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MDMA Assisted Psychotherapy

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MDMA Assisted Psychotherapy

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johnmorriscrypto
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© © All Rights Reserved
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MDMA Assisted Psychotherapy

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Introduction

3,4-methylenedioxymethamphetamine, an empathogen, is most commonly known as

MDMA. An empathogen is a medicine that changes a person's emotional state by acting on their

neurotransmitters. With the help of an empathy enhancer, people have a better time connecting

with people and feeling good about themselves. MDMA, frequently referred to as ecstasy, is a

psychoactive substance that shows great promise as a therapy for post-traumatic stress disorder.

The FDA recognized the therapeutic use of MDMA as a novel treatment option in 2017. The

German drug manufacturer Merck initially produced and commercialized MDMA in 1912. Still,

psychologists did not start utilizing it in treatment to improve cooperation and contemplation

until the end of the twentieth century. The U.S. Drug Enforcement Administration outlawed

MDMA in 1985, and the FDA classified it as a Schedule 1 prohibited medication due to its

likelihood for misuse and harmful usage in entertainment venues.

Pharmacologically, MDMA causes a surge in the production of various hormonal

substances, including oxytocin, prolactin, adrenaline, and vasopressin, as well as an influx of

brain chemicals, including serotonin, dopamine, and norepinephrine. In a normal MDMA-

based therapy session, the patient takes 120 mg of MDMA orally, with a second dosage of 40 mg

provided two hours later if necessary. Within the eight hours that an impact can endure, the client

and the two psychotherapists can talk about significant previous occurrences and feelings.

Therapy benefits are more likely to stick when patients participate in preparatory and adjustment

meetings. Individuals often attend a couple of appointments in that time frame. Until therapy

using MDMA has FDA approval, interested clients should participate in a controlled trial. Since

the point of therapeutic use of MDMA is to give patients a safe space to work through stressful

feelings in the company of qualified psychologists, using MDMA for pleasure will not result in
DUTY TO PROTECT AND ACA CODE OF ETHICS 3

the same positive outcomes. Clients must go through a medical authorization procedure before

they may take MDMA due to its list of contraindications. Nonetheless, when used as directed,

MDMA has a relatively low risk rating. This article is a literature review that delves deeply into

previously published studies to demonstrate the value of the therapeutic use of MDMA and its

efficacy in treating a wide range of mental health issues.

Literature Review

Historical Use of MDMA in Psychotherapy

Although 3,4-methylenedioxy-amphetamine (MDA), an extensively used relaxing

substance, was deemed illegal in 1970, it was not until the 1990s that MDMA gained broad

acceptance as an acceptable replacement. From 1977 to 1985, when it remained permissible in

the US, a handful of psychiatrists made use of MDMA due to its harmless, mood-enhancing, and

non-hallucinatory qualities (Sessa, 2011). The therapists who first used MDMA were able to

come up with strategies and reasons or reasons not to use MDMA for private or group therapy.

This made it possible for MDMA to be used in later research studies (Passie, 2018). MDMA's

positive benefits were widely believed to have contributed to a global resurgence in the use of

psycholytic and psychedelic therapies.

MDMA has remained at the frontier of a new trend in treatment that makes use of

psychoactive substances from the 1980s. Because of this, many researchers in the 1960s gave up

on using LSD and psilocybin for treatment purposes (Sessa, 2011). The last formal research

using hallucinogen-assisted psychiatry concluded in the 1970s, and they employed MDA, a drug

very similar to MDMA (Passie, 2018). Subversion therapists frequently used MDA. With its

relatively harmless impacts, MDMA has been the medicine preferred by numerous

psychotherapists, and it seems reasonable that an MDA-related chemical exhibiting fewer mental
DUTY TO PROTECT AND ACA CODE OF ETHICS 4

and perceptual aberrations could serve as the next frontier in psychedelic-assisted psychiatry (Dr.

Yehuda, 2020). European College for the Study of Consciousness (ECSC) studies and

conferences (1986 - 2000) provide a bridge between the MDMA tribunal in 1985 and the

investigations performed by Swiss psychiatrists in 1988 - 1993 (Passie, 2018). Current plans

conclude with stage three experiments in the United States to approve MDMA as an FDA-

approved medicine for the adoption in psychological therapy for PTSD and an eventual FDA

authorization for MDMA to combat the symptoms of a mental illness.

