Long-term MDMA users in this sample exhibited normal psychosocial functioning in regard to empathy and social pain and had higher subjective emotional empathy. This conflicts with previous suggestions that moderate, long-term MDMA use may cause heightened social distress, and is further evidence of the safety of the drug, which is relevant to considerations of its therapeutic use.

MDMA users had significantly greater subjective emotional empathy, and greater cognitive empathy on the computer task compared with the poly-drug users who do not use MDMA. There were no significant differences in subjective responses to social exclusion between the groups. Indices of MDMA use did not correlate with empathy.

Sixty-seven individuals were split into three groups based on their drug-use history: poly-drug MDMA users ( n = 25), poly-drug users who do not use MDMA ( n = 19), alcohol-only users ( n = 23), and were tested in an independent groups design. Participants completed both a self-report measure of emotional and cognitive empathy, along with the Multifaceted Empathy Task – a computerised assessment of empathy – and the Cyberball Game – a social exclusion paradigm.

3,4-Methylenedioxymethamphetamine (MDMA) is widely known for its positive acute effects on social behaviour, such as increasing empathy, whilst also attenuating the negative impact of social exclusion. However there is a scarcity of research that investigates the long-term impact of recreational MDMA use on these fundamental social processes.

References

Baron-Cohen, S, Wheelwright, S ( 2004 ) The empathy quotient: An investigation of adults with Asperger syndrome or high functioning autism, and normal sex differences . J Autism Dev Disord 34: 163 – 175 .

Google Scholar Medline | ISI

Bedi, G ( 2018 ) 3, 4-methylenedioxymethamphetamine as a psychiatric treatment . JAMA Psychiatry 75: 419 – 420 .

Google Scholar Medline

Bedi, G, Phan, KL, Angstadt, M. ( 2009 ) Effects of MDMA on sociability and neural response to social threat and social reward . Psychopharmacology (Berl) 207: 73 – 83 .

Google Scholar Medline | ISI

Blair, RJR ( 2005 ) Responding to the emotions of others: Dissociating forms of empathy through the study of typical and psychiatric populations . Conscious Cogn 14: 698 – 718 .

Google Scholar Medline | ISI

Crockett, MJ, Clark, L, Hauser, MD. ( 2010 ) Serotonin selectively influences moral judgment and behavior through effects on harm aversion . Proc Natl Acad Sci USA 107: 17433 – 17438 .

Google Scholar Medline | ISI

Danforth, AL, Grob, CS, Struble, C. ( 2018 ) Reduction in social anxiety after MDMA-assisted psychotherapy with autistic adults: A randomized, double-blind, placebo-controlled pilot study . Psychopharmacology (Berl) 235: 1 – 12 .

Google Scholar Medline

Danforth, AL, Struble, CM, Yazar-Klosinski, B. ( 2016 ) MDMA-assisted therapy: A new treatment model for social anxiety in autistic adults . Prog Neuropsychopharmacol Biol Psychiatry 64: 237 – 249 .

Google Scholar Medline

Davis, MH ( 1980 ) A multidimensional approach to individual differences in empathy . J Pers Soc Psychol 10: 85 .

Google Scholar

Dethier, M, Blairy, S ( 2012 ) Capacity for cognitive and emotional empathy in alcohol-dependent patients . Psychol Addict Behav 26: 371 – 383 .

Google Scholar Medline

DeWall, CN, Baumeister, RF ( 2006 ) Alone but feeling no pain: Effects of social exclusion on physical pain tolerance and pain threshold, affective forecasting, and interpersonal empathy . J Pers Soc Psychol 91: 1 – 15 .

Google Scholar Medline | ISI

Dolder, PC, Holze, F, Liakoni, E. ( 2017 ) Alcohol acutely enhances decoding of positive emotions and emotional concern for positive stimuli and facilitates the viewing of sexual images . Psychopharmacology (Berl) 234: 41 – 51 .

Google Scholar Medline

Dolder, PC, Müller, F, Schmid, Y. ( 2018 a) Direct comparison of the acute subjective, emotional, autonomic, and endocrine effects of MDMA, methylphenidate, and modafinil in healthy subjects . Psychopharmacology (Berl) 235: 467 – 479 .

Google Scholar Medline

Dolder, PC, Schmid, Y, Müller, F. ( 2016 ) LSD acutely impairs fear recognition and enhances emotional empathy and sociality . Neuropsychopharmacology 41: 2638 – 2646 .

Google Scholar Medline

Dolder, PC, Strajhar, P, Vizeli, P. ( 2018 b) Acute effects of lisdexamfetamine and D-amphetamine on social cognition and cognitive performance in a placebo-controlled study in healthy subjects . Psychopharmacology (Berl) 235: 1389 – 1402 .

Google Scholar Medline

Dziobek, I, Rogers, K, Fleck, S. ( 2008 ) Dissociation of cognitive and emotional empathy in adults with asperger syndrome using the multifaceted empathy test (MET) . J Autism Dev Disord 38: 464 – 473 .

