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Cannabis-Induced Depersonalisation: Why Symptoms Persist and How Therapy Can Help

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Cannabis is often used for its ability to relax the mind, heighten sensory perception, and foster creativity. It is associated with laughter, connection, and artistic inspiration. However, if you are predisposed to anxiety or other mental health difficulties, cannabis can open a door to a far darker experience of depersonalisation and derealisation (DPDR). These conditions strip away the sense of self or reality, leaving individuals feeling alienated, detached, or as though they are watching life unfold from behind a pane of glass.

 

Jane Charlton, founder of the UK charity Unreal, shared her own harrowing experience of cannabis-induced depersonalisation in Aeon. After consuming a yoghurt edible, she described a profound and terrifying shift in perception: “It felt like my body and mind had split,” she recalled. “The next morning, I thought it would wear off—but it didn’t. For three years, I lived in that state of disconnection, feeling like an observer of my own life.”

 

DPDR after cannabis use raises many questions: Why does it happen to some people and not others? Why do the symptoms often persist long after the drug has left the body? And most importantly, how can recovery be achieved?

 

I will explore the complex interplay between cannabis, neurobiology, and psychology in triggering DPDR. I will focus on how psychodynamic therapy Cognitive Behavioural Therapy (CBT) offer methods for exploring the meaning and function of DPDR, and can offer methods for managing these often distressing and confusing symptoms.

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Understanding Cannabis-Induced Depersonalisation

 

How Cannabis Triggers Depersonalisation

 

Cannabis interacts with the brain’s endocannabinoid system (ECS), which regulates essential functions such as mood, perception, and memory. While many people use cannabis recreationally without issue, others experience profound disruptions in brain function that lead to DPDR. Two primary mechanisms explain this connection:

 

Fragmentation of Self-Awareness

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Cannabis disrupts the Default Mode Network (DMN), a system of brain regions responsible for self-awareness and integrating thoughts, emotions, and memories. When the DMN is impaired, individuals may feel as though their sense of self has dissolved or fragmented, triggering depersonalisation. For example, someone might feel as though they are watching their life from a distance, unable to access their own emotions or identity.


 

Amplification of Fear Responses

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THC, the psychoactive compound in cannabis, overstimulates the amygdala, the brain’s fear-processing centre. This can lead to overwhelming feelings of dread, panic, or existential terror—particularly in individuals with a predisposition to anxiety. The brain’s response to this overload is often dissociation, a protective mechanism that “shuts down” emotional engagement to prevent further distress.
 

 

Why Do Symptoms Persist?

 

One of the most troubling aspects of cannabis-induced DPDR is its persistence. While THC is metabolised and leaves the body within days, symptoms can linger for months or even years. This persistence is driven by a combination of psychological and neurobiological processes:

 

Entrenched Defensive Patterns

Depersonalisation often acts as a psychological defence mechanism—a way for the mind to protect itself from overwhelming emotions or conflicts. For example, someone experiencing repressed shame or grief might unconsciously disconnect from their emotions through depersonalisation. Over time, this defence can become entrenched, making the dissociative state feel permanent.

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Unconscious Panic and Emotional Displacement

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Cannabis lowers the mental barriers that normally keep repressed thoughts and feelings at bay. For individuals with unresolved trauma or shame, this can lead to unconscious panic; a flood of distressing emotions that the mind cannot process. To simplify this panic, the brain displaces emotional pain onto more tangible fears, such as “I’ve damaged my brain” or “I’ll never recover.” This fixation can then sustain experiences of depersonalisation and derealisation.
 

Neurological Disruptions

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Chronic cannabis use disrupts neurotransmitter systems, particularly glutamate, which plays a crucial role in emotional regulation and memory. These disruptions make it harder for the brain to “reset,” perpetuating symptoms of DPDR.
 

Psychodynamic Therapy for DPDR

 

Psychodynamic therapy is particularly well-suited to treating cannabis-induced DPDR because it focuses on the unconscious conflicts and defences that drive depersonalisation and derealisation. Unlike CBT, which targets current symptoms, psychodynamic therapy seeks to uncover why the symptoms emerged in the first place.

