What is MDMA-assisted psychotherapy (and how does it work)?
Clinically reviewed by Dr. Chris Mosunic, PhD, RD, CDCES, MBA
Learn what MDMA-assisted psychotherapy is, including how it works, who might be candidates, and the scientific evidence and clinical studies results behind it.
What if MDMA, a drug once known for its role in the party scene, could be used in a way that would help heal your deepest emotional scars? That’s the idea behind MDMA-assisted psychotherapy, a new mental health treatment protocol gaining buzz in the mental wellness world. By pairing the effects of MDMA with structured psychotherapy, practitioners are offering new hope to some patients with severe post-traumatic stress disorder (PTSD) and other mental health conditions that may be tricky to treat.
While some experts claim that MDMA-assisted psychotherapy has potential to revolutionize therapy, others are wary of the risks associated with altering consciousness in this way. As clinical trials continue, the question remains: Is this latest form of drug-assisted therapy the one worth pursuing for lasting relief? Or is it just another fleeting treatment that only makes us feel better temporarily?
What is MDMA-assisted psychotherapy?
The synthetic drug MDMA (3,4-methylenedioxymethamphetamine) is more commonly known as Ecstasy or Molly. Although you may associate it with illegal drug use, recent clinical trials have combined traditional talking therapies with MDMA sourced from approved manufacturers. When MDMA is taken under close supervision in controlled circumstances, studies have shown positive results in helping patients face and process traumatic experiences.
Origins and development
In the 1970s and 1980s, therapists discovered that MDMA might be a useful treatment option for people with mental health disorders through positive results from various clinical trials.
Initially, MDMA was used legally in therapy. But after it was classified as a Schedule I substance in 1985, it then became illegal for all uses. Research for this type of treatment was only able to continue under strict regulations. Organizations like the Multidisciplinary Association for Psychedelic Studies (MAPS) have led scientific studies, providing evidence of its benefits for mental health treatment.
Potential to treat mental health conditions
MDMA-assisted psychotherapy is primarily being studied for its effectiveness in treating post-traumatic stress disorder (PTSD). Research also suggests potential benefits for other conditions, such as severe anxiety and depression — especially when patients haven’t responded well to other treatments.
How does MDMA-assisted psychotherapy work?
MDMA increases the release of hormones like serotonin, dopamine, and norepinephrine in the brain. This may heighten emotional openness and trust between the patient and the therapist, which may possibly make it easier for patients to confront and process difficult emotions and memories.
The drug may also help reduce fear and anxiety, which can help patients with PTSD explore traumatic memories without feeling overwhelmed. This may help patients work through their issues and process trauma safely.
MDMA-assisted psychotherapy has several key phases:
Preparatory sessions: Patients meet with their therapists to discuss their history and set goals. These sessions help build trust and prepare the patient for the experience.
The MDMA session: The patient takes a controlled dose of MDMA in a comfortable, safe environment. Therapists support the patient through a session that lasts about eight hours. The patient may lie down with eye shades and listen to calming music while they discuss their thoughts and feelings.
Integration phase: After the MDMA session, follow-up meetings help the patient process and understand their experiences. These sessions aim to help the patient apply the insights gained during the MDMA session to everyday life.
Who might be candidates for MDMA-assisted psychotherapy?
To determine whether MDMA-assisted therapy may be appropriate for you, a trained therapist or psychiatrist first evaluates a candidate’s psychological history, current symptoms, medications (paying special attention to drugs that impact serotonin levels), and previous treatments.
Some people who might be ruled out include people with heart problems and those with conditions like psychosis or bipolar disorder. If it’s determined that someone is a strong candidate, they must be willing to participate fully in the entire therapeutic process, including preparatory and integration sessions to begin treatment.
MDMA-assisted psychotherapy may help people who haven’t found relief from traditional treatments and patients mostly fall into two main groups:
1. People with severe PTSD
Patients who continue to experience severe symptoms, such as flashbacks and nightmares, despite standard treatments like cognitive-behavioral therapy (CBT) or medication may be good candidates for MDMA-assisted psychotherapy.
2. Patients with severe anxiety or depression
Patients with severe and treatment-resistant anxiety and depression who have found they don’t respond to other protocols could benefit from this approach.
It should be noted that not everyone is a suitable candidate, and certain criteria must be met to make treatment safe and effective.
Is there scientific evidence on MDMA-assisted psychotherapy?
Recent clinical trials have provided strong evidence supporting MDMA-assisted psychotherapy’s effectiveness for treating PTSD and other mental health conditions.
Key clinical studies into MDMA-assisted psychotherapy studies
Phase 2 trials: Early research involved small groups of participants with chronic, treatment-resistant PTSD. These trials showed significant improvements in PTSD symptoms for many participants.
Phase 3 trials: In these larger trials aimed to confirm the therapy’s effectiveness, participants were randomly assigned to receive either MDMA or a placebo, along with psychotherapy. The results showed substantial and lasting reductions in PTSD symptoms for those who received MDMA.
Findings on MDMA-assisted psychotherapy studies
Improvement in PTSD symptoms: Studies measured PTSD symptoms using standardized clinical scales like the Clinician-Administered PTSD Scale (CAPS). Participants in MDMA-assisted psychotherapy often reported significant decreases in symptoms such as flashbacks, nightmares, and anxiety.
Long-term benefits: Follow-up studies have indicated that benefits of MDMA-assisted psychotherapy may last for months or even years. Many participants continue to experience reduced PTSD symptoms and improved mental health well after treatment.
