A “bad trip” is an acute, adverse psychological reaction following the ingestion of a psychoactive substance, most commonly psychedelics, stimulants, or dissociatives. This experience involves intense psychological distress, characterized by overwhelming anxiety, paranoia, feelings of losing control, or frightening sensory distortions. Since the experience is subjective and often amplified by the user’s mindset and environment, the immediate priority for the helper is maintaining a calm demeanor and ensuring the safety of everyone present. This harm-reduction approach focuses on guiding the person through the temporary distress while monitoring for physical emergencies.
Securing the Environment and Ensuring Physical Safety
The first step in assisting someone experiencing a difficult trip is to actively manage their physical surroundings to create a safe haven. This involves quickly moving the person to an environment that is quiet, dimly lit, and free from excessive stimulation.
Once a safe space is established, check for potential physical hazards, including sharp objects or breakable items. The person should be gently encouraged to remain still, and physical restraint must be avoided unless they pose an immediate danger to themselves or others. Focus on supportive presence and gentle redirection away from potential harm.
Physical monitoring is continuous, particularly concerning temperature regulation and hydration. Many psychoactive substances can affect the body’s ability to manage heat, potentially leading to hyperthermia. Offer small, frequent sips of water or a sports drink to counteract dehydration, but avoid forcing them to drink large amounts. Ensure they are comfortable, using a blanket if they feel cold, or moving them to a cooler area if they show signs of overheating, such as flushed skin.
Providing Calming Reassurance and Psychological Anchoring
The primary goal of psychological first aid in this situation is to act as a grounded anchor to reality, counteracting the person’s internal chaos. The helper, often called a “sitter,” must project unwavering calmness and patience, as their non-verbal communication can significantly influence the person’s state.
Communication should be simple, clear, and delivered in a soft, steady voice, as complex narratives or questioning can be overwhelming. Avoid phrases like “Calm down” or “You’re fine,” which invalidate their current, terrifying experience. Instead, acknowledge their distress while gently affirming their physical safety with statements such as, “I see you are scared, but you are physically safe, and I am here with you.”
To help anchor them to the present moment, employ grounding techniques that focus on the five senses. A common method involves directing their attention to concrete details in the room, such as naming five things they can see, four things they can feel (like the texture of a blanket or the chair beneath them), and three things they can hear. This technique helps pull their focus away from internal delusions and towards the external reality.
It is unproductive and potentially harmful to argue with or challenge any hallucinations or paranoid thoughts they express. If they believe they are shrinking or that the walls are melting, you should not validate the delusion, but simply redirect their attention. One effective strategy is to shift their focus to their own breathing, guiding them through slow, deliberate inhales and exhales, which can lower their heart rate and quell rising panic. Maintain a steady presence and understand that their state is temporary, requiring patient support until the acute effects subside.
Recognizing When Immediate Medical Help is Necessary
While most difficult trips can be managed with supportive care, certain physical and behavioral symptoms indicate a medical emergency requiring professional intervention. Physical emergencies mandate an immediate call to emergency services. These include:
- Any sign of seizure activity.
- Loss of consciousness.
- Difficulty breathing (slow, shallow, or erratic).
- A sustained, high fever (hyperthermia).
- An abnormally fast, slow, or irregular pulse.
- Uncontrolled vomiting or severe chest pain.
Behavioral red flags are equally serious and require immediate professional help if they cannot be safely managed. This includes violent or aggressive behavior that poses a threat to the person or others, or an explicit expression of suicidal intent. Prolonged and severe psychosis, where the person is completely detached from reality and cannot be reached through grounding techniques, also warrants medical assessment.
When contacting emergency services, be honest and specific about the substance taken, if known, as this information allows first responders to provide the most appropriate and timely medical treatment. Never leave the person alone while waiting for help to arrive, as their condition can change rapidly. Polysubstance use or the ingestion of unknown substances significantly increases the risk profile and generally lowers the threshold for seeking medical help.