MDMA-assisted therapy for post-traumatic stress disorder (PTSD) appears to have positive effects on mental processes related to self-experience, such as emotional awareness and self-compassion, which are often linked to poor treatment outcomes in traditional therapies, according to new research published in PLOS One. These findings highlight MDMA’s potential in addressing deeper psychological issues that typically hinder successful treatment.
MDMA, or 3,4-methylenedioxymethamphetamine, is a synthetic compound commonly known in its recreational form as ecstasy or molly. Initially synthesized in the early 20th century, MDMA gained popularity in the 1970s and 1980s in psychotherapy, notably for its unique psychoactive properties that promote empathy, emotional openness, and a sense of well-being.
The Challenge of Treating PTSD
The motivation behind the new study stemmed from the limited success of traditional psychotherapies in treating PTSD. Traditional therapies for PTSD, such as cognitive-behavioral therapy and exposure therapy, are often not fully effective for all individuals. A significant number of patients either do not complete the therapy or continue to experience substantial symptoms. This is particularly true for those with complex trauma histories, such as childhood abuse, where emotional regulation, trust, and interpersonal issues are deeply intertwined with the traumatic experiences.
Given MDMA’s unique effects on emotional and social processing, the researchers hypothesized that it could enhance traditional psychotherapies by facilitating a deeper emotional engagement and processing of traumatic memories. The aim was to investigate whether MDMA, when used in a controlled, therapeutic setting, could help patients confront and work through their trauma more effectively than with therapy alone.
The Study’s Methodology
To examine this, the researchers conducted a secondary analysis of a randomized, double-blind, placebo-controlled trial, which had enrolled 90 participants, all diagnosed with severe PTSD as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
These participants were chosen based on specific criteria, including a minimum duration of PTSD symptoms and a relatively high severity score on the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Individuals with certain psychiatric or medical conditions, current alcohol and substance use disorders, or any condition where an increase in blood pressure or heart rate would be a concern, were excluded from the study.
Approximately 90% of the participants had suffered from multiple traumas. This is significant because the experience of multiple traumas can lead to more complex and persistent PTSD symptoms, making them more challenging to treat.
The intervention consisted of a series of therapy sessions. Participants first underwent three 90-minute preparatory therapy sessions, designed to establish a therapeutic alliance and prepare them for the experimental sessions. This was followed by the main treatment phase, which included three 8-hour experimental sessions, spaced about four weeks apart. In these sessions, participants received either MDMA or a placebo, in addition to the psychotherapy. The specific dosages of MDMA were carefully controlled, and the therapy followed a structured approach as outlined in the treatment manual.
After each experimental session, participants attended three 90-minute integration sessions. These sessions were intended to help them process their experiences during the experimental sessions. The integration of these experiences into their daily lives is a critical component of the therapy.
Participants were randomly assigned to either the treatment group (receiving MDMA-assisted therapy) or the control group (receiving therapy with a placebo), and neither the participants nor the researchers knew which group each participant was in until after the study was completed.
To assess the impact of the treatment, the researchers used several well-established measures. The primary measure was the change in PTSD symptoms, as assessed by the CAPS-5. In addition, they employed the Toronto Alexithymia Scale (TAS-20) to measure difficulties in recognizing and verbalizing emotions, the Self-Compassion Scale (SCS) to assess the level of self-compassion, and the Inventory of Altered Self Capacities (IASC) to evaluate a range of emotional and interpersonal skills. These measures were taken at baseline, during the final preparation session, and again at the study’s conclusion.
Key Findings
Improvements in PTSD, Alexithymia, & Self-Compassion
The researchers found that participants in the MDMA-assisted therapy group experienced greater improvements in PTSD symptoms compared to those in the therapy with placebo group. The improvements were not just limited to a reduction in the severity of PTSD symptoms but extended to several key areas of psychological functioning.
Particularly striking was the impact on alexithymia, which is a common challenge among individuals with PTSD. Participants who started the trial with higher levels of alexithymia and received MDMA-assisted therapy showed a more significant reduction in these symptoms than those in the placebo group. For those with alexithymia at baseline, the MDMA group saw a significant 12.85-point decrease versus a 1.51-point decrease in the placebo group. This suggests that MDMA may facilitate an enhanced emotional engagement, a crucial aspect often impaired in PTSD patients.
