Building the bridge-back: Dissociation as resource and resilience pathway in psychedelic-assisted therapy

Abstract: Background and

Aims: In Western clinical contexts, dissociation is a common transdiagnostic response to overwhelm and is highly relevant to integration capacity. In psychedelic-assisted therapy (PaT), non-ordinary states may open access to emotionally intense material while also activating protective distance when the experience outpaces coping capacity. This article introduces a clinical compass to support discernment and training and to strengthen conditions for return and integration in PaT.

Methods: This theory-informed conceptual synthesis advances a resilience-based reinterpretation of dissociation in PaT, integrating dissociation theory with resilience-as-resourcing pathways. This reinterpretation is expressed through the bridge-back model and operationalised as a practical compass for pacing and training.

Results: The bridge-back model conceptualises dissociation as protective distance and delineates three interrelated processes: protection, return, and integration. Two resilience capacities are central to returning from non-ordinary states: congruence (authentic self-contact in relationship) and sense of coherence (comprehensibility, manageability, and meaning). Set and setting influence the conditions that support—or strain—these capacities across preparation, dosing, and ongoing integration.

Conclusions: Reframing dissociation as a resilience-based process shifts clinical focus from “what's wrong?” to “where's the opportunity?” to inform leverage points for return. Preparation—and conditions that support predictability and agency—are especially important. By strengthening return capacities, practitioners can support integration and resilience pathways toward sustainable transformation.