Preliminary evidence for the importance of therapeutic alliance in MDMA-assisted psychotherapy for posttraumatic stress disorder.
Richard J. Zeifman, Hannes Kettner, Stephen Ross, Brandon Weiss, Michael C Mithoefer, Ann T Mithoefer, Anne C Wagner
European Journal of Psychotraumatology 2024 DOI: 10.1080/20008066.2023.2297536 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial with open-label phase Peer reviewed |
|---|---|
| Sample size | 22 |
| Population | Adults with chronic posttraumatic stress disorder |
| Intervention | MDMA-assisted psychotherapy |
| Topics | MDMA Psychedelic-assisted therapy |
| Keywords | MDMA-Assisted Psychotherapy Posttraumatic stress disorder Alianza terapéutica Mecanismos de cambio Mechanism of change Therapeutic alliance |
| Citations | 34 |
| Registration | NCT00090064 |
| Key findings | Therapeutic alliance at sessions 4 and 9 significantly predicted post-treatment PTSD severity, controlling for baseline severity. |
Abstract
Background: MDMA-assisted psychotherapy (MDMA-AP) is a combined psychotherapeutic and pharmacologic intervention that shows promise in the treatment of posttraumatic stress disorder (PTSD). Although therapeutic alliance has been established as a key predictor across psychotherapies and is emphasised within MDMA-AP treatment manuals, research has not yet examined the relationship between therapeutic alliance and MDMA-AP treatment outcomes.Objective: Examine whether therapeutic alliance predicts changes in PTSD symptoms following MDMA-AP.Method: Twenty-three individuals with chronic PTSD participated in a MDMA-AP clinical trial that included a randomised (MDMA vs. placebo) and open-label phase. The present analyses focused on participants who were administered MDMA over the course of the randomised and open-label phases (n = 22). Therapeutic alliance was assessed using the Working Alliance Inventory at sessions baseline (pre-session 3) and sessions 4 and 9. PTSD symptoms were assessed using the Clinician Administered PTSD Scale and the Impact of Events Scale-Revised.Results: Controlling for baseline clinician-assessed PTSD severity, therapeutic alliance at sessions 4 and 9 (but not baseline) significantly predicted post-MDMA-AP clinician-assessed PTSD severity. Controlling for baseline self-reported PTSD severity, therapeutic alliance at baseline (although this did not survive correction for multiple comparisons) and sessions 4 and 9 predicted post-MDMA-AP self-reported PTSD severity.Conclusions: The present results provide the first preliminary evidence for the relationship between the therapeutic alliance and treatment outcomes within MDMA-AP for PTSD. These findings highlight the important role of psychotherapy, and common psychotherapeutic factors, within MDMA-AP. Replication in studies with larger and more diverse clinical samples remain necessary.Trial
Registration: ClinicalTrials.gov identifier: NCT00090064.