As final trials move to establish MDMA-assisted psychotherapy as a legal and legitimate clinical treatment, a new study has recently been published demonstrating the results of the world's first clinical trial for another, albeit more controversial, application – treating severe social anxiety in adults with autism.

MDMA, or 3,4-Methylenedioxymethamphetamine, is perhaps more commonly known by its recreational moniker of Molly, or ecstasy, and despite its initial clinical and therapeutic uses, the drug spent several decades under heavy legal restrictions. More recently though, it has undergone a renaissance in research circles, and pioneering work from Rick Doblin and a large team of scientists has led to the previously taboo substance now sitting on the precipice of FDA approval for the treatment of post-traumatic stress disorder (PTSD).

In 2009, Alicia Danforth began reviewing hundreds of online anecdotal reports. The accounts, gathered from years of online discussion forums, examined the first-person experiences of autistic adults using MDMA. In 2011 original data collection began it affirmed a very significant majority of these accounts describing how the drug increased empathy and ease of communication, driving Danforth to establish a clinical trial examining the drug's effects on autistic subjects in controlled conditions.

The trial commenced in 2014 and spanned three years, ultimately comprising 12 autistic adults. Anxiety was measured using the Leibowitz Social Anxiety Scale (LSAS), a broadly accepted scale that assesses social phobia.

The design of the study was similar to the process effectively developed by Rick Doblin and the MAPS team for MDMA-assisted psychotherapy for PTSD. Initial dosages were lower than generally administered in psychotherapy contexts to account for an anecdotal tendency in autistic individuals to have extreme reactions to sensory stimulation, but after these lower volumes were well tolerated, dosages were escalated in the later stages of the trial.

As with the PTSD studies, the MDMA sessions were integrated into a larger regime of psychotherapy sessions. Two MDMA sessions, spaced one month apart, were bookended by three non-drug integrative psychotherapy sessions. The subjects were initially randomly split into placebo or active groups, but six months after the first sessions the placebo group was then administered an active course.

Tracking LSAS scores the MDMA-treated group showed significant clinical improvements one month after the two MDMA sessions. And perhaps more compelling were the six-month follow up results showing the effects were most certainly not transitory, holding strong long after the initial treatment.

Lisa Jerome, one of the other researchers working on the project, suggests that MDMA seemed to allow the subjects to relax to a point that helped them manifest latent social skills.

"These findings show that MDMA and psychotherapy can help people, maybe by giving people a whole new set of experiences with social interactions," explains Jerome. "MDMA isn't giving people something they didn't have already, it's helping them use what they had all along."

It's undeniably early days for this kind of research, and despite the significant outcome measures, the scientists do note this is a very small sample size. Another limitation readily accepted by the researchers is the imprecision in autism diagnosis methods. Autism is not a simple or straightforward condition, so it is fair to be skeptical about how generalizable this kind of MDMA-assisted treatment could be. However, in regard to a more specific type of autism-directed social anxiety, it is reasonable to conclude these results at the very least justify a need for more research into the area.

Danforth does explicitly add that autistic individuals should not take these results as encouragement to go out and self-administer MDMA. While this research does establish a safety profile for the treatment and suggest potential benefits in controlled settings, there is certainly still more work to be done to develop clearer and effective models.

"We hope that the good safety profile and encouraging reduction in social anxiety symptoms will inspire funding for new and larger studies," says Danforth. "It remains to be seen how the mainstream autism science community will respond to the new data."

The new study was published in the journal Psychopharmacology.

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