Manage agitation and elopement risk

The manuals converge on the need to preserve safety when agitation or leaving impulses arise, and they all treat containment as a central response. Across the extracts, the manuals recommend calm de-escalation, staying with the participant, and using redirection or verbal processing rather than meeting distress with force or allowing the situation to escalate unchecked. They also agree that leaving impulses or agitation are not handled in isolation, but within a prepared therapeutic frame. One manual recommends explicit advance agreement not to leave until the overnight period, another recommends preparing in advance for possible aggressive reactions, and the psilocybin trial describes calling a co-therapist, encouraging delay, and keeping close if the patient leaves the room. The shared emphasis is on maintaining the safety of the participant, facilitator, and others in the setting. The manuals differ in how far escalation goes. Some focus on therapeutic containment and reassurance, while others specify stronger responses when risk persists, including sedative medication, hospitalization, calling a psychiatrist, or using a secured window as a last resort. They also differ in how they frame leaving, with the MDMA manual explicitly treating leaving impulses as material to be verbalised and explored, whereas the other sources focus more directly on immediate safety and containment.