MDMA-assisted Psychotherapy for Treatment of Anxiety Related to LTI

A rising number of people with life-threatening illnesses (LTI) frequently endure anxiety,

sadness, and psychological discomfort as a result of a favorable outcome of contemporary

therapies. According to Wolfson et al. (2020), patients who had not responded effectively to

standard pharmacologic or psychological therapies for PTSD showed significant improvements

after receiving MDMA-based treatment. According to the scholars' report, the MDMA group

showed a tendency favoring decreased mental symptoms, including anxiety and sadness, and

poor sleeping habits linked to LTIs, in contrast to the alternative cohort in the randomized

portion of the current trial. MDMA's short-term impacts on key neural pathways responsible for

remembrance and handling feelings may help users confront traumatic thoughts and recollections

with tolerance instead of dread (Dr. Yehuda, 2020). Previous research in healthy individuals has

shown that MDMA can boost the clarity and magnitude of emotionally favorable recollections

while decreasing the adverse assessments of an individual's worst experiences. This method,

when applied to psychological treatment, could benefit those with LTIs by lowering their anxiety

about relapse and mortality and increasing their empathy for themselves, others, and their

circumstances (Wolfson et al., 2020). Patients with LTIs who partake in three rounds of MDMA-
DUTY TO PROTECT AND ACA CODE OF ETHICS 5

based psychotherapy report substantial improvements in rehabilitative advancement or perceived

advantages stemming from an LTI, attention (FFMQ), and interpersonal and familial wellness

(FACIT-S), in addition to a lasting decrease in apprehension. The fact that patients continue

getting better months after completing MDMA-based treatment suggests the

medication's beneficial outcomes could endure longer than initially thought.

MDMA-assisted Psychotherapy in Patients with Alcohol Use Disorder

Sessa et al. (2019) provided the first findings from a continuous investigation that aimed to

investigate the reliability and acceptability of MDMA-based medical procedures as a possible

treatment for individuals diagnosed with alcohol consumption problems. According to Sessa et

al. (2021), a total of seven individuals successfully underwent the whole 8-week MDMA-

backed therapeutic program, which involved engaging in two treatment sessions per individual,

each incorporating the use of MDMA. The primary objective of this study was to assess the

efficacy and acceptability of the medication regimen in the initial cohort of four subjects who

completed the medication protocol. The presentation of the longer-term consequences of

drinking habit was deferred until the publication of the whole study data. The findings indicated

that the therapy was well-tolerated by all four individuals (Yehuda, 2020). According to the

research report from this study, there were no significant adverse effects associated with MDMA

usage, nor were there any unanticipated physiological reactions observed during the MDMA

treatments. Additionally, there were no alterations in blood test outcomes or electrocardiograms

when comparing measurements taken before and after the 8-week program. The researchers

concluded that the medication exhibited a high level of tolerability, prompting them to strategize

the expansion of the initiative into a rigorous placebo-controlled trial.

Sleep Quality After MDMA-Assisted Psychotherapy for PTSD Treatment


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The relationship between sleep disruption and PTSD is complicated and encompasses

several dimensions. Existing data suggests a correlation between severe stress and sleep loss.

The study conducted by Ponte et al. (2021) demonstrates that addressing sleep quality can lead to

significant decreases in the intensity and impact of disorders related to post-traumatic stress

disorder. This finding underscores the need to include sleep interventions as an integral

component of a comprehensive treatment strategy for individuals with PTSD. Notwithstanding

the improvement of various signs associated with PTSD, cognitive behavioral therapy (CBT) for

PTSD, which is a prominent therapeutic approach, typically fails to address sleep difficulties

fully. Ponte et al. (2021) performed additional evaluations utilizing aggregated data obtained

from the four aforementioned randomized, placebo-controlled studies in order to investigate the

standard of sleep and the correlations between sleep quality and the intensity of indicators related

to post-traumatic stress disorder. The findings of their study provide empirical support for the

positive impacts of MDMA-based medical intervention in addressing sleep disruption among

persons diagnosed with PTSD. The study also observed that the subjects in the active-dose

MDMA category exhibited noteworthy enhancements in regard to restful sleep and

manifestations related to PTSD when contrasted with the control population. Specifically,

roughly 53.2% of the active-dose subjects experienced a significant drop of 3 points or more in

their Pittsburgh Sleep Quality Index (PSQI) assessments, indicating that MDMA-

based treatment has the potential to facilitate enhancements regarding sleeping habits and PTSD

signals or episodes. Furthermore, there was a notable improvement in the standard of sleep and

reduction in disorders related to PTSD from the time of treatment completion to the one-year re-

examination. This suggests that MDMA-integrated medical intervention has a lasting and

substantial positive impact on both sleep performance and PTSD symptoms. At the 12-month
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further investigation assessment, it was observed that 21 of the 63 individuals no longer

exhibited symptoms of sleep disruption, as indicated by a PSQI overall rating of 5 or less.

