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Post-Traumatic Stress Disorder
How Psychedelic-Assisted Psychotherapy with MDMA Works
While research is advancing on MDMA, it is still limited
Posted August 24, 2020 Reviewed by Kaja Perina
Post Traumatic Stress Disorder (PTSD), a condition that affects at least 8 million people in the US and millions more worldwide. Currently, psychotherapy, also known as talk therapy, is considered the best treatment. Although it relieves some symptoms, up to 72% of patients still leave therapy with a clinical diagnosis of PTSD.
How MDMA works
So how does MDMA work? Despite its reputation as a party drug that can, in some cases, lead to hospitalization and even death from overheating or drinking too much water, researchers have found it can help some patients open up in psychotherapy.
One of the ways the drug works is by increasing serotonin levels. We still don't completely know how serotonin works, and thus should remain cautious about use cases for drugs that target the neurotransmitter and its pathways. However, reports show that it can increase feelings of happiness and wellbeing in patients.
MDMA also increases oxytocin levels in the brain, known as the 'love hormone', which can heighten feelings of trust and help enable social bonds. In this way, MDMA can make it easier for patients to form a strong bond with their therapist- a predictor of how successful treatments will be.
On top of this, the drug also has been shown to reduce blood flow to the amygdala (the part of the brain that processes emotions) and the hippocampus (the brain's memory center) while increasing blood flow to the prefrontal cortex (the logical thinking part of the brain). This, say researchers, may make it easier for patients to access and process traumatic events.
Unlike other psychedelics like magic mushrooms, LSD, and DMT, MDMA leaves the Default Mode Network (responsible for a person's sense of self) more or less intact, meaning that patients maintain their sense of 'self' or 'ego' throughout their experience. This reportedly makes MDMA more gentle than other psychedelic drugs, which may involve losing one's sense of self.
All in all, these processes, and perhaps some we are yet to discover, seem to make cognitive restructuring- identifying irrational thoughts and ways to overcome them- easier for patients, which helps them break out of destructive thinking cycles.
By helping patients form bonds with their therapists and making cognitive restructuring easier, researchers say that MDMA may help create new neural pathways that override unhealthy ones in those with treatment-resistant PTSD. MDMA-assisted psychotherapy may thus shorten treatment timelines in some cases.
Trials
Until now, results from clinical trials for MDMA to treat treatment-resistant PTSD have yielded positive results. In June this year, the organization released its full Phase II clinical trial results. At a two-month follow-up, the researchers found that while an average of 23% of those treated in the control groups no longer had PTSD, an average of 56% of those who underwent MDMA-assisted psychotherapy sessions no longer had PTSD.
At the 12 month-follow-up, 67% of patients who underwent MDMA-assisted psychotherapy no longer had PTSD, meaning that patients continued to get better after the treatment. Rick Doblin, founder of the Multidisciplinary Association for Psychedelic Studies (MAPS), said this may have happened as MDMA-assisted psychotherapy teaches people strategies to process fearful emotions. Applying these strategies both during and outside of therapy ultimately means they no longer get overwhelmed by past traumas, whether they come up in memory or conversation.
The researchers note, however, that they were not able to compare their results at the 12-month mark to those in the control group. This is because, after the 2-month follow-up, most people in this group began treatment with MDMA-assisted psychotherapy.
Vulnerability Issues
Although this therapy may hold promise for some cases of mental health illness, it is worth noting that the influence of psychedelic drugs- whether MDMA, LSD, psilocybin or others- make patients significantly more vulnerable than when in regular therapy. This means that clinicians must take extra caution when assisting patients through their experience and not to take advantage of their vulnerability.
While it is difficult to get concrete numbers, evidence exists suggesting that a significant number of predominantly male psychotherapists- ranging from 3.5% to 11%- engage in sexual interactions with their mostly female clients. While this shouldn't ward off those in need away from seeking psychological help, it does mean that there may be a higher risk for such incidences in psychedelic-assisted psychotherapy given the heightened vulnerability experienced by patients.
In his Harvard University doctoral thesis, Doblin wrote: “Though extremely rare, there have been incidents in which a psychiatrist delivering psychedelic psychotherapy sexually abused several patients. The loving and trusting feelings that can be induced by MDMA can make patients more vulnerable to sexual pressure."
Doblin then suggested ways to mitigate this from happening, such as including two treatment professionals to guide patients through the therapy, which is a part of the general treatment protocol today. Nevertheless, despite the presence of two professionals, there have already been reports of sexual abuse of patients by therapists in clinical trials for MDMA.
To conclude, studies so far show that MDMA-assisted psychotherapy may have benefits when treating some mental health disorders. Due to limited knowledge on how the drug works in the brain and body, its long-term effects, and complications that could arise from heightened levels of vulnerability, however, it should not be considered as a silver bullet. Other options including diet, lifestyle, personal sense of meaning, psychotherapy, and community support may be better treatment options to consider before psychedelic-assisted help.