Google Scholar Medline | ISI

Feduccia, AA, Mithoefer, MC ( 2018 ) MDMA-assisted psychotherapy for PTSD: Are memory reconsolidation and fear extinction underlying mechanisms? Prog Neuropsychopharmacol Biol Psychiatry 84( Pt A ): 221 – 228 .

Google Scholar Medline

Francis, SM, Kirkpatrick, MG, de Wit, H. ( 2016 ) Urinary and plasma oxytocin changes in response to MDMA or intranasal oxytocin administration . Psychoneuroendocrinology 74: 92 – 100 .

Google Scholar Medline

Frye, CG, Wardle, MC, Norman, GJ. ( 2014 ) MDMA decreases the effects of simulated social rejection . Pharmacol Biochem Behav 117: 1 – 6 .

Google Scholar Medline | ISI

Gerber, JP, Chang, SH, Reimel, H ( 2017 ) Construct validity of Williams’ ostracism needs threat scale . Pers Individ Differ 115: 50 – 53 .

Google Scholar

Gilman, M ( 1994 ) Football and drugs: Two cultures clash . Int J Drug Policy 5: 40 – 40 .

Google Scholar

Heifets, BD, Malenka, RC ( 2016 ) MDMA as a probe and treatment for social behaviors . Cell 166: 269 – 272 .

Google Scholar Medline

Hoffmann, F, Banzhaf, C, Kanske, P. ( 2016 ) Empathy in depression: Egocentric and altercentric biases and the role of alexithymia . J Affect Disord 199: 23 – 29 .

Google Scholar Medline

Hysek, CM, Domes, G, Liechti, ME ( 2012 ) MDMA enhances ‘mind reading‘ of positive emotions and impairs ‘mind reading‘ of negative emotions . Psychopharmacology (Berl) 222: 293 – 302 .

Google Scholar Medline | ISI

Hysek, CM, Schmid, Y, Simmler, LD. ( 2014 a) MDMA enhances emotional empathy and prosocial behavior . Soc Cogn Affect Neurosci 9: 1645 – 1652 .

Google Scholar Medline | ISI

Hysek, CM, Simmler, LD, Schillinger, N. ( 2014 b) Pharmacokinetic and pharmacodynamic effects of methylphenidate and MDMA administered alone or in combination . Int J Neuropsychopharmacol 17: 371 – 381 .

Google Scholar Medline | ISI

Kamboj, SK, Kilford, EJ, Minchin, S. ( 2015 ) Recreational 3,4-methylenedioxy-N-methylamphetamine (MDMA) or ‘ecstasy’ and self-focused compassion: Preliminary steps in the development of a therapeutic psychopharmacology of contemplative practices . J Psychopharmacol 29: 961 – 970 .

Google Scholar SAGE Journals | ISI

Kirkpatrick, M, Delton, AW, Robertson, TE. ( 2015 ) Prosocial effects of MDMA: A measure of generosity . J Psychopharmacol 29: 661 – 668 .

Google Scholar SAGE Journals | ISI

Krull, J, Wilbert, J, Hennemann, T ( 2018 ) Does social exclusion by classmates lead to behaviour problems and learning difficulties or vice versa? A cross-lagged panel analysis . Eur J Special Needs Education 33: 1 – 19 .

Google Scholar

Kuypers, KP, de, la, Torre, R, Farre, M. ( 2014 ) No evidence that MDMA-induced enhancement of emotional empathy is related to peripheral oxytocin levels or 5-HT1a receptor activation . PLoS One 9: e100719 .

Google Scholar Medline | ISI

Kuypers, KP, Dolder, PC, Ramaekers, JG. ( 2017 ) Multifaceted empathy of healthy volunteers after single doses of MDMA: A pooled sample of placebo-controlled studies . J Psychopharmacol 31: 589 – 598 .

Google Scholar SAGE Journals | ISI

Lysaker, PH, Hasson-Ohayon, I, Kravetz, S. ( 2013 ) Self perception of empathy in schizophrenia: Emotion recognition, insight, and symptoms predict degree of self and interviewer agreement . Psychiatry Res 206: 146 – 150 .

Google Scholar Medline

Mithoefer, MC, Mithoefer, AT, Feduccia, AA. ( 2018 ) 3, 4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder in military veterans, firefighters, and police officers: A randomised, double-blind, dose-response, phase 2 clinical trial . Lancet Psychiatry 5: 486 – 497 .

Google Scholar Medline

Mithoefer, MC, Wagner, MT, Mithoefer, AT. ( 2011 ) 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 . J Psychopharmacol 25: 439 – 452 .

Google Scholar SAGE Journals | ISI

Morley, KC, Arnold, JC, McGregor, IS ( 2005 ) Serotonin (1A) receptor involvement in acute 3, 4-methylenedioxymethamphetamine (MDMA) facilitation of social interaction in the rat . Prog Neuropsychopharmacol Biol Psychiatry 29: 648 – 657 .

