The manifestations can range from feelings of vague anxiety and alienation to profoundly disturbing states of unrelieved terror, ultimate entrapment, or cosmic annihilation. Psychedelic specialists in the therapeutic community do not necessarily consider unpleasant experiences as threatening or negative, focusing instead on their potential to be highly beneficial to the user when properly resolved. They can be exacerbated by the inexperience or irresponsibility of the user or the lack of proper preparation and environment for the trip, and are reflective of unresolved psychological tensions triggered during the course of the experience.
It is suggested that, at a minimum, such crises be managed by preventing the individual from harming oneself or others by whatever means necessary up to and including physical restraint, providing him or her with a safe and comfortable space, and supervising him or her until all effects of the drug have completely worn off.
Users may exhibit actions suggesting harm to themselves or others around them. This harm could take the form of suicidal ideation, or full blown suicide attempts. Because of the magnification of emotions many psychedelics cause, death or thoughts of death can cause intensely adverse reactions in some users. Users can believe that their death is imminent or that the very universe itself is collapsing. Rapidly accelerated aging of other people may be experienced, irritating the aforementioned fears even more.
Some users may experience disorientation. The normal views of time, space, and person can be substantially altered, causing fear. Some can worsen their condition by trying to fight the psychedelic experience after embarkment. There can be illusions of insects crawling over or into one's self, or of being in dirty places such as sewers.
Alternatively, psychologist R. D. Laing held that psychedelic crises and other such extreme experiences, drug-induced or not, were not necessarily artificial terrors to be suppressed but rather signs of internal conflict and opportunities for self-healing. The greater the pain and pathos of an experience, the greater the urgency to explore and resolve it, rather than attempt to cover it up or dismiss it.
Likewise, Stanislav Grof suggested that painful and difficult experiences during a trip could be a result of the mind reliving experiences associated with birth, and that experiences of imprisonment, eschatological terror, or suffering far beyond anything imaginable in a normal state, if seen through to conclusion, often resolve into emotional, intellectual and spiritual breakthroughs. From this perspective, interrupting a bad trip, while initially seen as beneficial, can trap the tripper in unresolved psychological states. Grof also suggests that many cathartic experiences within psychedelic states, while not necessarily crises, may be the effects of consciousness entering a perinatal space.