Continuation, discontinuation, and risk-benefit judgment

The manuals converge on a strong safety first approach to continuation and discontinuation decisions. Across the extracts, clinicians and therapists are described as using clinical judgment to decide whether a participant can proceed, needs modification, should pause, or should stop, with participant welfare taking priority over scientific or protocol goals. Several sources also link this judgment to monitoring for worsening distress, suicidality, psychotic symptoms, medical instability, adverse effects, or unresolved events, and to escalating care, referral, or higher level support when needed. They also overlap in treating continuation as conditional rather than automatic. The manuals recommend reviewing current findings or response before further dosing, documenting reasons for stopping or modifying treatment, and allowing early termination when treatment is no longer clinically warranted, when adverse effects persist, or when the participant declines further treatment. Some sources also note that psychosocial or follow-up support may continue even when medication or a session is discontinued. The main differences are in emphasis and context. Some manuals focus on session level decisions, such as ending a session only when emotional stability and waning drug effects are adequate, or deciding whether to extend overnight support. Others focus on study level or medication level decisions, such as whether to proceed to another dose, withdraw from the study, or terminate pharmacologic treatment.