How can MDMA treat PTSD?

MDMA (the pure form of the street drug Molly, Ecstasy, or X) may be especially useful for PTSD, since it can decrease fear and fear-based reactions without impairing the patient's memory or blocking other genuine emotions. Stress-induced activity in the fear center of the brain, the amygdala, has been observably reduced in brain scans of MDMA therapy patients. This, combined with increases in trust, empathy, and expressiveness make MDMA, in the minds of many psychotherapists, a very promising drug for enhancing the effects of various types of talk and touch therapies. Patients can revisit traumatic memories without being overwhelmed by fear, stress, and anxiety, while their therapists can make good use of more open and empathetic interactions.

The drug itself might have some long-term mental and emotional benefits, but most of its use, according to the therapists who work with it, is as an agent to help the patient and therapist more quickly and easily explore and resolve whatever trauma the patient is suffering. Many studies have shown long-term changes in brain chemistry and neurotransmitter levels from MDMA, although whether these changes are positive or negative is an ongoing debate. But MDMA therapy is mostly about using the unique effects of MDMA to put a patient in an optimal state for therapy to have its biggest possible impact. While some lingering effects of MDMA may be positive, the therapy is more about using the open, empathetic MDMA space to boost therapy.

In most MDMA sessions and studies, the goal of the therapist is to support, not direct, the patient's ongoing experience. Trust, safety, and well-being of the patient are more important than addressing any certain issue or meeting goals of the therapy or study. The therapist invites the patient to consider various frameworks and approaches for their own healing, but does not try to direct the patient’s train of thought, except if they become dangerously agitated. The ultimate goal is to enable the processing of trauma without causing any new trauma. In practice, this approach can be pretty “hands-off” for the therapists, who may spend much of the actual MDMA session in silence or simply encouraging the patient to more deeply explore whatever thoughts and feeling are arising. As important as it is for the therapist to not try to influence the session too much, it is also important for the patient to not get in their own way by trying to push or mold the experience in some preconceived way.

Therapy relies on the “empathetic presence” of the therapist, which means not trying to fit the process onto their own ideas or frameworks, while staying open and adaptive to whatever the patient might experience. Leaving choice and interpretation up to the patient, while gently guiding when problems arise, is the difficult balance therapists seek to achieve in MDMA sessions.

The principle that the body knows how to heal itself is extended to the mental healing in MDMA therapy, where therapists believe the innate emotional intelligence of the patient can bring about healing if properly encouraged and supported. The concept of the body healing itself (as opposed to the medicine healing the body) is accepted in a lot of areas in western science and medicine, but the idea that the mind could spontaneously heal itself from trauma when aided by the insights and openness of psychedelics drugs continues to be a hard swallow for many doctors, scientists, and politicians.