Moreover, the study found significant improvements in self-compassion in the MDMA group. Self-compassion improved greatly in the MDMA group, with a mean increase of 1.08 points for those with moderate or high baseline self-compassion, and 0.76 points for those with low baseline self-compassion. This contrasts with 0.12 and 0.24 point increases in the placebo group, respectively. This suggests a more substantial enhancement in how participants perceive and treat themselves amidst failures and difficulties.
This finding was particularly notable because self-compassion is an essential component of mental health and well-being, often eroded by traumatic experiences. The fact that these improvements in self-compassion occurred independently of changes in PTSD symptoms suggests a unique therapeutic aspect of MDMA.
Altered Self-Capacities After MDMA-Assisted Therapy
In terms of overall psychological functioning, as measured by the IASC, except for the factor of identity diffusion, there were greater improvements across most factors for the MDMA-assisted therapy group compared to the placebo group.
For the factor of Interpersonal Conflicts, those in the MDMA-assisted therapy group saw a reduction in their scores by an average of 0.69 points, suggesting an improvement in managing interpersonal conflicts. In contrast, the placebo group only saw a 0.25-point reduction.
Participants in the MDMA-assisted therapy group who had higher than median scores for Abandonment Concerns at baseline showed a decrease of 0.69 points, while those in the placebo group had a decrease of 0.20 points. However, the change was not statistically significant for those with lower than median baseline scores. For those above the median, the change was statistically significant, suggesting that MDMA-assisted therapy could be particularly beneficial for individuals with significant concerns around abandonment.
The MDMA-assisted therapy group experienced a decrease in Identity Impairment scores by 1.57 points for those above the median baseline score, compared to a 0.66-point decrease in the placebo group. This difference was statistically significant (p-value = 0.0036), indicating that MDMA-assisted therapy had a notable impact on improving identity impairment issues.
Improvement in Self-Awareness was significant in the MDMA-assisted therapy group, with an increase of 0.96 points, as opposed to a 0.29-point increase in the placebo group. The p-value for this change was 0.0010, highlighting the therapy’s effectiveness in enhancing self-awareness.
In the MDMA group, there was a decrease of 0.55 points for those above the median in Susceptibility to Influence, indicating improved resistance to undue external influence. This was a statistically significant change, compared to a non-significant change of 0.14 points in the placebo group.
Participants with higher Affect Dysregulation scores at baseline showed a reduction of 0.56 points in the MDMA group, which was statistically significant, indicating improved emotional regulation. The placebo group had a minimal change of 0.02 points.
The MDMA group showed a decrease in Affect Instability scores by 0.73 points for those above the median baseline score, compared to a 0.55-point decrease in the placebo group. The change was statistically significant, suggesting better stability in emotional responses after MDMA-assisted therapy.
Finally, there was a reduction in Tension Reduction Activities scores by 0.42 points in the MDMA group, compared to a reduction of 0.19 points in the placebo group. This indicates a decrease in the use of maladaptive activities to reduce tension, and the change was statistically significant.
Main Takeaway
These findings collectively suggest that MDMA-assisted therapy has a broad and statistically significant positive effect on various aspects of altered self-capacities, specifically in areas that are key challenges for individuals with PTSD. It indicates that this therapeutic approach could help address impairments related to emotional regulation, self-awareness, and interpersonal functioning that often remains unresolved in traditional PTSD treatments.
Limitations of the Study
Despite the promising results, the study had its limitations. The participant group was not entirely representative of the broader PTSD population, with a lack of diversity in racial and trauma backgrounds. Nearly 80% of participants were white and a considerable majority had experienced developmental trauma, such as physical, emotional, or sexual abuse in childhood.
Another limitation of the study was the researchers’ use of an inactive placebo without robust controls for unblinding. This is an issue in psychedelic research, where the distinct and often intense experiences induced by drugs like MDMA can make it apparent to participants whether they have received the active drug or a placebo. Those aware of receiving MDMA might anticipate greater benefits, thereby enhancing the psychological impact of the therapy sessions.
The study, “Effects of MDMA-assisted therapy for PTSD on self-experience“, was authored by Bessel A. van der Kolk, Julie B. Wang, Rachel Yehuda, Leah Bedrosian, Allison R. Coker, Charlotte Harrison, Michael Mithoefer, Berra Yazar-Klosinki, Amy Emerson, and Rick Doblin.