MDMA-Assisted Therapy for Social Anxiety: What is the Process of Change?
The following is synopsis of findings from Luoma, J. B., Shahar, B., Kati Lear, M., Pilecki, B., & Wagner, A. (2022). Potential processes of change in MDMA‐Assisted therapy for social anxiety disorder: Enhanced memory reconsolidation, self‐transcendence, and therapeutic relationships. Human Psychopharmacology: Clinical and Experimental, 37(3), e2824.
Social Anxiety Disorder
Social Anxiety Disorder (SAD) is a prevalent and disabling disorder characterized by intense fear of being scrutinized or negatively evaluated by others in social situations. SAD is the fourth most commonly diagnosed psychological disorder in the United States, and people suffering from SAD are at increased risk of alcohol addiction and depression.
Mainstream treatment for SAD includes medications (specifically SSRIs) and therapy, including cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT). However, significant numbers of SAD suffers do not respond very well to these treatments, leading researchers to seek alternative options. Researchers have found evidence that psychotherapy for social anxiety disorder may be enhanced by the addition of 3,4‐methylenedioxymethamphetamine (MDMA). What processes occur during MDMA-Assisted Therapy that contribute to effective treatment in SAD patients is the focus of this paper.
MDMA and Change
MDMA impacts the serotonin, norepinephrine, and dopamine systems, triggering hormonal responses involving oxytocin, vasopressin, prolactin, and cortisol. MDMA was used in psychotherapy before being banned in the U.S in 1985. Therapists reported MDMA was supportive by enhancing empathy, lowering defensiveness, improving communication, and aiding in processing trauma. MDMA remains illegal in the U.S., but in July 2023 was made legal for prescription in limited circumstances in Australia. (Read our post here for an overview).
While there is growing evidence supporting a positive impact of MDMA-Assisted Therapy for social anxiety and PTSD, there are few studies exploring the direct processes of change that may occur during MDMA-Assisted Therapy. Through reviewing literature in this area, Louma et al., (2022) propose three processes of change. These processes are not mutually exclusive and may interact in complex ways to produce therapeutic effects.
Enhanced Memory Reconsolidation: Memory reconsolidation is a process where previously consolidated memories are recalled and modified with new information. In the context of SAD, negative self-beliefs and memories associated with social situations are often rigid and resistant to change. MDMA may enhance the process of memory reconsolidation, allowing these negative self-beliefs and memories to be updated with positive or neutral information. This could potentially reduce the intensity of fear and avoidance associated with social situations.
Induction of Self‐Transcendence: Self-transcendence refers to experiences that go beyond one’s usual sense of self and may involve feelings of unity, interconnectedness, and universality. MDMA may induce experiences of self-transcendence and self-transcendent emotions such as compassion, love, and awe. These experiences could potentially help individuals with SAD to view themselves and their social world in a more positive and less threatening way.
Enhancement of Therapeutic Relationships: The therapeutic relationship, also known as the therapeutic alliance, is a key factor in successful psychotherapy outcomes. It involves the collaborative and affective bond between therapist and client. MDMA may enhance the therapeutic relationship by increasing feelings of trust, emotional openness, and empathy. This could potentially make it easier for individuals with SAD to engage in the therapeutic process and benefit from therapy.
These potential processes of change provide a framework for understanding how MDMA could enhance psychotherapy for SAD. However, more research is needed to test these hypotheses and fully understand the mechanisms of action of MDMA in this context.