MDMA-assisted couples therapy investigated in landmark pilot trial
In the late 1970s and early 1980s MDMA was often utilized to help facilitate positive results in couples counseling. A few dozen pioneering psychotherapists in the United States explored the drug’s therapeutic uses until the US government declared MDMA a Schedule 1 controlled substance in 1985.
Richard Ingrasci, a psychiatrist who had for years been successfully using MDMA as an adjunct to marriage counseling, was one of several therapists who opposed the scheduling of the drug. Ingrasci, whose work became foundational for many modern psychedelic-assisted psychotherapy researchers, provided prominent testimony during the government's scheduling hearings in 1985.
“I have seen MDMA help many couples break through longstanding communication blocks because of the safety that emerges in the session as a result of the drug,” Ingrasci declared in his testimony from the scheduling hearings. “It is difficult to convey in words how deeply moving it is to watch couples heal in this way with the help of MDMA.”
Of course, we all know what happened next. MDMA was classified a Schedule 1 drug with no medical uses making it virtually impossible to clinically study anywhere in the world. Since the turn of century research into the therapeutic uses of MDMA has slowly but surely moved back into the realm of clinical credibility, largely due to the efforts of Rick Doblin and his non-profit organization MAPS (the Multidisciplinary Association for Psychedelic Studies).
MAPS was founded in 1986, in the wake of MDMA’s Schedule 1 restriction. Its goal was to get MDMA clinical research going again, and over the years its primary framework to do that was through investigating the drug as an adjunct to psychotherapy for post-traumatic stress disorder (PTSD).
After years of work, and some truly extraordinary results, MDMA-assisted psychotherapy for PTSD is now on the cusp of being approved in the United States. And now some researchers are turning their attention to engaging in clinical studies investigating the benefits of the drug in couples therapy.
This latest study, published in the European Journal of Psychotraumatology, is the first to explore the effects of MDMA therapy in couples where one member is suffering from PTSD. Candice Monson, corresponding author on the new study, says this new proof-of-concept trial arose organically out of the prior MDMA for PTSD research.
“PTSD in one partner can cause distress in the relationship and barriers to understanding each other,” says Monson. “It seems that MDMA-assisted psychotherapy can engender empathy and connection, opening a pathway to remembering why came together in the first place and a desire to understand the other.”
This preliminary study investigated the feasibility of incorporating two MDMA sessions into a previously established PTSD therapeutic regime known as CBCT, or cognitive-behavioral conjoint therapy. As opposed to traditional PTSD therapies focusing on the individual, CBCT is designed to help improve relationship functioning for couples, while still improving PTSD symptoms in the individual patient.
The new trial recruited six couples, in which one member of the couple had a pre-existing PTSD diagnosis, and explored the feasibility of incorporating two MDMA sessions into the CBCT protocol, which traditionally involves around 15 therapy sessions conducted over several months.
“The literature that inspired this study suggests that MDMA may allow people to talk about painful experiences without experiencing the pain again,” explains Monson. “The therapist can guide couples to talk about very difficult things that they’ve either experienced themselves or experienced together—against the other or with the other— with a greater sense of understanding, openness, connection, and empathy.”
The new study reports the addition of MDMA to the couples therapy protocol resulted in effects that were, “on par with, or greater than, those achieved with CBCT alone.” Improvements were detected in both relationship outcomes and individual PTSD symptoms. The effects were most significant at the six-month follow up implying the MDMA therapy confers compelling long-term benefits.
It is important to note the study was uncontrolled, so any efficacy comparisons to CBCT alone can only be garnered by examining prior CBCT studies. However, this feasibility study does establish the addition of MDMA to the pre-existing therapeutic protocol is safe and it does not negatively interfere with other PTSD treatments.
A previously published case study in the Journal of Psychoactive Drugs outlined the experiences of one couple in this preliminary trial. The couple, Stuart and Josie, were suffering from relationship difficulties after Stuart’s trauma-related PTSD symptoms had returned.
“For Josie, the CBCT + MDMA experience allowed her the opportunity to no longer feel she had to 'walk on eggshells,' and to experience relief from anxiety and tension,” the case study reports. “Together, Stuart and Josie were able to share the experience of Stuart’s traumatic memories, and face them in a united and accepting manner.”
Interestingly, the improvements seen in PTSD symptoms in this pilot study were noted as greater than those seen in several individually delivered MDMA-assisted psychotherapy for PTSD trials. Of course, this is a tiny pilot study, so little can be concluded by comparing its efficacy results to these larger ongoing randomized trials. However, the interpersonal nature of PTSD and the way the condition impacts close relationships does suggest involving partners in a therapeutic protocol could hypothetically improve treatment outcomes.
A larger Phase 2 randomized controlled trial is currently being prepared by the research team. The next steps will be to better explore the safety and efficacy of MDMA-facilitated CBCT for PTSD in a diverse set of participants with a variety of relationship distresses.
The new study was published in the European Journal of Psychotraumatology.