Treating PTSD with Ecstasy; Inside a Therapy Session With MDMA

What is it like to undergo experimental therapy with MDMA? A researcher participating in a New York Academy of Sciences program about psychedelics took us behind-the-scenes of a treatment session. Rachel Yehuda, PhD, is a professor of psychiatry and neuroscience and the Director of the Center for Psychedelic Psychotherapy and Trauma Research at the Icahn School of Medicine at Mt. Sinai. She explained that MDMA can help people overcome barriers that usually prevent them from confronting memories of past trauma.

In early May, researchers published results from the first Phase 3 clinical trial conducted with MDMA-assisted therapy. The study showed significant results in the treatment of patients with severe cases of Post-traumatic Stress Disorder (PTSD). Results like those have generated new rounds of enthusiasm for the possible therapeutic use of psychedelics.

Dr. Yehuda has undergone training to be a MDMA-assisted psychotherapist, and will soon be leading similar trials at Mount Sinai.

Dr. Yehuda makes clear treating people with MDMA is no simple affair. There are three sessions with a therapist before the drug is administered, to help ensure the patient has very clear expectations. “You really try to create a setting of safety and support,” she said. “And [you] explain how the therapy will be very different from other treatments they may have received…. [T]hey are actually going to trust what we call their ‘inner healing intelligence.’”

In explaining what a patient experiences on the day the drug is administered, Dr. Yehuda stressed that every effort is made to make the patient feel comfortable and relaxed. They are monitored carefully, and there is usually ongoing conversation with a therapist. That interaction is a core feature of treatment with MDMA; patients who go under the influence of other psychedelics often have a more private experience.

Dr. Yehuda said the patient is fully awake and sober after eight hours, and that the first “integration sessions” begin the next day.

Dr. Yehuda said that MDMA helps people reach and discuss painful memories because they move from self-blame and protective distancing to an emotional state of compassion toward themselves. This can permit going back in their minds to a time and place of trauma. If a person experienced child abuse, for example, they may explore memories from when they were five years old, if that is when the abuse occurred. Importantly, people undergoing treatment with MDMA are likely to speak about these memories.

Dr. Yehuda stresses the role of the therapist in treatment with MDMA, and in talking with the patient about memories. This helps patients gain insights about the impact of traumatic events in their lives. It is a process of “integration”, and it take time and hard work. Dr. Yehuda said the process should never be thought of as a “quick fix.”  With hard work and significant effort, she said “fantastic outcomes” are possible.

There have been important strides, too, in clinical trials with other psychedelics, such as psilocybin. That is the compound produced by fungi, including those known as "magic mushrooms". Roland Griffiths, PhD, of Johns Hopkins University School of Medicine, another leading researcher in the field, also participated in the program.  Click here to learn from Dr. Griffiths what a course of experimental therapy with psilocybin is like.

Dr. Griffiths, and another panelist, David E. Nichols, PhD, president and co-founder of the Heffter Research Institute, spoke about short term changes in brain chemistry brought about by psychedelics, and what is known about long-term effects. Click here to learn from Dr. Nichols and Dr. Griffiths about the biochemistry of these drugs, and their effect on communication pathways in the brain.

The Academy discussion, Psychedelics to Treat Depression and Psychiatric Disorders, was moderated by John Krystal, MD, of Yale School of Medicine.