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MDMA-Assisted Psychotherapy for Autistic Adults with Social Anxiety

3,4-methylenedioxymethamphetamine (MDMA), most commonly known by its street names “ecstasy” or “molly”, is often associated with raves and clubs. However, ecstasy or molly is not the same as pure MDMA because these street drugs also frequently contain unknown and sometimes dangerous substances. Pure MDMA under laboratory studies has been proven to be safe for consumption when taken in limited and moderate doses.

The Multidisciplinary Association for Psychedelic Studies (MAPS) is a non-profit research organization that is primarily focused on studying MDMA-assisted psychotherapy. MAPS has helped the therapy be recognized for its treatment of posttraumatic stress disorder (PTSD) and is even in the midst of the process of getting an FDA-approved prescription as early as 2022. While MAPS’ mainly researches MDMA’s benefits for PTSD, the organization also has completed studies for autistic adults.

MDMA has been found to have the potential to treat social anxiety in adults with autism because it helps promotes the release of the oxytocin. The hormone helps induce positive social feelings like trust, social communication, emotional recognition, and self-perception. Therefore, MDMA shows promise since it can help generate feelings of social affiliation and reduce social fear and avoidance that many autistic individuals face. Unlike most medications that are taken chronically, MDMA-assisted therapy is meant to be administered only a few times.

In a study done by Danforth et al, “Reduction in Social Anxiety after MDMA-Assisted Psychotherapy with Autistic Adults: a Randomized, Double-Blind, Placebo-Controlled Pilot Study”, autistic adults following MDMA-assisted psychotherapy have shown improvement in social anxiety symptoms. The study was done on a sample of twelve autistic adults with severe social anxiety, who were then either randomly given MDMA or a placebo during two psychotherapy sessions. Eight participants received MDMA at various doses while four participants received the placebo. The psychotherapy sessions were 60-90 minutes and occurred over six months. The self-rating Leibowitz Social Anxiety Scale (LSAS) questionnaire was used to measure anxiety levels from baseline to one month after the second experimental session and then measured again six months after the final experimental session.

LSAS scores improvement was significantly greater for the MDMA group compared to the placebo group. Several participants reported improved interaction with family members, two reported being able to initiate dating, and two reported feeling more comfortable in expressing and exploring their gender identity. While there were no serious adverse side effects for the MDMA group, moderate elevations in blood pressure, heart rate, and temperature were observed

but were mild or brief. In comparison, the mean scores of the placebo group improved near the end of the study, but not to the extent the MDMA group had.

In conclusion, the study has found rapid and consistent improvement in social anxiety in autistic adults following MDMA-assisted psychotherapy. However, it is too soon to conclude if MDMA could be used as a treatment for social anxiety just yet because of the small sample size. Although, the study does establish the safety and feasibility of MDMA-assisted psychotherapy. Therefore, more trials are needed in studies with a larger sample to further investigate MDMA’s potential. It is important to note that the Drug Enforcement Administration (DEA) has put MDMA as a Schedule I substance. To facilitate more research about MDMA-assisted psychotherapy, changing MDMA’s drug schedule is recommended in order to get more funding.

Danforth AL, Grob CS, Struble C, et al. Reduction in social anxiety after MDMA-assisted psychotherapy with autistic adults: a randomized, double-blind, placebo-controlled pilot study. Psychopharmacology (Berl). 2018;235(11):3137‐3148. doi:10.1007/s00213-018-5010-9

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