{{short description|Unpleasant experience triggered by psychoactive drugs}} {{Other uses|Bad Trip (disambiguation)}} A '''bad trip''' (also known as '''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.<ref>{{Cite journal |last1=Gashi |first1=Liridona |last2=Sandberg |first2=Sveinung |last3=Pedersen |first3=Willy |date=2021 |title=Making "bad trips" good: How users of psychedelics narratively transform challenging trips into valuable experiences |journal=International Journal of Drug Policy |volume=87 |article-number=102997 |doi=10.1016/j.drugpo.2020.102997 |pmid=33080454 |issn=0955-3959|hdl=10852/81144 |hdl-access=free }}</ref> According to the California Legislature's 1969 substance abuse guide, the term "freak-out" was used to refer to a bad trip during the 1960s.<ref> {{cite book |last=Wolfe |first=Tom |author-link=Tom Wolfe |title=The Electric Kool-Aid Acid Test |publisher=Farrar, Straus and Giroux |year=1968 |language=en|p=15}}</ref>
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.<ref name="grof-lsd-pt">{{Cite book |last=Grof |first=Stanislav |url=https://books.google.com/books?id=jAvSPgAACAAJ |title=LSD Psychotherapy |date=2008 |publisher=Multidisciplinary Association for Psychedelic Studies |isbn=978-0-9798622-0-5 |language=en}}</ref>{{page needed|date=October 2020}} 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.<ref name="johnson-et-al-2008">{{Cite journal |last1=Johnson |first1=Matthew W. |last2=Richards |first2=William A. |last3=Griffiths |first3=Roland R. |date=2008 |title=Human Hallucinogen Research: Guidelines for Safety |journal=Journal of Psychopharmacology |volume=22 |issue=6 |pages=603–620 |doi=10.1177/0269881108093587 |pmc=3056407 |pmid=18593734}}</ref> 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.<ref name="gashi-et-al-2021">{{Cite journal |last1=Gashi |first1=Liridona |last2=Sandberg |first2=Sveinung |last3=Pederson |first3=Willy |date=2021 |title=Making "bad trips" good: How users of psychedelics narratively transform challenging trips into valuable experiences |journal=International Journal of Drug Policy |volume=87 |article-number=102997 |doi=10.1016/j.drugpo.2020.102997 |pmid=33080454 |hdl-access=free |hdl=10852/81144|s2cid=224821288 }}</ref> 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.<ref name="johnson-et-al-2008" />
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.<ref name="grof-lsd-pt" />{{page needed|date=October 2020}} 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.<ref name="gashi-et-al-2021" />
While some users report benefits, a challenging psychedelic experience can lead to long-term negative consequences, particularly if the individual lacks proper support. A portion of users report being psychologically traumatized afterwards, and some have been diagnosed with PTSD following a particularly difficult trip.<ref name="CalderDiehlHasler2025">{{Cite journal|title=Traumatic Psychedelic Experiences|first1=Abigail E.|last1=Calder|first2=Vincent J.|last2=Diehl|first3=Gregor|last3=Hasler|date=April 29, 2025|journal=Current Topics in Behavioral Neurosciences|doi=10.1007/7854_2025_579|pmid=40299143}}</ref> In one survey,<ref>{{cite journal |last1=Simonsson |first1=Otto |last2=Hendricks |first2=Peter S. |last3=Chambers |first3=Richards |last4=Osika |first4=Walter |last5=Goldberg |first5=Simon B. |title=Prevalence and associations of challenging, difficult or distressing experiences using classic psychedelics |journal=Journal of Affective Disorders |date=1 April 2023 |volume=326 |pages=105-110 |doi=10.1016/j.jad.2023.01.073 |url=https://www.sciencedirect.com/science/article/pii/S0165032723000915 |access-date=11 December 2025|pmc=9974873 }}</ref> 9% of users reported difficulties lasting at least 24 hours after the trip itself. In another survey of 608 people who all reported post-psychedelic difficulties, one-third of the dataset said the difficulties lasted longer than a year, and one-fifth said the difficulties lasted longer than three years.