The psychedelic crisis (bad trip)

A psychedelic crisis (often called a bad trip) is a psychedelic experience which is perceived to be negative. Typically it involves the onset of negative emotions such as anxiety, fear, paranoia, revulsion, despair and anger. These emotions are often accompanied by a negatively altered perception of the world, other people and the self, 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 violence.
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 table lists some classic symptoms which are typical of bad trips. Each of these symptoms can be mild, moderate or extreme depending on how severe the bad trip is.

	Mild	Moderate	Extreme
Emotional state	Mild anxiety	Anxiety and fear	Uninhibited terror
Communicative state	Distracted, aversion to eye contact	Not really 'there', requires effort to get their attention	Unresponsive to any verbal or physical communication (if this is coupled with their eyes being closed this is extra cause for concern)
Body language	Agitated & nervous	Muscle straining, breathing fast, eyes darting around	foetal position, running around screaming, taking of clothes[1]
Speech	unable to understand mildly complex sentences, slurred speech	Unable to express themselves, slurred speech, anxiety or nervousness in the voice, child like thought process	incoherent speech, lack of logical content to sentences, yelling or screaming random phrases, repeating the words of others
Mental focus	A worrying focus on delusions or nonsensical social situations	Fear and anxiety due to delusions	intense preoccupation with delusions
Reckless/dangerous behavior	Erratic movement, not registering pain, falling over or walking into objects	They seem to be unaware that they are awake	They act with no regard to personal safety	Positive apparent intention to do harm to themselves, going berserk, flailing around blindly, running into walls, thinking they can fly or are dreaming

Advice for the sitter

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. These are general tips for sitters:

• Remind them that they have taken a drug
• Remind them that the experience will end
• Remind them that no brain damage can happen
• The mind can only begin to relax once the body has relaxed
• Cannabis is never a good idea. Instead of calming, it is likely to intensify the experience.
• You can be an anchor to reality for them. Communication is important in both reassuring them and dealing with issues
• Never crowd round them, never raise your voice: always speak with a calming tone. Never shake them or yell “calm down!” even if they start going berserk.
• Do not despair or give up, no matter how bad the situation gets. The person tripping needs you to be strong for them.
• If they appear to shrink away from physical contact, always back off. This applies unless you feel it is an emergency and you have to stop them harming themselves. If you have to touch someone that is disorientated e.g lift them, tell them what you are doing and why
• Do not be secretive as to your feelings, nor try trick the tripper in any way. This can include worrying but attempting to hide it. The tripper can sense your true feelings and may lose trust in you out of paranoia
  "He [the patient] can sense the therapist's unspoken feelings with phenomenal accuracy"[1]
• Keep them away from environmental hazards. People freaking out in a bad trip have jumped off rooftops[2], through windows, into traffic[3], stabbed themselves or others, fallen down stairs and drowned[4].

R Strassman is a clinical psychiatrist who has experience with psychedelic research involving human trials. He says:Treatment of acute panic reactions should be directed toward allaying the patient's overwhelming anxiety. A quiet, comfortable room with a minimum of distractions should be available, and the patient should not be left alone. Most of these individuals can be "talked down" by calmly discussing their fears and fantasies, orienting the patient as necessary, reinforcing the concept that the experience is drug induced and time limited, and that no permanent brain damage has been suffered.[5]
Julie Holland is a psychiatrist with extensive experience in dealing with people brought into hospital for a psychedelic crisis. Her approach is as follows[6] 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.
One thing that I've found crucial is for the patient to identify what makes them happy, makes them feel love and loved, and gives them joy.
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 on that.

Physical restraint

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 Restraint ... [is] generally to be avoided in a frightened, hallucinating patient, although where there is a concern that the patient may hurt himself or herself, or others ... [restraint] might be necessary - Strassman[7]

The decision to call an ambulance

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. 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 Grof[8]
R Strassman makes a similar point, though he clearly intends this statement to only apply to psychedelics given to patients in a clinical setting:Hospitalization is usually not necessary, but should be available.[9]Further points to consider:

• Introducing authorities into the picture has a risk of legal trouble for everyone involved.
• Hospital bills
• Hospitals are unlikely to be knowledgeable in dealing with a psychedelic crisis. Their approach will be sedation and isolation of the patient.

