Couple Therapy With MDMA—Proposed Pathways of Action

Abstract

MDMA's first identified potential as a therapeutic catalyst was for couple therapy. Early work in the 1970s and 1980s explored its potential amongst seasoned psychotherapists and their clients. With the completion of the first pilot trial of MDMA-assisted psychotherapy with couples for PTSD, and as the possibility of conducting MDMA-assisted psychotherapy trials expands due to new regulatory frameworks, we have an opportunity to explore and investigate how and why MDMA-assisted couples therapy works. This theoretical paper will explore the neurobiological and neurochemical effects of MDMA in a relational context, the emotional, behavioral, cognitive and somatic effects within a dyadic frame, and how empathy, communication, perception of social connection/support, non-avoidance, openness, attachment/safety, bonding/social intimacy and relationship satisfaction, are all impacted by MDMA, and can be harnessed to facilitate systems-level and interpersonal healing and growth. A model to support MDMA-assisted couple therapy is introduced, and future directions, including implications for intervention development and delivery, will be elucidated.

Exploring effects and experiences of ketamine in group couples therapy

“…Wagner writes that MDMA's empathogenic qualities have been shown to be beneficial in four areas related to neurochemical and psychological effects on mental health: emotions, cognition, behavior, and somatic experience. Benefits in these four areas promote positive outcomes in eight categories related to couples counseling, including: combined empathy, increased communication, perception of social connection, non-avoidance, openness, safety, bonding, and relationship satisfaction (Wagner, 2021). Similar themes were observed by Colbert and Hughes (2023) who interviewed 8 adult couples who had used or were actively using MDMA in private settings with the intention of providing individual and relational enhancement.…”

“…Similarly, Wagner (2021) examined the reasons why, and how, a transtheoretical model of MDMA-assisted couple therapy may be an important contribution to couple therapy treatment options. Wagner writes that MDMA's empathogenic qualities have been shown to be beneficial in four areas related to neurochemical and psychological effects on mental health: emotions, cognition, behavior, and somatic experience.…”

Co-use of MDMA with psilocybin/LSD may buffer against challenging experiences and enhance positive experiences

“…However, further research will be necessary to examine such speculative hypotheses. MDMA-attributed increases in positive experiences may also be particularly beneficial in specific therapeutic contexts, including couples-based treatment (e.g., see 64 ), positive psychology interventions (which are often gratitude focused; e.g., see 65 ), and group-based treatment/sessions 66 , 67 .…”

MDMA-assisted therapy is associated with a reduction in chronic pain among people with post-traumatic stress disorder

“…MDMA is a psychoactive compound that promotes serotonin release, and may exert therapeutic effects by enhancing fear memory extinction ( 47 ), promoting greater self-compassion ( 48 ), reducing self-criticism ( 48 ), reducing PTSD-related shame and anger ( 49 ) and causing acute prosocial and interpersonal effects that support the quality of the therapeutic alliance in psychotherapy ( 50 ). MDMA promotes oxytocin release, which helps increase interpersonal focus, feelings of interpersonal trust and social affiliation ( 51 – 53 ), and has been shown to reduce pain associated with social rejection ( 54 ). MDMA-AT has been associated with changes in personality persisting at two-month follow-up, notably increased personality trait Openness and reduction in Neuroticism ( 55 ).…”