Effects of MDMA-assisted therapy for PTSD on self-experience
Rachel Yehuda, Leah Bedrosian, Charlotte Harrison, Amy Emerson, Rick Doblin, Bessel Van der Kolk, Julie B. Wang, Allison R. Coker, Michael C Mithoefer, Berra Yazar-Klosinski
PLoS One January 10, 2024 DOI: 10.1371/journal.pone.0295926 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Placebo-controlled Double-blind Peer reviewed |
|---|---|
| Sample size | 90 |
| Population | Participants with severe PTSD |
| Interventions | MDMA-assisted therapy Therapy with placebo |
| Duration | 3 experimental sessions plus 3 preparation and 9 integration therapy visits; symptoms measured at baseline and 2 months after the last experimental session |
| Topics | Anxiety MDMA PTSD |
| Keywords | Placebo Clinical psychology Randomized controlled trial Exposure therapy Affect linguistics |
| Citations | 52 |
| Registration | NCT03537014 |
| Key findings | MDMA-assisted therapy led to significantly greater improvements in emotional coping and self-experience measures compared to therapy with placebo, which may help explain reductions in PTSD symptoms. |
Abstract
Introduction: There is a resurgence of interest in the therapeutic potential of psychedelic substances such as 3,4-methylenedioxymethamphetamine (MDMA). Primary findings from our randomized, double-blind, placebo-controlled, multi-site Phase 3 clinical trial of participants with severe PTSD (NCT03537014) showed that MDMA-assisted therapy induced significant attenuation in the Clinician-Administered PTSD Scale for DSM-5 compared to Therapy with placebo. Deficits in emotional coping skills and altered self-capacities constitute major obstacles to successful completion of available treatments. The current analysis evaluated the differential effects of MDMA-assisted therapy and Therapy with placebo on 3 transdiagnostic outcome measures and explored the contribution of changes in self-experience to improvement in PTSD scores.
Methods: Participants were randomized to receive manualized therapy with either MDMA or placebo during 3 experimental sessions in combination with 3 preparation and 9 integration therapy visits. Symptoms were measured at baseline and 2 months after the last experimental session using the 20-item Toronto Alexithymia Scale (TAS-20), the 26-item Self Compassion Scale (SCS), and the 63-item Inventory of Altered Self-Capacities (IASC).
Results: 90 participants were randomized and dosed (MDMA-assisted therapy, n = 46; Therapy with placebo, n = 44); 84.4% (76/90) had histories of developmental trauma, and 87.8% (79/90) had suffered multiple traumas. MDMA-assisted therapy facilitated statistically significant greater improvement on the TAS-20, the SCS, and most IASC factors of interpersonal conflicts; idealization disillusionment; abandonment concerns; identity impairment; self-awareness; susceptibility to influence; affect dysregulation; affect instability; affect skill deficit; tension reduction activities; the only exception was identity diffusion.
Conclusion: Compared with Therapy with placebo, MDMA-assisted therapy had significant positive effects on transdiagnostic mental processes of self-experience which are often associated with poor treatment outcome. This provides a possible window into understanding the psychological capacities facilitated by psychedelic agents that may result in significant improvements in PTSD symptomatology.