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When the psychologist and psychotherapist Leo Zeff took an experimental dose of MDMA in 1977, he felt a state of euphoria that he knew had the potential to change people’s minds. Already a pioneer in the underground psychedelic therapy movement, Zeff quickly put the drug to use among colleagues, reportedly calling it “penicillin for the soul.” It was revolutionary, he thought, and in a short period of time, it grew a reputation among therapists as a wonder drug. Anecdotal evidence showed that patients who were given MDMA just once experienced breakthroughs in their therapy that would have otherwise taken years to produce.
By the early 1980s, however, MDMA — or “ecstasy,” as it came to be known — was showing up in underground clubs and raves where its ability to create a feeling of euphoria was seen not as therapeutic, but dangerous. In 1985, the Drug Enforcement Administration (DEA) added the substance to the list of Schedule 1 drugs — those seen as having a high risk of abuse, no medical use, and severe safety concerns — and its potential as an antidepressant was overshadowed by its reputation as a party drug that did little more than make strangers get lovey-dovey on the dance floor.
Now, however, researchers are coming to understand that this lovey-dovey feeling could be the key to helping people with treatment-resistant post-traumatic stress disorder (PTSD). Though it’s now been illegal for more than 30 years, researchers never stopped pushing for clinical studies into MDMA’s potential to treat mental disorders. And while they’ve found that the drug could indeed be a powerful antidote to PTSD in its own right, they’ve also found that it isn’t just about the drug itself — it’s about the relationship between patient and therapist that the drug helps foster.
“When we started [researching MDMA] almost 20 years ago, George Greer, one of the psychiatrists who used MDMA with therapy before it became illegal told us, ‘there’s nothing you can do with MDMA that you can’t do without MDMA. You just might not get to it in this lifetime,’” says Michael Mithoefer, an MDMA researcher and clinical assistant professor of psychiatry at the Medical University of South Carolina. “I think that’s true. Deep healing and deep connection with therapists can definitely happen without MDMA or any other drug, but MDMA seems to make it much faster and more likely in many cases.”
What has made the treatment successful is using the medicine in combination with a stringent counseling plan led by a team of specially trained therapists. And while Mithoefer is focused on his ongoing research into MDMA and the bid for FDA approval of the drug, he’s also in the process of training the first cohort of therapists to guide patients through their MDMA experiences — and the first ones to be licensed to do it legally.
Mithoefer and his wife, Annie, a psychiatric nurse and fellow MDMA researcher, launched the first clinical study into MDMA’s therapeutic potential nearly two decades ago in partnership with the Multidisciplinary Association for Psychedelic Studies (MAPS) and have been studying the drug ever since. In 2017, the FDA granted “breakthrough therapy” status to MDMA based on a series of six clinical trials sponsored and led by MAPS, which turned up significant results. Of the 107 participants who participated in the study, 68% no longer had PTSD one year after treatment.
The high success rate has prompted the FDA to consider letting MAPS participate in its Expanded Access program, which would allow the use of the drug outside of clinical trials, and MDMA is also on track for FDA approval, which means it could be prescribed by doctors as early as 2021. To attain both of these milestones, MAPS is in the process of conducting Phase III trials of MDMA-assisted psychotherapy in 200–300 people with PTSD in the U.S., Israel, and Canada.
These trial treatments consist of a 12-week psychotherapy program, which includes three eight-hour sessions under the influence of a dose of MDMA led by a team of two psychiatrists. It’s these sessions that therapists have to be specially trained for. While the basis of the therapy is the classic talk-therapy discipline of cognitive behavioral therapy (CBT), the eight-hour sessions go well beyond the realm of the typical 50-minute counseling session. That means therapists need to employ different tools to successfully guide their patients through the experience, including transpersonal psychology, an alternative discipline that focuses on altered states of consciousness, and a therapy concept called the Inner Healing Intelligence, which is the belief that each person is equipped with their own deep-rooted ability to heal themselves — but also that this capacity can be nurtured in a therapy setting.
“It’s not that the therapists have the answers or are the magic, certainly. It’s not even that the MDMA is, although the MDMA definitely does things in the brain that supports that safe environment,” says Shannon Carlin, director of MAPS’ therapy training program. “It’s really creating this entire setting — this physical setting, the presence of the therapist, the support of the medicine — that allows a person to connect with their own innate healing intelligence.”
Carlin joined MAPS in 2011 to help the Mithoefers and a group of other psychotherapists develop the training program. It consists of five modules, including online courses, a seven-day retreat, video evaluations, and supervised therapy sessions, all of which teach therapists how to allow the patient lead the session while also giving them the tools needed to help the person when their progress stalls.
“We really focus on, what is the therapeutic approach and how are we meeting a participant in the midst of an MDMA experience?” Carlin says. “The therapist’s role is very dynamic. We’re really following what comes out of the participant.”
The training also includes an opportunity for the therapists to undergo a three-day MDMA-assisted psychotherapy experience of their own. While it’s not required, the majority of trainees opt to try it, according to Mithoefer, and the experience can be helpful to their training.
“I underestimated how valuable the MDMA experience would be for me,” says Veronika Gold, a co-therapist in MAPS’ MDMA-assisted psychotherapy trials who participated in the MDMA experience during her training. “It became instrumental to the way I’m now approaching the sessions and working with participants in the trial.”
MAPS has already trained some 150 therapists. The organization plans to have at least 300 therapists trained before 2021, and there are more than 5,000 therapists on the waitlist. Those who are already trained can work with participants in the Phase III trials and — if and when the FDA grants MAPS Expanded Access — can to work in designated clinics and retreats set up specifically for MDMA-assisted psychotherapy.
Although its reach is currently limited, MAPS’ MDMA-assisted psychotherapy is raising intriguing questions about the future of psychiatry, Mithoefer says. While antidepressants are usually taken continually to keep symptoms at bay, for example, MDMA-assisted psychotherapy has patients taking just a few doses of a drug, rather than relying on it. On top of that, it’s reshaping the long-accepted 50-minute, once a week therapy model, which “is in real need of advances,” Mithoefer says.
All of this makes MDMA not only a promising treatment for PTSD but a potentially radical new approach to how psychiatric treatment is delivered in general.
“People will say, ‘Well, tons of people are taking MDMA. Why aren’t they getting healed from their PTSD?’ Or, ‘Why can’t we just give people MDMA to take home? It would be so much cheaper,’” says Carlin. But she stresses the need to have a well-trained therapist in the room in “a safe and beautiful setting that’s incredibly private and supportive. All of that level of care and attention really communicates to the person, ‘This is the place for you to be safe, finally.’”