The phenomenology and sequelae of MDMA-assisted psychotherapy

MDMA (3,4-methylenedioxymethamphetamine; aka "ecstasy") has been used as an adjunct to psychotherapy since the 1970s. Psychotherapists and researchers involved in this work claim that the drug is uniquely suited to facilitate the therapeutic process. MDMA is reported to inhibit the fear response while increasing empathy, trust, openness, and emotional engagement. Despite its purported benefits, the use of MDMA is currently illegal for both medical and recreational purposes. Food and Drug Administration-approved trials are underway in an effort to demonstrate the drug's safety and efficacy in treating Post-Traumatic Stress Disorder, with the goal of legalizing MDMA for therapeutic purposes.;The current study contributes to the existing research through an exploration of the subjective experience of MDMA-assisted psychotherapy and its impact on participants. Using a qualitative, quasi-phenomenological theoretical framework and a thematic analysis approach to analyzing the data, this study examines the reports of 5 individuals who underwent MDMA-assisted psychotherapy an average of 5 years before being interviewed. The interview transcripts were distilled into 30 themes and organized into 4 temporal categories: leading up to the MDMA session, during the MDMA session, short-term sequelae, and long-term sequelae.;Many of the properties of the MDMA experience commonly described in the literature also emerged in this study's results, including empathy, insight, acceptance, and openness. It was notable that the experience appeared to bring to the surface intense emotions and traumatic memories that previously resided in the unconscious realms. When participants were well prepared for the MDMA session and felt safe and supported by the therapeutic relationship, these emotions and memories could be processed and the session was experienced as healing and transformative. However, in the absence of good preparation and a safe therapeutic alliance, the feelings and memories evoked by the drug were left unprocessed, ultimately leading to ongoing symptoms of anxiety and depression. These findings, though tentative due to the small sample size of the study, point to the importance of attending carefully to issues around the "set and setting" or "frame" of MDMA-assisted psychotherapy.