He begins to calm himself down, and for the first time in the game, becomes playable. The most you can do in this section is move around the constricted area and let the scenes play out in front of you.
Josh will begin to have harsh and vivid hallucinations about his decayed sisters, as they blame him for leaving them to die. There is one QTE you have to hit, that will punch off a pig's head - symbolizing the pigs that Josh had to kill in order to commit to his prank.
At the end of this section, Josh will see a Wendigo come down and screech in his face.
View the chapter's transcript here.
View the therapy session during the chapter here.