What’s Happening With MDMA-Assisted Therapy for PTSD?

Navigating MDMA for PTSD

Known colloquially as ecstasy or molly, MDMA has journeyed from being a psychotherapeutic tool in the 1970s to a popular recreational drug and back again into the spotlight as a potential groundbreaking treatment for post-traumatic stress disorder (PTSD).

Understanding MDMA

First synthesized by a pharmaceutical company as early as 1912, MDMA gained a small following in psychiatry about 60 years later. It found its way into the club scene in the 1980s, and swiftly after the DEA declared an emergency ban, classifying it as a Schedule I drug, with “no currently accepted medical use and a high potential for abuse”.

Renewed interest in MDMA as a treatment for PTSD has been supported by a growing body of clinical research led by the Multidisciplinary Association for Psychedelic Studies (MAPS). Their work has been instrumental in demonstrating MDMA’s safety profile and efficacy in controlled therapeutic settings, opening doors to new treatment possibilities and destigmatization campaigns.

Safety and Efficacy: The Clinical Perspective

Safety is a paramount concern when it comes to any form of therapy, especially when paired with a substance, and MDMA is no exception. Clinical studies have shown that, when used under professional guidance in a controlled setting, MDMA can be safe and effective for treating PTSD, but is not suitable for everyone. This list of contraindications is based on research data through 2023 and is not exhaustive. Care providers need to remain aware of any new data released on contraindications for the medicines they work with.

• Heart conditions
• Seizure disorders
• Pregnant/lactating
• Liver problems
• Malignant hyperthermia
• Bipolar I Disorder

MDMA in the Research

The body of research on the impact of MDMA on mental health is expanding, forming the foundation for recognizing the therapeutic potential. Key examples include:

• MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study, published in Nature Medicine by Mitchell et al (MAPS Phase III study), 2021
• A Review of 3,4-methylenedioxymethamphetamine (MDMA)-Assisted Psychotherapy, published in Frontiers of Psychiatry by Sessa et al, 2019

What Does MDMA Feel Like?

MDMA releases various neurotransmitters and alters brain activity, including a spectrum of “feel-good” hormones like dopamine and serotonin, along with oxytocin, cortisol, and others.
MDMA experiences can produce a range of profound feelings, including:

• A deep sense of empathy
• Enhanced self-awareness
• Heightened sensory pleasure
• Increased vitality
• Reduced anxiety
• An openness to express emotions
• Altered perceptions of time and space

The peak effects of MDMA can last anywhere from four to eight hours, granting time to explore repressed thought patterns and unearth insights. This window of opportunity requires a significant investment in therapists’ energy to be present for holding space during a medicine session.

Experts in mental health have observed that these emotional states can create an optimal environment for individuals with PTSD to do therapeutic work. Within this space, they find it easier to confront and articulate complex emotions, engage in introspective reflection, and process the events that may have been the catalysts for their condition.

Negative experiences are also subjective, so this guide is not comprehensive. Challenging experiences hold the potential for developing new neural pathways (e.g., healing, changing a belief system, changing a patterned emotional response, etc.). This list includes indicators of various levels of challenge and crisis.

• Muscle tension, tremors, shaking
• Blurred vision
• Lack of appetite
• Sleep disturbances
• Sweating, hyperthermia
• Increased blood pressure
• Tachycardia
• Flashbacks
• Psychological distress, e.g., panic attack, confusion, brooding or rumination, depression, agitation

It is important to note that each experience is unique to the individual and is greatly influenced by both the user’s and the provider’s mindset and setting, so creating a safe container, practicing attuned, empathic awareness, and providing careful preparation before and integration afterward is crucial to a transformative experience.

Is MDMA a Psychedelic? And does that matter?

Due to MDMA’s empathogenic nature and its unique effect profile, a common question arises: is MDMA a true psychedelic?
The term “psychedelic” is used by the FDA and includes MDMA. MDMA experiences have been widely reported to produce changes in perception, increase openness, and influence positive behavior change.

MDMA in Psychedelic-Assisted Therapy for PTSD

Incorporating MDMA into psychedelic-assisted therapy combines the unique effects of MDMA with the supportive process of psychotherapy, creating a treatment that takes the whole person into consideration. As opposed to just targeting symptoms, this therapy helps clients gain a deeper, more nuanced understanding of their emotions and experiences and together with a strong therapeutic relationship, can lead to lasting positive changes.

The MAPS MDMA-assisted therapy trial protocol evaluated a 12-week therapy program with three MDMA sessions, accompanied by therapeutic support, which has been shown to be particularly effective for treating PTSD.

MAPS: Pioneering MDMA Research for PTSD

The role of MAPS in the development of MDMA-assisted therapy cannot be overstated. Their rigorous research and advocacy have been pivotal in shifting public and regulatory perceptions, paving the way for potential FDA approval. Their research looks at both the effects of the drug itself and the value of the therapy process. It emphasizes the therapeutic alliance and the importance of preparation, setting, and other overall aspects of treatment.

Their most recent milestone is the submission of a New Drug Application to the FDA (2023) – a first for the entire psychedelic ecosystem. This submission represents over 25 years of research, advocacy, and dedication to accessible MDMA treatment, and we are eagerly awaiting the outcome.

How to Work With MDMA for PTSD

Right now, the only legal way to conduct this work in the United States is to be affiliated with a sponsored clinical trial.

In 2022, Australia approved both MDMA and psilocybin for medical use country-wide, making Australia the first country to openly approve of psychedelics being used for mental health purposes. MDMA and psilocybin can only be prescribed by an approved psychiatrist.

What is the Next Step?

There are many organizations offering psychedelic training programs, so it’s up to you to decide which course is right for you. At Beckley Academy, we offer two courses designed to meet the needs of your schedule, profession, preferred learning style, and more. One offers rigorous learning in an online flipped classroom setting for therapists while the other offers asynchronous essentials for anyone on the spectrum of care.

If you’re a therapist and you’d like to learn more about our course offering a deep, transformative, cohort-driven journey into psychedelic practice, download our syllabus for Relational Psychedelic-Assisted Therapy.

If you’re elsewhere on the spectrum of care – a nurse, doctor, guide, coach – eager to learn psychedelic care practices, download our syllabus for Essentials of Psychedelic Care.

Beckley Academy: Preparing Practitioners for a New Era

At Beckley Academy, we align with the ethos of MAPS, dedicating ourselves to training therapists in the ethical, safe, and effective use of MDMA-assisted therapy. Both MAPS and Beckley Academy approach training with influence from developmental and somatic psychology. Our comprehensive curriculum includes in-depth exploration of the history of psychedelic therapy, its therapeutic potential, and the nuances of facilitating transformative experiences among many other curriculum aspects.

References

https://nida.nih.gov/publications/research-reports/mdma-ecstasy-abuse/what-is-the-history-of-mdma
https://maps.org/about-maps/
https://maps.org/mdma/ptsd/
https://www.fda.gov/regulatory-information/search-fda-guidance-documents/psychedelic-drugs-considerations-clinical-investigations