This within-subjects, placebo-controlled study (n=21) found that MDMA (52,5-105mg/70kg) may be more accurately characterized as increasing social approach behavior rather than empathy as such.
Background
Users of ±3,4-methylenedioxymethamphetamine (MDMA), “ecstasy,” report that the drug produces unusual psychological effects, including increased empathy and prosocial feelings. These “empathogenic” effects are cited as reasons for recreational ecstasy use and also form the basis for the proposed use of MDMA in psychotherapy. However, they have yet to be characterized in controlled studies. Here, we investigate effects of MDMA on an important social cognitive capacity, the identification of emotional expression in others, and on socially relevant mood states.
Methods
Over four sessions, healthy ecstasy-using volunteers (n = 21) received MDMA (.75, 1.5 mg/kg), methamphetamine (METH) (20 mg), and placebo under double-blind, randomized conditions. They completed self-report ratings of relevant affective states and undertook tasks in which they identified emotions from images of faces, pictures of eyes, and vocal cues.
Results
MDMA (1.5 mg/kg) significantly increased ratings of feeling “loving” and “friendly”, and MDMA (.75 mg/kg) increased “loneliness”. Both MDMA (1.5 mg/kg) and METH increased “playfulness”; only METH increased “sociability”. MDMA (1.5 mg/kg) robustly decreased accuracy of facial fear recognition relative to placebo.
Conclusions
The drug MDMA increased “empathogenic” feelings but reduced accurate identification of threat-related facial emotional signals in others, findings consistent with increased social approach behaviour rather than empathy. This effect of MDMA on social cognition has implications for both recreational and therapeutic use. In recreational users, acute drug effects might alter social risk-taking while intoxicated. Socioemotional processing alterations such as those documented here might underlie possible psychotherapeutic benefits of this drug; further investigation of such mechanisms could inform treatment design to maximize active components of MDMA-assisted psychotherapy.
Papers cited by this study that are also in Blossom
Dumont, G., Sweep, F., van der Steen, R. et al. · Social Neuroscience (2009)
Papers in Blossom that reference this study
Jacobs, E., Zahid, Z., Hinkle, J. et al. · BMJ (2026)
Mayo, L. M., Haggarty, C. J., Petrie, S. R. et al. · Psychopharmacology (2025)
MDMA (±3,4-methylenedioxymethamphetamine, 'ecstasy') is commonly reported to produce so-called "empathogenic" effects, including increased empathy and prosocial feelings. Such subjective effects are cited both as reasons for recreational use and as a rationale for using MDMA as a psychotherapeutic adjunct. Although several controlled laboratory studies have demonstrated MDMA-induced increases in self-reported sociability-related states (for example friendliness, closeness, and talkativeness), there has been little direct evidence on whether MDMA alters overt social-cognitive behaviour in humans, such as the ability to identify emotions in others. Bedi and colleagues designed a within-subject, double-blind study to characterise MDMA's effects on two domains: socially relevant mood states and social cognition operationalised as emotion-recognition performance from faces, the eye region, and vocal cues. They tested two doses of MDMA (0.75 mg/kg and 1.5 mg/kg), included methamphetamine (20 mg) as a stimulant comparator, and hypothesised that MDMA would alter both self-reported sociability/empathy and accuracy on emotion-identification tasks. The authors noted that changes could reflect either improved sensitivity to others' emotions (consistent with enhanced empathy) or reduced sensitivity to threat-related signals (potentially increasing social approach behaviour).