MDMA in the Treatment of Substance Abuse

The issue of drug dependency and addiction is undeniably a substantial one throughout the

United States. The substances that are often utilized include cannabis, non-therapeutic usage of

psychiatric drugs such as benzodiazepines, tranquilizers, cocaine, psychedelic substances, and

ecstasy. Various therapies for drug misuse have been developed and have demonstrated

effectiveness either through a well-documented track record or by empirical evidence as

compared to conventional therapy (Yehuda, 2020). The treatment options encompass outpatient

psychological treatment in a variety of environments, which incorporate diverse behavioral and

psychotherapeutic initiatives. Additionally, medication therapies are employed, either as

replacements for specific substances such as methadone or with the aim of inducing aversion or

targeting the neuroscience of substance abuse. Support groups, detoxification procedures,

recovery centers, and therapeutic organizations are also utilized as part of the treatment regimen.

Jerome et al. (2013) assert that MDMA, similar to traditional psychedelics, possesses potential

utility in the treatment of drug abuse or dependence due to its pharmacological properties and

psychological impacts. The intricate monoaminergic actions of MDMA give rise to its capacity

to modulate neuronal circuits that are implicated in the development and maintenance of drug

misuse disorder. MDMA has the potential to mitigate the seriousness of mental disorders that are

often challenging to treat, therefore equipping individuals with alternative strategies to address

problematic drug use. Conventional psychedelics, like Lysergic acid diethylamide (LSD), may

offer a more favorable risk-to-benefit balance when used in a psychotherapy context for the

treatment of drug misuse. This is due to their lower risk profile and reduced propensity for
DUTY TO PROTECT AND ACA CODE OF ETHICS 8

abuse (Jerome et al. (2013). Nevertheless, MDMA induces modifications in cognition that are

comparatively moderate in intensity when compared to traditional psychedelics. In the realm of

psychological treatment, MDMA is seen as a more suitable option for people who may otherwise

struggle to endure the profound modifications in consciousness induced by psychedelic

substances. MDMA-based treatment has been found to be beneficial for individuals with drug

use disorders through its ability to alleviate co-occurring psychiatric problems and foster trust

and rapport within the therapeutic relationship, thus enhancing the overall efficacy of mental

health treatment.

MDMA-assisted Psychotherapy from A Child Psychiatrist’s View

An individual's ability to maintain emotional stability throughout their life is shaped by the

extent of their connection to their main parental figure throughout childhood. Physical and sexual

harassment, on interpersonal forces' radar, are not the only types of maltreatment that might

impede development (Sessa, 2017). Despite the fact that numerous individuals may not think it is

as bad as physical abuse, the psychological effects caused by abandonment and emotional assault

may be just as severe, leaving a victim feeling unloved and meaningless. An individual's

susceptibility to PTSD and other stress-based illnesses, as well as their ability to establish new

connections and maintain existing ones, is compromised by childhood attachment problems

(Sessa, 2017). Human studies on the pharmacokinetics and pharmacodynamics of MDMA, a

ring-substituted phenethylamine, are extensive. It works in part by increasing the release of

chemical messengers, particularly serotonin, though other processes are likely in play as well.

Anxiety, sadness, and the amygdala's panic sensitivity can all be mitigated and self-esteem

boosted by enhancing functioning at 5-hydroxytryptamine (HT)1A and 5-HT1B sensors (Sessa,

2017). In addition, increased serotonin at 5-HT2A receptors encourages fresh approaches to


DUTY TO PROTECT AND ACA CODE OF ETHICS 9

thinking about previous encounters and causes shifts in the way implication is perceived (Sessa,

2011). Dopamine and noradrenaline both have a role in alertness and consciousness. When both

are elevated, a person feels more prepared and may more easily recall unpleasant situations that

are reliant on their current psychological condition (Dr. Yehuda, 2020). MDMA's activation at

alpha-2 synapses causes both a surge in arousal—which might drive an individual to participate

in therapy—and an unexpected rise in relaxation—which can mitigate the drug's

hypervigilance impacts. The oxytocin chemical, which is linked to early infancy attachment,

heightened compassion, and proximity, is also released in response to MDMA use.