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.

Preventing a bad trip

Prevention of a psychedelic crisis is dealt with in this section and will include:

• An evaluation of the potential risk for the individual of experiencing a psychedelic crisis
• Precautionary measures over set and setting
• Consideration of the motivation for use

These factors are relevant to preparation for a psychedelic experience. There is another aspect to prevention which is immediate psychological techniques. These are useful should a psychedelic crisis initiate. That 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.
These are the most frequently reported causes of bad trips: Tripping with or around people you don't know or people you don't want to know you are tripping & using cannabis.

Evaluating susceptibility

Evaluating susceptibility means determining how likely you are to have a bad trip. Everyone is at some risk, but some people are at more risk than others.
Even those who are judged to be normal by psychiatrists can 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.[10]
Some of the worst reactions have been in persons, often physicians and other professionals, who appeared stable by ever indicator[11]
The nature of a psychedelic experience is that it is reflective of the mental state of the individual. So although everyone is at some risk, people whose mental states are unstable, either from a diagnosed condition or from negatively perceived life circumstances, will be more vulnerable to an unstable psychedelic 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[12] persons functioning in jobs or as students just prior to testing were far less likely to be psychiatrically disturbed by their LSD experiences[13]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.[14]Personality plays a significant part in shaping the psychedelic experience. So, those with an unstable mental state are at greater risk. This 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" [15]
Additionally, if a person has a history of mental illness in their family then they should consider themselves to be at greater risk of having a bad trip. Not only that, latent mental illnesses can be triggered by a psychedelic crisis. More on this in the "after a bad trip" section.Blumenfield and Glickman (1967) found that individuals who may be predisposed to schizophrenia, or who have disorganised thought processes, have the highest risk for LSD-related disorders. Conversely, the danger appears lower when LSD is used by emotionally stable individuals, in a protected setting (McWilliams & Tuttle, 1973).[16]
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 that 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" [17]
There was no clear relationship between the number of LSD sessions given and the onset of acute adverse reactions. In a few cases it came after the first session, and in one instance after the 60th. In the majority of cases it fell between the 5th and 10th sessions.[18]
There are studies which have given statistical evidence on the rate of psychotic episodes.Acute adverse reactions to LSD in clinical and experimental use in the United Kingdom. (1971):
Data on 4,300 patients given a total of 49,000 sessions.

Column 1	Column 2
Rate of suicide	Rate of psychosis over 48 hours
0.7/1000	9/1000

37 Cases of psychosis reported. In 8 the details are unknown; 10 appeared to be chronic and failed to recover. (In some cases the clinician's opinion was that these were potential psychotics who would have succumbed anyway.) The remaining 19 cases recovered completely: 7 had a duration over 3 months; 3 resolved between 2 weeks and 3 months; 9 cleared within 14 days.S COHEN, LSD: Side Effects and Complications (1960):
Data on 5,000 patients given a total of 25,000 sessions

Column 1	Column 2	Column 3	Column 4
	Rate of attempted suicide	Rate of completed suicide	Rate of psychotic reaction over 48 hours
Experimental subjects	0/1000	0/1000	0.8/1000
Patients undergoing therapy	1.2/1000	0.4/1000	1.8/1000

