A Brief Guide for Professionals

Disclaimer: If you are suffering from PTSD, do not attempt to treat yourself with MDMA. Street MDMA is notoriously impure and may contain psychoactive adulterants that can exacerbate PTSD symptoms. If you are interested in participating in a MDMA-assisted therapy for PTSD trial, you should contact the Multidisciplinary Association for Psychedelic Studies (MAPS). This document does not constitute medical advice.

Over nine million adults in the United States currently suffer from Post-Traumatic Stress Disorder (PTSD), a debilitating medical condition that can significantly decrease quality of life. Therapeutic approaches that incorporate 3,4-methylenedioxymethamphetamine (MDMA) present a potentially groundbreaking approach to treating PTSD. The United States Food and Drug Administration now considers MDMA a breakthrough therapy for individuals with treatment-resistant PTSD. In the following sections, we will define PTSD and outline the process and potential benefits of MDMA assisted therapy so that you can better understand this cutting-edge therapeutic approach.

What is Post-Traumatic Stress Disorder?
PTSD develops as a response to traumatic experiences and presents a range of symptoms. According to the National Institute of Mental Health (NIMH), a diagnosis of PTSD requires the following:

  • A re-experiencing symptom such as flashbacks, nightmares, or intrusive thoughts related to the traumatic event
  • An avoidance symptom such as intentionally avoiding “places, events, or objects” that are connected to the traumatic event or intentionally suppressing emotional states or thoughts connected to the event
  • A minimum of two arousal and reactivity symptoms such as feeling agitated, angry, and jumpy or having difficulty sleeping and resting
  • A minimum of two cognition and mood symptoms such as memory issues, negative thinking, feelings of guilt or shame, or experiencing a loss of pleasure in previously enjoyable activities

Epidemiological research sponsored by the U.S. Department of Veteran Affairs has calculated that over a lifetime, 3.6% of men and 9.7% of women in the United States will suffer from PTSD. Traditional treatments for the disorder rely on older models of therapy —specifically, exposure therapy (ET) and cognitive restructuring therapy (CRT). But these approaches, especially ET, can be difficult for patients to tolerate and may require years of therapy. MDMA-assisted therapy presents an alternative to these approaches and may prove more effective for treating PTSD.

What is MDMA Therapy?
MDMA-assisted therapy is a therapeutic approach that combines the use of MDMA, a potent psychoactive chemical, with traditional talk therapy that helps patients process traumatic memories. It is an emerging research area that may revolutionize how PTSD is treated. In this section, we will describe MDMA in terms of its effects and therapeutic potentials.

What is MDMA (3,4-methylenedioxymethamphetamine)?
MDMA (3,4-methylenedioxymethamphetamine) is a potent psychoactive stimulant that is considered an empathogen-entactogen due to its ability to generate positive feelings of connection and euphoria. Though the chemical is known by a wide variety of names (e.g., Ecstasy, E, XTC, Molly), in therapeutic settings it is referred to as MDMA to help distinguish it from street versions of the chemical, which are notoriously impure and should not be consumed for therapeutic purposes.

The Erowid Center, a 501(c)(3) nonprofit organization dedicated to providing accurate information about psychoactive plants and chemicals, provides details about the effects of MDMA. According to the Erowid Center, the effects of MDMA can include the following:

  • Positive effects: mild to extreme mood lift, euphoria; increased willingness to communicate; increase in energy (stimulation); ego softening; decreased fear, anxiety, and insecurities; feelings of comfort, belonging, and closeness to others; feelings of love and empathy; and forgiveness of self and others.
  • Neutral effects: decreased appetite; visual distortion; rapid, involuntary eye jiggling (nystagmus); mild visual hallucinations (uncommon); moderately increased heart rate and blood pressure (increases with dose); restlessness, nervousness, shivering.
  • Negative effects: inappropriate and/or unintended emotional bonding; anxiety or paranoia (less common than opposite); agitation (less common than opposite); tendency to say things you might feel uncomfortable about later; mild to extreme jaw clenching (trisma), tongue and cheek chewing, and teeth grinding (bruxia).

As these effects lists indicate, MDMA is a powerful psychoactive chemical that should be treated with a great deal of caution and respect. Used in a structured therapeutic setting, however, MDMA may provide the same relief as years of traditional therapy.

What are the Stages of MDMA-assisted Therapy for PTSD?
In general, MDMA-assisted therapy for PTSD occurs in three stages:
1.Initial counseling sessions. These sessions serve to determine the patients’ eligibility for MDMA-assisted therapy and to prepare them for the experience. The identification of therapeutic goals and education about the chemical and its effects both occur during this stage.

2. MDMA sessions. Following the initial counseling, patients will consume MDMA under the supervision of a licensed practitioner. During the sessions, patients work to identify and process traumatic memories. A variety of therapeutic modes are presently being investigated for this phase of the therapy. In general, there are three sessions; however, many patients experience significant improvement in their PTSD symptoms with as few as two sessions. The MDMA sessions occur within a controlled environment that is designed to facilitate healing from trauma.

3.Integration sessions. Following the MDMA sessions, patients will continue to work with a therapist (for up to 12 months) to integrate their experiences into their daily lives. As indicated by these stages, MDMA therapy for PTSD is an involved, long-term process that requires robust therapeutic support. Integration of the experience is necessary for achieving long-term recovery from PTSD. Patients should never attempt to treat themselves with MDMA.