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 The Integration of MDMA into Clinical Treatment for Posttraumatic Stress Disorder

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The Integration of MDMA into Clinical Treatment for Posttraumatic Stress Disorder

MDMA stands for 3,4-Methylenedioxymethamphetamine which is referred to as ecstasy. Apart from being manipulated as a “party drug”, with the increase in the amounts of individuals suffering from Posttraumatic Stress Disorder (PTSD), ecstasy has become a major area of research and development (Amoroso and Workman, 2016). Various researches and evidences have shown that MDMA’s integration into clinical treatment for PTSD is beneficial and is an effective adjunct to treatment.

Amoroso and Workman (2016) confirmed that the most widely accepted treatment for PTSD is prolonged exposure (PE) therapy however it has been proved to be ineffective and intolerable for many patients. Hence, MDMA-assisted psychotherapy (MDMA-AP) has re-emerged as a new treatment method (Amoroso and Workman, 2016). Two clinical trials have been published and have produced promising results (Amoroso and Workman, 2016). Based on two hypotheses and the results of the analysis, MDMA-AP studies have showed a large cumulative effect size on the primary outcome measures which is Hedges’ g=1.17. MDMA-AP had longer therapy sessions; eight hours, unlike the leftover state of arousal that PE left. MDMA-AP has proved to have a more “patient-centered” approach (Amoroso and Workman, 2016). MDMA-AP has proved to have lower dropout rates and one of the main reasons is due to the psychological effect it leaves on patients, hence said, a more “patient-centered” approach (Amoroso and Workman, 2016).

Furthermore, Mithoefer et al. (2012) approves that the subjects that pursued the MDMA-AP have participated in the long-term follow up (LTFU) and that on average subjects maintained statistically and clinically significant symptom relief despite the fact that two of the subjects had relapsed (Mithoefer et al., 2012). It is evident that the subjects that pursued the MDMA-AP have shown no harm from the participation in the study in accordance to the LTFU and that most of them had symptomatic relief from the MDMA-AP (Mithoefer et al., 2012). Moreover, Mithoefer et al. (2012) showed that subjects that proceeded with the MDMA-AP are not likely to seek out “street ecstasy” or become independent on the drug and that the MDMA-AP is free of the risk of substance abuse (Mithoefer, Wagner, Mithoefer, Jerome & Doblin, 2011). Also, there was a lack of evidence of neurocognitive decline associated with the MDMA in the study and that the risk of neurocognitive decline has not been shown (Mithoefer et al., 2012).

Klosinski and Mithoefer (2017) have confirmed that the MDMA-AP have demonstrated initial safety and efficacy as well as efficiency in the processes for the treatment of PTSD. The studies have also shown potential for expansion in anxiety and depression disorders. In the MDMA-AP involves continuous supervision which is around two or three times per month. In the MDMA-AP, participants have shown improvement in self-knowledge, sleep regulation, accuracy in perceiving mental states of others, coping strategies, emotion regulation, and cognitive insights (Klosinski and Mithoefer, 2017). Moreover, Klosinski and Mithoefer (2017) have also proved that MDMA-AP could assist with disorders such as attachment insecurities that include PTSD, depression, anxiety disorders, obsessive-compulsive disorder, suicidality, substance use disorders, and eating disorders. Positively, upon two months of receiving two to three MDMA treatments, 55% of chronic PTSD subjects no longer met the PTSD criteria. Also, 66.2% were in remission at least 12 months postdrug (Klosinski and Mithoefer, 2017). Phase I and phase II of MDMA-AP have shown nothing but positive outcomes and results and phase III program has been requested (Klosinski and Mithoefer, 2017). The benefit of MDMA-AP is that it is based on a single dose treatment which is proved to have a more favorable risk/benefit profile (Klosinski and Mithoefer, 2017).

Mithoefer (n.d.) stated proved that another small study was completed where three participants’ PTSD had relapsed after more than a year in participation in the study. Also, the MDMA-AP accompanies a set of adherence criteria that allows a group of adherence raters to score video recordings from research sessions (Mithoefer, n.d.). These sessions document the degree to which study therapists are adhering to the same approach in each of the study cites (Mithoefer, n.d.). This proves that recordings will be available to indicate improvements and record evidence of the improvement if individuals participating in MDMA-AP. The curremt MDMA-AP is also used in treating social anxiety in autistic adults (Danforth, Struble, Klosinski, & Grob, 2016). It is placebo-controlled and has a double-blind methodology being employed. (Danforth, Struble, Klosinski, & Grob, 2016) The dosage of the MDMA is in the range between 75mg to 125mg (Danforth, Struble, Klosinski, & Grob, 2016).

Nonetheless, the MDMA-AP sessions have been proved to be very participant friendly where therapists and the participant set goals for the participant in the session and any concerns that he or she might have (Ruse, Jerome, Mithoefer, Doblin, & Gibson, 2005). These MDMA-AP sessions are completely guided by therapists and under no condition, participants are left to consume MDMA without consultation. Therapists maintain a safe therapeutic alliance with participants and their role is to have a high self-awareness (Ruse, Jerome, Mithoefer, Doblin, & Gibson, 2005). Therapists are ensured to have complete focus and concentration (Ruse, Jerome, Mithoefer, Doblin, & Gibson, 2005). In addition, therapists are obliged to contact the participants for a week after each MDMA session with the purpose to assess the psychological wellbeing of each participant during that time period (Ruse, Jerome, Mithoefer, Doblin, & Gibson, 2005). A “Safety net” is established for each participant immediately after the MDMA session where each participant is given the ability and option to contact a therapist for any questions or concerns (Ruse, Jerome, Mithoefer, Doblin, & Gibson, 2005).

Finally, as per all the studies that were made and that are ongoing regarding MDMA-AP, it is of major importance to indicate that further research must be made in this matter and funding must be provided. As a possible cure to various psychological disorders such as anxiety and depression, its benefits and efficacy must be used for the wellbeing of individuals suffering from such psychological disorders and diseases.

 

References

Amoroso, T. & Workman, M. (2016, April 26). Treating posttraumatic stress disorder with           MDMA-assisted psychotherapy: A preliminary meta-analysis and comparison to prolonged exposure therapy. Journal of Psychopharmacology. Retrieved from www.academia.edu

Mithoefer, M., Wagner, T., Mithoefer, A., Jerome, L., Martin, S., Klosinski, B., Michel, Y., Brewerton, T., & Doblin, R. (2012, November 20). Durability of improvement in posttraumatic stress disorder and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study. Journal of Psychopharmacology. Retrieved from www.academia.edu

Klosinki, Y. & Mithoefer M (2017, January 13). Potential Psychiatric Uses for MDMA. Clinical Pharmacology & Therapeutics.  Retrieved from http://onlinelibrary.wiley.com

Mithoefer, M (n.d.) . Research Update: MDMA-Assisted Psychotherapy for PTSD. MAPS. Retrieved from www.maps.org

Ruse,J., Jerome, L., Mithoefer, M., Doblin, R. & Gibson, E (2005, May 30). MDMA-Assisted Psychotherapy for the Treatment of Posttraumatic Stress Disorder. MAPS. Retrieved from www.maps.org

Mithoefer, M., Wagner, M., Mithoever, A., Jerome, L. & Doblin, R (2011, April 25). The safety and efficacy of ±3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study. Ncbi. Retrieved from www.ncbi.nlm.nih.gov

Danforth, A., Struble, C., Klosinski, B. and Grob, C (2016, January 4). MDMA-assisted therapy: A new treatment model for social anxiety in autistic adults. Sciencedirect. Retrieved from www.sciencedirect.com


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