The point often made with reference to these statistics is that the rate of prolonged psychotic reaction is not greater than you would expect in an average population. Psychedelic drugs, then, on this evidence, only cause such reactions in those who were predisposed to suffer them anyway. This will be discussed further in the "after a bad trip" section. Cohen's evidence also corroborates the view that individuals suffering from diagnosed conditions are at more risk of having problems with psychedelic drug use.
A 2015 study[19] corroborates these findings:
14% described themselves as having used at any point in their lives any of the three ‘classic’ psychedelics: LSD, psilocybin (the active ingredient in so-called magic mushrooms) and mescaline (found in the peyote and San Pedro cacti). The researchers found that individuals in this group were not at increased risk of developing 11 indicators of mental-health problems such as schizophrenia, psychosis, depression, anxiety disorders and suicide attempts. Their paper appears in the March issue of the Journal of Psychopharmacology1.
“We are not claiming that no individuals have ever been harmed by psychedelics,” says author Matthew Johnson, an associate professor in the Behavioral Pharmacology Research Unit at Johns Hopkins University in Baltimore, Maryland. “Anecdotes about acid casualties can be very powerful — but these instances are rare,” he says. At the population level, he says, the data suggest that the harms of psychedelics “have been overstated”.[20]
The point of this section is to show that anyone could be at risk of having a bad trip when they use a psychedelic drug. Those who have a history of mental illness in the family could have a latent mental condition which might be triggered. Those who have a diagnosed condition could have that condition exacerbated. These are quite serious risks with potentially long-term implications. No one can be sure that they don't have a latent mental condition, so anyone taking a psychedelic drug is taking that risk.
Those who are feeling negative about life for any particular reason are at more risk of having a bad trip than those who are not. Most bad trips are unpleasant painful experiences which might cause temporary trauma for a few days or even in rare cases up to a few weeks. In very rare cases, a few months. This could certainly interrupt your studying or job/career. If you do have negatively perceived life circumstances but are determined to take a psychedelic drug, it seems advisable to try and get into a better place mentally before doing so. Your decision to take a psychedelic drug is your decision alone, but make it an informed decision. Know the risks.

Set and setting

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.

Timothy Leary & Richard Alpert (Ram dass) The Psychedelic Experience - A Manual Based on the Tibetan Book of the Dead[21]
​

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.

S.Grof[22]
​

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.

Julie Holland[23]
​

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.

Myron Stolaroff - Using psychedelics wisely[24]​

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.[25]

Lisa Bieberman - Session games people play: A manual for the use of LSD[26]
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.​

Further considerations:​

Set:

• No recent or lingering emotional trauma or issues.
• Currently feeling positive about life in general, not just feeling positive on the day of ingestion.
• It is not advised to attempt poly-drug combinations unless the user has considerable experience with the psychedelic state. Cannabis, especially, is frequently reported to be the cause of bad trips when taken in conjunction with a hallucinogen.
• It is a frequent mistake that some people make when they experience physiological discomfort as mental discomfort, which can then give them anxiety. Do not trip if you are ill or if you have any physical or mental problem/discomfort/distraction.
• It's not a good idea to trip if you are really worried about having a bad trip. Educate yourself until you are fully aware of the situation and are confident.

Setting:

• Do not trip in the potential presence of authority figures, eg parents.
• Work/school the following days. You should have a clear schedule for the following few days.
• Availability of quiet room with dim lighting if sensory overload occurs.
• You should feel completely comfortable with everyone you are tripping with.
• If there are people who have not tripped before, there must be enough experienced people to look after them.

Motivation for use

Myron Stolaroff - Using psychedelics wisely[27]​

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.[28]
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.

Lisa Bieberman - Session games people play: A manual for the use of LSD[29]​

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[30]
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.
If you are approaching an LSD experience with any of these notions as baggage, get rid of them now. LSD is not magic. It will not make you smarter, or give you any special powers. Your experience will be your own, and not like any you have heard of. LSD gives you a new perspective on your life for several hours, and since it is your life you will be looking at, it will not be like anybody else’s session. LSD is not much like marijuana at all, potheads’ boasts to the contrary notwithstanding. The session may or may not help “cure” some of your psychological problems, but you can’t count on it.[31]
Sometimes people take a psychedelic drug with the intention of the experience helping or even 'curing' some sort of psychological problem. This is highly inadvisable. While some medical professionals think this is possible, it is currently very experimental, and must only be attempted under supervision by a medical professional. If someone attempts this by themselves, it could easily result in their condition being worsened. Perhaps there is a chance a psychedelic experience could help them, but maybe that chance is 1%, while the chance for things to get worse is 20%. The chances & risks are simply unknown. The anecdotal reports are not encouraging though. It would be great if psychedelics were a magic fix for your condition, but they are not. Don't be tempted.

