Bad trip

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. According to the California legisture's 1969 substance abuse guide, the term "freak-out" was used to refer to a bad trip during the 1960s.

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.

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. In one survey, 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. 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.