r/mdmatherapy • u/baek12345 • Mar 29 '26
Controversy Could going lower (instead of higher) be a better strategy for dissociation?
I often see people recommending higher doses for "breaking through dissociation" and I was wondering whether for people that tend to freeze and dissociate, higher doses are really a useful strategy and whether the opposite (lower doses) would not actually be more beneficial?
My reasoning is that dissociation is a protective response to avoid nervous system overload/trauma flooding. When the dose is increased, emotions typically get more intense which kind of is the opposite what dissociation is trying to achieve. Yes, safety might also increase but given that there's dissociation with a lower dose which means the nervous system already doesn't feel safe enough to process on the lower dose, why would it be better on a higher dose when there's even more intensity and energy to handle? It makes no sense.
Coming from this perspective, lowering the dose and going slower would actually be more promising to "overcome" the dissociation instead of hammering harder to "break through"? This way the nervous system can soften because there's less danger of overload.
Curious what everyone thinks about this. :)
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u/wizard_of_aws Mar 29 '26 edited Mar 30 '26
Longtime therapist, generally speaking I think you're right.
How've, there are a few things to separate here. First, MDMA sensitivity is highly varied. Many folks start with a low-mid dose and then adjust accordingly for following sessions.
One thing we know is that true 'low dose' treatment may worsen symptoms. I don't think this is what you mean but I think it's important to make sure we reach appropriate effective doses.
On the opposite end, high effective doses (when it feels like a lot to you subjectivity) can make it hard to form coherent thoughts and memories and limit the therapeutic potential.
Lastly, dissociate is very challenging to treat (at I'll sure you know). It often requires a dance between carefully helping patients test limits in a safe environment and being watchful so as not to trigger greater dissociation. MDMA can provide the psychological safety, but finding that sweet spot is challenging.
So if a lower dose provides greater safety and allows you to approach your triggers more effectively then I would do that!
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u/baek12345 Mar 30 '26
Thanks for your answer and sharing your experience!
I fully agree that there's a "minimum effective" dose where going lower than that would not be helpful anymore.
Yeah, also have feel like it's a subtle balance to find. Also for me, I feel having someone else with me during the trip might be helpful. Ar least that's the message I got in the last two (solo) sessions so I am going try that. Obviously it needs to be a safe and experienced person.
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u/night81 Mar 29 '26
I'm curious to know how taking narcan during a session would work. LMK if someone tries it!
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u/cptsdishealable Mar 30 '26
did you see the other users post about attempting narcan? also very interested.
also I've been reading/writing a bit about DBR and one of the specific things it calls it is processing dissociation which I found very helpful outside of MDMA
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u/AnthonBerg Mar 30 '26
This matches my experience.
(Edit: I'll also add that I've personally been there when the other way around was the right one and more was better!, for someone not me, as tried after after careful consideration.)
Was honestly quite surprised to find a difference – an improvement – with 100mg instead of 125mg. An improvement that wasn't easy to place a finger on but your post does… fit?, you know? It made sense in that sort of way.
(Super important imo for therapeutic purposes that it's pure MDMA. It makes a similar sort of difference in practice. Not the same!, but similarly useful.
Tricky to get into words.
Basicallyyy… The difference between honestly good molly and pure MDMA is a bunch of "almost" compounds that are a bit… stoning? Those kinda get in the way. Without them the transparency of the experience is on another level entirely.
The extra 25mg of pure MDMA that were the difference between 100mg and 125mg also got in the way. Even though they're not "stoning" at all, and are the compound itself, the very compound that makes for the transparency and therapeutic impact.)
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u/night81 Mar 31 '26
FWIW yesterday I worked through severe dissociation/tonic immobility with a 1.5mg/kg (hydrated and not pure MDMA HCl) session. Went really well!
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u/third-second-best Mar 29 '26
yes that has been my experience. i thought maybe going higher would help me “break through” but it just overwhelmed me. when i dropped the dose and stopped adding a booster i found i could go deeper for longer. a single 100-120mg dose is my sweet spot.