Advice for the tripper

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.[32]
This section explains techniques and knowledge which can be used by a person who is experiencing a bad trip to try and help them calm down and deal with the situation. The common wisdom on what to do if you have a bad trip is this: "do not fight the trip" and "just go with the flow"
This advice can be true or false depending on how it is interpreted.
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.

This is the three step calming plan
recognition, calming, distraction
To be clear, this is a compilation of suggestions on how to deal with anxiety. If you have your own way, like meditation, that is just as valid if not more valid.
Step one: recognition
​

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.
This is exceptionally important but isn't always easy. This is because it is often some particular thing which is the focus of panic, like believing that the devil is possessing you, aliens are abducting you, friends are trying to kill you, etc. This thing could and often is an anxious thought brought about by the negative psychedelic experience. 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, you think 'this thing is happening !' (specific anxiety). For example, instead of thinking "I am experiencing a panic reaction!", you think "I am being possessed by the devil!" In other words, you believe the fear.
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.
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. 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.
This is more easily said than done, unfortunately. It is not easy to prevent negative thoughts from capturing your attention.

Step two: Calming
​

Objective: 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 - including the idea that nothing will help you. 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.
This point about the body being tensed is important. While experiencing anxiety, our muscles tense up. Shoulder and abdomen/stomach muscles but also leg and arm muscles will be tensed. Becoming aware of this and deliberately relaxing your body will help your mind let go of the anxiety.
Breathe in and deliberately relax your stomach muscles as much as possible - let your abdomen swell as you inhale and feel the tension and anxiety being held in that area melt away as you breathe into it. Imagine the anxiety is just being pushed out by your inhaling. Then breathe out and imagine the anxiety is just being exhaled. Repeat.
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 to normality. Time will get you to the end of your psychedelic experience no matter what. The only question is whether you will keep yourself calm and allow time to carry you to the end of your trip, or whether time will have to drag you there kicking and screaming. But you will get there.

Step three: new mental focus/distraction
​

Objective: 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 potentially 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 you are 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.
Further points
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:

Drug intervention

This section includes information about some drugs which 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.[33]
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.
Then again I would not like to talk against tranquilizers in general. There are certainly states where they are quite indicated, and people can be in states that don’t really respond very well to the kind of alternative strategy that we are suggesting. For example people who are heavily paranoid, they don’t usually cooperate, they will not accept this kind of help. Lots of people are in this state where they’re projecting, and they would be dangerous to themselves or to others, then tranquilizers would be very useful and appropriate for approaching it. So we just like to present our strategy as an alternative, as an option. -Stanislav Grof[34]

Benzodiazepines

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:
Diazepam (Vallium): 10-30mg
Alprazolam (Xanax): 1-3mg
Etizolam - 1-3mg
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.Anxiolytics can be used to 'successfully terminate' 'panic reactions' without 'subsequent discernible untoward effects'.[35]
For acute bad trips (which usually amount to an anxiety reaction), the most knowledgeable psychiatrist I know uses only anxiolytic (eg Valium, Ativan) drugs.[36]
For more severe agitation, minor tranquillisers such as diazepam should be used, in oral or parenteral form ... Usual doses range from 15 to 30 mg for diazepam.[37]
This advice is clearly only intended by the authors to pertain to administration by a medical professional.
Benzodiazepines must not be taken with other depressant drugs like alcohol or opiates, as that can be fatal.

Alcohol

discussion thread:
Alcohol calming a bad trip?

Anti-psychotics

Read this thread for a discussion on using anti-psychotics to stop a bad trip:
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.

After a bad trip

The aftermath of a psychedelic crisis refers to the mental state of the user once the drug effects has worn off.

