Crisis and adverse-event response

The manuals converge on the need for calm, supportive responses when a session becomes destabilising or unsafe. Across the extracts, the response begins with non-drug or low-intensity measures such as focused breathing, active listening, calm presence, reassurance, grounding, environmental modification, and redirection. They also agree that escalation to medical support is appropriate when the situation does not settle, with physician input, medication, or emergency services mentioned as later steps rather than first responses. Sources differ in how they frame preparation and escalation. The ayahuasca guide emphasises medication restraint and treats medication as a last resort, while the psilocybin manual gives more explicit attention to acute psychological states such as agitation, paranoia, and disorganization, including prompt assessment and possible emergency department referral if symptoms worsen after sessions. The Rocha et al. guideline focuses less on in-the-moment crisis handling and more on readiness, with regular training, simulated scenarios, and continuous protocol updates for rare or unexpected adverse events.