In my role as a social worker and psychotherapist, I see so many clients suffering from the repercussions of trauma—experiences of abuse, neglect, and discrimination—that have left them struggling to feel safe on a fundamental level.
Healing from these traumas invariably focuses on helping these clients overcome feelings of disempowerment and disconnection, rebuilding interpersonal trust and intimacy in the context of the therapeutic relationship.
At the same time, there is growing recognition in the mental health field that we must address trauma across multiple levels: not only interpersonally or psychologically, but physiologically. We must also heal the way trauma inscribes itself on the brain and body, leaving survivors hijacked by nervous systems that vault into fight, flight, or freeze at a moment’s notice.
That is why it is imperative that social workers, and all mental health professionals, take notice when a new promising treatment comes along that seems to treat trauma across these multiple levels: the limited, adjunctive use of MDMA (3,4-methylenedioxymethamphetamine) in psychotherapeutic treatment for posttraumatic stress disorder (PTSD) presents just such a treatment.
MDMA-Assisted Therapy as Breakthrough Treatment
Research on MDMA-assisted psychotherapy for PTSD has been growing over the past 15 years, showing remarkable success in clinical trials. The FDA granted it “breakthrough therapy” status in 2017 based on these strong results.
For example, a 2011 study found that 83% of those receiving a combination of supportive psychotherapy and two MDMA-assisted psychotherapy sessions no longer met criteria for a PTSD diagnosis after treatment, compared to only 25% of those who received the same supportive psychotherapy and a placebo [1].
Moreover, these studies were working with the hardest-to-treat cases—clients whose PTSD had failed to respond to other treatments, such as prolonged exposure therapy, other cognitive behavioral therapies, or pharmaceutical medications. Follow-up studies have shown that the majority of those helped are still PTSD-free nearly four years later [2].
These striking findings led me and my colleague, Dr. Sara Bressi, to explore the potential of this treatment, especially given the stigma often attached to MDMA as being the primary ingredient in the recreational drug “molly” or “ecstasy” (though substances found in recreational settings are rarely observed to be pure MDMA).
This article is a summary of the findings from our recent paper on this topic, including: why mental health professionals are in dire need of better treatment for PTSD, how MDMA-assisted psychotherapy works, and how important a treatment like this could be for addressing the immense burden of trauma in vulnerable communities, especially communities of color and low-income communities.
Treating PTSD is an Uphill Battle
For those with PTSD, past traumatic events intrude upon their daily life through flashbacks, nightmares, and pervasive anxiety and hyper-vigilance that makes it difficult for them to engage in day-to-day life, and can make it especially difficulty to talk about or reflect on their traumatic experiences.
In an attempt to minimize their symptoms, individuals with PTSD often avoid anything that could trigger them, and begin to isolate themselves from the world and others—consequences that tragically cut them off from the potentially healing effects of relationships, both within their personal lives and within the context of therapy.
Existing PTSD treatments try to reduce these symptoms in a few different ways: psychiatric medications try to change brain chemistry to reduce anxiety; exposure therapies try to de-link trauma triggers from the strong fear response; skills-focused therapies target areas such as emotional coping and interpersonal skills; other trauma-informed approaches try to create a sense of safety in session that rebuilds trust over time and extends outside of the therapy room.
Unfortunately, these treatments often have mixed results and do not meet the needs of all people with PTSD: studies in veterans, for example, show that more than 70% of those engaging in PTSD treatment do not see significant improvement [3].
How Does MDMA-Assisted Therapy Work?
In MDMA-assisted psychotherapy, the MDMA acts as a catalyst for the therapeutic process, working synergistically with regular psychotherapy sessions. Biochemically, MDMA releases chemicals that increase a sense of well-being, enhance empathy and feelings of closeness to others, and dramatically reduce fear and anxiety [4].
A potentially key ingredient in this process is oxytocin, sometimes called the “love hormone” because we release it when we bond socially, when we are with people we care about, and even when we cuddle with our pets.
In a course of MDMA-assisted psychotherapy, traditional talk therapy is interspersed with two or three medicated sessions. These medicated sessions occur over 6-8 hours (the drug’s duration plus a few hours), under medical supervision, and consist of periods of quiet introspection and client-led discussion of traumatic material, facilitated by two therapists [5].
Non-drug psychotherapy sessions then help process and understand what came up for client while on the drug. After treatment, which generally occurs over 8-15 weeks, the majority of participants are not only PTSD-free, they report an “increased self-awareness,” “increased ability to feel emotions,” and “improved relationships in general” [6].
Though research on why MDMA is such a powerful catalyst is still new, in our paper we hypothesize that MDMA’s fear-reducing and pro-social affects work together to help clients tap into their capacity to heal, allowing them to engage in therapy faster and more profoundly than they could otherwise.
The fear-reducing effects help clients think and talk about their trauma without being as hijacked by flashbacks or panic symptoms, allowing them to gain perspective on what happened to them and integrate it into a larger narrative of their lives.
The pro-social effects help clients trust and bond with their therapists and “take in” the support and empathic attunement they provide—a task that is especially difficult for those who have had their trust violated through interpersonal trauma and abuse.
Moving Forward: How this Treatment Could Be a Game-Changer
That MDMA-assisted psychotherapy has worked so rapidly, and so effectively, in many people who have not responded to existing treatments is a powerful testament to its potential—especially for low-income communities and communities of color who disproportionately experience trauma [7].
At the same time, it is unclear what access to this treatment will be like for these populations. Given that people of color and low-income individuals already face the dual hurdle of being more likely to experience trauma, and less likely to have reliable access to health care, it will be essential that social workers be attuned to these potential barriers and be fierce advocates for access to this breakthrough treatment [8].
First and foremost, trauma survivors have experienced ruptures in trust—trust in others, in the safety of the world, and in their own inherent value [9]. Too often, these ruptures are then tragically re-experienced in relationships with loved ones, clinicians, and institutions.
If MDMA-assisted psychotherapy, in helping clients move toward spaces of empathy and trust, can facilitate and accelerate repair of these ruptures, its use will have repercussions far beyond the treatment of PTSD symptoms.
It could enable clinicians to more readily, more consistently, and more profoundly tap into what psychotherapy at its best offers: a pathway toward more fully, authentically, and lovingly engaging with themselves and their lives.