Lingering psychological issues

It is common to experience lingering psychological issues after having a bad trip. This section explains what they are/involve and how to deal with them.
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 [38].
For several days after ingestion of LSD, anxiety, depression or paranoid thinking can occur even in normal control subjects.[39]
The psychiatrist Cohen observed that complications can be psychotic or non-psychotic: I) Psychotic disorders
1. Accidental LSD intoxication in children characterized by anxiety and visual illusions lasting several weeks.
2. Chronic LSD intoxication with ataxia, slurred speech and incoordination
3. An overt psychosis precipitated by the LSD experience occurring in schizoid individuals or ambulatory schizophrenics
4. Paranoia with relatively appropriate thought processes, except in the area of megalomanical delusions
5. Acute paranoid states, only occuring during the LSD experience itself and involving danger to the subject or to others around him.
6. Prolonged or intermittent LSD-like psychoses
7. psychotic depressions usually associated with agitation and anxiety
II) Non-psychotic disorders
1) Chronic anxiety reactions associated with depression, somatic symptoms, difficulty in functioning and a recurrence of LSD-like symptoms such as time distortion, visual alternations and body image changes for weeks or months.
2) Acute panic states with a potential to self-injury.
3) Dyssocial behavior, involving a complete loss of previously held values and ideas, loss of motivation to study or work and indulgence in "pseudophilosophic jargon."
4) Antisocial behavior, involving obliteration of cultural values of good and bad and society's rules of right and wrong, especially in individuals with a previously attenuated moral code.
(Cohen, 1966. 6, p182)[40]
Most of the time a person having mental issues after a bad trip is just anxious, traumatised and mentally weak so they find it difficult to cope. These are some common thoughts people have:

• I am going insane / have gone insane
• I have done permanent damage to my brain
• I have changed and will never be the same
• My life is ruined

What needs to be realised is that these are anxious thoughts caused by a traumtised anxious weakened mental state. This negative mental state is temporary, but thinking these negative thoughts and worrying about them will fuel and perpetuate the anxious state which causes them. For example, anxiety can emerge 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 or anxious thoughts for an actual psychotic reaction. So a person will think "I have gone insane!" and then they will feel even more negative because of that. What they should be trying to think is "I have anxiety and anxious thoughts caused by a temporarily negative and anxious mindset". Do not believe the fear. It's not possible to stop yourself thinking negative thoughts, but it is possible to stop yourself from feeling unnecessary additional anxiety over them by thinking they are actually true.
A person feels negative because they have been traumatised by what they experienced during the bad trip- they now feel negative things like anxiety. They then make the 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 mistake the anxiety they feel while worrying about being controlled for evidence that they actually are being controlled. This mistake is very often made.
The reason this mistake is made is that we have no idea what it feels like to be insane, and for the most part we have no idea what anxiety is like. After a bad trip, the mind is weak and vulnerable in ways probably never experienced or even imagined. So of course it's natural for people to worry that what is going on in their minds is insanity. 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, to worry and be 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. A panic attack can be traumatizing, especially a drug-induced one. It's no different to other things in life which could be traumatizing though. If you had been in a car accident, or witnessed a car accident, your mind would be negatively affected by it. You wouldn't be surprised, because you'd know it is normal to feel that way. To help yourself recover after a bad trip, you should realise that a bad trip is no different, so you should regard it as normal to feel negative and not be surprised or worried about that. A bad trip can scare us in a way nothing else can. There is something unimaginably disturbing about it. Even the memory of it is enough to scare us. It's no surprise that the mind needs some time to recover.
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 true 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.[41]
There are cases of people taking 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 [42]
It isn't clear to scientists whether latent conditions like schizophrenia develop inevitably. It could be possible for a condition to remain latent/dormant all of a persons life without being triggered.
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.
It is best to resume living as normal. Don't feel bad if it is difficult - this will be a difficult time. It should be accepted that that only small steps towards normality can be taken at this point. Unfortunately, someone with lingering psychological issues probably won't wake up feeling normal tomorrow. It takes time for the mind to recover after a negative traumatic experience. Eat healthily, do exercise, socialize, start a new hobby, try to enjoy doing simple relaxing happy things. Find a moment each day where you can pause yourself, relax yourself, and think strongly about how it's normal and expected to feel negative, and that you are going to be ok. Getting through this is difficult, but everyone manages it. Many people have had similar experiences, everyone gets better in the end. It can take weeks for some, on rare occasions months. Seeing a medical professional really could be a great help to deal with anxiety & negative thoughts. Also if you really are worried about permanent mental conditions, they could put your mind at ease about that.
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.

