Practical guide to psychedelic support and harm reduction

Psychedelic First Aid: The Role of the Sitter and Harm Reduction Psychedelic First Aid: A practical guide to assist as a Sitter, without being a guru A practical guide to psychedelic first aid for Sitters. Learn the 3 pillars: presence, acceptance, and safety. Support an intense journey with calm, without being a guru. Learn in this practical guide to psychedelic first aid the 3 pillars of the sitter (presence, acceptance, and safety) and the intervention protocol. Key principles to maintain safety during an intense journey, with a harm reduction ethic.

The essential role of the sitter

Even with careful preparation —a good set (mindset) and setting (environment), as we’ve already discussed in previous articles— psychedelic journeys can become intense or challenging. In those moments, the difference between an overwhelming and a contained experience often depends on a quiet yet crucial figure: the companion, or sitter.

It’s crucial to understand that a difficult journey can be triggered by factors such as interaction with other substances, taking an excessive dose, a poor set (going through a rough personal period), or a vulnerability or genetic predisposition to developing a mental health condition. These situations can manifest as unpleasant hallucinations, agitation, distrust of the environment, or trembling.

Psychedelic first aid is not a form of therapy or a spiritual intervention. It’s a set of practical actions and supportive attitudes intended to protect the person’s physical, emotional, and psychological safety during an intense psychedelic journey. The goal is not to “heal” or “guide,” but to offer safety, comfort, and validation.

This approach is grounded in a clear ethic: the “no-guru” ethic. The sitter is not a shaman, a therapist, or an enlightened being. They are a human, empathetic presence who holds space without imposing interpretations. They listen, observe, and accompany with humility and respect.

The philosophy of support: The 3 pillars of the sitter

The sitter’s role is not to lead but to accompany. Their task is to create and maintain a safe environment where the person can move through the experience with minimal risk. This role rests on three fundamental pillars.

🧘 Pillar 1: Calm Presence (Be Present)

The sitter’s calmness is the first aid. The emotional state of the companion is transmitted, and a serene presence can balance even the most chaotic moments. This means avoiding the furor curandis (the unnecessary urge to “do something” just to feel helpful) and avoiding reactive behavior.

Staying calm requires personal grounding:

• Take slow, deep breaths.
• Feel your body and its connection to the environment (for example, touch a wall or the floor).
• Remember that the goal is not to “fix” anything but to be available.

🌊 Pillar 2: Radical Acceptance (Don’t Fight)

Trying to stop or control the journey only increases resistance and fear. Radical acceptance means not fighting the experience but allowing the person to live it with as little suffering as possible. This involves validating what they feel, even if it seems irrational or incoherent:

• "I see that you’re scared, and it’s okay to feel that way."

The sitter does not argue or correct. They hold the emotional space, acknowledging fear or confusion without drama or judgment.

🛡️ Pillar 3: Physical Safety (Safety First)

The third pillar is to maintain physical integrity of the environment and the person. It’s not about control but prevention:

• Prevent the person from running, climbing stairs, or handling Dangerous objects.
• Ensure the environment is free from hazards: lit candles, open windows, unstable furniture.
• Keep a respectful distance and avoid touch without consent, except in emergencies.

The principle is simple: don’t interfere more than necessary, but intervene when safety is at risk.

Practical intervention phases during an intense journey

Support intervention should follow a logical sequence prioritizing safety, calm, and validation, progressing from physical to psychological. For that, we’ve created a practical guide to accompany with clarity and calm, through 4 phases: Check, Contain, Return, and Refer.

1. Initial contact and environment safety

Before interacting, the priority is to secure the environment and establish safe contact. Check the space and the person’s condition.

• Assess whether the person is conscious and able to communicate.
• Maintain a comfortable distance. Avoid physical contact unless necessary for safety.
• Remove sharp objects, heat sources, glass, or anything dangerous.
• Ensure soft lighting, comfortable temperature, and minimal distractions.
• Speak softly and calmly, without sudden movements or tone changes.

2. Active and empathetic listening

Listening is the core of accompaniment. Empathy is the main tool; don’t try to rationalize what the person is feeling.

