Efficacy of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for posttraumatic stress disorder: A systematic review and meta-analysis

Bahji, Anees; Forsyth, Ashleigh; Groll, Dianne; Hawken, Emily R.

doi:10.1016/j.pnpbp.2019.109735

Cited by 59 publications

(48 citation statements)

References 82 publications

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“…Nevertheless, two recent meta-analyses with larger samples confirmed that MDMA-AP for PTSD has large effect sizes. 19,20 The improved CAPS-4 scores observed in the present study were further supported by reduced PTSD symptoms according to the PTSD Checklist -Civilian Version: one patient's scores dropped from the high severity to the little or no severity range, while the other patients' scores dropped approximately 20 points, although they remained in the high severity range. Improvements were also seen in post-traumatic growth according to Post-Traumatic Growth Inventory scores: dramatic increases occurred in two cases (5-fold and 7-fold, for patients 1 and 3, respectively), while a considerable (2.5 fold) increase occurred in patient 2.…”

Section: Discussionsupporting

confidence: 76%

3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for victims of sexual abuse with severe post-traumatic stress disorder: an open label pilot study in Brazil

Jardim¹,

Jardim²,

Chaves³

et al. 2021

Braz. J. Psychiatry

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Objective: To conduct Brazil's first clinical trial employing 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder (PTSD), given its high prevalence resulting from epidemic violence. Methods: Of 60 volunteers, four matched the inclusion & exclusion criteria. Three patients with PTSD secondary to sexual abuse (diagnosed by the Structured Clinical Interview for DSM-IV and the Clinician Administered PTSD Scale for DSMV-4 [CAPS 4]) completed enrollment and treatment, following a standardized Multidisciplinary Association for Psychedelic Studies protocol consisting of 15 weekly therapy sessions: three with orally administered MDMA with concurrent psychotherapy and music, spaced approximately 1 month apart. CAPS-4 scores two months after the final MDMA session were the primary outcome. Results: No serious adverse events occurred. The most frequent adverse events were somatic pains and anguish. CAPS-4 reductions were always greater than 25 points. The final scores were 61, 27, and 8, down from baseline scores of 90, 78, and 72, respectively. All reductions were greater than 30%, which is indicative of clinically significant improvement. Secondary outcomes included lower Beck Depressive Inventory scores and higher Post-Traumatic Growth Inventory and Global Assessment of Functioning scores. Conclusion: Considering the current limitations in safe and efficacious treatments for PTSD and recent studies abroad with larger patient samples, MDMA-assisted psychotherapy could become a viable treatment in Brazil. Clinical trial registration: RBR-6sq4c9

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Section: Discussionsupporting

confidence: 76%

3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for victims of sexual abuse with severe post-traumatic stress disorder: an open label pilot study in Brazil

Jardim¹,

Jardim²,

Chaves³

et al. 2021

Braz. J. Psychiatry

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“…Random-effects meta-analysis models were created to pool effect sizes for each psychotherapy's effectiveness and acceptability, and the results were graphed using Forest plots. The speci c methods have been previously described [57][58][59][60][61][62]. The I 2 statistic was used to quantify heterogeneity; values greater than 50% indicated high variance [63].…”

Section: Summary Measures and Synthesis Of Resultsmentioning

confidence: 99%

Psychological interventions for posttraumatic stress injuries among public safety personnel: a systematic review and meta-analysis

Bahji

Nota

Groll

et al. 2021

Preprint

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Background Public safety personnel (PSP) are exposed to potentially psychologically traumatic events (PPTE) far more often than the general public, which increases the risk for various posttraumatic stress injuries (PTSIs). There are many evidence-based psychological interventions for PTSI, but whether the interventions benefit PSP despite the repeated PPTE exposures remains unclear.Objectives The current study assessed the effectiveness and acceptability of psychological interventions of PTSI among PSP.Methods A systematic review and random-effects meta-analysis were performed on the effectiveness and acceptability of psychotherapies for PTSIs (i.e., symptoms of depression, anxiety, posttraumatic stress disorder) among PSP. The review adhered to the PRISMA reporting guidelines and used standardized mean differences (Cohen’s d) and rate ratios (RR) to measure pooled effect sizes across studies. Heterogeneity was quantified using I2, and publication bias was evaluated using Egger’s test.Results The analyses included data from eight randomized controlled trials representing 402 PSP (79.4% male, 35.3 years). Psychological interventions included narrative exposure therapy (n = 1), cognitive behavioural therapy (n = 2), eclectic psychotherapy (n = 2), eye-movement desensitization and reprocessing (n = 1), supportive counselling (n = 2), and group critical incident stress debriefing (n = 1). The interventions were associated with statistically significant reductions in symptoms associated with PTSD (d=-1.23), anxiety (d=-0.76), and depression (d=-1.10). There were smaller but statistically significant improvements at follow-up for symptoms of PTSD (d=-1.29), anxiety (d=-0.82), and depression (d=-0.46). There were no statistically significant differences in dropout rates (RR = 1.00), suggesting high acceptability across interventions.Conclusions There is preliminary evidence that psychotherapies help treat PTSIs in PSP; however, the shortage of high-quality studies with PSP indicates a need for additional research into treating PTSI among PSP.PROSPERO: CRD42019133534.

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“…For some patients who are unsuited (or unwilling) to undergo treatment with classic psychedelics, MDMA may be considered as a more easily tolerable alternative (106). MDMA-assisted psychotherapy shows remarkable promise as a treatment for PTSD (107), and appears to work by facilitating engagement with traumatic memories and supporting fear extinction (108). Thus, as is proposed here for (classic-)psychedelic therapy, MDMA-assisted psychotherapy may parallel CBT in promoting motivation for acceptance, avoidance-free exposure, and the revision of avoidance-related beliefs.…”

Section: Applicability To Mdma-assisted Psychotherapymentioning

confidence: 99%

Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance

et al. 2020

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The efficacy of psychedelic-assisted therapies for mental disorders has been attributed to the lasting change from experiential avoidance to acceptance that these treatments appear to facilitate. This article presents a conceptual model that specifies potential psychological mechanisms underlying such change, and that shows substantial parallels between psychedelic therapy and cognitive behavioral therapy: We propose that in the carefully controlled context of psychedelic therapy as applied in contemporary clinical research, psychedelic-induced belief relaxation can increase motivation for acceptance via operant conditioning, thus engendering episodes of relatively avoidance-free exposure to greatly intensified private events. Under these unique learning conditions, relaxed avoidance-related beliefs can be exposed to corrective information and become revised accordingly, which may explain long-term increases in acceptance and corresponding reductions in psychopathology. Open research questions and implications for clinical practice are discussed.

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Efficacy of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for posttraumatic stress disorder: A systematic review and meta-analysis

Cited by 59 publications

References 82 publications

3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for victims of sexual abuse with severe post-traumatic stress disorder: an open label pilot study in Brazil

3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for victims of sexual abuse with severe post-traumatic stress disorder: an open label pilot study in Brazil

Psychological interventions for posttraumatic stress injuries among public safety personnel: a systematic review and meta-analysis

Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance

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