Bad trip

A bad trip (also known as challenging experiences, acute intoxication from hallucinogens, psychedelic crisis, or emergence phenomenon) is a term describing an acute adverse psychological reaction to effects produced under the influence of psychoactive substances, namely psychedelics. There is no clear definition of what constitutes a bad trip. Additionally, knowledge on the cause of bad trips and who may be vulnerable to such experiences are limited. Existing studies report that possible adverse reactions include, anxiety, panic, depersonalization, ego dissolution, paranoia, as well as physiological symptoms such as dizziness and heart palpitations. However, most studies indicate that the set and setting of substance use influence how people respond.

With proper screening, preparation, and support in a regulated setting these are usually benign. A bad trip on psilocybin, for instance, often features intense anxiety, confusion, agitation, and psychosis. They manifest as a range of feelings, such as anxiety, paranoia, the unshakeable sense of one's inevitable and imminent personal demise or states of unrelieved terror that they believe will persist after the substance's effects have worn off. As of 2011, exact data on the frequency of bad trips are not available.

Bad trips can be exacerbated by the inexperience or irresponsibility of the user or the lack of proper preparation and environment for the trip, and are often reflective of unresolved psychological tensions triggered during the course of the experience. In clinical research settings, precautions including the screening and preparation of participants, the training of the session monitors who will be present during the experience, and the selection of appropriate physical setting can minimize the likelihood of psychological distress. Researchers have suggested that the presence of professional "trip sitters" (i.e., session monitors) may significantly reduce the negative experiences associated with a bad trip. In most cases in which anxiety arises during a supervised psychedelic experience, reassurance from the session monitor is adequate to resolve it; however, if distress becomes intense it can be treated pharmacologically, for example with the benzodiazepine diazepam.

The psychiatrist Stanislav Grof wrote that unpleasant psychedelic experiences are not necessarily unhealthy or undesirable, arguing that they may have the potential for psychological healing and lead to breakthrough and resolution of unresolved psychic issues. Drawing on narrative theory, the authors of a 2021 study of 50 users of psychedelics found that many described bad trips as having been sources of insight or even turning points in life.

Intervention
Medical treatment consists of supportive therapy and minimization of external stimuli. In some cases, sedation is used when necessary to control self-destructive behavior, or when hyperthermia occurs. Diazepam is the most frequently used sedative for such treatment, but other benzodiazepines such as lorazepam are also effective. Such sedatives will only decrease fear and anxiety, but will not subdue hallucinations. In severe cases, antipsychotics such as haloperidol can reduce or stop hallucinations. Haloperidol is effective against acute intoxication caused by LSD and other tryptamines, amphetamines, ketamine, and phencyclidine.

Effects
Bad trips may cause hallucinogen persisting perception disorder (HPPD).

Stanislav Grof
Psychiatrist Stanislav Grof once said in an interview:

"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."

In a 1975 book, Grof suggested that painful and difficult experiences during a trip could be a result of the mind reliving experiences associated with birth, and that experiences of imprisonment, eschatological terror, or suffering far beyond anything imaginable in a normal state, if seen through to conclusion, often resolve into emotional, intellectual and spiritual breakthroughs. From this perspective, Grof suggests that interrupting a bad trip, while initially seen as beneficial, could potentially trap the tripper in unresolved psychological states. Grof also suggests that many cathartic experiences within psychedelic states, while not necessarily crises, may be the effects of consciousness entering a perinatal space.

Rick Strassman
Professor of psychiatry Rick Strassman is critical of reframing the experience of bad trips as one of "challenging experiences".