What Is a Bad Trip and How Do You Prevent One?

What is a bad trip, really?

A bad trip is not an illness and not a punishment. It is a difficult experience with recognisable causes and workable answers. What stands out for most people is anxiety, paranoia, dissociation, or the feeling of losing your grip on who you are. Sometimes that lasts a few minutes; sometimes a few hours. For most people it fades as soon as the mushrooms or truffles wear off.

There is an important difference between acute distress during the trip itself and longer-lasting destabilisation afterwards. The first is usually unpleasant but temporary. The second is rare, and tends to involve underlying factors more than the trip itself. In an online questionnaire of 1,993 mushroom users, Carbonaro et al. (2016) found that 84 percent said they had taken something useful from the difficult experience in retrospect. Worth knowing: this was a self-selected online sample, not a cross-section of all users.

Since 2016, “challenging experience” has been the preferred term in scientific writing. Barrett et al. (2016) built a questionnaire (the CEQ) that measures these experiences for clinical studies. The phrase “bad trip” does not always do justice to the outcome. Difficult in the moment, often valuable later, sometimes simply unpleasant. We use “bad trip” in the title because that is what people search for; in the body of the article we lean on “difficult” or “challenging experience”.

How often does it happen?

In the Carbonaro survey, 39 percent of respondents named their hardest trip among the top five most challenging experiences of their lives. Eleven percent said they had briefly felt physically at risk to themselves or others. 2.7 percent sought medical help. In a pooled analysis of eight controlled laboratory studies in 110 healthy, screened volunteers (Studerus et al., 2011), acute panic or severe anxiety occurred only at the highest doses, and even then only in a small subset of participants. None developed long-lasting problems on follow-up.

Reading the Carbonaro figures as “39 percent chance of a bad trip” misreads them. The respondents were people who voluntarily filled in an online questionnaire about their hardest mushroom trip ever. That kind of sample mostly attracts people who went through something heavy. Surveys rarely underestimate. They usually overestimate: someone who once had a difficult trip is more likely to fill in a bad-trip questionnaire than someone who never did. For the average mushroom or truffle user, the real numbers almost certainly sit lower than these studies suggest.

Why bad trips happen: set, setting, substance

Researchers have used the “set, setting, substance” model since the 1960s. Hartogsohn (2017), in a widely cited review, argues that these three factors together shape what a psychedelic does. Pharmacology alone does not explain it.

Set is your mental space heading into the trip. How stressed you were the week before. What you expect or fear. Whether something has been simmering that you have not looked at. That is not a reproach. Almost everyone carries something. It does affect how cautious your dose and environment need to be.

Setting is everything around you. A familiar place with soft lighting, comfortable furniture and few sensory stimuli works better for almost everyone than an unknown room with loud music and people you do not trust. Social safety counts at least as much as the physical space. Someone who stays calm, can be quiet when needed and knows you without judging is worth more than a lively group.

Substance is what and how much. Truffles and mushrooms differ in potency. A batch can deviate considerably from what you expect. Mixing with cannabis or alcohol raises the chance of paranoia or panic (see our article on combining with alcohol or cannabis). Mixing with SSRIs usually changes the experience and makes it unpredictable (see our article on combining with antidepressants).

Specific risk factors

Johnson, Richards and Griffiths (2008) described the safety framework still in use for clinical psychedelic research. The risk factors their review highlights: a personal or family history of psychotic disorders, acute serious psychiatric symptoms, a high dose for what your tolerance can handle, an unsafe environment, and concurrent use of certain medications. The presence of one risk factor does not make a bad trip inevitable. The absence of all of them is no guarantee.

A family history of psychosis is a serious warning, not a forecast. Clinical studies exclude this group as a precaution. Not because it has been shown that they always or usually have a severe bad trip, but because the consequences of a rare outlier can be large (Carhart-Harris and Goodwin, 2017).

Prevention: the checklist before the trip

1. A lower dose, especially the first time or after a long break. Use the Trimbos micro / regular / strong tables.

2. A familiar environment. A room where you feel safe, with the option of stepping outside or lying down somewhere quiet.

3. A tested batch, via DIMS (drugs-test.nl) or a trusted source.

4. A sober trip-sitter, especially the first time or at a higher dose. Brief them in advance: what you need, what you do not want, when they should step in.