Unwanted insight

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.

Flashbacks

This section contains relevant information quoted from studies on the phenomenon of flashbacks.
flashbacks are:“sudden and unexpected recurrence of some or all
of the drug experience.” Reported experiences “include relived intense emotion, relived intense emotion, a feeling of unreality, and visual distortions such as geometric patterns, trails of moving objects, or a rippling effect.”[43]
“While care must certainly be taken in the use of psychoactive substances of any type in therapeutic, experimental, and recreational contexts, concerns about devastating flashback experiences appear not to be warranted from current research reports.”[44]
Stability of the Visual Disorder in Time
The hypothesis that all such disturbances disappear in time was rejected, since approximately half the user in each time interval from last drug exposure continued to report flashbacks at the time of the interview.
The most common precipitant was emergence into a dark environment, followed by intention, marijuana, phenothiazines. Other precipitants are listed.See table 5 in original article. Abraham makes much of this possible drug interaction:
“Fourteen percent of the users also reported that marijuana could precipitate LSD-type flashbacks. A further examination of 15 control subjects with a history of heavy marijuana use ("more than once a day") revealed that none of the subjects ever reported experiencing any flashback phenomena, while seven of the 12 LSD users with the same marijuana history did report flashbacks (P=.003). This finding strengthens a reportedly unique form of drug-drug interaction between LSD and marijuana, though the evidence to date remains solely based on clinical histories.”[45]
Psychedelic Drug Flashbacks: Psychotic Manifestation or Imaginative Role Playing?
“One reaction to prolonged use of psychedelic drugs, especially LSD, is the recurrence of drug like experiences days, weeks, months, or over a year after taking the drug. Such experiences are commonly called ‘flashbacks.’” – 434
“Previous research *Matefy 7 Krall, 1974) indicates that almost half of the subjects detailing their flashback experiences claim flashbacks are not always unpleasant. For many, flashbacks are viewed as ‘free trips,’ not as symptoms requiring treatment. One third of the subjects feel they can somehow predict or control flashbacks” – 434
“This study examined possible differences in psychopathological characteristics among flashbackers, nonflashback drug users and nondrug user controls ... Results indicated that flashbackers showed no more general maladjustment than the nonflashback drug users, although both drug-taking groups showed higher scores than the control group. Flashbackers had higher scores than nonflashbackers on the Hy subscale ... indicating a tendency toward hysterical behavior under stress. Analysis of the personality profiles from MMPI score elevations revealed that some flashbackers differed from their nonflashback drug using peers by being more prone to episodic attacks of acute distress, hysteria, and hyperactivity. They also tended to irresponsibility avoid unpleasant situations. These data do not indicate that flashbackers as a group suffer from severe psychopathology as compared with nonflashbackers.” – 434
“In conclusion, the results ... showed that drug users experiencing flashbacks are not, in general, more severely maladjusted than nonflashback drug users. Flashbackers as a group may be slightly more prone to neurotic hysteria, but they do not show more psychotic characteristics.”
“The study offers support for the aspect of role learning theory of flashbacks, which predicts that flashbackers are more predisposed to cognitive role playing than nonflashbackers. The flashbacker becomes more absorbed in his role playing fantasies. Thus, psychedelic drug flashbacks may represent, in part, imaginative role playing, and not always the symptoms of psychotic decompensation that are so often suggested."[46]

Should I trip again?

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:

• Have you been trying to cope with some kind of mental burden or troubles in your personal life? Psychedelics have a nasty way of bringing out suppressed mental issues, and can easily exacerbate existing ones.
• Did you feel safe and comfortable with the people and place you tripped in?
• Have you had similar reactions to other drugs of the same type?
• Is the anxiety in part provoked by something like the actual duration of the trip itself?

