Will Psychedelics Give Us a New Way to Heal?
PSYCHEDELICS AND THERAPY
In therapy rooms across the United States there is a new mental health treatment. MDMA-assisted psychotherapy, a psychoactive psychedelic assisted therapy, is being tested on people with trauma, and it is working. Combining the psychoactive drug MDMA (similar to the street drug ecstasy) and talk therapy has produced rates of healing that have caused the FDA to approve the study for Breakthrough Therapy Designation. This designation is reserved for only the treatments intended to be used for life-threatening diseases that also show a great improvement over existing treatments. And this vote of confidence is backed up by test results previously unseen in most mental health treatments. Which leads to the question, will psychoactive drugs be the new mental health cure?
The research being done on MDMA-assisted therapy is be sponsored by the Multidisciplinary Association of Psychedelic Study (MAPS). MAPS is a non-profit research organization that develops medical, legal, and cultural contexts for the use of psychedelics. MAPS is involved in a variety of studies of psychoactive medications, but their research into MDMA’s effects on PTSD has become their highest priority project.
WHAT THE MDMA-ASSISTED THERAPY LOOKS LIKE
Unlike other treatment modalities MDMA-assisted psychotherapy integrates the medication and the therapy into one treatment. The psychoactive medication is administered only a few times (2-3), over the course of several month and in tandem with traditional psychotherapy. This medication structure is unlike most for mental illnesses which often rely on people taking the medication daily for years.
The therapy is provided both while the client is experiencing MDMA and outside of the psychoactive sessions. Therapy involves three 90-minute preparatory sessions, three total eight hour MDMA therapy sessions, and nine total 90-minute integrative therapy sessions, summing 42 hours of therapy across 13-26 weeks. In treatment two therapists work together as co-therapists, preparing the client for the experience, siting and working with the client during every MDMA session, and helping the client integrate the work during talk sessions afterwards. Each of these therapist must go through extensive training. In general the therapist works to create a safe and growth oriented space where people can process their experiences.
RESULTS OF THE FDA STUDY
Recently MAPS completed phase two of the research, working with 107 participants. The last of the phase two studies was published in the Fall of 2018, by a group of therapists in Boulder, Colorado. The Boulder study enrolled 28 participants who were considered to be chronic suffers of PTSD. Measuring symptoms before and after on the Clinician Administered PTSD Scale (CAPS-IV) they found a “61 percent point reduction” in symptoms after participants engaged in MDMA-assisted psychotherapy (Feduccia, 2018). Most impressively, the follow up assessments conducted at twelve months found that most participants (76%) no longer meet criteria for PTSD (Feduccia, 2018).
WHY USE MDMA
PTSD is known for creating a state of chronic fear during everyday life. This can often get in the way of traditional therapy as clients will find themselves in a heightened state of fear and mistrust when asked to explore their trauma with a therapist. All too often clients will leave therapy because the fear becomes too great. With MDMA a client can actually explore their traumas without the fear. MDMA significantly decreases activity in the left amygdala (associated with fear and traumatic memories) and increases the release of oxytocin and prolactin (hormones associated with trust and bonding), allowing patients to discuss their memories openly (Dangerfield, 2017). This experience has been described as “much of the empathy of psychedelics without much sense of altered consciousness (Harris, 2018) .” by Sam Harris, author of Waking Up.
GOING FORWARD
MAPS has begun participant screening for their phase three study. If all goes well they predict that MDMA will be approved for use with PTSD in 2021. Additionally MAPS has applied to the FDA for expanded access, a program that would allow designated therapists to begin providing this therapy before the end of phase three and outside of the research environment. Expanded access would focus on treating individuals suffering from chronic and treatment resistant PTSD. It appears that we will soon have a new treatment available to support some of our most fragile clients.
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SOURCES
Danerfield, K. (2017, September 1). ‘Party drug’ MDMA touted as breakthrough therapy for PTSD patients. Global News. Retrieved from https://globalnews.ca/news/3712234/mdma-treatment-for-ptsd/
Feduccia, A. (2018, October 29). Healing Trauma with MDMA: A New Study Published. Psychedelic Support. Retrieved from https://psychedelic.support/resources/healing-trauma-mdma-therapy/
Ot’alora, G., Marcela, Jim Grigsby, Bruce Poulter, Joseph William Van Derveer III, Sara Gael Giron, Lisa Jerome, Allison A. Feduccia, Scott Hamilton, Berra Yazar-Klosinski, Amy Emerson, Michael C. Mithoefer, Rick Doblin. “MDMA-assisted psychotherapy for Treatment of Chronic Posttraumatic Stress Disorder: A Randomized Phase 2 Controlled Trial.” Journal of Psychopharmacology. (2018). Retrieved from https://journals.sagepub.com/doi/abs/10.1177/0269881118806297
Harris, Sam, narrator. “The Drive Interview with Peter Attia.” Making Sense, 20 December 2018. Retrieved from https://samharris.org/podcasts/drive-interview-peter-attia/