MDMA-assisted therapy: A new treatment model for social anxiety in autistic adults
This overview/review paper lays the groundwork for offering MDMA-assisted psychotherapy for the treatment of social anxiety in autistic adults.
Authors
- Berra Yazar-Klosinski
- Charles Grob
- Alicia Danforth
Published
Abstract
The first study of 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy for the treatment of social anxiety in autistic adults commenced in the spring of 2014. The search for psychotherapeutic options for autistic individuals is imperative considering the lack of effective conventional treatments for mental health diagnoses that are common in this population. Serious Adverse Events (SAEs) involving the administration of MDMA in clinical trials have been rare and non-life threatening. To date, MDMA has been administered to over 1133 individuals for research purposes without the occurrence of unexpected drug-related SAEs that require expedited reporting per FDA regulations. Now that safety parameters for limited use of MDMA in clinical settings have been established, a case can be made to further develop MDMA-assisted therapeutic interventions that could support autistic adults in increasing social adaptability among the typically developing population. As in the case with classic hallucinogens and other psychedelic drugs, MDMA catalyzes shifts toward openness and introspection that do not require ongoing administration to achieve lasting benefits. This infrequent dosing mitigates adverse event frequency and improves the risk/benefit ratio of MDMA, which may provide a significant advantage over medications that require daily dosing. Consequently, clinicians could employ new treatment models for social anxiety or similar types of distress administering MDMA on one to several occasions within the context of a supportive and integrative psychotherapy protocol.
Research Summary of 'MDMA-assisted therapy: A new treatment model for social anxiety in autistic adults'
Introduction
Danforth and colleagues frame this paper as an overview of the rationale and methods for a pilot trial of MDMA-assisted therapy targeting social anxiety in autistic adults. They note overlap between lines of autism research and MDMA research—neurobiological work on oxytocin, vasopressin and serotonin, cognitive studies such as face-recognition mechanisms, and functional imaging findings implicating atypical amygdala and fusiform responses in autism—that together suggest MDMA’s multi-level effects could be relevant to social perception and affect regulation in this population. Earlier human MDMA studies showing attenuated amygdala response to angry faces and reports of reduced fearfulness are invoked to motivate testing MDMA in autistic adults with clinically significant social anxiety. The paper sets out to describe the design of an FDA‑compliant, Institutional Review Board‑approved pilot study to evaluate feasibility, safety parameters and preliminary efficacy of MDMA-assisted psychotherapy for moderate to severe social anxiety in autistic adults. In doing so, the authors draw on three supporting strands of evidence: (1) legacy clinical observations from early psychedelic work with autistic minors, (2) more rigorous modern safety and trial methodologies for psychedelic research, and (3) numerous first-person reports from autistic adults who have used MDMA recreationally. The planned pilot is positioned as a cautious, dose-finding, placebo-controlled first step toward assessing whether MDMA-assisted therapy warrants further development in this clinical indication.
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Study Details
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- APA Citation
Danforth, A. L., Struble, C. M., Yazar-Klosinski, B., & Grob, C. S. (2016). MDMA-assisted therapy: A new treatment model for social anxiety in autistic adults. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 64, 237-249. https://doi.org/10.1016/j.pnpbp.2015.03.011
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