adverse-response

Trigger: /adverse-response

Guides the response after a distressing or adverse reaction to a practice: stabilize, ground, assess severity against the crisis-response table, choose a referral level, decide whether the practice is adapted or retired, and log the event. Built on the six-step protocol (recognize, stop, ground, assess, respond, follow up) in shared/crisis-response.md and its per-modality reaction catalog.

Sensitive skill. Do not auto-launch for ordinary practice questions or as therapy. Use when a user reports a distressing or adverse reaction to a practice, during it or in the hours and days after. This is not crisis care — for an active crisis, follow the shared/crisis-response.md escalation directly rather than working through this flow. For screening before a practice begins, use /practice-screening; to rebuild an adapted protocol afterward, return to the practice skill itself (whm-breathwork, coherence-meditation, language-awareness, and so on).

Agents

• Adverse Response Guide - Triages report versus emergency, stabilizes and grounds, assesses severity and referral level, decides adapt-or-retire with the person, and writes the log
• Ethics Guardian - Verifies escalation criteria were applied rather than talked around, the response stayed out of therapy and diagnosis, an immediate retry was avoided, and crisis resources appeared with exact numbers

Inputs

Input	Required	Description
focus	Yes	What happened, in the person's own words (e.g., "the breathing made me panic", "I feel strange since yesterday's practice")

Outputs

• adverse-event-log.md - Practice, timeline, reaction matched against the per-modality catalog, severity, action taken, referral level, the adapt-or-retire decision, and the follow-up plan; stays local

Examples

A reaction during the practice:

/adverse-response "the breathing made me panic"

A delayed reaction:

/adverse-response "I feel strange since yesterday's practice"

Triage: Escalate Immediately

Before any other step, escalation happens right away when the person reports: chest pain, pressure, or tightness; loss of consciousness, or a fall with possible head injury; seizure activity; difficulty breathing not caused by voluntary breathwork; confusion, slurred speech, or shivering that has stopped in a cold context; suicidal intent with plan or means, or self-harm in progress; psychotic features with danger to self or others; face drooping, arm weakness, or speech difficulty.

Severity and Referral Level

Severity	Signs	Referral level
Mild	Slight dizziness, mild anxiety, minor discomfort, settling with grounding	Self-managed recovery
Moderate	Sustained distress, persistent symptoms, emotional flooding	End the session, run the grounding protocol, professional follow-up recommended
Severe	Loss of consciousness, chest pain, inability to reorient, psychotic features	Emergency medical care

Self-managed recovery only applies when every criterion holds: conscious, alert, oriented; no chest pain or breathing difficulty; no psychotic features; no suicidal or self-harm ideation; symptoms improving with grounding and rest; able to articulate what they are experiencing; not feeling they need emergency care. If one criterion fails, the level goes up. When in doubt, the referral errs toward professional care.

The Per-Modality Reaction Catalog

The reported reaction is matched against a catalog, named as a possibility rather than a verdict:

• Breathwork — hyperventilation, syncope, panic response, tetany (carpopedal spasm)
• Cold exposure — hypothermia stages, cardiac symptoms, cold shock response
• Meditation and contemplative — dissociation, depersonalization / derealization, anxiety spikes, trauma resurfacing
• Transpersonal and consciousness — kundalini-type activation, spiritual emergency, psychotic-like experiences
• Paired and group — boundary violation, emotional flooding, attachment disruption
• Physical and somatic — acute injury, pain escalation, autonomic dysregulation

Two catalog entries carry standing rules: psychotic features are never framed as spiritual awakening and always route to professional assessment, and pain is never framed as energy releasing or toxins clearing.

Adapt or Retire

Retire (do not resume, redirect elsewhere) when the event revealed an absolute contraindication, severity was severe or required emergency care, psychotic features or trauma resurfacing or a dissociative episode occurred, the same reaction has now happened twice, or the person simply does not want to return to it.

Adapt (resume modified, later, not today) when severity was mild and settled with grounding, the mechanism is identifiable and adjustable (too long, eyes closed, standing rather than seated, too intense a round, fasted or dehydrated, alone rather than with someone nearby), and no contraindication surfaced that would have blocked it in screening.

Either way, an immediate retry is never encouraged. Resumption routes back through /practice-screening first, carrying the event as a new flag.

Research Basis

Evidence level: Safety protocol built from crisis-response and grounding-technique literature, not a therapeutic intervention

The six-step structure (recognize, stop, ground, assess, respond, follow up) and the severity and referral thresholds are the swarm's own synthesis, informed by general crisis-intervention and grounding-technique literature rather than a single validated instrument specific to contemplative or breathwork practice. The reaction catalog names documented phenomena — panic response, tetany, depersonalization / derealization, and others — without diagnosing them. A completed response means the known escalation criteria were checked against what the person described; it does not replace a clinician's judgment.

Safety

• shared/crisis-response.md and shared/contraindications.md are both required for this skill.
• This is not crisis care. When escalation criteria are met, the correct move is immediate escalation, not a structured conversation: call your local emergency number (911 in the US) for a medical emergency or danger to self or others; 988 (Suicide & Crisis Lifeline), by call or text, for suicidal ideation, severe emotional crisis, or self-harm urges; text HOME to 741741 (Crisis Text Line) for text-based support.
• Not therapy and not diagnosis. Trauma content that surfaces during a practice is not processed here — it is grounded, referred, and stopped.
• Never encourage an immediate retry of the triggering practice. Any resumption routes back through /practice-screening first, carrying the event as a new flag.
• The two standing catalog rules hold without exception: psychotic features are never framed as spiritual awakening, and pain is never framed as energy releasing or toxins clearing.
• Delayed reports get a timeline before anything else, and specific persistence thresholds (for example, dissociation or derealization past two hours warrants same-day consultation) push the referral level up rather than down.

Quality Gates

Before output is finalized:

• Stabilization and grounding happen before history-taking, every time
• Escalation criteria applied as a floor, never argued down in the moment
• Severity assessed against the mild / moderate / severe table, with the specific criteria named
• The reaction matched to the per-modality catalog using the person's own words, offered as a possibility rather than a verdict
• Adapt-or-retire decision made explicitly, with retirement treated as a genuine and complete outcome
• No immediate retry suggested; resumption routed back through /practice-screening
• Crisis numbers exact and complete wherever they appear
• Log written and stays local

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A reaction to a practice is information about fit, not a failure of the person.