 

Depersonalisation as a Psychological Defence

 

For many individuals, DPDR is not just a symptom—it is a psychological defence designed to shield the mind from unbearable emotions. For example, person with unresolved feelings of inadequacy may experience depersonalisation as a way to avoid confronting those painful emotions. Similarly, cannabis use may lower the mental defences that normally keep these feelings repressed, causing DPDR to emerge as a “shield” against emotional overload. While this defence is initially protective, it becomes a source of suffering when it persists, leaving the individual feeling trapped and disconnected. Psychodynamic therapy can help by helping  fostering understanding of why this defence developed and how it can be resolved.

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How Psychodynamic Therapy Helps

 

Psychodynamic therapy can help depersonalisation and derealisation in the following ways:

 

1. Creating a Containing Environment

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Containment refers to the therapist’s ability to create a stable and predictable environment where you can feel supported as they explore their emotions. For someone with DPDR, this containment provides the stability needed to begin addressing their fears of “never feeling normal” or being permanently detached. It also reduces the need for depersonalisation and derealisation as defences.

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2. Exploring Repressed Material

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DPDR often shields individuals from confronting painful emotions such as shame, guilt, or grief. Therapy can help you gradually uncover and process these feelings in a way that feels manageable. For example, someone fixated on fears of brain damage might explore the deeper emotions underlying this fear, such as feelings of inadequacy or loss.
 

3. Reintegrating the Self

Over time, psychodynamic therapy can help you develop a a more cohesive sense of identity. By processing unresolved emotions, you may become less reliant on depersonalisation as a defence, allowing you to reconnect with themselves and their experiences.

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I have written more about psychodynamic therapy generally here.

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CBT: Tools for Managing DPDR Symptoms

 

CBT complements psychodynamic therapy by providing practical, skills-based tools to address DPDR symptoms in the present. While psychodynamic therapy focuses on the “why,” CBT focuses on the “how”, teaching strategies to disrupt unhelpful thought patterns and behaviours.

 

1. Challenging Catastrophic Thinking

 

Catastrophic thinking is a hallmark of DPDR. Many individuals fear their symptoms are permanent or indicative of serious brain damage. CBT helps challenge these fears by examining the evidence.

 

For example, a therapist might ask: “Have you had any moments, however brief, where you felt more grounded? What does that tell you about your capacity to recover?”

 

Reframing thoughts like “I’ve ruined my brain forever” to “DPDR is a temporary response to anxiety” helps reduce fear and re-establish a sense of control.

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2. Avoidance and Exposure

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Avoidance is common in DPDR, as individuals often withdraw from situations that trigger their symptoms. Exposure therapy helps crebuild confidence by gradually re-engaging with these situations. You might might start by spending five minutes in a café, gradually your time there.

This process teaches the brain that these situations are safe, reducing reliance on DPDR as a coping mechanism.
 

Grounding Techniques: Reconnecting with the Present

 

Grounding techniques are essential for DPDR because they help individuals anchor themselves in the present moment, countering feelings of detachment. These exercises work by engaging the senses and the body, creating a sense of stability and reality.

 

1. Five-Finger Breathing

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This technique combines breathing with tactile awareness:

 

Hold one hand out, palm facing up.

 

Trace the outline of your hand with the index finger of your other hand, inhaling as you trace up and exhaling as you trace down.

 

Repeat for all five fingers, focusing on the sensation of touch and the rhythm of your breath.

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The combination of breath control and tactile focus calms the nervous system and re-establishes a connection between the mind and body.
 

2. Progressive Muscle Relaxation (PMR)

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PMR can help reduce the physical manifestations of anxiety, which often exacterbate feelings of depersonalisation and derealisation. It can also help you feel more connected to, and grounded in, your body by systematically tensing and relaxing each muscle group:

 

Start with your toes, curling them tightly for five seconds before releasing.

 

Gradually move upward through your legs, abdomen, arms, and face.


By focusing on physical sensations, PMR draws attention away from depersonalisation and derealisation towards physical sensations in the body, particularly in a way that can feel safe and grounding due to the feelings of mucular relaxation.
 

3. Sensory Stimulation

 

Techniques like biting into a lemon or smelling invigorating essential oils (e.g., rosemary) engage the senses, pulling attention away from internal preoccupations. Rosemary, for instance, has an energising scent that stimulates the nervous system, helping you feel more alert, grounded and in direct contact with your environment.

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