Non-Responders in Psychedelic Therapy: Understanding Dissociation and Endogenous Opioid Responses

As the field of psychedelic therapy expands, researchers and practitioners have observed a puzzling phenomenon: the presence of non-responders. While many individuals experience transformative benefits from psychedelics, some show limited therapeutic response or none at all. Understanding why some individuals are non-responders is critical for refining psychedelic therapy protocols and ensuring its effectiveness. An emerging theory suggests that non-response in psychedelic therapy may be linked to dissociation and an endogenous opioid dump—a sudden release of the body’s natural opioids in response to stress, potentially triggered by the psychedelic experience itself. Research in neurobiology, trauma, and therapeutic response sheds light on this theory.

Who Are Non-Responders in Psychedelic Therapy?

Non-responders in psychedelic therapy are individuals who do not experience the anticipated therapeutic effects of psychedelics, even with adequate preparation and support. Non-response varies: some clients report minimal psychological shifts, while others may not feel the emotional effects typically associated with psychedelics. Examining how trauma, dissociation, and the body’s natural stress response may affect therapeutic engagement can provide valuable insights into non-response.

Dissociation as a Protective Mechanism and Its Impact on Psychedelic Therapy

Dissociation is a well-documented response to trauma, where an individual disconnects from emotions, thoughts, or physical sensations to avoid overwhelming pain. Dissociation may manifest as emotional numbness, feeling detached from reality, or experiencing disconnection from one’s body. For individuals with trauma histories, dissociation often becomes a survival strategy that protects them from emotional pain.

Lanius et al. (2010) explored how trauma-induced dissociation acts as an emotional and physical numbing mechanism, allowing individuals to distance themselves from painful memories or sensations. In psychedelic therapy, dissociation may limit engagement with the experience. While psychedelics often encourage emotional openness and introspection, individuals prone to dissociation may struggle to access these therapeutic benefits. Consequently, non-responders may not fully engage with the psychedelic process, as dissociation inhibits access to the deep emotional experiences and insights that psychedelics typically facilitate.

The Role of the Endogenous Opioid Dump in Non-Response

The body’s response to acute stress includes the release of endogenous opioids, such as endorphins, which provide natural pain relief and emotional dampening. This phenomenon, known as "stress-induced analgesia," serves as a protective mechanism, reducing the intensity of physical and emotional sensations in situations perceived as threatening. Drolet et al. (2001) demonstrated that exposure to acute stress triggers the release of endogenous opioids, which helps buffer against both physical and emotional overwhelm.

In psychedelic therapy, it is theorized that some individuals may experience an opioid dump when they perceive the onset of the psychedelic experience as a stressor. When these individuals sense the rapid shift in perception as the psychedelic begins to take effect, their body may react as if it were encountering a threat, resulting in an endogenous opioid release. This opioid dump can create a numbing effect that counteracts the emotional and perceptual shifts typically associated with psychedelics, leading to a muted experience and, ultimately, non-response.

The Interplay Between Dissociation and Endogenous Opioid Response

In some cases, the combination of dissociation and an endogenous opioid dump may create a powerful barrier to engaging fully in psychedelic therapy. Dissociation alone limits emotional engagement, while an opioid dump further dampens sensations, reinforcing a non-responsive state. Together, these mechanisms create a “protective shield” that prevents the individual from fully accessing the therapeutic effects of psychedelics.

• Dissociation as an Initial Defense: Individuals with a history of trauma may enter psychedelic therapy with heightened dissociative tendencies. When the psychedelic takes effect, this protective response may intensify, resulting in emotional numbness that limits access to deep feelings or insights. Spiegel et al. (2013) highlighted how high levels of dissociation can interfere with emotional processing, making it challenging for individuals to engage in traditional therapeutic interventions.
• Opioid Dump as Secondary Reinforcement: In response to the psychedelic experience, individuals with trauma may experience an opioid release that further numbs emotional and physical sensations. This response can be particularly strong in individuals whose bodies are conditioned to react defensively to perceived threats, a phenomenon observed by Drolet et al. (2001). The result is a diminished ability to engage with the psychedelic effects, leading to non-response.

Trauma Histories and the Stress Response in Psychedelic Therapy

The trauma histories of non-responders may contribute to heightened stress responses that interfere with psychedelic therapy. Johnson et al. (2019) emphasized the importance of trauma-informed care in psychedelic therapy, noting that individuals with trauma histories may be prone to dissociation or stress-related responses during psychedelic sessions. These individuals may interpret the disorientation associated with psychedelics as a threat, triggering a cycle of dissociation followed by an endogenous opioid release to protect against overwhelming emotions.

This protective cycle is often unconscious and difficult to disrupt. For clients who have relied on dissociation and opioid responses as coping mechanisms, the body may instinctively view vulnerability as a risk, even within a controlled therapeutic setting. The inability to move past these protective barriers may result in a blunted or muted response, limiting the therapeutic potential of psychedelic therapy.

Strategies for Supporting Non-Responders in Psychedelic Therapy

Understanding the connection between non-response, dissociation, and endogenous opioid release highlights the importance of trauma-informed facilitation in psychedelic therapy. Trauma-informed facilitators can use specific strategies to support non-responders:

1. Pre-Session Grounding and Safety Techniques: Grounding exercises before a session help clients feel connected to their bodies, which may reduce dissociation. Facilitators can use breathwork, mindfulness, or somatic practices to help clients enter a calm and receptive state, increasing the likelihood of engagement.
2. Gradual Dosing or Microdosing: For clients with trauma histories, starting with a lower or microdosed psychedelic dose may allow them to acclimate to the experience more gradually, potentially reducing the chance of triggering a strong stress response.
3. Emphasizing Somatic Awareness: Trauma-informed facilitators can guide clients to focus on body sensations, which helps them stay grounded and reduces the likelihood of dissociation. Somatic practices, such as gentle body scans or grounding techniques, encourage clients to feel safe in their bodies.
4. Post-Session Integration Support: Even if a session feels numb or muted, integration support can help clients process the experience. By discussing dissociation and the body’s protective responses, clients gain insight into their patterns, empowering them to work with these mechanisms in future sessions.
5. Psychoeducation on Dissociation and Trauma Responses: Educating clients about dissociation and the body’s natural stress response helps normalize their experiences and fosters trust. This understanding can prepare clients to approach future sessions with greater awareness and confidence.

Rethinking Success in Psychedelic Therapy

While psychedelic therapy is promising for treating trauma and mental health conditions, it’s crucial to recognize that individual responses vary widely. For non-responders, therapeutic progress may require working through layers of dissociative protection and opioid-based defenses before achieving transformative results. By integrating trauma knowledge, somatic awareness, and a compassionate understanding of these protective mechanisms, facilitators can better support non-responders and create an environment where even those with complex trauma can benefit from psychedelic therapy over time.

Final Thoughts

Non-response in psychedelic therapy is complex, rooted in the body’s protective mechanisms like dissociation and the endogenous opioid response. These processes create a buffer against overwhelming sensations and emotions, yet they can limit the transformative potential of psychedelic experiences. Carhart-Harris and Friston (2019) discuss how trauma-related stress responses may interfere with the psychedelic’s ability to encourage emotional processing and neuroplasticity, further underscoring the need for trauma-informed care.

By recognizing the impact of dissociation and endogenous opioids on non-response, facilitators can adapt their approach, fostering a safe, supportive environment for clients. As research continues, these insights can help shape a more inclusive and effective framework for psychedelic therapy, ultimately empowering facilitators to address non-response with greater understanding and care.

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© 2024 Steve Elfrink. All rights reserved.

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