MDMA-assisted Therapy on Phase 3 Trial for Treatment of Severe PTSD

Many people who have PTSD also struggle with dependency on drugs and alcohol. The

effectiveness and reliability of MDMA-assisted therapy (MDMA-AT) in the alleviation of grave

PTSD were established in a randomized, placebo-controlled, third-phase study. A comparison of

drug and alcohol consumption between participants undergoing MDMA-AT and those getting

placebo plus treatment (Placebo + therapy) was investigated by Nicholas et al. (2022). Adults

with chronic PTSD were randomly assigned to receive either MDMA-AT or Placebo+Therapy in

addition to three appointments of trauma-centered therapy. Each participant had to match the

DSM-5 standards for acute PTSD, and they could have experienced either a mild (current) or

intermediate (early relapse) alcohol or marijuana-related problem. Results from the Alcohol Use

Disorder Identification Test (AUDIT) and the Drug Use Disorder Identification Test (DUDIT)

were analyzed both before and after participants were randomly assigned to treatment. The mean

(standard deviation) AUDIT rating changes decreased more with MDMA-AT than with placebo

+ treatment. There is no evidence that MDMA-AT raises the likelihood of engaging in illegal
DUTY TO PROTECT AND ACA CODE OF ETHICS 10

drug usage (Nicholas et al., 2022). These findings provide credence to the potential of MDMA-

AT as a combined therapy for those with PTSD and ASUD.

The Costs and Health Benefits of Access to MDMA-assisted Therapy

Self-harm thoughts and attitudes are only two of the many devastating outcomes of post-

traumatic stress disorder (PTSD). This neurological disorder influences outlook, mental

processes, and physical and psychological wellness. Approximately 7.3–9.8 million people in the

US have PTSD yearly (Avancea et al., 2022). Several groups of former combatants have

documented PTSD incidences as high as 20% pre-treatment (Marseille et al., 2022). The present

incidence of PTSD among former military personnel is as significant as 13%. Therapy for PTSD

is more expensive and requires more medical attention than therapy for other psychological

illnesses (Marseille et al., 2020). Although 50% of those diagnosed with PTSD may improve or

go into relapse based on the standard of care (SoC), the other half will have prolonged or grave

symptoms of PTSD that will necessitate periodic therapy. Although sertraline and paroxetine are

now licensed FDA therapeutic medications, they are not without their limitations and undesired

negative consequences (Avancea et al., 2022). Recent research has revealed that individuals with

chronic or acute PTSD benefit substantially from a combination of MDMA, a presently

unlicensed psychedelic substance, and counseling than from a placebo plus a comparable period

of treatment alone.

Suicide-related thoughts and other negative consequences are not more common

in MDMA-AT patients, even people with co-occurring disorders, including detachment and

melancholy (Dr. Yehuda, 2020). Such encouraging findings suggest that MDMA-AT for PTSD

may be approved by the FDA (Avancea et al., 2022). Even with modest assumptions about the

advantages of therapy, MDMA-AT has been demonstrated to be less expensive than SoC during
DUTY TO PROTECT AND ACA CODE OF ETHICS 11

previous affordability assessments (Marseille et al., 2020). Avancea et al. (2022) sought to assess

the costs, health benefits, and net savings of greater access to MDMA-AT among the adult

population in the United States suffering from persistent and acute PTSD. MDMA-AT was

discovered to have the potential to reduce the high cost of treating PTSD (Marseille et al., 2022).

The lives of individuals suffering from persistent and grave PTSD can be saved, and medical

costs can be reduced if more people are granted access to this medication.

Benefits of MDMA-Assisted Psychotherapy Beyond Signs Severity

Barone et al. (2019) study covers a comprehensive examination of the outcomes of a

qualitative investigation that followed veterans, firefighters, and police officers with recurring,

drug-resistant post-traumatic stress disorder (PTSD) who had MDMA-AT over an extended

time. Conversational qualitative assessments were carried out during the one-year inquiries of

individuals who completed a phase 2 medical investigation. The research focused on interviews

conducted with nineteen out of a total of twenty- four individuals. The relevant information

extracted from the transcripts of the interviews was subjected to coding and analysis, employing

the interpretive phenomenological analysis (IPA) analytical model. The researchers examined

significant theme components derived from the narratives provided by the participants in order to

get a deeper comprehension of the outcomes seen in this study. All individuals involved in the

study expressed lasting individual benefits and improved overall well-being that surpassed

measurable alleviation of symptoms. The research likewise examined various treatment

advantages that extend beyond the alleviation of symptoms, emphasizing the need for qualitative

inquiries into the method and outcomes of MDMA-based treatment.

Conclusion
DUTY TO PROTECT AND ACA CODE OF ETHICS 12

Some cautions accompany the administration of MDMA, necessitating individuals to be

subjected to a comprehensive medical clearance procedure. Nevertheless, when MDMA is

provided in accordance with the established procedure, it exhibits a satisfactory safety profile.

