bad trip where lingering psychological effects took around 3-5 weeks to go away could perhaps be gotten over by 4-6 months abstinence. These are extremely rough estimates. The point is that even when the lingering mental issues go away, you still need to continue abstaining for around 3-5x the amount of the time those lingering mental issues took to go away.
The following are an assortment of further quotes from experts which are relevant.
Frosch et al. (1965) categorized LSD related hospitalisations as panic reactions with a good prognosis, usually resulting in discharge in 1 to 3 days, reappearance of symptoms up to 1 year after multiple exposures to the drug, and extended psychosis in long standing schizophrenics who had taken the drug illicitly.
Cooper ... described in detail some of the reactions which occurred more than 24 hours after administration of LSD. These included mood swings occurring 2 or 3 days later, childish regression 1 week later, and preoccupation and absent-mindedness persisting for weeks afterwards. Insomnia was described as "a great difficulty" and it was pointed out that adverse reactions were particularly likely to occur then the individual was relaxing for sleep. He also noted that the reactions could begin again after an apparent return to normal behavior.
-During the immediate post-LSD period, there could be a prolongation of the LSD state, with the persistence of anxiety or visual apparitions for another day or two in wavelike undulations. Short-lived depressions were also described during the immediate post-LSD period.
Unwanted insight is when a person comes to believe that a certain representation of the world which they perceive to be negative is true, due to their psychedelic experience(s). An example of this is nihilism- the feeling that life has no meaning or purpose. Another might be that we are all in the matrix or something similar.
The nature of their acquisition allows for such beliefs to be disregarded. During the psychedelic experience, the boundary between your mind and the external world can break down. This means everything comes flooding in, but also flooding out. Ideas you might have, then, such as nihilism or the matrix can be seen to be part of the world, and, thanks to the hallucinatory nature of the psychedelic experience, in a very animated way. The fact is, however, that these ideas are not part of the world merely because you perceive them to be during a psychedelic crisis.
It might be replied that a person might understand this, but still feel that their belief is true. This cannot be the case, however. Emotions do not constitute beliefs, they only occur concomitantly with beliefs. In this case, then, the person either wants the belief to be true (no doubt due to some teenage angst, masochistic impulse or because they think it makes their life 'meaningful'), or has been temporarily impressionated by the experience to feel a certain emotion which they are currently associating with a certain belief. Getting over such issues are best done with the help of a cognitive behavioral therapist or other medical professional. They are completely normal and indicative of nothing other than having had a significant experience.
This section is currently being researched
Maybe the drug you are having a problem with really isn't for you, but "bad" trips aren't necessarily a sign that it's just flat out time for someone to stop using, as much as that there's been something wrong with their mindset and/or preparation and maybe they need to approach things a little differently the next time.
Now that the trip is over, consider the following, and any other possible causes on why his trips seem to have a tendency to turn out rather rough:
Read the section on 'how to prevent'.
But for now, just give things some time and live and move on... Right now, the memory is still fresh in your mind - The mind can easily recreate familiar situations, so by tripping again too soon it's very possible that you might be reminded of previous difficult trips, setting negative feelings into motion all over again.
In time, if there is still interest, consider giving it another go. Again though, really give some consideration to what may have made your trips become rough and if anything could be done to change it.
Ultimately, it's your choice, and really whatever you choose to do is fine. Just make sure it is a genuine and well thought out decision once everything has settled down again.
It should be noted that bad trips of such magnitude are extremely rare and you (the future tripper/trip sitter) will be very unlikely to encounter and have to deal with such a bad trip. Nonetheless, much of the information provided is relevant to less bad trips.
Behavior during an extreme psychedelic crisis can go through 'phases' of types of behavior. The following is a description of these phases, what to expect and what to do. I call them phases, not stages, because they have not been observed to follow a chronology.
This list is by no means exhaustive.
It is not the case that a psychedelic crisis will necessarily involve any of these phases.
When in an extremely bad trip, people may perform a physical movement or action that they then repeat with increasing violence/intensity, relaxing in between loops. The physical effort involved in each loop increases, and each movement is a more strenuous, more intense version of the prior movement. This continues until the entire body is strained to its maximum, and they collapse.
