Psychedelics help with PTSD?

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Bessel Van Der Kolk, a recognized expert on trauma, was initially skeptical about studying the effects of psychedelics on post-traumatic stress disorder (PTSD). However, the results of his research ultimately overturned his doubts — in the best possible way.

The findings, published in January this year, provide a new perspective on how therapy using MDMA, a psychedelic drug known as ecstasy, can help people suffering from trauma.

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Van der Kolk, author of the best-selling book «The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma» has heard about the potential of therapy with MDMA. Studies have already shown that such therapy significantly reduces symptoms in people with PTSD, so much so that some no longer meet the criteria for PTSD after only a few sessions.

However, when Rick Doblin, founder of the
Multidisciplinary Association for Psychedelic Studies (MAPS), invited van der Kolk to help conduct a new study on MDMA and trauma, the expert was wary.

«I tried to pressure Rick to exclude people from the study. I told him, for God's sake, don't include people here who have never felt safe» — he said.

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He made a distinction between people with PTSD who had experienced a single trauma later in life (such as a car accident) and those who had experienced trauma in childhood, such as those who had been abused by their parents. The latter group tends not to respond as well to psychotherapy, so van der Kolk did not expect improvements over the course of the study.

The stakes were high: the MAPS study was in its final phase (phase 3) to convince the FDA to approve
MDMA-based therapy for PTSD. Doblin knew that the lack of improvement in participants could have affected the study's results. Still, he didn't heed the warning.

«I said, ‘We've already worked with people who have complex PTSD related to childhood sexual abuse and other forms of adverse attachment — and they got better!’ So we will continue to include them» — Doblin recalled.

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Van der Kolk is now glad that Doblin held his opinion. Participants with early childhood trauma were included in the study and made up 84% of the sample, and they responded very well to the treatment.

«We had the best results using MDMA that I've ever seen for a study aimed at treating developmental trauma» — Van der Kolk told me.

But the big question is why exactly MDMA has such an amazing effect. What is the mechanism by which MDMA helps treat trauma?

A new study offers a tantalizing answer that suggests that PTSD sufferers with childhood trauma may actually benefit the most from MDMA's therapeutic effects.

How does MDMA change the perception of the self?
The study began with observations of the fact that many trauma survivors face a variety of emotional difficulties that make it difficult to successfully complete trauma-focused psychotherapy. Some are unable to recognize and acknowledge their inner feelings. Others struggle with intense feelings of shame and self-blame. Some find it extremely difficult to process suffering.

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All of these factors have a direct impact on the outcome of therapy. For example, if you have overwhelming feelings of shame, you may not believe you deserve help and improvement. The researchers wondered if MDMA could partially help people overcome these difficulties.

To do this, the researchers picked 90 participants suffering from post-traumatic stress disorder and divided them into two groups: half were treated with MDMA and the other half received a placebo. Over the course of the study, they were assessed on how they coped with various emotional problems before and after therapy.


It turned out that people who took MDMA showed significant improvements — both in terms of certain emotional aspects and in terms of PTSD in general.

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One impressive finding was that people who took a course with MDMA improved their ability to notice, recognize, and describe their inner feelings. Researchers label this inability as alexithymia, which translates to «lack of words to express emotions».

People who grew up with trauma and adverse environments sometimes exhibit alexithymia, perhaps because they were forbidden from childhood to express their feelings and it was dangerous, so instead they distracted themselves from their inner feelings.

https://pubmed.ncbi.nlm.nih.gov/18001224/
According to research, alexithymia has a negative impact on mental health.
In contrast, emotional detailing is beneficial to our mental state. It helps us become more aware of our inner feelings, which in turn helps us manage our emotions and remain emotionally resilient. Therefore, it is important to teach children to identify their feelings, as recognizing their state («I am angry» or «I am sad») is the first step to mastering the skill of emotion management.

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The study found that MDMA therapy led to a significant reduction in alexithymia, meaning that participants became better at recognizing and expressing their feelings. Those who took a placebo did not show the same improvement. The authors note that MDMA therapy can help to deal with painful memories and experiences that are usually too difficult or frightening to acknowledge.

The study also found that participants who received MDMA showed more self-compassion compared to those who took a placebo. To measure self-compassion, the researchers used a scale developed by
psychologist Kristin Neff, who has been a leading authority on self-compassion research for two decades. She identified three main components of self-compassion: kindness to self, humanity, and mindfulness.

Self-care means that you treat yourself with understanding and tenderness in those moments when you experience suffering or make mistakes, rather than judging yourself harshly. Ordinary humanity means that you remember that everyone faces difficulties and mistakes sometimes, rather than feeling that you are the only one going through such trials. Within mindfulness, you don't exaggerate or downplay your distressing thoughts: you are aware of them, but you also realize that they are only thoughts, not your entire being.

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According to the authors of a recent study, self-compassion can help people find the strength they need to overcome the traumatic experiences they are trying to process. It's also an effective way to combat the shame that often haunts people who have experienced trauma.

An important factor for mental health and effective treatment after trauma is emotion regulation. Because treatment often involves working with painful memories to change them, it is essential to be able to tolerate the suffering they cause. Managing these emotions can be challenging for people with PTSD, which is one of the reasons they may discontinue treatment.

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The study showed that therapy using MDMA had a significant effect on emotion regulation, reducing emotional instability and dysregulation twice as much as placebo therapy.

This adds to the already existing knowledge of psychedelics
We have a lot of information on the psychological effects of MDMA, gleaned both from clinical studies of the drug unrelated to PTSD and from less formal observations.

Anyone who has ever witnessed a hug on the dance floor at a rave can attest that MDMA makes us more sociable. Its known to promote feelings of openness and connection with others. Studies also indicate that it improves our positive attitude towards pleasant memories and reduces our negative attitude towards painful memories.
This factor also reduces the degree to which we react to emotionally threatening stimuli.

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These effects may provide a basis for us to view our traumatic experiences from a more favorable angle. We asked van der Kolk about the relationship between these known effects and his findings regarding alexithymia, self-compassion, and emotion regulation.

His hypothesis is that changes in emotional abilities may underlie other MDMA-related changes. For example, increasing your capacity for self-compassion may be a mechanism by which you can relate less negatively to painful memories.


Another example: improving your ability to regulate emotions, as a study among MDMA-using patients has shown, may be a mechanism by which you can respond less fearfully to emotionally threatening stimuli, including perhaps disturbing memories you have when experiencing trauma.

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«From a strategic standpoint, when I had to figure out what drug to test and what condition to treat, I really thought that MDMA was more likely to give good results than any of the other classic psychedelics because of the fear reduction that you get from MDMA» — Doblin said.

Although research has been done that suggests that psychedelics help you forget old associations and learn new ones, and that some psychedelics are used to treat trauma, such as LSD, which has been used successfully with Holocaust survivors. In this case, MDMA may be even more appropriate than LSD.


There is no sense of fear when using LSD, unlike MDMA. People facing trauma with LSD sometimes slip into panic over their painful memories, which hinders progress. In this case, MDMA's fear-reducing effects may be beneficial. However, direct research is needed to determine which psychedelics are best for treating PTSD.


But for the portion of people who struggle with these abilities, psychotherapy alone can't help them far. That's where psychedelics can come to the rescue.
 
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