<ref name="Argyri">{{cite journal |last1=Argyri |first1=Eirini K. |last2=Evans |first2=Jules |last3=Luke |first3=David |last4=Michael |last5=Michelle |first5=Katrina |last6=Rohani-Shukla |first6=Cyrus |last7=Suseelan |first7=Shayam |last8=Prideaux |first8=Ed |last9=McAlpine |first9=Rosalind |last10=Murphy-Beiner |first10=Ashleigh |last11=Robinson |first11=Oliver C. |title=Navigating groundlessness: An interview study on dealing with ontological shock and existential distress following psychedelic experiences |journal=PLOS ONE |date=5 May 2025 |volume=20 |issue=5 |article-number=e0322501 |doi=10.1371/journal.pone.0322501 |pmid=40323979 |pmc=12052184 |bibcode=2025PLoSO..2022501A |doi-access=free }}</ref> The most commonly-reported post-psychedelic difficulties in this study were anxiety, feeling traumatized by the experience or uncovering earlier trauma, social isolation, derealization/depersonalization, visual distortions, and existential confusion. Most people recover from these difficulties with the help of accurate information, social support, and therapy.<ref>{{cite web |title=Difficulties after psychedelics |url=https://challengingpsychedelicexperiences.com/symptoms/ |website=Challenging Psychedelic Experiences |access-date=11 December 2025}}</ref>
== Signs and symptoms == {{See also|Psychosis|Substance-induced psychosis}} With proper screening, preparation, and support in a regulated setting symptoms are usually benign.<ref>{{cite journal |last1=Barrett |first1=FS |last2=Bradstreet |first2=MP |last3=Leoutsakos |first3=JS |last4=Johnson |first4=MW |last5=Griffiths |first5=RR |date=December 2016 |title=The Challenging Experience Questionnaire: Characterization of challenging experiences with psilocybin mushrooms. |journal=Journal of Psychopharmacology |volume=30 |issue=12 |pages=1279–1295 |doi=10.1177/0269881116678781 |pmc=5549781 |pmid=27856683}}</ref> A bad trip on psilocybin, for instance, often features intense anxiety, confusion, agitation, and psychosis.<ref name="van-amsterdam-et-al">{{Cite journal |last1=van Amsterdam |first1=Jan |last2=Opperhuizen |first2=Antoon |last3=van den Brink |first3=Wim |date=2011 |title=Harm potential of magic mushroom use: A review |journal=Regulatory Toxicology and Pharmacology |volume=59 |issue=3 |pages=423–429 |doi=10.1016/j.yrtph.2011.01.006 |pmid=21256914}}</ref> 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.<ref name="van-amsterdam-et-al" />
== Treatment ==<!-- Treatment (i.e., management, intervention) --> {{See also|Trip killer}} [[File:Xanax (alprazolam) 2 mg.jpg|thumb|Xanax is a benzodiazepine used as a trip killer.]] 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. A trip killer such as alprazolam, diazepam, quetiapine, or trazodone is the most frequently used treatment.<ref>{{Cite journal |last=Yates |first=Gregory |last2=Melon |first2=Emily |date=2024-02-01 |title=Trip-killers: a concerning practice associated with psychedelic drug use |url=https://emj.bmj.com/content/41/2/112 |journal=Emergency Medicine Journal |language=en |volume=41 |issue=2 |pages=112–113 |doi=10.1136/emermed-2023-213377 |issn=1472-0205 |pmid=38123961}}</ref> Other benzodiazepines such as lorazepam are also effective. Such sedatives will only decrease fear and anxiety, but will not subdue hallucinations. Antipsychotics such as quetiapine, aripiprazole, risperidone, and haloperidol can reduce or stop hallucinations. Haloperidol is effective against acute intoxication caused by LSD and other tryptamines, amphetamines, ketamine, and phencyclidine.<ref>{{Cite journal |last1=Giannini |first1=A. James |last2=Underwood |first2=Ned A. |last3=Condon |first3=Maggie |year=2000 |title=Acute Ketamine Intoxication Treated by Haloperidol |journal=American Journal of Therapeutics |volume=7 |issue=6 |pages=389–91 |doi=10.1097/00045391-200007060-00008 |pmid=11304647}}</ref><ref>{{Cite web |title=Sage Journals |url=http://jcp.sagepub.com/cgi/pmidlookup?view=long&pmid=6725621 |archive-url=https://web.archive.org/web/20140824075401/http://online.sagepub.com/site/moved?view=long&pmid=6725621 |archive-date=2014-08-24 |access-date=2018-03-27 |language=en}} </ref>