5. An honest state-of-mind check. No acute crisis is not the same as “obliged to feel cheerful”. What it does mean: no recent panic episode, no overwhelming bad news that just landed, no unprocessed acute loss. A calm baseline is enough.

6. No mixing on a first time or peak dose. Alcohol, cannabis and certain medications raise the chance of paranoia or panic.

7. Phone, water and simple food within reach. Set the phone to do-not-disturb, but keep it reachable.

What to do during a difficult moment

Clinical therapist manuals (Johnson et al., 2008) and Dutch harm-reduction practice (Trimbos, Unity, Jellinek) point to a handful of simple interventions that often help. Stand up or, on the contrary, lie down. Walk to another room. Drink water. Switch the music to something slow or instrumental, or turn it off entirely. Breathe out more slowly than you breathe in. Say it out loud: “This is the trip. This will pass.”

The literature holds two approaches side by side. “Leaning in”: investigating the content of the fear instead of pushing it away. And “grounding in the body”: coming back to breath, gravity, the chair underneath you. Which one works better differs from person to person, and from moment to moment. Neither is always the right answer. The part of you that does not want to let go is there for a reason. Ask it quietly what it needs to feel safe, instead of overruling it.

For anyone sitting next to someone: offer water, stay calm, do not argue with the content of the trip, limit physical holding to acute safety only. A light hand on an arm can help, but only if the person asks for it or clearly welcomes it. Calm presence is usually enough. Carbonaro et al. (2016) found that absence of social support was one of the predictors of a harder trajectory.

Acute panic versus prolonged distress

A mushroom or truffle trip usually lasts 4 to 7 hours (Holze et al., 2023; Brown et al., 2017). Most acute anxiety eases as the substance wears off. Until then, grounding helps: water, breathing, familiar presence. If you notice you are not coping alone and there is no one with you, call someone you trust who can stay calm on the phone.

Call 112 if someone fully loses contact with reality and cannot stay safe, with self-harm ideation, with prolonged confusion or dissociation well past the substance window (24+ hours after a normal dose), or with physical emergency signs such as chest pain, fainting or a seizure. Doubt belongs on the side of getting help, not waiting it out.

In the Netherlands, you are not prosecuted as a user for seeking medical help. The Public Prosecution Service focuses prosecution on production and trade, not on users (Aanwijzing Opiumwet 2015A003). When unsure, you can call the Trimbos drugs information line (0900-1995) or, in an acute situation, 112. For a suicide-related crisis: 113 Suicide Prevention via 0800-0113.

After a difficult trip: integration

A pooled analysis of eight laboratory studies in 110 healthy volunteers (Studerus et al., 2011) found no lasting psychiatric harm, no persistent perceptual disturbance, no enduring decline. In a systematic review of 34 modern studies (Aday et al., 2020), long-term effects in supervised settings were predominantly positive. Roseman, Nutt and Carhart-Harris (2018) showed that the quality of the acute experience (how much ego-dissolution, how much fear) predicts how someone is doing in the long run. A difficult moment during the trip therefore does not automatically mean a poor outcome.

Sustained sleep disturbance lasting longer than a week, intrusive imagery, depersonalisation or prolonged anxiety are reasons for professional support. That does not have to mean psychiatry straight away. A general practitioner, an integration-oriented therapist, or a trusted friend with experience can be the first step. A small subset of users develops longer-running symptoms such as HPPD (persistent visual disturbances). Prevalence is low. An online questionnaire of 2,455 psychedelic users (Baggott et al., 2011) estimated HPPD at around 4.2 percent, with the known limitations of a self-selected sample. Most cases are mild and improve over time.

You can reach out free of charge to the Drugs Information Line of Trimbos (drugsinfo.nl/paddos-truffels, 0900-1995), Jellinek (jellinek.nl/alcohol-drugs-gedrag/truffels-en-paddos), and Unity (unity.nl) for peer support at events. The OPEN Foundation (open-foundation.org) coordinates a volunteer network for integration after difficult experiences. For crisis: 112 for emergencies, 113 Suicide Prevention (113.nl) for suicide-related thoughts.

Myths we can clear

“A bad trip means mental illness coming out.” Often overstated. The link between psychedelic use and psychotic disorders in case-report literature is heavily skewed by selection effects. Vulnerable people are reported more often than someone who simply had a few hard hours and then went on with their life.