This was a four-session, within-participant, double-blind, randomised study. Twenty-one healthy volunteers who reported at least two prior occasions of MDMA/ecstasy use were recruited after screening for psychiatric, medical and pregnancy-related exclusions. Sessions were spaced at least five days apart and participants were required to abstain from other recreational drugs and alcohol for specified intervals prior to each session; compliance was verified with urine, saliva and breathalyser screens. Female participants provided a pregnancy test on each session. At each session participants received one of four oral capsules in randomized order: MDMA 0.75 mg/kg, MDMA 1.5 mg/kg, methamphetamine (METH) 20 mg, or placebo. Drug administration occurred at noon; baseline cardiovascular and subjective measures were recorded, and cognitive tasks were initiated 65 minutes after capsule ingestion to coincide with anticipated peak drug effects. Participants remained under observation in a laboratory room with minimal social interaction for at least 4.5 hours following dosing. Subjective measures comprised Visual Analogue Scales (VAS) for adjectives including stimulated, loving, sociable, playful and lonely, administered at multiple timepoints up to 240 minutes post-dose, and the Profile of Mood States (POMS), administered at baseline, 90 and 240 minutes, with a particular focus on the Friendliness subscale. Cognitive assessments included three emotion-recognition tasks completed once per session during peak effects: a Facial Emotional Recognition (FER) task using Ekman faces morphed from neutral to prototype in 10% increments (four basic emotions: anger, fear, happiness, sadness; 500 ms presentation per face; primary outcome accuracy), the Reading the Mind in the Eyes (Eyes) test (36 eye-region images of complex emotional states; accuracy), and the DANVA-2 Adult Paralanguage vocal affect task (24 audio clips conveying happy, sad, angry or fearful tone at two intensity levels; accuracy). Statistical analyses used repeated-measures ANOVA for primary subjective and cognitive outcomes, with Bonferroni corrections for multiple comparisons. For FER and DANVA-2, two-way repeated-measures ANOVAs assessed drug-by-emotion interactions; significant interactions led to simple main effects testing with adjusted alpha levels. When normality assumptions were violated for some measures (VAS Loving, VAS Lonely, POMS Friendliness, DANVA scores), non-parametric tests (Friedman's ANOVA and Wilcoxon signed-rank tests) were applied; VAS Lonely is reported using non-parametric statistics. Mauchley's test of sphericity and Greenhouse-Geisser or Huynh-Feldt corrections were applied as appropriate. Session order was tested and found non-significant, and analyses were conducted in SPSS 17.0.
Twenty-one participants (mean age 24.4 years, SD = 4.9; 9 female) completed the study. Most were White (17), with the remainder Asian (2), African-American (1) or mixed race (1). Mean age at first ecstasy use was 19.8 years (SD = 2.7) and lifetime ecstasy use averaged 15.0 occasions (SD = 23.1); 13 participants had used ecstasy fewer than 10 times. Use of other substances in the prior month was common (alcohol for all, cigarette smoking in 12 participants, cannabis in 16), and most reported lifetime use of stimulants and hallucinogens. Subjective effects: Drug condition affected all five pre-specified subjective measures. MDMA 1.5 mg/kg significantly increased self-reported loving feelings on the VAS relative to placebo (F(3,57) = 5.04, p = 0.004, η2 = 0.21). POMS Friendliness was increased by MDMA 1.5 mg/kg versus both placebo and MDMA 0.75 mg/kg (F(2.7,51) = 6.81, p = 0.001, η2 = 0.26). MDMA 0.75 mg/kg unexpectedly increased reported loneliness (χ2(3) = 11.94, p = 0.008, r = 0.54; non-parametric). Both MDMA 1.5 mg/kg and methamphetamine increased VAS Playfulness (F(3,57) = 8.57, p < 0.001, η2 = 0.31), whereas only methamphetamine significantly increased VAS Sociability relative to placebo (F(2.5,47.7) = 3.06, p < 0.05, η2 = 0.14). Emotion-recognition performance: There was a significant interaction between drug condition and emotion type on FER accuracy (F(5.2,104.6) = 3.23, p = 0.008). Follow-up analyses revealed a specific effect on fear recognition: MDMA 1.5 mg/kg reduced accuracy for fearful facial expressions relative to placebo (simple main effect for fear: F(2.8,56.0) = 4.45, p = 0.008, η2 = 0.18). After correction for multiple comparisons, no significant drug effects were observed for identification of angry, happy, neutral, or sad faces. Neither MDMA dose nor methamphetamine altered accuracy on the Eyes test or the DANVA-2 vocal task; there was no drug-by-emotion interaction on DANVA-2 scores. Exploratory analyses indicated that MDMA 1.5 mg/kg increased the tendency to misclassify non-neutral facial expressions as neutral compared with placebo (p < 0.05, uncorrected). Re-analyses based on participants' guesses about which drug they had received found no significant relationship between expectancy and the measures sensitive to drug effects.