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.
Some people might want to trip again soon after, but this is inadvisable. Every time you have a bad trip, your mind will more strongly associate tripping with anxiety. The only way to loosen/weaken this negative association is time. So, the more time you wait to trip again, the better. Experiencing anxiety on a bad trip is like opening a door in your mind to anxiety. This door will only close with time, and unfortunately it closes a lot slower than it opens.
Some people hit a brick wall with trip anxiety where they can never experience psychedelics again, because they have had too many bad trips. If you want to avoid this happening to you, it really is worth taking every precaution - a long break, such as a year - before using psychedelics again. This can be a frustrating fact, but there is plenty of time left in life to take psychedelics.

The extreme psychedelic crisis

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. One possible example 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. - S. Grof[47]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. This list is not complete and it is not the case that a psychedelic crisis will necessarily involve any of these phases.

Physical Looping phase

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. 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 is plausible that simple imperatives stated calmly like "No, don't do 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 feeling of helplessness or even despair 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.

Mental looping

is described by many and seem to be more common than physical looping. The following is a condensed trip report which featured mental looping. The trip report is also worth reading for the reason that it demonstrates how unpredictable, weird, confusing and difficult to manage a bad trip can be.

The advise given is debatable, especially about the part where 'tricking' the trippers mind is recommended. It seems a danger that important trust might be lost if the tripper believes they are being tricked by the sitter. If it alleviated anxiety, however, then perhaps it was a good strategy. There could also be a problem with validating delusions. As I said before, it is debatable and should be debated. The state of consciousness described is clearly extremely fragile.

Seizure phase

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.
Here are some basic tips to manage a seizure:

• Protect from injury-remove any hard objects or obstructions from the area if possible
• Protect the head as best you can-placing something soft under the head e.g a pillow or improvise with a rolled up jumper/blanket
• Gently roll the person onto their side (ideally the recovery position)as soon as possible as this assists with breathing
• Stay with the person
• Calmly talk to the person until they regain consciousness. Let them know where they are, that they are safe and you will stay with them. People often become disoriented for a while after having a seizure.
• Avoid having an audience- ask onlookers or even numerous concerned friends to stay back.
• Time the seizure-if it goes over 5 minutes, call an ambulance. It is advisable to get medical/first aid support if at all possible even for shorter seizures unless you are aware they have epilepsy.

You must not:

• Restrain the persons movements
• Force anything into their mouth

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'[48]

Catatonic phase

When they sit or lie down with their eyes open or closed and don’t really move or say anything, often in a foetal position and/or clenching muscles. 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 [49]

Traumatised phase

Consists of sitting or lying down and just crying and being really upset, usually straining muscles, often pausing for a second in total confusion to look around, and then crying again. 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. In this state, it is best to help them calm down by looking cheerful if they look around them, and saying calming soothing things.

Coming out of it phase

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. They may seem fine and even happy 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.[50]

Violent, self-destructive behavior

From an experience report on the internet:

Some quotes from Drugs-Forum:

Reference:
"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. [51]
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.

Other sections

Myths about bad trips

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.[52]
Bad acid. The idea that bad trips are caused by acid which is adulterated or has impurities - "bad acid" - is a myth. Bad trips are caused by psychological factors.

Bad trip: a misnomer?

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.

Examples of the psychedelic crisis

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.

LSD

Link	Cause	Trip content	Immediate aftermath	Followup aftermath
>	Pre-trip anxiety	Fear of Going insane, Brain splitting into five other brains/personalities	n/a	User has 'gotten over' any trauma
>	Negative mindset re:relationship, Unprecedented dose; Cannabis use	Blackout involving death experience, paranoia, sitter perceived personality change	n/a	Motivation to make life changes
>	Negative mindset re:relationship, cannabis	World slows down, Loved ones expressing disappointment that tripper is now vegetable, scenarios repeating with varying time speeds	n/a	"his evening has been etched in swim brain forever"
>	young teenager, took LSD every week for 1-2 months	Memory lapse, aliens staring and laughing, phoned people because he thought he was

COHEN, LSD: Side Effects and Complications (1960)

NY high school baseball player killed in rooftop fall took LSD

Bad LSD trip turns into deadly nightmare

Mother Talks About Danger of Drugs 1 Year Later

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https://drugs-forum.com/forum/local_links.php?action=ratelink&catid=126&linkid=10238

