MDMA-assisted psychotherapy for PTSD in adolescents: rationale, potential, risks, and considerations
This article (2023) advocates for MDMA-assisted psychotherapy (MDMA-AT) in treating adolescent PTSD, highlighting potential benefits such as reduced avoidance and enhanced therapeutic alliance. It proposes adaptations including stronger motivation reinforcement, additional emotion management techniques, and family involvement, and calls for clinical trials to assess safety and effectiveness.
Authors
- Kangaslampi, S.
- Zijlmans, J.
Published
Abstract
3,4-methylenedioxymetamphetamine(MDMA)-assisted psychotherapy (MDMA-AP) is a proposed treatment for posttraumatic stress disorder (PTSD) that may be approved for adults soon. PTSD is also common among trauma-exposed adolescents, and current treatments leave much room for improvement.We present a rationale for considering MDMA-AP for treating PTSD among adolescents. Evidence suggests that as an adjunct to therapy, MDMA may reduce avoidance and enable trauma processing, strengthen therapeutic alliance, enhance extinction learning and trauma-related reappraisal, and hold potential beyond PTSD symptoms.Drawing on existing trauma-focused treatments, we suggest possible adaptations to MDMA-AP for use with adolescents, focusing on 1) reinforcing motivation, 2) the development of a strong therapeutic alliance, 3) additional emotion and behavior management techniques, 4) more directive exposure-based methods during MDMA sessions, 5) more support for concomitant challenges and integrating treatment benefits, and 6) involving family in treatment. We then discuss potential risks particular to adolescents, including physical and psychological side effects, toxicity, misuse potential, and ethical issues.We argue that MDMA-AP holds potential for adolescents suffering from PTSD. Instead of off-label use or extrapolating from adult studies, clinical trials should be carried out to determine whether MDMA-AP is safe and effective for PTSD among adolescents.
Research Summary of 'MDMA-assisted psychotherapy for PTSD in adolescents: rationale, potential, risks, and considerations'
Introduction
Kangaslampi and Zijlmans frame MDMA-assisted psychotherapy (MDMA-AP) as a combined pharmacological and psychotherapeutic approach that has completed adult Phase III trials for PTSD and may soon receive regulatory approval for adults. They note that many adolescents experience potentially traumatic events and a substantial minority develop persistent PTSD; although several trauma-focused psychological treatments for young people (for example TF-CBT, PE-A, NET/KIDNET, and developmentally adapted CPT) produce large average improvements, a non-trivial proportion of adolescents either drop out or fail to respond adequately. Given these limitations, the authors argue it is timely to consider whether MDMA-AP might offer an alternative or adjunctive option for adolescents with PTSD. The paper sets out to provide a rationale for studying MDMA-AP in adolescents aged roughly 14–17, to suggest possible adaptations to the psychotherapeutic component if MDMA-AP were to be used with this age group, and to highlight risks and ethical considerations that may be specific to minors. The authors restrict their focus to PTSD specifically and emphasise the need for empirical clinical trials rather than extrapolating adult results to adolescents by default.
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- APA Citation
Kangaslampi, S., & Zijlmans, J. (2023). MDMA-assisted psychotherapy for PTSD in adolescents: rationale, potential, risks, and considerations. https://doi.org/10.31234/osf.io/k3hz6
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