MDMA-based clinical intervention has exhibited superior therapeutic effectiveness compared to

alternative forms of psychotherapy or medicine in the treatment of post-traumatic stress disorder.

In contrast to other alternative therapies for PTSD, most clients can enjoy a decrease in

symptoms following a solitary therapy session. Moreover, the enduring impact of MDMA-AT is

evident, as demonstrated by the fact that over two-thirds of the clients who had this treatment no

longer exhibited symptoms of PTSD when assessed one year after the course of treatment.

Academics ascribe these effects to the distinctive capacity of MDMA to help patients

explore past traumas without crashing into the associated distress, enabling them to address the

issue in collaboration with their clinician effectively.


DUTY TO PROTECT AND ACA CODE OF ETHICS 13

References

Avanceña, A. L., Kahn, J. G., & Marseille, E. (2022). The costs and health benefits of expanded

access to MDMA-assisted therapy for chronic and severe PTSD in the USA: a modeling

study. Clinical Drug Investigation, 42(3), 243-252.

Barone, W., Beck, J., Mitsunaga-Whitten, M., & Perl, P. (2019). Perceived benefits of MDMA-

assisted psychotherapy beyond symptom reduction: qualitative follow-up study of a

clinical trial for individuals with treatment-resistant PTSD. Journal of psychoactive drugs,

51(2), 199-208.

Dr. Yehuda. (2020, March 5). Five Things to Know About MDMA-Assisted Psychotherapy for

PTSD. Mount Sinai Physician’s Channel. https://physicians.mountsinai.org/news/five-

things-to-know-about-mdma-assisted-psychotherapy-for-ptsd

Jerome, L., Schuster, S., & Klosinski, B. B. (2013). Can MDMA play a role in the treatment of

substance abuse?. Current drug abuse reviews, 6(1), 54-62.

Marseille, E., Mitchell, J. M., & Kahn, J. G. (2022). Correction: Updated cost-effectiveness of

MDMA-assisted therapy for the treatment of posttraumatic stress disorder in the United

States: Findings from a phase 3 trial. Plos one, 17(6), e0269623.

Marseille E, Kahn JG, Yazar-Klosinski B, Doblin R., (2020). The cost-effectiveness of MDMA-

assisted psychotherapy for the treatment of chronic, treatment-resistant PTSD. PLoS ONE.

15:e0239997

Nicholas, C. R., Wang, J. B., Coker, A., Mitchell, J. M., Klaire, S. S., Yazar-Klosinski, B., ... &

Doblin, R. (2022). The effects of MDMA-assisted therapy on alcohol and substance use in

a phase 3 trial for treatment of severe PTSD. Drug and alcohol dependence, 233, 109356.
DUTY TO PROTECT AND ACA CODE OF ETHICS 14

Passie, T. (2018). The early use of MDMA (‘Ecstasy’) in psychotherapy (1977–1985). Drug

Science, Policy and Law, 4, 2050324518767442.

Ponte, L., Jerome, L., Hamilton, S., Mithoefer, M. C., Yazar‐Klosinski, B. B., Vermetten, E., &

Feduccia, A. A. (2021). Sleep quality improvements after MDMA‐assisted psychotherapy

for the treatment of posttraumatic stress disorder. Journal of Traumatic Stress, 34(4), 851-

863.

Sessa, B., Higbed, L., O’Brien, S., Durant, C., Sakal, C., Titheradge, D., ... & Nutt, D. J. (2021).

First study of safety and tolerability of 3, 4-methylenedioxymethamphetamine-assisted

psychotherapy in patients with alcohol use disorder. Journal of Psychopharmacology,

35(4), 375-383.

Sessa, B., Sakal, C., O’Brien, S., & Nutt, D. (2019). First study of safety and tolerability of 3, 4-

methylenedioxymethamphetamine (MDMA)-assisted psychotherapy in patients with

alcohol use disorder: preliminary data on the first four participants. BMJ Case Reports CP,

12(7), e230109.

Sessa, B. (2017). Why psychiatry needs 3, 4-methylenedioxymethamphetamine: a child

psychiatrist’s perspective. Neurotherapeutics, 14(3), 741-749.

Sessa, B. (2011). Could MDMA be useful in the treatment of post‐traumatic stress disorder?

Progress in Neurology and Psychiatry, 15(6), 4-7.

Wolfson, P. E., Andries, J., Feduccia, A. A., Jerome, L., Wang, J. B., Williams, E., ... & Doblin,

R. (2020). MDMA-assisted psychotherapy for treatment of anxiety and other psychological

distress related to life-threatening illnesses: a randomized pilot study. Scientific reports,

10(1), 20442.

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