How to Survive a Bad Trip, According to a Psychedelic Therapist

This article originally appeared on VICE Germany.

A sunny day outdoors, good friends, and an afternoon of funny, mind-expanding experiences—that’s how everyone hopes their psychedelic trip will go. Unfortunately, things don’t always turn out that way. Even if you’re an experienced drug user, chances are you might have a bad trip someday, a negative experience while high on psychedelics like LSD, mushrooms, or ayahuasca. 

A “bad trip” is a bit of a catch-all that refers to anything from anxiety to full-blown panic attacks or even psychoses and delusions. From a scientific point of view, we still don’t understand particularly well why bad trips happen or what they are exactly. What we do know is that, surprisingly, people who went through one don’t always regret it. Some say they later understood it as an important moment of growth. 

But finding a silver lining after having dreadful hallucinations isn’t easy. That’s why Berlin-based anesthesiologist and physician Andrea Jungaberle decided to specialize in a type of therapy that helps people make sense of what they experienced while on psychedelic drugs, both the good and—most importantly—the bad. 

Jungaberle believes psychedelics have great therapeutic potential and is also participating in a study to treat mental health patients with the help of psilocybin, the psychedelic component in shrooms. We spoke to her about what happens during a psychedelic trip and what you can do to avoid some of their more negative repercussions.

VICE: Hello Dr Jungaberle. Some people say there’s no such thing as a bad trip. Why?
Andrea Jungaberle: Many of the trips people perceive as negative are just very demanding or challenging—living through them means learning something about yourself or the world. However, there are also some truly horrific trips, for instance, when someone thinks they’re in a state of danger or close to death. It can be very hard to draw some positives from these kinds of experiences, at least at first. That’s why we offer help with that in the form of integration therapy.

What does integration mean, actually?
Integration means you work with the psychedelic experience to integrate what you’ve learned during the trip into your life. In the best-case scenario, you’ll see a change in your behavior or perspective. 

In general, I’d recommend this integrative mindset to anyone who has had a psychedelic experience. It starts with thinking about what you’re taking, with whom and where you’re taking it beforehand. The better prepared you are for the experience, the more likely you are to do the integration on your own. But obviously, there’s no guarantee.

What do you mean?
You might have 20 years of experience with psychedelics and have a bad trip the hundredth time you do it. It doesn’t even have to be a high dose. Anyone seeking a psychedelic experience puts their psychological integrity at risk. You have to keep that in mind. Psychedelics simply aren't playthings.

Are some people particularly at risk?
Definitely. Mentally healthy people have an easier time integrating intense psychedelic experiences. Due to recent research on the possible effects of psychedelics on mental illness, more and more people are trying to use psychedelics to treat their depression, anxiety, or trauma by themselves. This is partly because there’s simply no legal way of accessing these treatments at the moment. And integrating your experience without a therapist can be very overwhelming. 

What experiences are particularly difficult to integrate?
Those related to fear or shame. For example, feeling your own mind is broken or that you broke the world, that you’ve encountered the ultimate evil, or that you’re dying. It can be anything, really. Those experiences are closely tied to our primal fears. Often, the main issue is that the person on drugs can’t surrender to these negative experiences.

Why should they surrender? 
Psychedelic experiences are often about acceptance. People who believe they’ll make it out unscathed usually get through it better than people who fight it tooth and nail. That only makes things worse and worse, and you might come out of it feeling like you can’t cope with what you've just been through. The negative effects can also continue beyond the trip in the form of sleep disturbances, for example, or loss of appetite, stress, anxiety. In this case, integration therapy can really help. 

So you mostly need therapy for negative experiences?
Not necessarily. People who have gained important insight but don’t know what to do with it also come to us. Sometimes it’s for practical things, like someone understanding why they smoke during a trip and wanting to quit without knowing how. 

Why are we suddenly able to realize important things during a psychedelic trip?
There are several theories, but we don’t have a clear answer. The theory that makes the most sense to me on a neurobiological level is that these substances connect areas of the brain that don’t normally communicate. 

Think of it like this: Some areas of our brain have formed groups that are used to work with each other. Out of the blue, psychedelics introduce them to new team members, giving you access to new voices and images. You remember things differently or make mental connections that weren’t possible before. 

You can see it happen in MRI scans when you’re measuring someone’s metabolic activity and blood flow during a trip. We call these experiences disruptive because they stir things up. That’s where the healing lies. But if you stir things up too much, you can also break something. There’s a difference between intense and too intense, and the line is different for everyone. 