“You will never recover.” For most users, just untrue. The Studerus follow-up of 110 volunteers found no lasting harm. Aday’s review points the same way. What is true: someone with an underlying psychotic vulnerability and a heavy uncontrolled trip carries a real risk. That is why clinical research screens this group out.

“Everyone gets a bad trip eventually.” Not true. In controlled studies, the majority do not, and the same holds in naturalistic surveys. The idea comes mainly from self-selected online communities, where people who had heavy experiences share more often.

“If you can’t go with it, you shouldn’t have done it.” A clumsy frame. Half of what the literature says recommends grounding precisely at hard moments. That a part of you does not want to let go does not mean the trip failed, or that you failed. It means that part has something to protect. Quietly listening for what that is tends to be more fruitful than overruling yourself.

For sitters and friends

Do: offer water, stay calm, slow your breathing, stay physically present without claiming the space, help with changing posture or room, name out loud that this is temporary.

Do not: argue with the content of the trip, lecture, physically restrain without need, judge, force eating or movement, treat the trip session as therapy.

When to escalate: at safety risk, at prolonged distress that does not ease, at signs of medical emergency.

Sources

1. Aday JS, Mitzkovitz CM, Bloesch EK, Davoli CC, Davis AK (2020). Long-term effects of psychedelic drugs: A systematic review. Neuroscience & Biobehavioral Reviews 113: 179-189. DOI: 10.1016/j.neubiorev.2020.03.017

2. Baggott MJ, Coyle JR, Erowid E, Erowid F, Robertson LC (2011). Abnormal visual experiences in individuals with histories of hallucinogen use: a Web-based questionnaire. Drug and Alcohol Dependence 114(1): 61-67. DOI: 10.1016/j.drugalcdep.2010.09.006

3. Barrett FS, Bradstreet MP, Leoutsakos JS, Johnson MW, Griffiths RR (2016). The Challenging Experience Questionnaire: Characterization of challenging experiences with psilocybin mushrooms. Journal of Psychopharmacology 30(12): 1279-1295. DOI: 10.1177/0269881116678781

4. Brown RT et al. (2017). Pharmacokinetics of escalating doses of oral psilocybin in healthy adults. Clinical Pharmacokinetics 56(12): 1543-1554. DOI: 10.1007/s40262-017-0540-6

5. Carbonaro TM, Bradstreet MP, Barrett FS, MacLean KA, Jesse R, Johnson MW, Griffiths RR (2016). Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences. Journal of Psychopharmacology 30(12): 1268-1278. DOI: 10.1177/0269881116662634

6. Carhart-Harris RL, Goodwin GM (2017). The therapeutic potential of psychedelic drugs: past, present, and future. Neuropsychopharmacology 42(11): 2105-2113. DOI: 10.1038/npp.2017.84

7. Hartogsohn I (2017). Constructing drug effects: A history of set and setting. Drug Science, Policy and Law 3: 2050324516683325. DOI: 10.1177/2050324516683325

8. Holze F et al. (2023). Direct comparison of the acute effects of lysergic acid diethylamide and psilocybin in a double-blind placebo-controlled study in healthy subjects. Biological Psychiatry 93(3): 215-223. DOI: 10.1016/j.biopsych.2022.10.018

9. Johnson MW, Richards WA, Griffiths RR (2008). Human hallucinogen research: guidelines for safety. Journal of Psychopharmacology 22(6): 603-620. DOI: 10.1177/0269881108093587

10. Roseman L, Nutt DJ, Carhart-Harris RL (2018). Quality of acute psychedelic experience predicts therapeutic efficacy of psilocybin for treatment-resistant depression. Frontiers in Pharmacology 8: 974. DOI: 10.3389/fphar.2017.00974

11. Studerus E, Kometer M, Hasler F, Vollenweider FX (2011). Acute, subacute and long-term subjective effects of psilocybin in healthy humans: a pooled analysis of experimental studies. Journal of Psychopharmacology 25(11): 1434-1452. DOI: 10.1177/0269881110382466

12. Trimbos drugsinfo (mushrooms/truffles factsheet). https://www.drugsinfo.nl/paddos-truffels/

13. Jellinek (truffles and mushrooms). https://www.jellinek.nl/alcohol-drugs-gedrag/truffels-en-paddos/

14. Unity. https://www.unity.nl/

15. OPEN Foundation. https://www.open-foundation.org/

16. DIMS (drugs-test). https://www.drugs-test.nl/

17. 113 Suicide Prevention. https://www.113.nl/