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Nearly sixty years after an underground educator published a $1 mail-order booklet on how to avoid bad LSD trips, contemporary psychedelic users and facilitators still endorse almost all of her practical advice. A new survey study published in Psychedelics indicates that experienced users agreed on average with 18 out of 19 safety recommendations from Lisa Bieberman’s 1967 manual, suggesting that much of today’s harm reduction advice was already circulating in grassroots literature decades before modern clinical guidelines.
Psychedelics are mind-altering substances, such as psilocybin (the active compound in “magic mushrooms”) and lysergic acid diethylamide (LSD), that temporarily produce profound shifts in perception, emotion, and thought. Psychedelic harm reduction refers to practical strategies aimed at lowering the psychological and physical risks of taking these drugs, rather than relying solely on abstinence. In practice, harm reduction focuses on preparing one’s mindset beforehand, arranging a calm and secure physical environment, and ensuring reliable emotional support during a session.
Growing public interest in clinical trials of psychedelic-assisted therapy has coincided with rising psychedelic use in the general population, most of which still occurs outside supervised medical settings. Although classic psychedelics carry relatively low risks of organ toxicity or addiction compared to many legal and pharmaceutical drugs, unsupervised trips can provoke acute panic, paranoia, confusion, and, in rarer instances, cardiovascular strain or severe psychiatric episodes.
Difficult reactions can also linger long after the drug wears off. In an earlier study of people who experienced extended difficulties after taking psychedelics, persistent anxiety and fear were the most common post-trip challenges, reported by 67 percent of respondents, and taking substances without a guide was associated with a wider range of lasting problems.
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“More people are using psychedelics now than at any other point in history, proportionally more than even in the 1960s,” study lead author Daniel J. Kruger, a research scientist and research associate professor at the University at Buffalo, State University of New York, told PsyPost. “There are now regulated, legal pathways for psychedelic therapy in Oregon, Colorado, and soon in New Mexico. Although thousands of people have taken psychedelics in these supervised settings, there is a much larger increase in the number of people taking psychedelics outside of the regulated environments in these same states.”
“Many people are reporting seemingly miraculous recoveries from treatment-resistant depression, PTSD, and other challenges,” Kruger added. “At the same time, many people have challenges during their psychedelic experiences and some people have negative effects that persist long after their trip. We have a program of research on reducing these risks for people taking psychedelics outside of regulated settings.”
Popular histories of 1960s psychedelia typically spotlight former Harvard University psychologists Timothy Leary and Richard Alpert, whose mystical writings and countercultural celebrity dominated headlines before federal prohibition. Far less attention has gone to Lisa Bieberman, a 1963 graduate of Radcliffe College who worked for Leary and Alpert’s organization before founding the Psychedelic Information Center in Cambridge, Massachusetts, in 1965. Through a national bulletin and mail-order pamphlets, Bieberman sought to counter widespread rumors with level-headed safety information for ordinary people experimenting with psychedelics on their own.
In February 1967, long before the phrase “harm reduction” entered public health vocabulary, Bieberman self-published a $1 booklet titled Session Games People Play: A Manual for the Use of LSD. Unlike other guides of the era that leaned heavily on Eastern mysticism and esoteric language, her manual offered a secular, down-to-earth discussion of what could go wrong during a trip and how novices could prevent trouble through sensible preparation. Borrowing the title concept of Eric Berne’s popular book on human relationships, she described unhelpful behaviors people might be tempted to act out under the influence of LSD, such as running off from companions, starting a session without enough free time, or becoming convinced they had unlocked cosmic truths that had to be announced to the world right away.
Working alongside fellow academic researchers, therapists, and community advocates, Kruger, who is also affiliated with the Michigan Psychedelic Center at the University of Michigan, set out to assess how closely Bieberman’s 1967 advice aligns with contemporary views among experienced psychedelic users. Their work formed part of a broader community-collaborative survey. A 2025 study by five of the same authors, drawing on the same survey sample, gathered open-ended safety tips for newcomers and found that modern users frequently advised novices to stay with trusted companions, have a guide or sitter, set aside recovery time, and put phones away.
