The Altered State of Medicine: Pros and Cons of Treating PTSD With MDMA Psychotherapy

Psychedelic therapy holds potential to treat a range of conditions, including PTSD.
Psychedelic therapy holds potential to treat a range of conditions, including PTSD. Image Source: Wikimedia user Sasata.

The following is a guest post from journalist and blogger Peter Piscitello. After experiencing first-hand the potential medical benefits of psychedelics, he has become an advocate of legalizing medical applications of these substances through monitoring and reporting on the progress of this modern revolution in medicine. You can follow Peter, the progress of this movement, and his journey down the rabbit hole on Twitter @PeterPiscitello

Psychedelics—the controversial chemical compounds that sparked a nationwide thought revolution throughout the 1960’s—are now creating new waves in the field of psychotherapy. It was Grace Slick, lead vocalist of Jefferson Airplane, that stated in her psychedelic anthem White Rabbit: “One pill will make you larger, one pill makes you small, and the one that your mother gives you does nothing at all.” Four decades later, doctors and psychotherapists are starting to see that Slick, along with the free-spirited hippie culture of the 1960’s, may have been on to something.

Psychedelic psychotherapy is gaining new momentum in 2016. The medical benefits of certain chemical compounds such as MDMA, LSD, and psilocybin, previously seen only as having no medical application, are beginning to be viewed in a new light thanks to organizations like MAPS and The Heffter Research Institute.

MAPS Studies Indicate MDMA Could Be Powerful PTSD Treatment

The Multidisciplinary Application of Psychedelic Studies (MAPS) was founded in 1986 in California with the vision to return psychedelics to the hands of capable chemists and scientists who sought a new breakthrough in psychotherapy. Their primary focus is MDMA’s potential as a catalyst for curing post-traumatic stress disorder (PTSD).

MDMA (3,4-Methylenedioxymethamphetamine), commonly known as ecstasy or molly, is often categorized as an empathogen, a term used to describe psychoactive drugs that produce emotional communion, oneness, openness, and heightened levels of empathy and sympathy. MDMA also increases the release of dopamine and serotonin within the brain, often resulting in high levels of euphoria. The drug shares both characteristics of a mild hallucinogen as well as a stimulant.  

A number of experienced psychotherapists believe MDMA’s ability to increase empathy within the user can be harnessed to produce significant, long-lasting progress in patients suffering from PTSD by helping them face repressed trauma with a more positive and empathetic mindset.  

“MDMA is, without a doubt, a powerful substance, and under the right set and setting, could be used as a powerful medicine,” says Communications and Marketing Director of MAPS, Brad Burge.

MAPS' Director of Communications and Marketing Brad Burge. Image Source: Maps.org
MAPS’ Director of Communications and Marketing Brad Burge. Image Source: Maps.org

MAPS began phase two (clinical trials) of MDMA medical applications studies in 2012. Two studies were conducted, one in Switzerland and the other in Charleston, South Carolina. Each trial had 19 participants currently undergoing chronic treatment and had an average PTSD diagnosis length of 19 years. The demographic of the participants mostly consisted of sexual assault victims and war veterans.  

Nicholas Blackston—an O331 infantry machine gunner who did two deployments in Iraq—was a study participant in the MDMA-assisted psychotherapy clinical trial conducted by MAPS. The horrific acts Blackston witnessed on the battlefield left him feeling hollow, and he returned home from war with severe post-traumatic stress disorder.

“Before the therapy sessions, living with PTSD was just a nightmare. One of the biggest things with that is an intense sense of hopelessness,” says Blackston.

Patients like Blackston sometimes see traditional methods of treatments as being as useful as treating a bullet wound with a band-aid. “I guess I got the healing that I needed for the combat experiences that I went through during just the first session. It helped me to go so much deeper within my consciousness, and I accepted that part of myself that I have cut off,” Blackston says.

PTSD patients generally have decreased brain communication between the amygdala and hippocampus, but MRI analysis has shown that MDMA actually increases communications within these regions. This could explain the neurological benefits MDMA provides for PTSD patients.

The results from the phase two clinical trials found that “83 percent of participants were cured of their PTSD—compared to 25 percent who were cured from talk therapy alone.”

However, Burge wants to stress that these positive results will not manifest themselves through drug use alone. “MDMA is a tool for the psychotherapy sessions. The real reason we are seeing such positive results is because of our fantastic staff of therapists and a well engineered program,” Burge says.

The psychotherapy sessions themselves last eight to ten weeks. They begin with a number of standard sessions, allowing the patients and therapists to get to know each other and establish a layer of trust. A system that MAPS has implemented is to always have both a male and female psychotherapist present during the sessions. Having both genders present, especially when treating patients suffering from sexual trauma, creates a balance in the session and helps prevent the patient from re-experiencing a traumatic event or projecting that trauma onto a therapist.   