Bedi and colleagues interpret their findings as demonstrating that MDMA at 1.5 mg/kg produces measurable changes in social cognition by reducing the accuracy of recognising fearful facial expressions, while concurrently increasing subjective feelings commonly labelled "empathogenic" (loving feelings and friendliness). The authors argue that this dissociation—enhanced prosocial affect alongside reduced sensitivity to threat-related facial cues—may reflect an increase in social approach behaviour rather than an enhancement of empathic perception per se. Reduced detection of others' negative or threat-related emotions could plausibly lower social avoidance and thereby facilitate interpersonal approach. The study also found that some subjective prosocial effects were not unique to MDMA: methamphetamine increased playfulness and, uniquely among the tested drugs, increased self-rated sociability. The authors acknowledge that expectancies could influence subjective reports but report that participants' guesses about drug identity were not associated with the measured outcomes. They therefore suggest that some prosocial properties may be shared across psychostimulants, and that methamphetamine's prosocial potential may be underappreciated. Several limitations are acknowledged. The behavioural tasks may not capture all socially relevant effects of MDMA: static facial photos may lack ecological validity compared with dynamic stimuli, tasks did not include matched non-social stimuli to test specificity, MDMA doses were weight-adjusted while methamphetamine was not (although participants were within a relatively narrow BMI range), and all participants had prior experience with MDMA so results may not generalise to MDMA-naive individuals. The authors propose further research directions, including studies probing the role of oxytocin—given evidence that MDMA elevates plasma oxytocin and that oxytocin mediates prosocial behaviour in animals—and investigations into the cognitive mechanisms underlying increased misclassification of subtle emotional cues as neutral. They also note potential individual differences, such as baseline trait sociability, that might moderate MDMA's effects. Finally, the investigators discuss implications for recreational and therapeutic contexts. Recreationally, they warn that MDMA's combination of increased interpersonal warmth and reduced sensitivity to negative social signals could increase social risk-taking while intoxicated. Clinically, reduced perception of fear or negative social cues might assist engagement with traumatic material in MDMA-assisted psychotherapy, but the authors stress that mechanistic work is needed to inform treatment design and to optimise any therapeutic application.
For subjective outcomes, repeated measures Analyses of Variance (ANOVA) were used to assess the effects of drug on peak change from baseline scores. Significant omnibus F tests were followed with post-hoc pairwise comparisons with full Bonferroni adjustment of the significance threshold. For the FER and DANVA-2 scores, two-way repeated measures ANOVAs assessed for main effects of drug and interactions between drug and emotion type. In the case that a significant interaction was identified, simple main effects analysis assessed for effects of drug on identification of each emotion. The significance threshold was set at 0.05 for the omnibus ANOVA, with Bonferroni-adjusted thresholds employed for each of the simple main effects analyses (p = 0.05/number of emotions). Significant simple main effects were followed with post-hoc pairwise comparisons with full Bonferroni adjustment for the total number of analyses undertaken (i.e. 0.05 corrected for simple main effects analyses as well as pairwise comparisons). An ANOVA assessed the effect of drug on total Eyes score. Alpha was set at p < .05 (adjusted as described above). In the case that Mauchley's test of sphericity indicated significant departure from sphericity (p < .05), Greenhouse-Geisser corrected degrees of freedom and significance levels were interpreted. Where the assumption of sphericity was met, we conservatively interpreted Huynh-Feldt corrected significance levels. Session order did not have a significant effect in any of the analyses, and was therefore not retained in the models. We assessed for normality of the data and univariate outliers prior to analysis. Data for four outcome measures were nonnormal (VAS Loving, VAS Lonely, POMS Friendly, and DANVA scores). In these cases, we conducted non-parametric analysis (Friedman's ANOVA followed by Wilcoxon signed rank tests). In all cases except VAS Lonely, the non-parametric approach yielded the same results; therefore parametric statistics are reported. For VAS Lonely, non-parametric statistics yielded slight alterations to the outcome; therefore non-parametric statistics are reported. Truncation of two outlying data points (both in DANVA scores) did not alter results and original data were retained. Effect sizes are presented as η 2 for parametric analyses and r values for non-parametric analysis. All analyses were conducted using SPSS 17.0.
We found that MDMA (1.5mg/kg only) altered a behavioral indicator of social cognition. Specifically, it robustly reduced recognition of fearful faces, without changing recognition of other emotions from facial or vocal cues. Although previous studies have confirmed that the drug induces subjective feelings related to sociability and empathy, this is the first published demonstration of an overt behavioral effect of MDMA in humans. The pattern of findings in our study may be more consistent with increased social approach behavior (i.e. sociability) than increased empathy. Anecdotal reports indicate that ecstasy increases interpersonal connection, which may suggest increased sensitivity to emotions in others. In the present study, MDMA produced self-reports of loving feelings and friendliness, but it decreased participants' accuracy in identifying fear in others. A decreased ability to identify negative emotions, particularly threat-related signals such as fear, may facilitate social approach behavior. Thus, MDMA may facilitate social interactions because it reduces the impact of others' negative emotions, rather than by enhancing recognition of, and sensitivity to, others' emotions. Unexpectedly, some subjective effects measured were increased by methamphetamine as well as MDMA. Indeed, only methamphetamine significantly increased self-rated