How a so called ‘party drug’ can help to heal the deep wounding of trauma.
We have been experiencing an underground psychedelic renaissance since the 90’s but not in the way that you might think. In the 60’s, psychedelics were associated with a stigma brought about by the American government’s ‘war on drugs.’ Think rebellion, social uprisings and a whole generation of young people shedding responsibility in favour of what Timothy Leary famously asked them to do; “turn on, tune in and drop out.”
Today’s psychedelic use is for clinical research. The drugs are administered strictly in a therapeutic setting for people wishing to treat, and recover from, mental health issues such as treatment resistant depression and treatment resistant post traumatic stress disorder (PTSD.) There is also a large underground movement who are using assisted psychedelic therapy but for the purpose of this story I will be discussing the therapy that has been given approval for trials.
Advocates of psychedelic assisted psychotherapy emphasis over and over how ‘set’ and ‘setting’ are the most important components in this healing work. For healing trauma work (and it is work and not the blissed out state one might imagine) psychedelics are taken, with therapists on hand, in a safe environment. There are preparatory sessions where goal setting and intention is discussed. Afterwards, there are several integration sessions with therapists where the client will talk about what they have learnt from the experience and how they can use this learning in their lives in moving forward.
MDMA assisted psychotherapy.
MDMA, is also be known as ‘ecstasy’, ‘molly’ or3,4-Methylenedioxymethamphetamine. It is important to note here that recreational ecstasy may only contain a minimal amount of MDMA and it is not entirely the same as clinical MDMA. Clinical MDMA is pure, and all ingredients and dosage are known by the clinicians who are administering the drug.
Whilst not strictly classified by some as a psychedelic because it does not cause hallucinations it is known for its euphoric effects inducing empathy, warmth, loving, compassion and trust. These are the emotions that therapists encourage in clients in order to allow them to view themselves in a more compassionate way to help soften judgements and shame towards themselves and to begin to heal. A trusting therapeutic relationship takes time and it can take many weeks in therapy to build this trust.
The non-profit Multi-disciplinary Association for Psychedelic Studies (MAPS), has been granted FDA (Food and Drug Administration) approval for Phase 3 MDMA trials for treating PTSD. This news has been a long time coming and has excited psychotherapists, participants and sufferers of drug resistant PTSD. Six phase 2 trials were conducted between 2004 and 2017. These trials showed that PTSD symptoms went into remission in 76% of participants with the benefits seemingly to increase after a year rather than decrease. Historically, it has been difficult to treat severe PTSD. Most of the treatments are exposure based where the client will be encouraged to imagine the traumatic experiences that will trigger their fear responses. The goal being to extinguish the fear to cues associated with trauma.
As with any trauma treatment the MDMA trials are rigorous. Participants take MDMA once a month for three months. The procedures and interventions involved in the therapy follow a treatment manual that has been designed for MDMA assisted psychotherapy for PTSD. During the process, participants are closely monitored and two specifically MDMA trained psychotherapist will sit with them for 8 hours; the length of time it takes for the drug to enter the body, take effect and for the participant to go on their healing ‘journey.’ The participants will be wearing an eye mask and be listening to instrumental music if they wish to do so and music during psychedelic assisted therapy has been shown to enhance the therapeutic process. The environment that participants are in will be a comfortable room with a bed, cushions, potted plants and framed prints with all medical instruments removed.
During the treatment there will be a method used with periods of introspection combined with periods of communication between the participant and therapist. This method allows them to revisit traumatic experiences while staying emotionally engaged through intense emotions. After the session, the participants may spend the night in the clinic and are then in touch with their therapists every day for a week.
Rick Doblin, founder of MAPS, spent many years battling the DEA in courts trying to get the initial MDMA assisted psychotherapy trials approved. The phase 3 project will be somewhere in the region of 33 million dollars and much of this money will have been donated by people wishing to see MDMA assisted psychotherapy used in clinical settings in America and the UK. Taking into account that The Department of Veteran Affairs reported in 2019 that at least 60,000 veterans took their lives between 2008 and 2017 we can see why people are looking for alternative ways to treat PTSD.
