Recently, researchers have been rethinking psychedelic therapy, exploring psilocybin treatments of PTSD, death anxiety during the late stages of cancer and similar ailments. According to an article on AlterNet, what sets contemporary trials apart is “the new crop of establishment-oriented academics are exceedingly cautious and responsible” as opposed to researchers of the ’60s, which were a little too enthusiastic in riding the wave of hallucinogenic popularity. This new, “sober and serious” approach might utilize psilocybin’s psychologically altering properties more effectively and determine, without Hoffmannian giddiness, what causes “bad trips.”

After some really longwinded descriptions of the writer’s own trips of various enjoyment levels, AlterNet references Charles Grob, MD — a pioneer of psychedelic therapy and professor of psychiatry at UCLA.

“What’s happening now is very different than what went on in the 1960s,” Grob says. In those days, information about hallucinogens “seeped out” from starry-eyed academics who, along with a pliant media, “popularized it as a rite of the so-called counter-culture and there were very few precautions.”

In a 2013 paper entitled “Hallucinogens and Related Compounds,” Grob describes the social fallout that ensued. “Given [young] users’ relative lack of knowledge and understanding [about] the range of effects of these potent compounds, and often disregarding essential safeguards, the use of hallucinogens by young people was capable of causing psychological injury.

Grob observed the specifics of a bad trip thusly:

Grob’s view is that a “bad trip” is a psychedelic-heightened anxiety attack. But he also observes that LSD users are prone to “anxiety symptoms resembling paranoid psychosis toward the latter part of the eight-to-twelve-hour experience.”

Unsurprisingly, this is more common to young and otherwise new users:

Grob’s paper highlights case studies of adolescent patients undergoing bad trips. He describes physical symptoms such as “tachycardia, sweating [and] palpitations” alongside a potpourri of “psychological distress,” including “varying degrees of anxiety, depression, ideas of reference, fear of losing one’s mind, paranoid ideation and impaired judgment.” Transient anxiety states are observed in “adolescent, novice users.”

How do you prevent “bad trips?” In short — careful supervision, extremely controlled environments, direct goals, and other responsible and experience-sterilizing practices of research science.

A critical aspect of current psychedelic clinical trials has been the establishment of an experimental process intended to ensure safety and maximize the potential benefits for the subject. “This has to be very serious, sober work,” Grob says. Such require a stamp of approval from several regulatory bodies, and the trial design, including the screening process, is evaluated very closely. “Some people are way too vulnerable for this—for example, anyone who has had a history of schizophrenia,” he says.

Once a subject is chosen for a trial, a three-part process ensues. The first session is prep work as to what can be expected from the drug and how to handle its effects. The next time the person comes in, he is administered the drug. The investigator stays by his side “for the entire trip,” Grob says. That way “if someone hits a rough patch or has a hard time, we can talk him down.” Whether it’s part of a scientific or spiritual framework, having a knowledgeable facilitator is key to a good experience.” Transient anxiety states can usually be “resolved quickly with gentle reassurance and reduction of sensory stimuli.” If this technique fails, Grob recommends 20 mg of Valium, a benzodiazepine, “with bad trips usually resolving in about 30 minutes.”

The third step of the process is therapy, in which the subject talks about the psychedelic experience. Summing up the outcomes of several studies that he and his fellow investigators conducted, Grob says, “A lot of impressive data is piling up and we’ve had no bad trips,” adding that his patients in the cancer study were suffering from existential-level anxiety “sparked by their impending death.”

On an unnecessarily personal note, though there are definite trigger controls that could potentially curb a universal and wildly fluctuating existential dread and related hallucinations when it does go “bad,” this isn’t positively encouraging. It’s not hard to realize why some previous trials — like government DMT trials of the ’90s — ended in disaster. When it crests, it would be hard to feel calmed by white walls and men in lab coats soberly standing around you with needles of emergency downers.

In summary, contemporary research hasn’t yielded any magical solutions, just the old Leary “set and setting” disclaimer and guidelines already practiced by responsible hallucinogenic enthusiasts, coupled with an advertisement of the safety that an official lab environment may provide. Meanwhile, heavy criminalization of psychedelic substances remains a roadblock to independent and medical investigations. Which is really a bummer.

Maybe, in the future, this research will move forward and beyond shooting people up with psilocybin while they lie in MRI scanners and come up with a happy medium. Something gentle, like a therapist’s office. (Image: @rqusGed)