What to know before trying psychedelics for the first time
First things first:
Psychedelics change your mental state during a trip. Regardless of what you experience, it’s important to let go, trust, and be open.
Lean in. Let yourself be open to experience whatever unfolds during your trip. People who fight against the natural progression of their experience tend to get less out of it. For example, if you see a door, be curious—walk through it, explore. If you see a window—take a look out, open it. If you feel like you’re dying, melting, dissolving, exploding, going crazy, etc., just go ahead and embrace it. Remember that you’re safe and that experience will pass.
If you’re feeling fear, try to confront it. You can approach those feelings with questions like, “What are you doing in my mind?” or “What can I learn from you?”
If you experience mild physical pain during your trip, I would encourage you to investigate the pain by trying to visualize it. Try to determine where the source of that pain might be. See if you can embrace the pan or make it go away. Ask whether that sensation is helping or hurting you. But, like I said earlier, do not fight against your experience. Force no pain away -- it is all there to bring you home.
Remember that your emotions are valid. Emotional states are valid 100% of the time.
When you find yourself caught up in overthinking, overinterpreting, and overanalyzing, know that you’re in an egoic or cognitive state. Instead, drop into the associated emotional state, feel it all, and ask yourself: what am I feeling? Sink into this feeling. Embody it. Every emotional state also has a bodily felt sense, and this somatic connection is a golden opportunity to explore and remind present with what is happening in the here and now.
When you’re struggling, try using your mind to ignore the content, and focus instead on the underlying emotion and bodily felt sense. It also helps to remember the intention you set before starting your trip.
This is a mantra I find helpful: “Breathe. Feel. Heal.” Focus on your breath, and inhale deeply into the space where the discomfort lies. Connect with authentic gratitude for experiences and lessons, even if they are difficult ones.
Health and safety disclaimers:
Though health complications after using psychedelics are rare (less than .1% among general users and even fewer when proper screening is involved), it’s still important to take these medicines and the experiences they induce seriously. And although the psychedelic renaissance we’re currently witnessing is extremely exciting, it’s important to our enthusiasm and hope for the future do not overshadow the need to consider optimal conditions and creating the best, safest environment.
In clinical settings, informed consent is absolutely essential for both patients and providers. People need to know what they’re getting into, including being aware of potential risks prior to psychedelic use. Clinicians also need to ensure there’s consent around physical touch, and this needs to be done before a person starts tripping. To avoid any gray areas, they should describe types of therapeutic touch they might use and ensure the client is comfortable with it.
On occasion, some people experience nausea, which usually passes within a short period of time. If you encounter this, keep in mind that it’s temporary and will subside with time.
Be gentle with yourself the day of treatments and give yourself plenty of time to rest afterwards.
In our clinic, we commonly prescribe ketamine. An important disclaimer we always give is that while this medication has been FDA approved for anesthesia and as a pain reliever, it is still off-label and hasn’t yet been FDA approved for depression or other psychiatric conditions.
Set and setting play a huge role in psychedelic drug experiences. Your mindset going into the ketamine journey can influence what you get out of it. You can optimize your mindset by setting intentions for your experience.
Additionally, conscious preparation and psychoeducation are important going into a psychedelic journey. There are varied protocols (lifestyle modifications, meditation practice) depending on the medicine. For example, when people prepare for an ayahuasca ceremony, they are typically asked to avoid certain foods or substances or cleansing of the body and mind.
How can you know if you’re a good candidate for psychedelics:
I only use psychedelics when we have a mental health-related diagnosis on record. We also do a thorough medical and psychiatric screening including reviewing pertinent factors such as personal or family history of psychosis and any history of substance abuse.
Some contraindications for psychedelics include medical or psychological fragility, certain medications, and lack of social support, especially around medicine use.
What might first timers expect to feel during their first trip?
A lot of the specific sensations a person will feel are dependent on the drug being used—each medicine has their own unique psychedelic “flavor.” That being said, there are some commonalities among psychedelics and related substances (i.e. ketamine, MDMA, ayahuasca…).
Ego-dissolution
Visual hallucinations
Out of body experiences
Empathogenic experiences (meaning feelings of comfort, relaxation, empathy, and love)
Altered perception
What next?
After your journey, I encourage people to take time to reflect. This could be journaling, a voice memo, a video, whatever medium works best for you. Ask yourself the following questions and record the responses:
What struck you?
What are you struggling to make sense of?
How do I get in my own way?
What wisdom will I take from this day?
What is the most significant thing that you received and would like to hold on to?
Reflect on what you need, or what you plan to do, to support your integration from this week until next.
Remember the importance of bridging psychedelics with conventional mental health protocols. Psychedelics are not a magic fix-all. The real long-lasting magic happens when psychedelic experiences are integrated into everyday life. Integration is the process of digesting that change and manifesting its fullest expression. To quote Jack Kornfield, “after the ecstasy, the laundry.”
Anyone who has backpacked around the world or done extensive traveling knows that returning home can be a shock to the system. It can take months for you to adjust to being “back home.” You’ve had all these incredible experiences in that time and it changed you, but the life, the people, and the circumstances you’re returning to appear to be basically the same. They’ve been simply living out their regular lives.
It takes time to adjust both the “new you” to your life and your life to the “new you.” It’s similar with psychedelics. You’ve gone on a consciousness world-tour or experienced eternity in an hour, and now you’re expected to go back to the office tomorrow and make small talk with co-workers? This can be very jarring to the psyche and sometimes results in quite a bit of emotional turbulence.
Making your integration process a priority is key to integrate the wisdom/insights/experience in a more conscious and intentional manner. It’s like bringing back seeds from a voyage, and now we need to plant, nourish and care for these.
Advice for trip-sitters/guides/support people:
If a person is having a difficult experience, I recommend moving them to an environment that is comfortable, peaceful, and warm. Avoid being in busy or noisy locations, these can be distressing during a trip. I also recommend wearing comfortable clothing with layers you can take on or off.
A bit of advice for trip-sitters: sit and support, but don’t guide. Let the medicine and the person’s unfolding be the guide. Your calm, compassionate presence is the best way to help.
And another recommendation: talk through, not down. Without distracting or taking away from the experience, help the person connect with what they are feeling. Invite person to take the opportunity to explore what’s happening and encourage them to try not to resist it.
For folks who may be interested yet hesitant to try psychedelics:
I like to remind people going to a journey that triggers are friends to follow. What triggers us, shows us where we need work.
Keep in mind that difficult is okay. In fact, many times the most challenge experiences end up being the most valuable and lead to the most personal growth. So, I encourage patients to simply approach the parts of their experience that cause anxiety or fear with openness and curiosity. That acknowledgement alone is a huge step of courage and sets a nice pattern for the entire healing journey.
Resources
I recommend psychedelic.support as a resource to find therapists, guides and groups.
Third wave has a nice vetted retreats directory: https://directory.thethirdwave.co/.
For MDMA studies, folks can see if there’s a MAPS-sponsored trial looking for volunteers in their area: https://maps.org/take-action/participate-in-trial/