Google Scholar Medline

Nummenmaa, L, Hirvonen, J, Parkkola, R. ( 2008 ) Is emotional contagion special? An fMRI study on neural systems for affective and cognitive empathy . Neuroimage 43: 571 – 580 .

Google Scholar Medline | ISI

Oehen, P, Traber, R, Widmer, V. ( 2013 ) A randomized, controlled pilot study of MDMA (±3, 4-Methylenedioxymethamphetamine)-assisted psychotherapy for treatment of resistant, chronic Post-Traumatic Stress Disorder (PTSD) . J Psychopharmacol 27: 40 – 52 .

Google Scholar SAGE Journals | ISI

Parrott, AC ( 2007 ) The psychotherapeutic potential of MDMA (3,4-methylenedioxymethamphetamine): An evidence-based review . Psychopharmacology (Berl) 191: 181 – 193 .

Google Scholar Medline | ISI

Peroutka, SJ, Newman, H, Harris, H ( 1988 ) Subjective effects of 3,4-methylenedioxymethamphetamine in recreational users . Neuropsychopharmacology 1: 273 – 277 .

Google Scholar Medline | ISI

Pokorny, T, Preller, KH, Kometer, M. ( 2017 ) Effect of psilocybin on empathy and moral decision-making . Int J Neuropsychopharmacol 20: 747 – 757 .

Google Scholar Medline

Preller, KH, Pokorny, T, Hock, A. ( 2016 ) Effects of serotonin 2A/1A receptor stimulation on social exclusion processing . Proc Natl Acad Sci 113: 5119 – 5124 .

Google Scholar Medline | ISI

Roberts, CA, Jones, A, Montgomery, C ( 2016 ) Meta-analysis of molecular imaging of serotonin transporters in ecstasy/polydrug users . Neurosci Biobehav Rev 63: 158 – 167 .

Google Scholar Medline

Schmid, Y, Hysek, CM, Simmler, LD. ( 2014 ) Differential effects of MDMA and methylphenidate on social cognition . J Psychopharmacol 28: 847 – 856 .

Google Scholar SAGE Journals | ISI

Sessa, B ( 2018 ) Why MDMA therapy for alcohol use disorder? And why now? Neuropharmacology 142: 83 – 88 .

Google Scholar Medline

Siegel, RK ( 1986 ) MDMA - Nonmedical use and intoxication . Journal of Psychoactive Drugs 18: 349 – 354 .

Google Scholar Medline | ISI

Song, MK, Choi, SH, Lee, DH. ( 2018 ) Effects of cognitive-behavioral therapy on empathy in patients with chronic pain . Psychiatry Investig 15: 285 – 291 .

Google Scholar Medline

Stewart, LH, Ferguson, B, Morgan, CJ. ( 2014 ) Effects of ecstasy on cooperative behaviour and perception of trustworthiness: A naturalistic study . J Psychopharmacol 28: 1001 – 1008 .

Google Scholar SAGE Journals | ISI

Szigeti, B, Winstock, AR, Erritzoe, D. ( 2018 ) Are ecstasy induced serotonergic alterations overestimated for the majority of users? J Psychopharmacol 32: 741 – 748 .

Google Scholar SAGE Journals | ISI

Thompson, MR, Callaghan, PD, Hunt, GE. ( 2007 ) A role for oxytocin and 5-HT1A receptors in the prosocial effects of 3,4 methylenedioxymethamphetamine (‘ecstasy’) . Neuroscience 146: 509 – 514 .

Google Scholar Medline | ISI

van Wel, JH, Kuypers, KP, Theunissen, EL. ( 2012 ) Effects of acute MDMA intoxication on mood and impulsivity: Role of the 5-HT2 and 5-HT1 receptors . PLoS One 7: e40187 .

Google Scholar Medline | ISI

Verheyden, SL, Henry, JA, Curran, HV ( 2003 ) Acute, sub-acute and long-term subjective consequences of ‘ecstasy’(MDMA) consumption in 430 regular users . Hum Psychopharmacol 18: 507 – 517 .

Google Scholar Medline | ISI

Vizeli, P, Liechti, ME ( 2018 ) Oxytocin receptor gene variations and socio-emotional effects of MDMA: A pooled analysis of controlled studies in healthy subjects . PLoS One 13: e0199384 .

Google Scholar Medline

Wardle, MC, de Wit, H ( 2014 ) MDMA alters emotional processing and facilitates positive social interaction . Psychopharmacology (Berl) 231: 4219 – 4229 .

Google Scholar Medline | ISI

Williams, KD, Govan, CL, Croker, V. ( 2002 ) Investigations into differences between social-and cyberostracism . Group Dyn 6: 65 .

Google Scholar ISI

Williams, KS, Yeager, DS, Cheung, CKT. ( 2012 ) Cyberball (version 4.0) [Software]. Available at: https://cyberball.wikispaces.com.

Google Scholar