Potential processes of change in MDMA‐Assisted therapy for social anxiety disorder: Enhanced memory reconsolidation, self‐transcendence, and therapeutic relationships

Luoma, Jason B.; Shahar, Ben; Lear, Mary K.; Pilecki, Brian; Wagner, Anne Catherine

doi:10.1002/hup.2824

Cited by 17 publications

(11 citation statements)

References 145 publications

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“…Some authors have suggested that the therapeutic relationship may be enhanced through the administration of psychedelics (Grinspoon and Bakalar, 1979; Grinspoon and Doblin, 2001) and MDMA (Luoma et al, 2022). On the other hand, the therapeutic relationship could rupture through the work with substances as adjuncts.…”

Section: Resultsmentioning

confidence: 99%

Therapeutic (Sub)stance: Current practice and therapeutic conduct in preparatory sessions in substance-assisted psychotherapy—A systematized review

et al. 2022

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Background: Clinical trials are currently investigating the potential of substance-assisted psychotherapy (SAPT) as treatment for several psychiatric conditions. The potential therapeutic effects of SAPT may be influenced by contextual factors including preparation prior to and integration after the substance-assisted therapy sessions. Aims: This systematized review outlines recommendations for current practice in preparatory sessions in SAPT including safety measures and screening procedures, preparation of set and setting, session contents, methods, and roles, prerequisites, and appropriate conduct of therapists. Methods: A systematized review of the literature was conducted based on PRISMA guidelines. MEDLINE (OVID), PsycINFO (OVID), and Cochrane Library were searched and clinical trials, treatment manuals, study protocols, case studies, qualitative studies, descriptive studies, theoretical papers, reviews, book chapters, and conference proceedings published until February 1, 2022 were retrieved. Results: The final synthesis included k = 83 sources. Information about safety measures including screening of participants, set and setting, contextual-, physiological-, and psychological preparation, roles, competencies, prerequisites, and characteristics of the therapists, and the establishment of a therapeutic relationship were summarized and discussed. Conclusion: It is concluded that there is a consensus in the literature about the importance of adequate preparation before the administration of psychoactive substances in SAPT. However, the extent and approaches for these sessions vary across different models and there is a need for timelier and more rigorous qualitative and quantitative investigations assessing different approaches and techniques for the optimal preparation of clients in SAPT.

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Section: Resultsmentioning

confidence: 99%

Therapeutic (Sub)stance: Current practice and therapeutic conduct in preparatory sessions in substance-assisted psychotherapy—A systematized review

et al. 2022

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“…It is neither the intention of this review to provide a comprehensive accounting of the proposed mechanisms of action of MDMA as they relate to the treatment of mental illness nor dimmish the importance of the pro-social effect of the drug and the role it may play in facilitating therapeutic alliance. Rather we suggest a relationship between the current model of pathological memory encoding and inhibited memory extinction with subsequent reconsolidation in PTSD and the action of MDMA to reverse or ameliorate this defect (18,19).…”

Section: Introductionmentioning

confidence: 92%

A proposed mechanism for the MDMA-mediated extinction of traumatic memories in PTSD patients treated with MDMA-assisted therapy

Sottile

Vida

2022

Front. Psychiatry

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Post-traumatic stress disorder (PTSD) is a devastating psychiatric disorder afflicting millions of people around the world. Characterized by severe anxiety, intrusive thoughts, pervasive nightmares, an assortment of somatic symptoms, associations with severe long-term health problems, and an elevated risk of suicide, as much as 40–70% of patients suffer from refractory disease. 3,4-Methylenedioxy-methamphetamine (MDMA), like classic psychedelics such as psilocybin, have been used to enhance the efficacy of psychotherapy almost since their discovery, but due to their perceived potential for abuse and inclusion on USFDA (United States Food and Drug Administration) schedule 1, research into the mechanism by which they produce improvements in PTSD symptomology has been limited. Nevertheless, several compelling rationales have been explored, with the pro-social effects of MDMA thought to enhance therapeutic alliance and thus facilitate therapist-assisted trauma processing. This may be insufficient to fully explain the efficacy of MDMA in the treatment of psychiatric illness. Molecular mechanisms such as the MDMA mediated increase of brain-derived neurotrophic factor (BDNF) availability in the fear memory learning pathways combined with MDMA's pro-social effects may provide a more nuanced explanation for the therapeutic actions of MDMA.

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“…A recently completed Phase III clinical trial ( 18 ) has similarly shown good efficacy for PTSD, and therefore, MDMA may soon be offered as a mainstream treatment for it. MDMA is also showing promise for treating other anxiety-spectrum disorders, particularly social anxiety ( 62 ). The effects on other disorders such as phobias and panic are unclear, and need more study.…”

Section: Proposed Mdma Effects On Relevant Misophonia Symptomsmentioning

confidence: 99%

MDMA for the treatment of misophonia, a proposal

Webb¹,

Keane²

2022

Front. Psychiatry

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Misophonia is a disorder characterized by negative physical and emotional reactions to certain trigger sounds, such as chewing food. Up to 50% of population samples endorse some symptoms of misophonia, with about 20% having symptoms that impair normal life functioning. Most misophonia patients exhibit intense negative emotions and autonomic arousal (the fight-flight-freeze response) in response to a trigger, similarly to how someone with post-traumatic stress disorder (PTSD) might respond to a trauma trigger. Curiously, misophonia trigger sounds are often most distressing when coming from a specific person, suggesting the disorder may be responsive to interpersonal relationship factors. Treatment of misophonia is currently limited to the use of hearing modifications (e.g., earplugs or headphones) and psychotherapy, but many patients continue to suffer despite these best efforts. Phase 3 clinical trials suggest that MDMA is efficacious at treating the symptoms of autonomic arousal, negative emotions, and interpersonal suffering found in PTSD. As such, we propose that MDMA may represent an ideal treatment for some suffering from severe misophonia. In this perspective article, we review the symptoms of misophonia, and outline how MDMA may be uniquely suited for treating it, perhaps using a protocol analogous to the MAPS Phase 3 studies for PTSD.

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Potential processes of change in MDMA‐Assisted therapy for social anxiety disorder: Enhanced memory reconsolidation, self‐transcendence, and therapeutic relationships

Cited by 17 publications

References 145 publications

Therapeutic (Sub)stance: Current practice and therapeutic conduct in preparatory sessions in substance-assisted psychotherapy—A systematized review

Therapeutic (Sub)stance: Current practice and therapeutic conduct in preparatory sessions in substance-assisted psychotherapy—A systematized review

A proposed mechanism for the MDMA-mediated extinction of traumatic memories in PTSD patients treated with MDMA-assisted therapy

MDMA for the treatment of misophonia, a proposal

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