sociability. Moreover, whereas MDMA (1.5mg/kg) significantly increased loving feelings and friendliness compared to placebo, these ratings were not significantly different from ratings on methamphetamine. These similarities were unexpected based on the different pharmacological profile and anecdotal reports of the effects of amphetamine and MDMA. It is possible that the expectation of receiving MDMA influenced subjects' reports of empathogenic feelings. Although expectancies were minimized using double-blind conditions, and a range of possible drugs to be administered, it was difficult to completely control expectancies. Indeed, 6 participants of 21 guessed that they had consumed ecstasy when they had received methamphetamine. However, follow-up analyses revealed that participants' guesses about the drug received were not significantly related to outcome measures, suggesting that expectancies play a minor role in these results. A more likely alternative is that methamphetamine may have a more prosocial profile than previously thought. Psychostimulants have been shown to enhance the rewarding value of social interactions in rodentsand humans, and methamphetamine is associated with social, and particularly sexual, enhancement in some subcultures. Thus, the prosocial effects of MDMA may be less selective than believed. The effect of MDMA on social cognition was limited to identification of emotions from facial expressions, with no apparent effect on recognition of affective cues from the eye region or from voices. Thus, it appears that performance alterations arising from MDMA are specific to processing of whole-face visual affective cues. However, whereas the facial task required participants to identify emotions based on subtle, briefly presented pictures, there were no time limits on responding to items in the Eyes task. Moreover, whereas the vocal stimuli presented contained two levels of emotion intensity (high versus low), the facial task included 10 levels (from neutral to 100% intensity, in 10% increments). Thus, it may be that MDMA affects identification of subtle emotional cues, rather than having modality-specific effects. Future research requiring affect recognition from subtle, briefly presented vocal and eye-region stimuli could clarify this issue. Some limitations should be noted. First, as noted above, the behavioral tasks we used may not have been sensitive to all of the unusual social effects attributed to MDMA. For example, the static photos of facial affect we employed may be less ecologically valid than dynamic stimuli [e.g.. At the time of study initiation, no suitable dynamic stimuli were available. Second, we are not aware of tasks that include both social and non-social stimuli, making it difficult to determine the specificity of these findings to social stimuli. A third possible limitation was that we adjusted the dose to the body weight for MDMA but not for methamphetamine. This is unlikely to be a major factor because participants were within a narrow weight range (BMI 18.5 -30), and post-hoc analysis indicated that only one measure of methamphetamine's effects (playfulness) correlated with body weight (r = -0.45, p = 0.04). A final limitation is that, for ethical reasons, all participants had prior experience with ecstasy or MDMA, so the findings may not generalize to MDMA-naive individuals [see 42]. However, we intentionally recruited candidates with limited previous exposure to minimize possible effects of prior use. There are a number of directions for future enquiry. In rodents, MDMA increases prosocial behaviorand this effect is attenuated by an oxytocin receptor antagonist. Oxytocin is a neuropeptide known to be a critical modulator of social behavior in mammals. In humans, MDMA increases plasma oxytocin levels, and plasma oxytocin levels also vary positively with enhanced subjective sociability after MDMA. This suggests that a fruitful area of future research will be to examine the role of oxytocin in the social cognitive, affective and behavioral effects of MDMA in humans. Second, there is a need for studies of the cognitive mechanisms underlying alterations to social cognition. For example, we found that MDMA (1.5mg/kg) increased the number of non-neutral faces erroneously identified as neutral, apparently reducing the capacity to detect subtle emotional signals. This phenomenon, which may underlie the reduced fear identification demonstrated in this study, requires further investigation. Finally, it is possible that certain social predispositions, such as high or low levels of trait sociability, affect the degree to which MDMA alters social processing in humans, potentially contributing to individual preferences for MDMA. The present findings have implications for both recreational and therapeutic MDMA use. Recreational ecstasy users may benefit from knowledge that ecstasy, while increasing feelings of interpersonal connection, can subtly impair interpersonal competence. For instance, compromised social cognition may increase social risk-taking while under the influence of the drug. In addition, considering that social expectancies predict use of other drugs such as alcohol, modifying users' expectations about positive social effects of MDMA may alter ecstasy-use behavior [see 48]. Regarding therapeutic use of MDMA, ongoing research on MDMA-assisted therapy should investigate possible mechanisms of any therapeutic effects. A recent placebo-controlled pilot study has indicated that MDMA-assisted psychotherapy may be useful in reducing symptoms in patients with treatment-resistant post-traumatic stress disorder (PTSD). Although mechanisms of this apparent effect remain unclear, reductions in the intensity of fear perception, including but not limited to those reported here, might facilitate engagement with traumatic material during therapy. Moreover, reduced sensitivity to subtle signs of negative emotions in others (e.g., the therapist) may enable a patient to express thoughts or feelings that were previously inhibited because of perceived negative responses in the listener. In addition to further controlled research to investigate the effectiveness of MDMA in psychotherapy, an understanding of the socioemotional cognitive mechanisms underlying such effects will help clinical researchers design treatments that optimize the drug's therapeutic potential. Biol Psychiatry. Author manuscript; available in PMC 2011 December 15.
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