By Christian Jarrett

Researchers reported recently that MDMA (3,4-Methylenedioxymethamphetamine; also known as Ecstasy) can act as a catalyst for psychotherapy, apparently improving outcomes for clients with previously intractable PTSD (post-traumatic stress disorder). Now a study from the same group in Journal of Psychopharmacology has uncovered what may be the key psychological mechanism: lasting positive personality change, especially increased trait Openness to Experience and reduced trait Neuroticism.

Speculating as to how MDMA might facilitate these trait changes, the research team, led by Mark Wagner at the Medical University of South Carolina, and including Ann Mithoefer and Michael Mithoefer who’ve conducted a lot of the recent pioneering research on MDMA-assisted psychotherapy, observed that “Qualitatively, a consistent subjective theme emerged, with our subjects reporting a profound cathartic experience, often described as going to a ‘place’ (in their mind) where they had never been before”.

The data come from earlier research that involved twenty participants (17 women) with a diagnosis of PTSD related to crime or war-based traumatic experiences and which had so far been untreatable with either drugs or psychotherapy.

The participants took part in up to 12 sessions of psychotherapy with a pair of therapists working together. Crucially, during two key experimental eight-hour long sessions in the middle of the course of therapy, half the participants received a dose of MDMA (125mg, with the option of a 62.5mg supplement), the others received an inert placebo. Among its effects MDMA can increase feelings of love, empathy, trust and friendliness and reduce fear.

During these key sessions, all participants were encouraged to introspect and were helped to process traumatic memories and experiences using cognitive restructuring and other techniques (more detail). In a later phase of the trial, those participants previously in the placebo group were given the option to take part in MDMA-assisted psychotherapy.

We know from earlier published reports that the participants who took MDMA during the experimental psychotherapy sessions showed significantly improved and lasting recovery from PTSD compared with participants who took placebo (and there was no apparent harm from the drug). What’s new is that the researchers have now reanalysed the data, adding personality trait scores taken through questionnaires at baseline and two-month follow-up as covariates – allowing them to see if changes in personality traits appeared to be important for the differences in symptom outcome for the two groups.

That’s exactly what they found. When adjusting the data to account for group differences in change to Openness to Experience scores, there was no longer a recovery outcome difference between the MDMA and placebo groups. This suggests MDMA is catalysing psychotherapy by facilitating increased Openness in clients. Indeed, across groups, greater increases in Openness correlated with greater symptom improvement. The same patterns were true for reduced Neuroticism but to a lesser extent.

The new results complement past research that has suggested in some cases the symptoms of PTSD, including chronic social withdrawal and mistrust and feelings of estrangement, can manifest as lasting harmful personality change. It seems MDMA-assisted psychotherapy may help reverse the harmful personality changes sometimes associated with trauma.

“Individuals scoring higher on Openness tend to seek out new experiences and be open to self-examination, factors that can serve to enhance therapeutic change in both behaviors and cognitions,” the researchers said. “Qualitatively, and consistently with previous work, therapeutic change seemed to be associated with an epiphany-type experience that subjects consistently reported following the MDMA-assisted psychotherapy sessions and reiterated in the long-term follow-up.”

Obviously this was a small study and the findings are at a very early experimental stage; larger replication attempts are needed. A methodological shortcoming was that sometimes the participants and clients were able to correctly guess which group (MDMA or placebo) they were in. The researchers also caution that MDMA may not have beneficial epiphany-related effects outside of a psychotherapy context, in fact the opposite could occur (they added that medically managed MDMA is not the same as street Ecstasy which will be of unknown strength and may contain other ingredients which may be harmful).

—Therapeutic effect of increased openness: Investigating mechanism of action in MDMA-assisted psychotherapy

—Information on MDMA/Ecstasy from the drug advice charity Frank

Christian Jarrett (@Psych_Writer) is Editor of BPS Research Digest