• Allow expression: Let the person talk, cry, or yell without interrupting. Avoid rationalizing their words.
• Show understanding: Use brief paraphrasing to mirror their feelings: "I understand that you feel like time has stopped, that may be confusing."
• The goal is not to guide interpretation but to hold the calm mirror where the person can recognize themselves without judgment.

3. Normalization and grounding

Once the emotion is contained, the goal is to reconnect the person with the present and physical reality, reminding them that their state is temporary.

Gently remind them that what’s happening is temporary:

• "You’re under the effect of a substance. This will pass."

Then, facilitate sensory grounding:

• Touch a blanket or familiar texture.
• Drink some room-temperature water.
• Focus on a gentle scent or on breathing.

In moments of sensory overload, offer only simple choices:

• "Would you like to sit or lie down?"
• "Do you want to change the music or turn it off?"

Avoid complex conversations. Silence is a powerful tool; often, a calm presence is more helpful than any words.

4. Risk assessment and referral

The sitter must know their limits. Some situations require urgent medical help:

• Prolonged loss of consciousness or seizures.
• Difficulty breathing or chest pain (possible cardiovascular issues).
• Aggressive behavior or uncontrollable self-harm risk.

In those cases, calling emergency services is the correct and immediate response. It’s not about “betraying” trust but protecting life.

The phrases manual: What to say and what to avoid

✅ Helpful phrases (validation and calm)

• "You’re safe, I’m here with you."
• "Everything you’re feeling is normal; you’re going through an intense journey."
• "This will pass. Just allow yourself to feel it."
• "Focus on your breathing, inhale and exhale slowly."

These phrases validate and normalize the experience, helping to reduce anxiety without imposing interpretation.

❌ Phrases that make it worse (judgment and interference)

• "Calm down" or "Relax."
• "You should have known / you shouldn’t have taken that much."
• "It’s almost over / hang in there."
• "The universe is teaching you something."

These expressions judge, minimize, or create false expectations, increasing confusion. The sitter doesn’t preach or deliver mystical messages; they simply accompany.

🚨 Emergency resources and professional support

Before any experience, it’s essential to research and write down the following information for your local context. Prepare and note this information in your Set & Setting:

• Emergency medical and police numbers for your country or city.
• Toxicology or poison control centers that can provide specialized phone support.
• Recognized mental health or harm reduction hotlines in your region.

🆘 Referral protocol: Knowing when to call

The sitter’s role ends where professional help is needed. The intervention should be brief and focused on safety. If the person experiences a crisis persisting beyond the acute phase or shows severe physical symptoms, external help is imperative.

The immediate action is to call medical emergency services or transport the person to a care center, informing staff (if possible and safe) about the substance taken, in cases of:

• Acute physical danger: Seizures, prolonged unconsciousness, breathing/cardiac issues, high fever, or major injuries.
• Persistent severe psychological crisis: Psychotic behavior, self-harm risk, or aggression.

Seeking external medical or psychological help is a responsible act of care. Life always takes precedence over secrecy or substance confidentiality.

The responsibility of caring

Psychedelic first aid is not an enlightenment manual but a practice of responsible care and harm reduction. It involves empathy, calm, and respect for boundaries. Learning to accompany without intruding, diagnosing, or imposing meaning is a vital skill in modern psychedelic culture.

Commitment to harm reduction doesn’t stop at prevention—it also shows in how we care for each other during the journey. The beauty of vulnerability lies in the ability to be held within it.

Share this resource. Spreading knowledge about psychedelic first aid is a direct and practical way to save lives and promote a culture of more conscious, compassionate, and safe use.

Before any experience, preparation is essential. Complete your learning:

• Check out our complete Set & Setting guide.
• Learn how to avoid and manage Bad Trips.

⚠️ Disclaimer and HARM REDUCTION ETHIC

This article has been created with an exclusive focus on harm reduction (Harm Reduction). The information presented here is not intended to promote, encourage, or incite the consumption of illegal or controlled psychoactive substances. Our ethical aim is to provide safety and care guidelines for individuals who autonomously choose to consume, always prioritizing the protection of life, mental health, and physical security.