The concept of set and setting is central to psychedelic studies, referring to how mindset and environment shape psychedelic experiences and their outcomes. This paper proposes a framework for understanding set and setting in relation to harm reduction. It describes four modalities—therapeutic, clinical trial, ritualistic, and recreational—and examines how set and setting differ across them, the implications of these differences, and how harm reduction strategies can be tailored to each. Integrating set and setting principles into public health policies and education could enhance the effectiveness of harm reduction programs for psychedelics.
Psychedelic substances show therapeutic promise but can cause distressing episodes known as challenging experiences or bad trips. Three case reports illustrate the problem and inform strategies for management. A stepwise approach is outlined, including helpful interventions, supportive care, and rescue medication, to ensure well-being and prevent complications or long-term harm.