Why is the experience so personal?
We all have different hardware and software, if I may use the computer analogy here. The hardware is our brain. We’ve all developed different neural connections over the course of our lives. Someone who’s been depressed for 20 years will have different brain pathways than a healthy person. 

The software is our beliefs, which we’ve acquired throughout life, our view of the world. For instance, someone who believes in angels is more likely to see angels during their trip. The way we approach our trip is also part of this software. You might have a shamanistic approach to taking psychedelics, or a learning approach, or maybe just a recreational one.

Psychedelics are a sort of temporary program that affects both our hardware and the software, kind of like an update. You just have to see that the system still runs smoothly afterward.

How does integration therapy differ from other therapies?
One reason is that it’s a legal gray area. In Germany, possessing and trafficking psychedelics is against the law; consuming them isn’t, but things get tricky since you’re not allowed to have them. We only offer therapy after the trip, although we keep getting requests from people seeking it in preparation. That actually would make a lot more sense in terms of harm minimization. On top of that, many old-school therapists have been taught that patients can only be treated if they don’t take drugs at all.

Do you disagree with that?
It can definitely put people in a tough spot. For instance, if we take the case of someone with a cocaine addiction seeking therapy, they might be in need of urgent help, but their therapist might tell them they’ll only treat them after they get clean. This shifts the burden of the hardest part onto the patient.

Are there patients who cannot be helped with integration therapy?
Of course, some need more than just that. For example, if someone’s experienced a psychotic episode that continues even after the psychedelics have worn off.

Like people who get stuck inside a trip?
Exactly. There is also HPPD, Hallucinogen Persisting Perception Disorder: Changes in perception that persist after the trip. For example, seeing colored patterns in space. But that's very, very rare. 

What's the best way to avoid a bad trip? 
You should find a safe environment and take your time. You should always have a sober companion whom you trust. If they can’t be there in person, you should at least be able to call them. The substance you choose is also important. The wilder the cocktail, the higher the dose, the more unknown the substance, the higher the risk that something bad might happen. Psychedelics are by no means party drugs. You can only take them at a party in small doses if you know what you’re doing.

You should also think about the mindset you are in. Did your grandma die recently? Are you stressed because of work? Did your partner just break up with you? Sure, you can also process a breakup during a trip, but it’s not for beginners. It’s also important to know your history. If you’re a trauma patient, you need to take into consideration that your trauma might resurface.

What if something does go wrong?
That’s what the sober companion is for. They can use the classic methods to calm the person down: Talk to them, bring them to a safe environment, offer them something to drink, and get some fresh air. You can try to ride out the wave and see if the problem goes away. 

And if it doesn’t?
If the person gets aggressive and puts themselves or others in danger, you might need to call the emergency services. This means possibly involving the authorities. One thing needs to be clear – protecting the person is always more important than the fear of punishment or being caught. You should always make a pact among those present that, if necessary, you’ll call an ambulance. 

How can you tell the difference between a normal and a psychotic experience?
Under the influence of psychedelics, it’s normal to picture vivid inner images, hear voices, or have other experiences outside the bounds of reality. However, you’ll usually retain some form of consciousness, an ego that can observe the experience. Even if someone experiences ego dissolution, there’s still a part of you present that can say your ego has dissolved. 

But when you lose your ego completely, you lose your anchor to reality. If you’re completely drifting into inner images and worlds, you’re probably on your way to a psychotic episode. For example, you might think every food tastes weird and believe you are being poisoned. Still, it’s important to note here that it’s very rare for psychosis to be induced by traditional psychedelics alone. People who become psychotic usually already have it within themselves. Maybe it already runs in their family, for example.

So, if you have a history of psychosis, you should stay away from psychedelics?
You should definitely be very careful. It’s possible you’ll never experience a psychotic or schizophrenic episode if you don’t take these drugs. But you can’t really know for sure because these disorders can be triggered in other ways. 

The problem is not many people know about this. I was at a party when a woman told me she had just been diagnosed with bipolar disorder and put on medication. Her best friend advised her to stop taking her prescriptions and drink ayahuasca instead. That is really dangerous advice. Someone who already has a diagnosed mental illness shouldn’t be wildly experimenting at all. 

The question of whether we’ll ever get to the point where we dare to treat people with mental illnesses with psychedelics is still open. The problem is simple: Once you have them in your blood, they’re in there, and you can’t control them. You have to go through with the experience until the end.