MAPS train psychotherapist in MDMA assisted therapy and at the moment have around 80 therapists doing the training. “We’ve been working for 28 years and have another seven to go before MDMA is available as a prescription medicine” says Rick Doblin. “For people who are so stuck in the fear reaction they have to their trauma, psychotherapy alone can only take them so far. The addition of MDMA makes much more progress. When combined with supportive psychotherapy, people can make great progress.”
Bessel Van Der Kolk is the Principal Investigator of the clinical trials of MDMA in the Boston Trauma Centre. Van Der Kolk is best known for his ground-breaking work on trauma and his bestselling book The Body Keeps the Score. Brain, Mind, and Body in the Healing from Trauma. He believes that we can heal trauma through MDMA assisted psychotherapy. In his online Trauma Mastery course he presents a taped video recording of a war veteran 2 hours in to an MDMA psychotherapy session with a male and a female therapist to hand. The veteran spends periods of time on internal self-reflection and then tells the therapists about the introspective work that has been going on. He tells how there are parts of himself that he has locked away in a ‘jail cell’’ that is like a monster with glowing red eyes and that is full of rage. During the session we see him begin to fill with self-compassion for that part of himself.
How does MDMA work on the brain to process the traumatic experience?
MDMA releases three neurotransmitters in the brain: serotonin, dopamine and norepinephrine. There is also a release in oxytocin which is the chemical involved in love, connection and the attachment system when we are born. Trials though Imperial College in London have shown that MDMA acts on the brain by decreasing limbic activity and increasing the communication between the amygdala and hippocampus.
The amygdala in the brain is responsible for processing emotions, memory and for the survival instinct. As is the case with people with PTSD, the amygdala is over firing which creates further fear and puts people in a constant state of threat. MDMA decreases activity in the amygdala but increases activity in the prefrontal cortex, which is our information processing part of our brains.
This allows clients to access therapy whilst in the ‘optimum arousal’ zone or within their window of tolerance. If people are hyper-aroused and flooded with threat and anxiety then psychotherapy is not effective. Similarly, if people are in the hypo-aroused state, with people being shut down or in a state of emotional numbness it is difficult to work with clients.
MDMA puts people in the perfect place to accept therapeutic interventions for trauma. It enables people to talk through their story and for them to make sense of what has happened to them. MDMA eliminates anxiety and fear, which in turn helps the client to access their emotions and internal conflicts.
The participant is then able to share these memories and experiences with the therapists and in doing so this enhances the therapeutic relationship. Strengthening the therapeutic alliance is also known better outcomes for psychotherapy.
All of this is a huge step towards helping people who are suffering from PTSD. Often, these people live in a state of fear and anxiety which impacts on their whole lives. With these trials eliminating participants suffering, there is hope on the horizon that clients can begin to live a fulfilling life free from emotional pain.
1. Marcela Ot’alora G et al. 3,4-Methylenedioxymethamphetamine- assisted psychotherapy for treatment of chronic posttraumatic stress disorder: A randomized phase 2 controlled trial. Journal of Psychopharmacology 2018, Vol. 32(12) 1295 –1307
2. Mithoefer MC. (2017). A manual for MDMA-assisted psychotherapy in the treatment of posttraumatic stress disorder; Version 8.1 http://www.maps.org/research/mdma/mdma-research-timeline/4887-a-manualfor-mdma-assisted-psychotherapy-in-the-treatment-of-ptsd.
3. Kaelen M, Giribaldi B, Raine J, Evans L, Timmerman-Slater C, Rodriguez N, Roseman L, Feilding A, Nutt D, Carhart-Harris R (2018) The hidden therapist: evidence for a central role of music in psychedelic therapy. Psychopharmacology 235:505–519.
4. 2019 National Veteran Suicide Prevention Annual Report. https://www.mentalhealth.va.gov/docs/data-sheets/2019/2019_National_Veteran_Suicide_Prevention_Annual_Report_508.pdf
6. Bouso et al. MDMA-Assisted Psychotherapy using low doses in a small sample of women with chronic posttraumatic stress disorder. Journal of psychoactive drugs. Volume 40 (3) September 2008/