Between September and October 2023, the researchers recruited adults aged 18 and older who had previously used at least one psychedelic substance, reaching participants through scannable smartphone links at Entheofest (an annual psychedelic advocacy event in Ann Arbor, Michigan) as well as online newsletters, email lists, and social media. Participation in the online questionnaire was anonymous and uncompensated. Out of 581 respondents in the broader survey, the authors restricted their analysis to the 496 adults who reported taking full doses of psychedelics. They excluded people who had only ever taken microdoses, which are tiny amounts not intended to cause noticeable perceptual changes, so that the sample matched the full-dose sessions Bieberman addressed.
The 496 participants had an average age of 43, with roughly equal proportions of women and men and a predominantly White demographic profile. Nearly everyone in the group (95.8 percent) had used psilocybin mushrooms or truffles, nearly half had taken LSD, and a similar share had used MDMA (commonly known as ecstasy or Molly). Almost nine in ten had used a psychedelic within the past year. More than half of the respondents (58.5 percent) reported holding at least one specialized role involving psychedelics, such as a trip sitter or guide, therapist, educator, health care clinician, academic researcher, or Indigenous or shamanic facilitator.
The survey asked participants, in a prompt that did not mention the manual’s origin, to think about the advice they would offer a first-time psychedelic user and rate 19 recommendations adapted from Session Games People Play. Ten statements covered preparation before a session and nine covered conduct during the trip, all displayed in random order and scored on a five-point scale ranging from “strongly disagree” (1) to “strongly agree” (5). The researchers ranked the items by their average scores within each set and ran statistical tests to determine which recommendations received measurably higher or lower endorsement than others.
Across the sample, average ratings fell on the side of agreement for 18 of Bieberman’s 19 recommendations, accompanied by moderate variation across individuals. Among the ten preparation items, participants most strongly backed “Be with people who all know, like, and trust each other” (averaging 4.66 out of 5) and “Be aware that even with a guide, you have to do most of the work yourself” (4.59 out of 5), two “strongly agree” scores whose slight difference was not statistically significant.
All eight remaining preparation tips landed in the “somewhat agree” tier, led by deciding well in advance who will join the session, keeping both the session day and the following day free, setting aside expectations, and having an experienced guide present. Somewhat more modest support went to reflecting beforehand on what one holds dearest and most sacred and to letting go of negative emotions such as resentment. Avoiding groups larger than five people (3.82 out of 5) and mapping out in advance how intense the drug’s effects will likely be at each hour (3.78) drew the weakest support.
Among the nine rules for an active psychedelic trip, respondents gave their highest ratings to two pieces of psychological reassurance: “Recognize that the experience will eventually end” (4.76 out of 5) and “Recognize that you may experience anxiety, which does not mean that something is wrong” (4.74 out of 5), with a tiny gap between them that was not statistically significant. Participants also strongly agreed on average with choosing a private location where they would not be disturbed (4.56 out of 5).
Five other in-session rules received moderate agreement in the “somewhat agree” range, topped by putting phones away, a contemporary counterpart to Bieberman’s 1967 instruction to disconnect landline telephones to block incoming and outgoing calls. Respondents also generally favored staying out of public places, staying together when tripping as a group, eating no more than a light snack, and taking a full dose rather than hesitating with a smaller one (3.50 out of 5).
Only one piece of advice failed to earn consensus: “Avoid looking in the mirror.” That item averaged 2.96 out of 5, landing almost squarely on the neutral midpoint of “neither agree nor disagree.” In exploratory analyses checking whether agreement with one statement went along with agreement on others, ratings across most rules showed little overlap aside from intuitive pairs, such as favoring a private location alongside staying out of public, or pairing reminders that the trip will end with reassurance about anxiety.
“In general, if we looked at advice from two generations ago on any topic, I would expect to see more of a range in agreement,” Kruger explained. “People today would agree with some things, disagree with others, and have no opinion or be neutral on some. In this case there was consistent agreement on everything but ‘Avoid looking in the mirror,’ where there is a whole range of perspectives.”