This is better described by an example: yelling. The initial movement is a moderately loud growling noise accompanied by a slight tensing of the arm muscles. Then they pause for breath, relax their muscles, and begin the second loop in which they growl louder and tense their muscles harder. After a few loops, they jump to their feat clenching their arms in front of them, roaring as hard as they can. After this peak, they instantly forget how to stand, and fall over again. Make sure you catch them and lower them down safely. Another example is when they get stuck on a loop of breathing through their nose with ever increasing violence. At the peak of this, they are forcing the air in and then out of their nose with incredible force, throwing their shoulders and head back and forth like a piston creating such a loud noise it seems likely their sinuses will rupture, although that did not happen. Do not try to hold or cover their nose, as they will probably just rupture their eardrums instead.
Once they have finished one loop and collapsed back on the floor, they will instantly pick up on whatever physical movement they happen to make next, and turn it into a loop. Dangerous loops for example, are things like smashing their teeth together with ever increasing force. If you see them do this, force a towel in their mouth. They are likely to carry on and not notice at all, but their teeth will be saved.
It should be noted that they will likely not have any recollection of performing these “loops”.
In situations like this, getting the tripper to calm and rest their physical body is needed if they are to get out of the looping stage. They will not be properly conscious so you will have to physically move them into a relaxed position. Do not move them forcibly. Hopefully, after being relaxed for a while, they will stop looping. Later on, they may give a sign that they are going to start looping such as beginning a loop movement. It has been observed that saying "no, don't do that" in a very calm relaxed tone stopped them re-entering the looping phase every time. It is plausible that simple imperatives like that may 'get through' to them, whereas real communication at this stage is impossible. You are unlikely to get a response to asking them how they feel, as they will likely not have a sense of who or what they are, let alone how to recognise a sensation as their own or put it into words.
There may be a sense of helplessness for the sitter during this phase but as the tripper will be totally oblivious to the external world all you can really do is stop them harming themselves and try to keep them comfortable. There may be times when they come out of it a bit and try to communicate saying things like "how do I get out of it?"- tell them to relax their body and think about nice things. They will not be able to stand or sit up, so put some cushions under them. The looping stage could last for hours.
is described by many and seem to be more common than physical looping. The following is a condensed trip report which featured mental looping.
People on a very bad trip may start shaking their body, with their eyes rolling back into their head. DO NOT crowd around them yelling “whats wrong?!” and shaking them. Try to remain calm and support their head, saying calming things.
You must not:
After the seizure is over, help the person to rest on their side with their head tilted back.
Ungerleider and Fisher (1967) reported 'grand mal seizures in a previously non epileptic person and persistence of episodic recurrences up to 1 year after ingestion'
When they sit or lie down with their eyes open or closed and don’t really move or say anything, often in a clenched position. Put a blanket over them and hold their hand if they don’t object. If they have their eyes closed and are in a clenched position and appear to be getting anxious then, if you feel a need to gauge how present they are, gently lift their eyelids for them and say “hi, X, it’s me Z”. If this makes them more anxious, then you can either choose to carry on holding them open and try to soothe them, or you can close them again and try to soothe them- (more experience reports are required for this advise). They may ask for water. When asked things like “how are you feeling?” they might reply with things like “you should just be yourself…” Try not to laugh at them even if you are in need of some humor as it can confuse them although they will probably simply not register your response. Cohen describes this as a defensive mechanism against the painful emotions encountered in a bad trip:
Those subjects whose major defensive response is somatization have been able to fight off the psychic effects of the drug at the cost of suffering a variety of aches and pains for six hours. Osmond warns of the occasional appearance of a severe catatonic state. We have reported one which was impressive to observe 
Consists of sitting or lying down and just crying and being really upset, usually straining arm muscles, often pausing for a second in total confusion to look around, and then crying again. This can last for hours. They will likely be semi aware of surroundings in the sense that they will be able to "see" the room they are in and the people they are with, but they will not really take in the information properly, and will be very confused, upset and worried. For example, if you offer them water, they might recognise it but will not likely take it. In this state, it is best to help them calm down by looking cheerful if they look around them, and saying calming soothing things.