Safety and tolerability: MDMA-assisted psychotherapy is generally safe when conducted in a controlled setting with medical supervision. Common side effects include temporary increases in blood pressure and heart rate, mild anxiety, and occasional headaches, which are usually short-lived and manageable.
Enhanced therapeutic process: MDMA may reduce fear and increase emotional openness, allowing patients to engage more deeply with their therapists. This helps them work through difficult memories and emotions more effectively.
Emotional breakthroughs: Participants often have emotional insights during MDMA sessions. This may lead to a better understanding of their trauma, which can then bring emotional healing. Many report feeling more connected to their emotions and better able to process their experiences.
The growing evidence for MDMA-assisted psychotherapy’s effectiveness is making further research possible. The potential to transform mental health treatment for PTSD and other severe conditions may lead to its approval and regulation.
The future of MDMA-assisted psychotherapy
With further research, MDMA-assisted psychotherapy may become an accepted treatment for PTSD and other mental health conditions.
Ongoing research into MDMA-assisted psychotherapy
Researchers are conducting more studies to see if MDMA-assisted psychotherapy may help with other mental health issues, like anxiety, depression, and eating disorders.
Scientists are studying how MDMA affects the brain and emotions to try to understand exactly how MDMA helps people feel better.
Other studies are exploring how MDMA-assisted psychotherapy might be combined with other treatments, like cognitive-behavioral therapy or mindfulness therapy to help patients even more.
Potential FDA approval
The FDA has given MDMA-assisted psychotherapy Breakthrough Therapy designation, which speeds up the review process for promising treatments. While the recent advisory panel voted against MDMA’s approval due to concerns about data quality and potential bias is a major hurdle, ongoing research and improvements in study design could address these issues and lead to eventual approval in the near future.
Challenges and ethical considerations
Ensuring safety: Strict guidelines and ongoing research around this form of therapy may help minimize risks and manage side effects.
Addressing stigma: MDMA’s history of recreational use means there’s stigma attached to its therapeutic use. Educating the public, healthcare providers, and policymakers about the therapeutic benefits is important for broader acceptance.
Ethical use: As with any medical treatment, clear guidelines are needed to ensure informed consent and to protect patients from potential abuse.
Global access: While research is mainly focused in the U.S., international collaborations will be needed to bring the potential benefits of MDMA-assisted psychotherapy to patients worldwide.
MDMA therapy FAQs
What are the potential risks and side effects of MDMA-assisted psychotherapy?
MDMA-assisted psychotherapy is generally safe when conducted in a controlled, therapeutic setting, but there are some risks and potential side effects.
MDMA may cause temporary increases in heart rate and blood pressure, so it may not be suitable for people with severe heart conditions.
Some patients might experience increased anxiety or agitation during the session, but therapists are present to help manage these feelings.
Other common side effects include dehydration and an imbalance of electrolytes, so staying hydrated is important.
Sometimes people experience physical symptoms like jaw clenching and muscle tension, but they’re usually mild and temporary.
Revisiting traumatic memories may be distressing, but supportive therapists are present to help patients process their emotions safely.
How long do the effects of MDMA-assisted psychotherapy last?
Immediate: After the session, patients often report emotional insights and breakthroughs, leading to a sense of relief and a new perspective on their trauma.
Short-term: In the weeks following the MDMA session, many patients say they’ve had substantial reductions in symptoms of PTSD, anxiety, and depression, as confirmed during follow-up therapy sessions.
Long-term: Long-term follow-up studies indicate that the positive effects may persist for months or even years, with many patients continuing to experience reduced symptoms and improved mental health well after the initial treatment.
Are there any legal considerations for MDMA-assisted psychotherapy?
There are important legal considerations for MDMA-assisted psychotherapy.
Currently, MDMA is classified as a Schedule I controlled substance in the United States, making it illegal for most uses outside of approved clinical research settings. However, the FDA has granted Breakthrough Therapy designation to MDMA-assisted psychotherapy for PTSD, which eases the development and review process.
If ongoing Phase 3 trials continue to show positive results, MDMA could be reclassified and approved for medical use. As of today, patients can only access MDMA-assisted psychotherapy through participation in clinical trials conducted under strict regulations. But if MDMA receives FDA approval, it’ll become legally available for therapeutic use under controlled conditions.
How does MDMA-assisted psychotherapy compare to traditional psychotherapy?
MDMA-assisted psychotherapy may offer several advantages over traditional psychotherapy.
MDMA may help patients feel more emotionally open and connected, helping them undertake deeper therapeutic work.
For patients who struggle to access and express deep emotions in traditional therapy, MDMA may help reduce their fear responses, so they can confront and process traumatic memories.
Many patients experience rapid improvements after just a few sessions of MDMA-assisted psychotherapy, whereas traditional psychotherapy often takes longer to achieve similar results.
MDMA may strengthen the relationship between the therapist and the patient, leading to more effective sessions.
What should patients expect during an MDMA-assisted psychotherapy session?
Patients can expect a structured and supportive experience during an MDMA-assisted psychotherapy session.
Before the session, several preparatory meetings with their therapists help build trust, set expectations, and prepare for the experience.
On the day of the session, patients take a controlled dose of MDMA in a comfortable and safe environment. Therapists provide continuous support throughout a session that typically lasts eight hours, and patients often lie down with eye shades and headphones playing calming music to create a soothing atmosphere.
During the session, patients may experience heightened emotions and vivid memories, with therapists guiding them and encouraging them to explore and process their feelings.
After the MDMA session, patients have follow-up integration sessions to discuss their experiences and insights. This may help them apply the lessons learned to their daily lives.
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