Lived experiences of psilocybin-assisted therapy in non-responders

Psychedelic-assisted therapy (PAT) is commonly framed as a rapid and transformative intervention for treatment-resistant mental health conditions, with research and public discourse emphasising clear therapeutic endpoints and sustained symptom reduction. Far less attention has been given to individuals who engage meaningfully in PAT yet experience minimal, negative, or ambiguous long-term outcomes. This omission limits clinical preparedness and obscures ethically important patient experiences that fall outside dominant narratives of improvement.

This talk presents findings from a longitudinal qualitative study of participants with limited treatment response following psilocybin-assisted therapy. Six participants were drawn from a large clinical trial for anxiety and identified based on minimal or negative change on the Hamilton Anxiety Rating Scale at long-term follow-up. In-depth semi-structured interviews explored how participants interpreted their acute psychedelic experiences and made sense of their therapeutic trajectories over time.

Across cases, psilocybin-assisted therapy was experienced less as a discrete therapeutic event and more as the initiation of complex, ongoing processes without clear or stable endpoints. Participants described non-linear trajectories involving difficulty integrating acute experiences, challenges associated with symptom re-emergence, experiences of empowerment or progress, the surfacing of previously unrecognised psychological vulnerabilities, and the need to renegotiate expectations of healing and recovery.

These findings deepen understanding of the lived experience of limited response to PAT. Clinically and ethically, they underscore the importance of preparing patients for uncertain or incomplete trajectories of change and highlight the need for care models that can accommodate slow, partial, or unresolved therapeutic processes.