Bad trip

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A bad trip (also known as challenging experiences, acute intoxication from hallucinogens, psychedelic crisis, or emergence phenomenon) is an acute adverse psychological reaction to the effects 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. [1]

Contents

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. [2] [ page needed ] 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. [3] 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. [4] 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. [3]

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. [2] [ page needed ] 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. [4]

Signs and symptoms

With proper screening, preparation, and support in a regulated setting these are usually benign. [5] A bad trip on psilocybin, for instance, often features intense anxiety, confusion, agitation, and psychosis. [6] 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. [6]

Treatment

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.[ citation needed ] 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. [7] [8]

Pathophysiology

Bad trips may cause range of conditions such as psychosis and hallucinogen persisting perception disorder (HPPD). [9]

Perspectives

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. [10]

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. [11]

Rick Strassman

Professor of psychiatry Rick Strassman is critical of reframing the experience of bad trips as one of "challenging experiences". [12]

See also

Related Research Articles

<span class="mw-page-title-main">LSD</span> Hallucinogenic drug

Lysergic acid diethylamide, commonly known as LSD, is a potent psychedelic drug that intensifies thoughts, emotions, and sensory perception. Often referred to as acid or lucy, LSD can cause mystical, spiritual, or religious experiences. At higher doses, it primarily induces visual and auditory hallucinations. While LSD does not cause physical addiction, it can lead to adverse psychological reactions, such as anxiety, paranoia, and delusions. Additionally, it may trigger "flashbacks," also known as hallucinogen persisting perception disorder, where individuals experience persistent visual distortions after use.

<span class="mw-page-title-main">Psilocybin</span> Chemical compound found in some species of mushrooms

Psilocybin, also known as 4-phosphoryloxy-N,N-dimethyltryptamine (4-PO-DMT), and formerly sold under the brand name Indocybin, is a naturally occurring psychedelic prodrug compound produced by more than 200 species of fungi. Psilocybin is itself biologically inactive but is quickly converted by the body to psilocin, which has mind-altering effects similar, in some aspects, to those of other classical psychedelics. Effects include euphoria, visual and mental hallucinations, changes in perception, a distorted sense of time, and perceived spiritual experiences. It can also cause adverse reactions such as nausea and panic attacks.

<span class="mw-page-title-main">Psychedelic drug</span> Hallucinogenic class of psychoactive drug

Psychedelics are a subclass of hallucinogenic drugs whose primary effect is to trigger non-ordinary mental states and a perceived "expansion of consciousness". Also referred to as classic hallucinogens or serotonergic hallucinogens, the term psychedelic is sometimes used more broadly to include various types of hallucinogens, such as those which are atypical or adjacent to psychedelia like salvia and MDMA, respectively.

<span class="mw-page-title-main">Haloperidol</span> Typical antipsychotic medication

Haloperidol, sold under the brand name Haldol among others, is a typical antipsychotic medication. Haloperidol is used in the treatment of schizophrenia, tics in Tourette syndrome, mania in bipolar disorder, delirium, agitation, acute psychosis, and hallucinations from alcohol withdrawal. It may be used by mouth or injection into a muscle or a vein. Haloperidol typically works within 30 to 60 minutes. A long-acting formulation may be used as an injection every four weeks for people with schizophrenia or related illnesses, who either forget or refuse to take the medication by mouth.

An altered state of consciousness (ASC), also called an altered state of mind, altered mental status (AMS) or mind alteration, is any condition which is significantly different from a normal waking state. It describes induced changes in one's mental state, almost always temporary. A synonymous phrase is "altered state of awareness".

<span class="mw-page-title-main">Stanislav Grof</span> American psychiatrist

Stanislav "Stan" Grof is an American psychiatrist. Grof is one of the principal developers of transpersonal psychology and research into the use of non-ordinary states of consciousness for purposes of psychological healing, deep self-exploration, and obtaining growth and insights into the human psyche.

<span class="mw-page-title-main">Trip sitter</span> Person who remains sober to ensure the safety of a drug user

A trip sitter—sometimes known as a sober sitter, spotter, or co-pilot—is a term used by recreational or spiritual drug users to describe a person who remains sober to ensure the safety of the drug user while they are under the influence of a drug; they are especially common with first-time experiences or when using psychedelics, dissociatives and deliriants. This practice can be seen as a means of harm reduction.

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<span class="mw-page-title-main">Set and setting</span> Mindset and location of a drug experience

Set and setting, when referring to a psychedelic drug experience or the use of other psychoactive substances, means one's mindset and the physical and social environment in which the user has the experience. Set and setting are factors that can condition the effects of psychoactive substances: "Set" refers to the mental state a person brings to the experience, like thoughts, mood and expectations; "setting" to the physical and social environment. This is especially relevant for psychedelic experiences in either a therapeutic or recreational context.