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Crisis Intervention in Situations Related to Unsupervised Use of Psychedelics; .LSD Psychotherapy -- Stanislav Grof part 1 appendix 1

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Louria, D. Nightmare Drugs. Pocket Books, New York, 1966. 29, p49

Ungerleider, J. T. and Fisher, D. D. The problems of LSD-25 and emotional disorder. Calif. Med., 106: 49-55, 1967 p51

Harmful aspects of the LSD experience (1967) p470

Harmful aspects of the LSD experience (1967) p470

Harmful aspects of the LSD experience (1967) p471

Klee, G. D. and Weintraub, W. Paranoid reactions following lysergic acid diethylamide (LSD-25). In Bradley, P.B., Demicker, P. and Radouco-Thomas, C., eds. Neuro-psychopharmacology, pp. 457-460. Elsevier, Princeton, N.J., 1959. quoted in The Complications of LSD: A Review of the Literature p175

The Heffter Review of Psychedelic Research, Volume 1, 1998 51 7. Flashbacks in Theory and Practice Lin S. Myers, Ph.D., Shelly S. Watkins, M.A., and Thomas J. Carter, Ph.D.

p341 Pos, R. LSD-25 as an adjunct to long-term psychotherapy. Canad. Psychiat. Ass. J., 11:330-342, 1966.

Acute adverse reactions to LSD in clinical and experimental use in the United Kingdom. (1971)

No link found between psychedelics and psychosis

https://drugs-forum.com/threads/263900

The Psychedelic Experience - A Manual Based on the Tibetan Book of the Dead p4

Beyond Psychotic Experience - Stan Grof interviewed by Jon Atkinson p3

https://drugs-forum.com/forum/lo...6&linkid=10238

Using psychedelics wisely

Using psychedelics wisely - p2

Session games people play: A manual for the use of LSD

Using psychedelics wisely

Using psychedelics wisely - p2-3

Session games people play: A manual for the use of LSD

Session games people play: A manual for the use of LSD

Session games people play: A manual for the use of LSD

Session games people play: A manual for the use of LSD

Session games people play: A manual for the use of LSD

Beyond Psychotic Experience - Stan Grof interviewed by Jon Atkinson -p 1-2

Ditman, K., Hayman, M. and Whittlesey, J. Nature and frequency of claims following LSD. J. Nerv. Ment. Dis, 134: 346-352, 1962 Quoted in Harmful aspects of the LSD experience (1967) p470

http://www.maps.org/old_forum/1999/msg00681.html

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Ungerleider, J. T. and Fisher, D. D. The problems of LSD-25 and emotional disorder. Calif. Med., 106: 49-55, 1967 p51

The Complications of LSD: A Review of the Literature p183

Cohen, S. A classification of LSD complications. Psychosomatics, 7: 182-186, 1966

http://www.maps.org/old_forum/1999/msg00681.html

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The Heffter Review of Psychedelic Research, Volume 1, 1998 51 7. Flashbacks in Theory and Practice Lin S. Myers, Ph.D., Shelly S. Watkins, M.A., and Thomas J. Carter, Ph.D.

The Heffter Review of Psychedelic Research, Volume 1, 1998 51 7. Flashbacks in Theory and Practice Lin S. Myers, Ph.D., Shelly S. Watkins, M.A., and Thomas J. Carter, Ph.D.

Visual Phenomenology of the LSD Flashback by Henry David Abraham, MD (Arch Gen Psychiatry 1983;40:884-889)

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Beyond Psychotic Experience - Stan Grof interviewed by Jon Atkinson p3

Ungerleider, J. T. and Fisher, D. D. The problems of LSD-25 and emotional disorder. Calif. Med., 106: 49-55, 1967 p51

S COHEN, LSD: Side Effects and Complications (1960) J. Nerv. Ment. Dis., 130: 30-40, 1960. p32

S COHEN, LSD: Side Effects and Complications (1960) J. Nerv. Ment. Dis., 130: 30-40, 1960. p32-33

Ungerleider, J. T. and Fisher, D. D. The problems of LSD-25 and emotional disorder. Calif. Med., 106: 49-55, 1967 p51

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