They seem to be getting better and can get up, move around and talk almost normally. If they are completely normal, then great, they have “snapped” out of it- which is very possible, even snapping out of violent looping back to total normality is possible. If, however, they seem a bit weird and confused then it is VERY important that you keep them company and talk about really simple things, perhaps put on some calming music. Signs of confusion include not seeming to remember much if any of the experience, mixing up words and meanings, extreme short term memory loss, repeatedly saying they want something but they don’t know what, such as saying “come on guys!” “what do you want?” “I don’t know…” DO NOT suggest that they try to get some sleep. They may seem fine and even happy and will probably laugh at jokes but if they show signs of general confusion then there is still real danger that they may fall back into the catatonic or even the looping phase, EVEN if they are nearing the 12 hour mark. Bad trips of this magnitude can easily reach the 18 hour mark. They need to stay awake and happy until the effects have fully worn off AND they are EXTREMELY tired before going to sleep.
A valuable point is illustrated by Merlis' three patients who were left alone after the interview period was completed. The drug effects were declining and it was assumed that they were recovering uneventfully. Instead, they became increasingly tense and confused and required further therapeutic support. This exemplifies the importance of constant attendance even during the waning phase of the psychotomimetic experience.
From an experience report on the internet:
"One patient hospitalized for treatment of self-inflicted injuries"
(Downing, 1964) (12) Quoted by Schwartz?
Ungerleider and Fisher (1967) reported one young man who was prevented from throwing his girl friend off a hotel roof under the delusion that he had to offer a human sacrifice during his first LSD trip. 
Although extremely rare, such reports are always seen as very significant and therefore there are a large number of reports of a similar theme to these quotes. As the first quote demonstrates, constant vigilance is required to prevent self-harm as a person can hurt themselves in the blink of an eye. If possible, a person should be taken to a room/place which does not offer much opportunity for harm as soon as the bad trip initiates. Physical restraint may indeed be necessary for extremely hostile people.
Some Basic Constructive Tips for First Timers and Veterans to Help Combat "The Bad Feelings And Stuff"
Orange Juice. The idea that orange juice can help someone having a bad trip comes from the notion that vitamin C helps the Liver metabolise the drug faster. Unfortunately, it is too late once a bad trip has begun. See footnote for details.
It is often argued that the commonly used term 'bad trip' is a misnomer; an unsuitable name. The position is that a bad trip can ultimately cause positive life changes, resolution of psychological issues, motivation to break out of unsatisfactory mindsets, etc.
It need not necessarily be so profound. Even a psychedelic crisis which cause an individual to consider their drug use more seriously and inspire a desire for less reckless behavior, or merely to learn more harm reductive strategies could be considered a positive life change. This is not trivial, considering the consequences for health of recklessness with drug use.
Given such possibilities, a psychedelic crisis can be viewed as an opportunity for growth of the individual, psychologically and in terms of responsibility and maturity. To call it 'bad', then, seems to be a mistake.
It might be countered that if nothing is gained from a psychedelic crisis, as has often been reported, then it is correct to call it a bad trip.
This might be responded to by claiming that opportunity was there, but missed. While this may be true, it is impossible to show, so gets nowhere.
It seems right to say that ultimately, however, a psychedelic crisis is always a learning experience in how to deal with suffering and drug-induced freak-outs.
It must always be wrong, then, to say that a psychedelic experience is totally bad. However, whether or not such a learning experience makes the overall experience 'good' depends on the individual's preferences.
Others suggest that thinking of it in terms of 'good' and 'bad' is incorrect.
The purpose of this section is to give the reader an idea of the varied subjective nature of a psychedelic crisis. Because this table was complied from trip reports on the site, there is often incomplete information. In such cases, n/a will stand for none/nothing/not mentioned.
If you wish to read the full trip report, click on the > in the Link column in the row of the desired report.
extremely bad trips: (table and more in development)
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