BrainLine

Disclaimer: This article is for informational purposes only. Please speak with a medical professional before seeking treatment. 

PLEASE NOTE: Currently, the only place in the United States you can legally use MDMA or other “classic” psychedelics (e.g., psilocybin mushrooms) to treat mental health disorders is in an FDA-approved study. Please do not attempt to access or use MDMA on your own.

What can MDMA-assisted psychotherapy help with?

Post-Traumatic Stress Disorder (PTSD)

Psychedelics are to the study of the mind what the microscope is to biology and the telescope is to astronomy.

Dr. Stanislav Grof

What is MDMA?

Methylenedioxymethamphetamine, or MDMA, is a drug that can act as a stimulant, a hallucinogen, and an entactogen. This means MDMA can cause increases in energy, changes in perception, and enhanced sensory experiences. It can also cause increases in emotional openness, empathy, and self-awareness.

Therapeutic use of MDMA and psychedelic drugs is a relatively new area of study, since research on therapeutic use of these drugs was restricted for decades. MDMA-assisted psychotherapy for PTSD has been granted “Breakthrough Therapy Designation,” by the U.S. Food and Drug Administration (FDA), and it is currently being studied in Phase 3 Clinical Trials.

How does MDMA work to treat PTSD?

MDMA, the active ingredient in “ecstasy” or “Molly,” has been isolated and controlled for safe, therapeutic use in research studies. MDMA-Assisted Psychotherapy for PTSD involves the use of prescribed doses of MDMA in conjunction with psychotherapy sessions. PTSD can make it difficult for you to respond appropriately to trauma-related triggers, and talking about a traumatic event in psychotherapy sessions can be difficult. Research suggests that MDMA may reduce activity in the amygdala, partly responsible for the exaggerated fear response in PTSD. The chemical changes that happen in the brain in response to MDMA use also evoke feelings of calm and trust and affiliation with other people, including a therapist. In addition to enhancing trust in the therapeutic relationship, MDMA can create a feeling of detachment from traumatic memories, allowing you to talk about and work through these memories without the sense of immediate threat. MDMA is not a therapy for PTSD in and of itself; rather, it is used in MDMA-assisted psychotherapy for PTSD as a “catalyst” or as a drug that supports the therapeutic processing of traumatic events in therapy sessions.

My three MDMA sessions built on one another and took me from outside influences on my life to my inner psyche. I was nervous at first, had never tried MDMA before.

veteran Virgil Huston

What is the treatment like?

In the current clinical trials of MDMA-assisted psychotherapy, treatment takes place in a quiet, comfortable, and private space with a psychotherapist. There are non-MDMA psychotherapy sessions before those with MDMA use begin. This provides an opportunity for you and your therapist to get to know each other and create an environment of comfort and trust. MDMA is only taken three times under supervision of the psychotherapist during the 12-week course of treatment. The in-between sessions don’t involve MDMA use. Eyeshades and headphones for calming music are provided, but their use is optional. The therapist will encourage the recognition of physical reactions and provide guidance on how to express and release uncomfortable feelings that may arise. Sometimes breathwork will be used with the aim of providing control, relaxation, or focus.

Since MDMA is a controlled substance, safety measures should be in place, as they are in supervised research trials. Although there have not been emergencies requiring medical intervention during any MDMA research sessions, MDMA-assisted psychotherapy should take place with quick access to medical care, just in case it’s needed.

What do patients say?

I saw my whole past completely differently. It no longer became something that was haunting me.

— Nicholas Blackston, Veteran, U.S. Marine Corps

 

The MDMA allowed me to be my very, very, very best self, and I got to take care of my most broken self with my best self.

— Rachel Hope, sexual abuse survivor

 

 

The adrenaline kick didn’t happen. The hair didn’t stand up on my neck…There was no ‘A-ha’ moment. It was an incremental change over time, with jumps after each therapy session.

— Jon Lubecky, Veteran, U.S. Army 

My three MDMA sessions built on one another and took me from outside influences on my life to my inner psyche. I was nervous at first, had never tried MDMA before.

— Virgil Huston, Veteran, National Guard and U.S. Army

Why does MDMA-assisted psychotherapy work?

As studies are still being conducted, the current research suggests that MDMA may reduce activity in the amygdala, partly responsible for the exaggerated fear response in PTSD. It may also increase the levels of beneficial hormones in the brain including serotonin and oxytocin, which evoke feelings of calm and trust and affiliation with other people, in this case the psychotherapist. With fears allayed and trust enhanced, you are able to connect with emotions surrounding the traumatic event and share those feelings openly with the therapist.

[The MDMA-assisted psychotherapy] process catalyzed the healing process that people can continue on their own.

Rick Doblin, founder and executive director of MAPS

How can someone access MDMA-assisted psychotherapy for PTSD?

Currently, the way to access this treatment is through participation in an approved, supervised research study. It is important to note that this therapy is still being researched and that it is not recommended for all people with PTSD. This treatment also involves much more than simple use of MDMA. It focuses on the use of MDMA to support therapy for PTSD as provided by trained professionals. This research is being conducted by the Multidisciplinary Association for Psychedelic Studies (MAPS).

Where can I find more information?

Multidisciplinary Association for Psychedelic Studies (MAPS)

Available Programs (limited list)

MDMA-Assisted Psychotherapy - MAPS (scroll down to “MDMA-Assisted Therapy for PTSD: MAPS-Sponsored Clinical Trials”)

How To Join a Psychedelic Clinical Trial - Psychedelic.Support (scroll down)

 

References

Doblin, R. (2019, July 9). The future of psychedelic-assisted psychotherapy. TED Talks.

Mithoefer, M.D., M. C. (2015). A Manual for MDMA-Assisted Psychotherapy in the Treatment of Posttraumatic Stress Disorder (Version 7 ed.) [E-book]. Multidisciplinary Association for Psychedelic Studies.

Mithoefer, M. C., Wagner, M. T., Mithoefer, A. T., Jerome, L., & Doblin, R. (2010). The safety and efficacy of ±3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study. Journal of Psychopharmacology, 25(4), 439–452.

Morgan L. (2020). MDMA-assisted psychotherapy for people diagnosed with treatment-resistant PTSD: what it is and what it isn’t. Annals of general psychiatry, 19, 33.

PRESS RELEASE: FDA Grants Breakthrough Therapy Designation for MDMA-Assisted Psychotherapy for PTSD, Agrees on Special Protocol Assessment for Phase 3 Trials - MAPS. (2017, August 26).

Thal, S. B., & Lommen, M. J. J. (2018). Current Perspective on MDMA-Assisted Psychotherapy for Posttraumatic Stress Disorder. Journal of Contemporary Psychotherapy, 48(2), 99–108.

The Veteran: Psychedelics for PTSD: What a Long Strange Trip It's Been - MAPS. (2021). MAPS.

Wagner, M. T., Mithoefer, M. C., Mithoefer, A. T., MacAulay, R. K., Jerome, L., Yazar-Klosinski, B., & Doblin, R. (2017). Therapeutic effect of increased openness: Investigating mechanism of action in MDMA-assisted psychotherapy. Journal of Psychopharmacology, 31(8), 967–974.

Disclaimer: This article is for informational purposes only. Please speak with a medical professional before seeking treatment. 

 

Reviewed by Katherine McCauley, PhD, Lyndsay Tkach, MA, CBIS, and Michelle Neary, March 2021.

The BrainLine Treatment Hub was created in consultation with TBI and PTSD experts.