What if I have a bad trip?


I get asked this a lot by new patients. Understandably with consternation. Some carry the weight of depression or lingering effects of unprocessed trauma. I can see my patients' anxiety provoking visible physical discomfort as they recall an earlier experience with psychedelic medicines like Psilocybin, Ketamine, Ayahuasca, LSD, etc. that was unpleasant and challenging.  

Fortunately, Ketamine is one of the more gentle psychedelic medicines due to it's short duration of action and empathogenic pharmacodynamics reinforcing this. Challenging experiences certainly can occur with ketamine assisted therapy but  generally not with high frequency.

Despite psychedelic substances historically being marked illegal by federal laws, Americans have been using them and continue to use them as humans have been doing for thousands of years all over the world. I am not suggesting that these powerful medicines that alter consciousness should be sold at gas stations or dispensaries without any consideration or support. They are powerful. They absolutely can be harmful when abused. But observing the legal taboo associated with them negated their potential therapeutic value while also preventing users the opportunity to explore what their experience meant to them: good, bad, awful, and otherwise.

What is a bad trip? I've heard them described as feeling anxious, vulnerable, scared, losing a sense of  personal identity and purpose, or feeling detached from  surroundings. When I listen to people recall these experiences they painfully recall  an absolute realization that seems disturbing or invasive. Profound in a stark way. Not what you expected when you ate that bag of magic mushrooms on prom night was it? It's like thinking you are embarking on a pleasant sunny afternoon walk  only to find out you will be landing a fighter jet on an aircraft carrier during a hurricane.

On one hand all of these things sound pretty unhealthy. They feel bad.  And there is no reason to minimize how awful those experiences can be for people. But why can't these experiences be redemptive? Can't awful things be meaningful? To accomplish this we will need to  seperate what your brain thought was happening from what was actually happening. Many people report they felt like they were in some kind of danger, be it physical or existential in nature. When people begin to unpack these experiences afterwards it occurs to them they were not in any mortal danger- but couldn't tell at the time.

As contradictory as this may seem- I congratulate my patients when they have a bumpy ride during treatment. Heading into fear is advisable. Facing your fears is advisable.  Make sense?   "Bad trips" often lead to good clinical outcomes. Just like any other experience that we learn from. 

If you feel that the potential to re-experience a challenging experience with psychedelics is in no way, shape or form  helpful. that you see no benefit from it, and want to avoid it at all costs, then this is also a reasonable conclusion to make.  There is no requirement that psychedelic medicine is the path to understanding the meaning of those experiences or how they impacted you. The decision to use any psychedelic substance is deeply personal and no one knows better than you how to care for your hurt. There is no shame in saying, "No, thank you." None at all. 

Set & Setting offers an ideal safe and protective environment to explore this inner terrain. With proper support and compassion that will provide you the foundation to confront challenging sessions and get relief from depression, or anxiety from unprocessed trauma. 

The primary purpose of ketamine assisted therapy at Set & Setting  is to mitigate all extenuating factors that historically have contributed to bad trips and at core, give you all the advantages,  support, and tools you need  to roll with one if the opportunity to have one should occur. Because you've got this!

Next up in part II: Reasons why you may have had a bad trip 

Justin Rice, PMHNP-BC Owner and practitioner. Justin is a board-certified psychiatric mental health nurse practitioner (PMHNP-BC). Justin’s practice is focused on the use of Ketamine to help patients move past intractable, or stuck, areas that cause distress. Justin has post-graduate education in psychedelic medicine and ketamine-assisted psychotherapy. He is an active member of the Psychedelic Medicine Association, Portland Integration Network, and has been accepted into the MAPS MDMA therapist training program. Justin’s values are influenced by Buddhist, Jewish, and Jesuit teachings.