Combining Cognitive-Behavioral Conjoint Therapy for PTSD with 3,4-Methylenedioxymethamphetamine (MDMA): A Case Example
This case study (n=2) describes the treatment methodology of MDMA (112.5mg) -assisted Cognitive-Behavioral Conjoint Therapy administered to a PTSD patient in conjunction with his romantic partner. Through the therapeutic context, set, and setting that entailed multiple days of participant engagement and the empathy-inducing effects of the MDMA, the procedure created strong therapeutic bonds between the couple and the therapists and facilitated the resolution of PTSD symptoms and improvement in relationship satisfaction.
Authors
- Michael Mithoefer
- Mark Wagner
- Anne Wagner
Published
Abstract
Introduction
Treatments for posttraumatic stress disorder (PTSD) have evolved significantly in the past 35 years. From what was historically viewed as a pervasive, intractable condition have emerged multiple evidence-based intervention options. These treatments, predominantly cognitive behavioral in orientation, provide significant symptom improvement in 50-60% of recipients. The treatment of PTSD with MDMA-assisted psychotherapy using a supportive, non-directive approach has yielded promising results. It is unknown, however, how different therapeutic modalities could impact or improve outcomes.
Methods
Therefore, to capitalize on the strengths of both approaches, Cognitive Behavioral Conjoint Therapy for PTSD (CBCT) was combined with MDMA in a small pilot trial.
Results
The current article provides a case study of one couple involved in the trial, chosen to provide a demographically representative example of the study participants and a case with a severe trauma history, to offer a detailed account of the methodology and choices made to integrate CBCT and MDMA, as well as an account of their experience through the treatment and their treatment gains.
Discussion
This article offers a description of the combination of CBCT for PTSD and MDMA, and demonstrates that it can produce reductions in PTSD symptoms and improvements in relationship satisfaction.
Research Summary of 'Combining Cognitive-Behavioral Conjoint Therapy for PTSD with 3,4-Methylenedioxymethamphetamine (MDMA): A Case Example'
Introduction
Over the past three decades, treatments for posttraumatic stress disorder (PTSD) have evolved from largely palliative approaches to multiple evidence-based options, most of which are cognitive–behavioural in orientation. Wagner and colleagues note that while cognitive therapies such as Cognitive Processing Therapy and Prolonged Exposure produce substantial benefit for many patients, 40–50% still have persistent PTSD after treatment, and the standard model of weekly individual psychotherapy does not suit all patients. PTSD is also conceptualised as an interpersonal problem because symptoms affect close relationships and relationship functioning can in turn maintain or ameliorate PTSD. Against this background, the investigators combined Cognitive–Behavioural Conjoint Therapy for PTSD (CBCT), a manualised dyadic intervention that targets both PTSD symptoms and relationship satisfaction, with MDMA-assisted psychotherapy. Previous MDMA studies have used non-directive supportive therapy and shown promise; however, it is unknown how MDMA would interact with an evidence-based, trauma-focused dyadic treatment. To illustrate the approach and decision-making involved in integrating these modalities, the paper presents a detailed case example from a small pilot trial in which two full-day MDMA sessions were embedded into the CBCT protocol for one couple with severe trauma history and clinically significant PTSD symptoms.
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Study Details
- Study Typeindividual
- Journal
- Compound
- Topics
- Authors
- APA Citation
Wagner, A. C., Mithoefer, M. C., Mithoefer, A. T., & Monson, C. M. (2019). Combining Cognitive-Behavioral Conjoint Therapy for PTSD with 3,4-Methylenedioxymethamphetamine (MDMA): A Case Example. Journal of Psychoactive Drugs, 51(2), 166-173. https://doi.org/10.1080/02791072.2019.1589028
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Ching, T. H., Williams, M. T., Wang, J. B. et al. · Journal of Psychopharmacology (2022)
Cavarra, M., Falzone, A., Ramaekers, J. G. et al. · Frontiers in Psychology (2022)
Earleywine, M., Low, F., Lau, C. et al. · Journal of Humanistic Psychology (2022)
Ching, T. H., Williams, M. T., Reed, S. et al. · Journal of Humanistic Psychology (2022)
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Monson, C. M., Wagner, A. C., Mithoefer, A. T. et al. · European Journal of Psychotraumatology (2020)
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