In the authors’ reading, the broad endorsement of Bieberman’s checklist illustrates how closely her practical precautions align with contemporary clinical safety protocols and community norms emphasizing mindset, physical setting, and interpersonal trust. On the one item that drew neither agreement nor disagreement on average, Bieberman had warned novices in 1967 that dilated pupils and visible skin pores often made LSD users think they looked terrible in a mirror, whereas Timothy Leary and his co-authors had encouraged mirror-gazing in their 1964 manual to help disoriented users reconnect with ordinary reality.
Examining why modern users remain divided on that rule, the researchers point to a 2023 analysis of online reports from psilocybin users, which studied Reddit posts about looking in a mirror while tripping and found wide variation from person to person, with positive emotional reactions occurring more often than negative ones. The researchers also note a separate report of a lasting traumatic reaction after looking in a mirror while tripping, alongside contemporary commentary suggesting the practice can prompt helpful insights even when frightening. The authors suggest that Bieberman and Leary may both have recognized this trade-off, and that their opposite advice reflects how much weight each placed on preventing harm versus seeking potential benefits.
“People with psychedelic experience endorsed nearly all the advice from the previous psychedelic era 60 years ago: If you are seriously considering taking a psychedelic, especially for the first time, educate yourself and prepare for the experience,” Kruger noted. “Be with people who all know, like, and trust each other. Have someone who is experienced with psychedelics there.”
“Create your own container, separate from the outside world – be in a private place where you will not be disturbed, do not go out in public, put your phones away,” he continued. “Stay together as a group. There are also practices that were not available in Bieberman’s time, like testing the substance for purity and hazardous contaminants.”
There are a few things to keep in mind when weighing these findings. Surveying experienced users and facilitators shows which historical safety tips enjoy community backing today, but agreement cannot establish whether following a given rule actually prevents bad trips or lasting psychological distress.
Determining how specific precautions affect psychological, social, or spiritual outcomes over time would require controlled trials, though the authors caution that such studies must be designed ethically so volunteers are never deprived of essential safety guidance. In addition, the survey relied on a convenience sample recruited largely through North American psychedelic networks, and nearly three-fifths of the participants served in expert or practitioner roles. Their views represent an engaged, English-speaking psychedelic subculture rather than casual novices. Bieberman’s 1967 manual likewise reflected mid-century North American norms rather than the practices of cultures with much longer histories of psychedelic use.
Her booklet also offered almost no advice on post-session “integration,” the modern practice of processing and applying insights in the days and weeks after a psychedelic experience, beyond keeping the day after the trip free. The authors suggest that future studies could examine Bieberman’s separate writings on post-session ethics, adapt safety assessments across diverse cultures and user goals, and evaluate other overlooked underground manuals from the prohibition era.
“We continue to research how to best reduce risks for people taking psychedelics outside of regulated settings,” Kruger said. “Often, the safest thing is not to do something that is risky, but people take all sorts of risks in life and an estimated 14 million adults in the U.S. took psychedelics in 2025. If people are going to take psychedelics, we want them to do it as safely as possible.”
As part of that ongoing effort, the team has launched a new phase of data collection, with background on the broader initiative posted on the Psychedelic Community Survey webpage.
“We are recruiting participants for the current round of the Psychedelic Community Survey; anyone 18 years or older can participate, whether they have experienced psychedelics or not,” Kruger shared. “We do not collect any information that could be used to identify participants and their data. This year there are different sections based on the roles and experiences people have, including the experiences of psychedelic therapy facilitators, perceptions of psychedelic clinical trials, experiences of volunteers or staff in harm reduction services, first experiences with psychedelics, memories and psychedelic use, and psychedelics and women’s health issues.”
The study, “Highlighting the legacy of a psychedelic harm reduction pioneer: Assessing contemporary agreement with advice in Lisa Bieberman’s 1967 “Session Games” manual,” was authored by Daniel J. Kruger, Paul Gillis-Smith, Jacob S. Aday, Julie Barron, Moss Herberholz, and Kevin F. Boehnke.
