What to do if someone is tripping on psychedelics and becomes anxious, to avoid it turning into a “bad” trip
- Mild anxiety: “The appropriate first response is to provide strong personal support and reassurance (O’Brien, 2006).” Interact with them in a “comforting and reassuring manner.”1
- If anxiety escalates:1
- You “should convey a solid sense of security and calm, while empathizing with what may be an incredibly intense and unpleasant experience.”
- Don’t try and ‘talk them down’ and back into reality. These “may be counterproductive and aggravate a difficult reaction (McCabe, 1977).”
- Remind them “to surrender to the experience.”
- You may offer “a supportive touch to the arm or shoulder with verbal reminders that the participant … has taken the hallucinogen, and that he or she will return to normal consciousness in ‘a few minutes’ or ‘a few hours’”
- If verbal interactions are of limited help due to their intense experience, “a powerful form of reassurance (sometimes called ‘interpersonal grounding’) is simply holding the hand of the participant (McCabe, 1977). Many volunteers report that during such experiences, a reassuring hand provides an incredible sense of stability and connection. Monitors should demonstrate this practice during preparation to normalize hand holding during sessions.”
- These methods should be enough if the other guidelines have been followed. The paper notes that reassurance was sufficient for any cases of distress in 54 recent study participants.
- If the reassurance methods in number two don’t succeed, which is unlikely but possible:
- Oral 10mg Valium (diazepam) can be used. “In these cases, we recommend a 10 mg oral dose of diazepam (Grinspoon and Bakalar, 1979).” Xanax is slightly less ideal than Valium, but can be used as an alternative, with 0.5-1mg being roughly equivalent to 10mg Valium.2
- Emergency department personnel “who are inexperienced with hallucinogen effects can readily escalate and prolong an adverse reaction.” “Therefore, all possible efforts should be made to treat a difficult experience in the session context, even if pharmacological intervention is required.”1
Are antipsychotic drugs good for bad trips?
Antipsychotic drugs include: Seroquel (Quetiapine), Chlorpromazine, Haloperidol, Perphenazine, Fluphenazine, Risperidone, Olanzapine, Quetiapine, Ziprasidone, Aripiprazole, Paliperidone, and Lurasidone.3
Also, antipsychotic medications (e.g., risperidone, olanzapine) should be available in the event that an adverse reaction escalates to unmanageable psychosis.
However, experienced clinicians have suggested that although antipsychotic medications may reduce psychotic behavior through sedation, [the use of antipsychotic medications] may be problematic because the effects may be abrupt, unpleasant, and intense and their use may result in subsequent psychological problems (McCabe, 1977; Grinspoon and Bakalar, 1979; Grof, 1980).
Furthermore, pretreatment with the antipsychotic haloperidol has been shown to exacerbate the psychosis-like effects of psilocybin (Vollenweider, et al., 1998), suggesting that haloperidol should not be used as a rescue medication.1