During the late 70s and early 80s, MDMA (3-4 methylenedioxymethamphetamine, aka Ecstasy or Molly) was frequently used to help facilitate positive outcomes in couples counseling. Several “early adopter” psychotherapists in the U.S. explored the potential therapeutic effects until the U.S. government declared MDMA to be a Schedule 1 controlled substance in 1985.
One psychiatrist, Richard Ingrasci, used MDMA successfully as a part of couples counseling, and he opposed the FDA putting the drug into the Schedule 1 of controlled substances. His work continues to be influential for many current psychotherapy researchers who look into psychedelic-assisted counseling. In addition, Ingrasci provided testimony in favor of MDMA during the government’s scheduling hearings in 1985. (It is important to note that Richard Ingrasci surrendered his medical license after being sued over abusive sexual behavior). His testimony included this statement:
“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. It is difficult to convey in words how deeply moving it is to watch couples heal in this way with the help of MDMA.”
Despite this, the U.S. government followed through on scheduling MDMA as a schedule 1 drug with no medical uses. This made clinical study nearly impossible. However, since the early 2000s, research into the therapeutic use of MDMA has gradually come back to gain some clinical credibility based on efforts by Rick Doblin and his non-profit organization MAPS (the Multidisciplinary Association for Psychedelic Studies).
Founded in 1986, MAPS sought to initiate MDMA clinical research again. Its primary framework to achieve this goal was to investigate the drug as an adjunct to psychotherapy for post-traumatic stress disorder (PTSD).
With many years of investigation and some optimistic results, MDMA-assisted psychotherapy for PTSD is now close to being approved in the United States. As a result, some researchers are moving into the next potential phase of discovery: investigating the benefits of using MDMA in couples therapy.
Published in the European Journal of Psychotraumatology, the latest study is the first investigation that looks at the effects of MDMA therapy for couples in which one member suffers from PTSD. Candice Monson, corresponding author on the new study, says this new trial developed naturally out of the previous 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. Differing from conventional PTSD therapies that targeted the individual, CBCT was designed to help improve relationship functioning for couples, while still improving PTSD symptoms in the individual patient.
The study looked at six couples in which one member had a pre-existing PTSD diagnosis and explored the feasibility of integrating two MDMA sessions into the CBCT protocols. These protocols typically involve around 15 therapy sessions conducted over several months.
Monson believes that this process enables couples to discuss painful experiences without the member with PTSD re-experiencing the pain.
“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,” Monson stated.
In addition, this new study using MDMA in conjunction with CBCT, while relatively small, points to outcomes that were the same or greater than outcomes achieved using CBCT alone. The effects were improvements in the relationship and in individual PTSD symptoms. The study noted that the most significant improvements showed at the six month follow up. Researchers are optimistic that this detail points to the potential for long-term benefits.
It is critical to note that the study was not a controlled study. Any analysis of benefits may be made only by examining previous CBCT studies. Still, this feasibility study does establish the addition of MDMA to the pre-existing therapeutic protocol is safe and appears to have no negative impact on other PTSD treatments.
A prior case study published in the Journal of Psychoactive Drugs outlined the experiences of one couple in the preliminary trial. The couple, Stuart and Josie, suffered from relationship difficulties when Stuart’s trauma-related PTSD symptoms 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 reported. “Together, Stuart and Josie were able to share the experience of Stuart’s traumatic memories, and face them in a united and accepting manner.”
This study showed that improvements were greater than previously noted in several individually delivered MDMA-assisted psychotherapy for PTSD trials. Since these studies are small, concrete conclusions are difficult to make by comparing them to larger ongoing randomized trials. However, these results point to the possibility that MDMA may improve interpersonal relationships when used therapeutically and in guided settings.
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.
This study was published in the European Journal of Psychotraumatology.