Curing the Roots of Trauma: MDMA and PTSD
In the wake of Nixon’s war on drugs, an unlikely candidate is reshaping the way in which we think about and treat post-traumatic stress.
“Without the study, I’d probably be dead right now” declares C.J. Hardin, a retired sergeant of the US army. Hardin is one of the many veterans who had returned from military conflict with post-traumatic stress disorder (PTSD), a serious psychiatric condition diagnosed when post-traumatic stress is persistent and uncontrollable. To make matters worse, upon returning to the US Hardin’s condition failed to improve with conventional talking therapies and medication. This looked set to change, however, when in 2013 the veteran was presented with a strange opportunity that would change his life: to take part in a study for MDMA-assisted psychotherapy.
“MDMA is the perfect tool to enhance trauma-focused therapy” explains Ben Sessa, a British psychiatrist specialising in trauma. The drug increases interpersonal trust, enhances positive emotions such as love and empathy, and reduces fear. As a result, patients find themselves more able to access and process their trauma without being overwhelmed by the negative emotions associated with it.
Post-Traumatic Stress
Traumatic events occur in everyday life, with PTSD developing in many cases following sexual assault, physical violence, or the sudden death of a loved one to name but a few. In the follow up to trauma, a subset of individuals will go on to develop PTSD, often presenting with a persistent highly alert state, feelings of anxiety, irrational fear responses, and terrifying flashbacks and nightmares. It is estimated that 1 in 10 people in the UK will experience PTSD at some point in their life.
Despite its prevalence, conventional treatments for PTSD have shown limited efficacy, with only 40-60% of sufferers seeing improvements.
The History of MDMA-Assisted Psychotherapy
The psychoactive qualities of MDMA were first recognised in the 1960s, paving the way for its use alongside psychotherapy through the 1970s. With the announcement of Nixon’s war on drugs, however, the drugs' place in medicine and research was ultimately revoked, with the UN classing MDMA as a schedule 1 controlled substance in 1986 due to a ‘high potential for abuse’. This move would remain controversial for decades to come.
In response, American drug activist Rick Doblin founded the Multidisciplinary Association for Psychedelic Studies (MAPS) in a venture aimed at continuing the research needed for the drug's eventual reacceptance into modern medicine. 30 years later, in 2016, MAPS was granted permission by the FDA to conduct a large-scale study with the aim of determining the drug's real-life potential for the treatment of PTSD.
The experience involved 90 participants suffering from PTSD and took place over 12 therapy sessions, 3 of which including MDMA intake. In their publication, researchers explain that the mindsets of both the patient and therapist are key to the experience and stress the importance of preparation and integration sessions for beneficial assimilation of the drug. With these considerations, 18 weeks after the 3 sessions 67% of the participants who were administered MDMA no longer met the diagnostic criteria for PTSD, compared with 32% of those in the placebo group. Furthermore, in contrast to conventional therapeutics that require regular oral consumption, in many cases MDMA could effectively treat the disorder with only 3 intakes. Thus, it was concluded that “compared with current first-line pharmacological and behavioural therapies, MDMA-assisted therapy has the potential to dramatically transform treatment for PTSD”.
Where Are We Now?
MAPS has recently concluded MAPP2, the second phase three clinical trial looking into using MDMA to treat PTSD, with the drug expected to receive FDA evaluation in 2023. The service also provides MDMA psychotherapy training, with an up to date MAPS manual for MDMA-assisted therapy available to interested parties. Alongside this, research on MDMA is ongoing at Imperial College’s Centre for Psychedelic Research and King’s College London, each of whom are looking at the drug's potential for the treatment of mood disorders and anorexia nervosa. Furthermore, although approval for prescription is not yet guaranteed, the drug has received recognition as a breakthrough therapy by the American FDA, an acknowledgement set to expedite the pace of research enormously. In all, an unprecedented bright light is shining on MDMA, marking the substance’s journey from recreational drug to transformative healer.