When lasting trauma is caused by callous acts of violence, the key to recovery can be making meaning out of meaninglessness. Although such trauma is difficult to treat, the drug MDMA – known on the street as Ecstasy or Molly – appears to help when used as an adjunct to psychotherapy.
This year, UConn Health will host a phase three FDA trial for patients with a post-traumatic stress disorder that will test whether the drug MDMA is a safe and effective treatment.
While many people have a tough time handling the standard therapy for PTSD, MDMA has shown promise not only by making therapy more tolerable but also by opening a door for the patient into their own mind. The insight allows them to process a shattering, horrific event into something that makes them stronger.
The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders defines PTSD as when a person is traumatized in some way and then continues to re-experience it through flashbacks, nightmares, or unwanted, intrusive memories.
Often the source of the trauma is a shocking event involving interpersonal violence like rape, combat, or sexual abuse. Racial discrimination and harassment, particularly when it is shocking or pervasive, can also cause PTSD.
The phase 3 study is organized by the Multidisciplinary Association for Psychedelic Studies, a non-profit pharmaceutical company that explores the beneficial medical uses of psychedelic substances. They had not previously had many people of color participate in their trials, and they reached out to Williams for advice.
But no matter what type of trauma causes the PTSD, the most effective treatment for it is exposure-based therapy, such as 'prolonged exposure.' Essentially, the therapist has the patient discuss the traumatic event in excruciating detail, over and over again, until it ceases to cause overwhelming fear and anxiety.
Prolonged exposure works – indeed, it's got the most research evidence behind it. But it's difficult for the patients, who often get visibly upset during sessions; and many quit therapy because the experience is too much like reliving the original trauma.
MDMA-assisted psychotherapy could be one way to change that. It stimulates the release of neurotransmitters that promote a feeling of trust and well-being, and might also help the brain rewire itself.
"The MDMA was a terrific anti-anxiety medicine," but didn't make her fuzzy headed like most anti-anxiety meds had. "It amplified access to memories and, really, I had access to everything, and I wasn't terrified. I could actually tell someone, for the first time in my life, what had happened to me. I had so much access to my own mind."
Williams agrees that the MDMA seems to help patients rapidly make connections and breakthroughs in a single therapy session. Typically, a patient in psychotherapy might have just one such realization every few months.
The participants in the phase three trial at UConn Health will have a total of 20 therapy sessions, three of which will include MDMA. Each session will have two therapists present.
The MDMA-assisted sessions will be six to eight hours long, after which the participant stays overnight in the hospital to rest, supervised by a night attendant. And as part of their effort to recruit participants from communities of color, all but one of the therapists participating at UConn Health identify as ethnic, racial, and/or sexual minorities.
To get a better understanding of what the MDMA-assisted psychotherapy would be like for study participants, Ching participated in a session himself as part of his training.
He hopes that the participants benefit from their MDMA-assisted psychotherapy the same way he did. "For someone who has experienced trauma, MDMA-assisted psychotherapy might help them be able to make meaning of it," Ching says. "I really believe in this work."