Then two experimental sessions are conducted three to five weeks apart, and the psychedelic is administered under the guidance and supervision of two highly experienced psychotherapists. The experimental sessions start in the morning and last six to eight hours while the substance runs its course. The patient then stays the night at the clinic, eats dinner, has breakfast, and is driven home by a staff member the next morning. Finally, the process concludes with a number of follow-up sessions for reflection and progress monitoring. “The MDMA assisted therapy really did feel like years compacted into a moment,” Blackston says.

Considering the Risks and Challenges of MDMA Psychotherapy

Although a popular substance for recreational use, MDMA actually did not start its existence on the dance floor of a club scene in the ‘80s. Instead, it was first used in the United States during the late 70’s and early 80’s by a small group of underground psychotherapists. Although it was not FDA approved and had never undergone human trials before, it quickly gained popularity within the psychotherapy community. Many even referred to it as “penicillin for the soul” because of its perceived ability to enhance communication during patient sessions and allow users to reach new depths of insight into their emotions.

One of those underground psychotherapists was Dr. George R. Greer. According to his profile on the Heffter Research Institute, “Greer conducted over 100 therapeutic sessions with MDMA for 80 individuals from 1980 to 1985 with his psychiatric nurse wife, Requa Tolbert. Their review of this work still remains the largest published study of the therapeutic use of MDMA.” Although many of the trials produced positive results for patients, there were still drawbacks to using a powerful, mind-altering substance such as MDMA in a therapeutic setting.

While under the influence of most psychoactive substances, positive thoughts and emotions tend to become more enhanced, but, along with that, negative thoughts and emotions can also be intensified. This negative effect is usually most prominent in more powerful substances like LSD.

This combination of both positive and negative mood manipulation is also evident in the psychotherapeutic setting. In an early trial conducted by Greer and Tolbert consisting of 29 volunteers, 18 reported a positive sense of euphoria while 16 participants experienced more challenging effects such as apprehensive anxiety.

Psychology Professor Andrew C. Parrott of Swansea University has extensively looked over Greer and Tolbert’s research and believes the findings are concerning. “MDMA can have beneficial effects in the area of psychotherapy, but there are definitely some issues that should be addressed before it is to be used as a co-drug for psychotherapy,” says Parrott. These issues include the unpredictability of how patients will react to the substance as well as MDMA-induced experiences being sometimes challenging to control in a therapy setting. For patients with predispositions to anxiety, depression, or psychosis, the intense nature of MDMA could become more harmful than helpful in some cases. 

Parrott believes the immediate after effects or “come down” from the drug could prove problematic in a therapeutic setting. The “comedown” from MDMA results from the brain releasing high levels of dopamine and serotonin before it can replenish itself and can result in a feeling of temporary depression and fatigue. “The depletion of dopamine and serotonin brings to light the issue of neurochemical recovery afterwards when negative moods tend to predominate. This period of negative cognitions may prove to be counter-productive,” says Parrott.  

Parrott also believes any progress made by using MDMA in psychotherapy will most likely be temporary. For Parrott, MDMA has far too many potentially damaging effects for safe general usage. “For enduring gains, cognitive restructuring through high-quality psychotherapy should always be the main focus,” says Parrott.

But Burge has some data that counteracts Parrott’s belief that any gains made would simply wash away over time. “We monitored all of our participants that partook in our phase two trials and found that two thirds (66 percent) still did not qualify for PTSD one year later,” says Burge.

These theories and concerns will soon be put to the test as MAPS is currently preparing to conduct phase three of their study and will start in 2017. The trial will include at least 200 participants but could expand to up to 400. The trial will be conducted over the course of four years under the supervision of the DEA and FDA. MAPS is raising $400,000 to purchase the one kilogram of pharmaceutical-grade MDMA to be used during the phase three experiments. So far, they have raised $140,000 during 2016. If you would like to donate to their cause, you can do so via their website. If the results of the phase three study are positive overall, MDMA will be granted clearance for medical applications by the DEA and FDA. MAPS expects nation-wide medical legalization of MDMA for use during psychotherapy sessions as early as 2021, so although MDMA’s future as a potential PTSD treatment is still being researched, there is certainly future potential to more fully realize the benefits of psychotherapy.

 

Psychotherapists and other experts are harnessing the transcendent power of psychedelics to treat mood disorders, substance addiction, and much more. The staff at Psychedelic Times is here to provide guidance and support through the processes of psychedelic integration and recovery coaching. Contact us with your questions about psychedelic therapy―the journey starts today.
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