The use of MDMA-assisted therapy for mental illnesses, particularly PTSD, is inching it’s way towards approval by the Federal Drug Administration in the United States.

An earlier, relatively small study published in the Journal of Psychopharmacology in 2011 (of 20 patients) by the Multidisciplinary Association for Psychedelic Studies (MAPS) found that 83% of patients (10/12) receiving the MDMA-assisted therapy saw an improvement in symptoms, and 25% of patients (2/8) receiving the placebo saw an improvement. Phase 2 clinical trials are coming to an end in March 2016, with Phase 3 trials expected to start in 2017 and wrap up in 2021.

Keep in mind that these studies are being conducted by an organization that has an interest in seeing the studies succeed, although that’s no different than any other company or organization that brings a new product to market. It’ll be important that they compare their results to newer forms of therapy for PTSD. The fact that the type of psychotherapy used in these trials was less effective without the MDMA could be caused by the type of therapy and the way the therapy was delivered. It doesn’t necessarily mean that all therapy is less effective. If you’re focused on medication, there’s not much incentive to ensure the therapy component is the most innovative or effective.

But why use MDMA in therapy? Apparently, this is not because sweating in dark basements while gyrating deliriously to deafening bass is useful exposure therapy for people with PTSD. At this point, the reason the MDMA might be effective (if it is) remains purely conjecture. Although, if you’ve ever been in a sweaty club around lots of people on ecstasy (obviously not you, yourself), then you might have had the pleasure of getting hugged by a really sweaty high person. They might have even told you how much they love you. MDMA can, potentially, make people feel very positive about those around them. And what has research shown is one of the biggest predictors for developing PTSD and success with recovering from it through therapy? The sufferer’s perception of social support.

Meta-analyses, like this one: (PDF) Meta-Analysis of Risk Factors for Posttraumatic Stress Disorder in Trauma-Exposed Adults show that lack of social support or perception of social support plays a key role in the development of PTSD and recovery from it. So, if a pill is creating in the patients a sense of being supportive and supported, and that’s then combined with behavioral therapy exercises the patient might not have done otherwise (because they felt unsupported), I can see how, theoretically, that could kick start some progress on recovery. It might be a false sense of social support but so much of recovery is about taking a fake-it-til-you-make-it approach. That could be used to help with building up social networks and pro-social behaviors that create a foundation for support when the patient stops taking the drugs. If those supports aren’t put in place, however, relapse probably wouldn’t be surprising. Hopefully the researchers looking at this approach to therapy are tracking data on perceived social support before, during, and after therapy. Social support might be the actual active ingredient in this treatment.

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