<span class="mw-page-title-main">Psychedelic experience</span> Altered state of consciousness brought upon by the consumption of psychoactive substances

A psychedelic experience is a temporary altered state of consciousness induced by the consumption of a psychedelic substance. For example, an acid trip is a psychedelic experience brought on by the use of LSD, while a mushroom trip is a psychedelic experience brought on by the use of psilocybin. Psychedelic experiences feature alterations in normal perception such as visual distortions and a subjective loss of self-identity, sometimes interpreted as mystical experiences. Psychedelic experiences lack predictability, as they can range from being highly pleasurable to frightening. The outcome of a psychedelic experience is heavily influenced by the person's mood, personality, expectations, and environment.

<span class="mw-page-title-main">Rick Strassman</span> American drug researcher

Rick Strassman is an American clinical associate professor of psychiatry at the University of New Mexico School of Medicine. He has held a fellowship in clinical psychopharmacology research at the University of California San Diego and was Professor of Psychiatry for eleven years at the University of New Mexico. After 20 years of intermission, Strassman was the first person in the United States to undertake human research with psychedelic, hallucinogenic, or entheogenic substances with his research on N,N-dimethyltryptamine, also known as DMT. He is also the author of DMT: The Spirit Molecule, which summarizes his academic research into DMT and other experimental studies of it, and includes his own reflections and conclusions based on this research.

<span class="mw-page-title-main">Hallucinogen persisting perception disorder</span> Medical condition

Hallucinogen persisting perception disorder (HPPD) is a non-psychotic disorder in which a person experiences apparent lasting or persistent visual hallucinations or perceptual distortions after using drugs, including but not limited to psychedelics, dissociatives, entactogens, tetrahydrocannabinol (THC), and SSRIs. Despite being designated as a hallucinogen-specific disorder, the specific contributory role of psychedelic drugs is unknown.

<span class="mw-page-title-main">Emergency psychiatry</span> Clinical application of psychiatry in emergency settings

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Ego death is a "complete loss of subjective self-identity". The term is used in various intertwined contexts, with related meanings. The 19th-century philosopher and psychologist William James uses the synonymous term "self-surrender," and Jungian psychology uses the synonymous term psychic death, referring to a fundamental transformation of the psyche. In death and rebirth mythology, ego death is a phase of self-surrender and transition, as described later by Joseph Campbell in his research on the mythology of the Hero's Journey. It is a recurrent theme in world mythology and is also used as a metaphor in some strands of contemporary western thinking.

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<span class="mw-page-title-main">LSD art</span> Art inspired by psychedelic experiences

LSD art is any art or visual displays inspired by psychedelic experiences and hallucinations known to follow the ingestion of LSD. Artists and scientists have been interested in the effect of LSD on drawing and painting since it first became available for legal use and general consumption.

<span class="mw-page-title-main">Psychoactive drug</span> Chemical substance that alters brain function

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The Spring Grove Experiment is a series of lysergic acid diethylamide (LSD) studies performed from 1963 to 1976 on patients with psychotic illnesses at the Spring Grove Clinic in Catonsville, Maryland. These patients were sponsored by the National Institute of Mental Health to be part of the first study conducted on the effects of psychedelic drugs on people with schizophrenia. The Spring Grove Experiments were adapted to study the effect of LSD and psychotherapy on patients including alcoholics, heroin addicts, neurotics, and terminally-ill cancer patients. The research done was largely conducted by the members of the Research Unit of Spring Grove State Hospital. Significant contributors to the experiments included Walter Pahnke, Albert Kurland, Sanford Unger, Richard Yensen, Stanislav Grof, William Richards, Francesco Di Leo, and Oliver Lee McCabe. Later, Spring Grove was rebuilt into the Maryland Psychiatric Research Center where studies continued to be performed for the advancement of psychiatric research. This study on LSD is the largest study on psychedelic drugs to date.

Philosophy of psychedelics is the philosophical investigation of the psychedelic experience. While psychedelic, entheogenic or hallucinogenic substances have been used by many traditional cultures throughout history mostly for religious purposes, recorded philosophical speculation and analysis of these substances, their phenomenological effects and the relevance of these altered states of consciousness to philosophical questions is a relatively late phenomenon in the history of philosophy. Traditional cultures who use psychedelic substances such as the Amazonian and Indigenous Mexican peoples hold that ingesting medicinal plants such as Ayahuasca and Peyote allows one to commune with the beings of the spirit world.

A trip killer, or hallucinogen antidote, is a drug that aborts or reduces the effects of a hallucinogenic drug experience. As there are different types of hallucinogens that work in different ways, there are different types of trip killers. They can completely block or reduce the effects of hallucinogens or they can simply provide anxiety relief and sedation. Examples of trip killers, in the case of serotonergic psychedelics, include serotonin receptor antagonists, like antipsychotics and certain antidepressants, and benzodiazepines. Trip killers are sometimes used by recreational psychedelic users as a form of harm reduction to manage so-called bad trips, for instance difficult experiences with prominent anxiety. They can also be used clinically to manage effects of hallucinogens, like anxiety and psychomotor agitation, for instance in the emergency department.

References

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