== Pathophysiology == <!-- Signs and symptoms --><!-- Pathophysiology --><!-- Pathogenesis to be written -->
Bad trips may cause range of conditions such as psychosis and hallucinogen persisting perception disorder (HPPD).<ref>{{cite journal |last=Bracco |first=Jessica |date=May 2019 |title=The United States Print Media and its War on Psychedelic Research in the 1960s |url=https://digitalcommons.buffalostate.edu/exposition/vol5/iss1/2/ |journal=The Exposition |volume=5 |issue=1 |pages=9–10}}</ref> ==Perspectives==
===Stanislav Grof=== Psychiatrist Stanislav Grof once said in an interview:
{{blockquote|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.<ref>{{Cite web |title=Beyond Psychotic Experience - Stan Grof interviewed by Jon Atkinson |url=http://www.lycaeum.org/leda/docs/16869.shtml?ID=16869 |archive-url=https://web.archive.org/web/20110927122540/http://www.lycaeum.org/leda/docs/16869.shtml?ID=16869 |archive-date=2011-09-27 |access-date=2011-04-12}}</ref>}}
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.<ref>{{Cite book |last=Grof |first=Stanislav |title=realms of the human unconscious - Observations from LSD research |publisher=souvenir press |year=1975 |isbn=0-285-64882-9 |pages=95–153}}</ref>
===Rick Strassman=== Professor of psychiatry Rick Strassman is critical of reframing the experience of bad trips as one of "challenging experiences".<ref>{{cite web |title=Misguided Mainstreaming of Psychedelic Drugs: Challenging Experiences |url=https://www.rickstrassman.com/misguided-mainstreaming-of-psychedelic-drugs-challenging-experiences/ |website=Rick Strassman MD |date=25 October 2017}}</ref>
==See also== *Altered state of consciousness *Ego death *Existential crisis *Hallucinogen *Hallucinogen persisting perception disorder *Harm reduction *Near-death experience *Out-of-body experience *Overdose *Posttraumatic growth *Posttraumatic stress disorder *Psychedelic experience *Psychedelic therapy *Psychedelic drug *Risks of psychedelic drugs *Psychonautics *Psychosis *Recreational drug use *Responsible drug use *Sensory deprivation *Set and setting *Spiritual crisis *Substance-induced psychosis *Trip killer
==References== {{Reflist}}
==External links== {{Medical resources | DiseasesDB = | ICD10 = {{ICD10|F|16|0}} | ICD9 = {{ICD9|305.3}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = }} * [http://www.psychedelic-library.org/grof2.htm Crisis Intervention in Situations Related to Unsupervised Use of Psychedelics] * [http://www.erowid.org/psychoactives/faqs/psychedelic_crisis_faq.shtml Psychedelic Crisis FAQ: Helping someone through a bad trip, psychic crisis, or spiritual crisis] * [http://www.maps.org/resources/responding_to_difficult_psychedelic_experiences/ Psychedelic Harm Reduction] {{Webarchive|url=https://web.archive.org/web/20140604020401/http://www.maps.org/resources/responding_to_difficult_psychedelic_experiences/ |date=2014-06-04 }} * [http://vimeo.com/15960576 Psychedelic Harm Reduction and Policy] lecture in the Psychedelic Science in the 21st Century conference in 2010. * [http://vimeo.com/16702478 Psychedelics in the Psychiatric ER - Julie Holland, M.D.] lecture in the Psychedelic Science in the 21st Century conference in 2010. * [https://archive.today/20130122013826/http://www.drugs-wiki.com/forum/showwiki.php?title=The_psychedelic_crisis:_bad_trip The Psychedelic crisis (bad trip) entry at Drugs-Wiki]
{{Psychoactive substance use}}
{{DEFAULTSORT:Bad Trip}} Category:Drug culture Category:Drug overdose Category:Psychedelia Category:Substance intoxication