Current treatment options for PTSD are limited but one novel approach which utilizes MDMA along side psychotherapy could be the cure patients have been waiting for.
For United States military veterans, PTSD (Post-traumatic Stress Disorder) is a growing struggle. To illustrate the severity of the problem Evan Sola from the California Institute of Integral Studies states “U.S. combat veterans with PTSD represent a population in crisis. In modern U.S. warfare, deaths and casualties are far less likely to come from combat than from psychological sequelae experienced after the battlefield,” (Norwood 15). Substantiating Sola’s claim, David Rudd, from the University of Utah, reports that “46% of veterans have significant PTSD symptoms, 24% are severely depressed, and 46% stated they had suicidal ideation,” (Rudd 354). Additionally, “More than 30,000 suicides a year happen in the United States and 20% of those are veterans,” (Rudd 355). This amounts to 18 veterans committing suicide every day, making suicide the leading cause of death for combat veterans. Despite these issues and the severe symptomology as well as the larger picture of suffering that contribute to alarming suicide rates, very few medications have been approved for treatment, most of which have demonstrated limited efficacy. Entrenched in a cultural value system that discourages the seeking of help, U.S. veterans struggle to receive the treatment they need. Therefore, it is necessary to explore novel approaches for the treatment of PTSD, including the use of psychedelics.
Therapists Marcela Ot'alora and Bruce Poulter are trained to conduct MDMA-assisted psychotherapy. In this reenactment, they demonstrate how they help guide and watch over a patient who is revisiting traumatic memories while under the influence of MDMA. Courtesy of the Multidisciplinary Association for Psychedelic Studies
There are many ways a person can develop PTSD, but according to James Norwood, from the California Institute of Integral Studies, combat-related PTSD is the least responsive to psychotherapy. Currently the treatment for PTSD is dependent on “...exposure-based therapies, which rely on imaginal visualization of the traumatic events and exposure to trauma-related cues that trigger fear responses,” (Krediet 386). Although some patients see a reduction in PTSD symptoms, “...40% to 60% of patients do not respond adequately” (Krediet 388). Processing traumatic memories can be challenging for PTSD patients causing them to not respond to treatment or dropout. The integration of certain psychoactive substances through a psychotherapeutic approach may have the potential to address these challenges. “The rationale behind this approach is that these drugs can catalyze the psychotherapeutic process, for example, by increasing the capacity for emotional and cognitive processing through pharmacologically diminishing fear and arousal, by strengthening therapeutic alliance through increased trust and rapport, or by targeting processes of fear extinction and memory consolidation,” (Krediet 388).
More specifically, MDMA, has been uncovered as a “catalyst to psychotherapy” by reducing the fear response to anxiety-provoking stimuli, including previous trauma or traumatic memories (Krediet 387). According to Norwood, MDMA causes pharmacological effects that “...assist the therapeutic environment by supporting a balance of emotional activation within a safe, supportive, and controlled therapeutic context,” (Norwood 28). MDMA administration releases the hormone oxytocin, which as a prosocial hormone supports a strong therapeutic alliance otherwise made difficult by PTSD symptoms. MDMA also provokes a number of physiological responses that reduce fear and support trust. “It brings anxious content to the forefront in a unique way that is likely not as accessible by other therapeutic modalities,” (Norwood 29). Overall, MDMA-assisted psychotherapy has shown the ability to induce lasting changes in PTSD symptoms and its encounter is unlike others experienced in prolonged exposure therapies.
The first clinical trial that looked into the use of MDMA-assisted psychotherapy for the treatment of PTSD was conducted in Spain from 2000 to 2002. Six women with chronic PTSD due to sexual assault were given a low dose of MDMA in combination with multiple 90-minute nondrug psychotherapy sessions. “Reductions of PTSD symptoms were observed among the women, but the small number of patients did not allow for statistical analysis,” (Krediet 390). However, an important conclusion made from this study was that the administration of MDMA in this population seemed both physically and psychologically safe. Subsequently, the first randomized placebo-controlled trial of MDMA-assisted psychotherapy for PTSD was published in 2010 by Michael Mithoefer. In this study, “Twelve treatment-resistant patients received 2 sessions with 125 mg MDMA, while 8 patients received a placebo. The results showed that 83% of the patients in the MDMA group did not meet the criteria for PTSD anymore, compared with 25% in the placebo group,” (Krediet 390). Additionally, a long-term follow-up made by Mithoefer demonstrated that treatment effects were stable over a 3-year period. “These results were replicated in 2 other studies in which MDMA-treated patients also showed increases in post-traumatic growth,” (Krediet 391). An analysis on 105 patients from 6 randomized placebo-controlled trials showed that patients who received MDMA experienced significantly greater reductions in PTSD symptoms than patients in the control group.
Today, exposure-based psychotherapy remains as the first-line treatment for PTSD, however it is far from the solution. PTSD remains a chronic illness and those who suffer its symptoms remain desperate for help. There is an urgent need for novel interventions that can increase the efficacy of PTSD treatments, psychedelics being one. Psychedelics offer a groundbreaking approach for the treatment of PTSD by rapidly targeting its symptoms. In particular, MDMA reduces fear and shame while also instilling feelings of trust and safety, often of great importance in PTSD treatment. This enables patients to more easily revisit and process traumatic memories and gain openness and trust. “Integrated within a psychotherapeutic treatment, 2 to 3 sessions with MDMA have shown the ability to induce significant and sustained reductions in PTSD symptoms,” (Krediet 391). Currently researcher’s ability to further explore the healing powers of psychoactive substances is being impeded by their classification under Schedule I. By removing MDMA from this classification and successfully pairing it with psychotherapy, many patients with PTSD could potentially recover and a new era of entheogenic treatment could be born.
-Bianca Horst
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