Gwyneth Asks: Will MDMA-Assisted Psychotherapy Go Mainstream?

“We want to demonstrate a new way to market drugs where we’re maximizing public benefit, not profit,” says Rick Doblin, PhD, the founder and executive director of the Multidisciplinary Association for Psychedelic Studies (MAPS).

You might remember Doblin from his conversation with Elise on The goop Podcast in July 2019. You might also know that we like having conversations about psychedelics as a healing modality. And if you didn’t, you might have a good time watching the psychedelics episode of The goop Lab on Netflix.

Because it’s been a while and there have been some exciting updates, GP interviewed Doblin for the podcast about how the landscape of psychedelic research has changed and what the future is looking like. They talk about how—and why—MDMA is being used in conjunction with psychotherapy and the continuing research underway looking at the potential therapeutic benefits of MDMA for people who are trying to heal from PTSD, eating disorders, alcoholism, social anxiety, and other forms of trauma.

Part of Doblin’s mission is to make psychedelic-assisted psychotherapy accessible to people who could benefit from it. To that end: MAPS is working on a $10 million fund-raising challenge that will hopefully fund the final research stages needed to make MDMA-assisted psychotherapy a legal prescription treatment for PTSD in the US.

In the meantime, the FDA is allowing the use of MDMA-assisted psychotherapy for PTSD through a program called expanded access (also known as compassionate use). This allows people with PTSD (who have tried other treatment options to no avail) to pay for their own MDMA therapy now, while clinical trials are still underway. Unfortunately, this treatment currently costs about $25,000 per patient. In an effort to ensure that MDMA-assisted psychotherapy will be available to marginalized communities, MAPS has a $100,000 matching challenge grant for people who donate to support BIPOC PTSD patients going through expanded access treatment. Equally important, this fund will also support BIPOC therapists who are going through MAPS training.

GP has donated to the expanded access fund, and you can learn more or to donate yourself on the MAPS site.

A PSA before we continue and in case you’re new to this world: The legal status of psychedelics depends on where you use them. In the US, recreational use is illegal. If psychedelics are done without careful attention to dose, set (mindset), and setting (environment), it’s possible for things to go wrong. As always, consult your doctor before beginning any protocol.

Psychedelics aside, we love listening to Doblin’s perspective on how people can store, process, and release memories, stuck emotions, and old—even unconscious—wounds. His vision of a more interconnected world is a beautiful one. Below, a few (truncated) highlights from his conversation with GP.

Has research on MDMA-assisted psychotherapy gained acceptance in the past year?
“It’s gotten much more accepted, much more legitimized in all different ways,” says Doblin. “I’m almost in this perpetual state of astonishment about people that previously were uncomfortable with this but now seem to be welcoming it.”

When do you think MDMA-assisted psychotherapy could be available as a legal prescription treatment for PTSD?
“We think by the middle of 2022, we should be done with all the research, and that’s where we start negotiating with the FDA. We’re hoping before the end of 2022 that this [MDMA-assisted psychotherapy for PTSD] will be legally available by prescription. But the FDA has also given us permission for what’s called expanded access or compassionate use,” says Doblin. “Because the data is not used by the FDA to prove safety, they’ll make MDMA available for compassionate use, so people can pay for their own treatments. We have about ten expanded access sites in the United States.”

Generally, how long is the treatment process for MDMA-assisted psychotherapy?
“It’s a three-and-a-half-month treatment process. There are only three times that people get MDMA, each one month apart. Those are eight-hour-long sessions, and they’re with a male-female co-therapist team,” says Doblin. “Because the treatment is really the psychotherapy that the MDMA helps make better, we also have twelve ninety-minute nondrug psychotherapy sessions. Because you could have a great time on MDMA, but if you don’t process it, it might not lead to long-term positive change.” (Editor’s note: Listen to the podcast for a more nuanced breakdown of “a great time,” as it might not be what you’re thinking.)

What is the role of the therapist?
“The most important factor in therapy in general, regardless of whether it’s MDMA-assisted or not, is called the therapeutic alliance,” says Doblin. “It’s the relationship between the person and their therapist. Do they feel safe? Do they trust them? Can they be honest? Can they feel loved and supported?”

“We don’t use the word ‘guide,’” he says. “We’re not the guide because we don’t know where people need to go. We call it inner-directed therapy, meaning that it’s directed by the person who is taking the MDMA. We don’t say, ‘You must start with your trauma and tell us all the horrible things.’ Sometimes people will start with wonderful experiences that they had. And it’s like they’re gathering strength to go back into the trauma. Everybody has their own unique rhythm, and it’s an eight-hour session so that we have time to work with people.”

“You’re just observing their body language; you’re checking in with them every once in a while,” he explains. “The main thing you’re trying to see is if they’re open to it: Is the energy flowing through them or are they resisting? And then if they’re resisting it, you’re trying to help them bring up what’s under the surface and help them express it.”

What might be happening to the brain on MDMA?
“MDMA stimulates oxytocin,” says Doblin. “There were researchers at Johns Hopkins that did studies with mice. And what they showed is that this release of oxytocin actually promotes new neural connections in prosocial areas of the brain. You are physically rewiring your brain. There’s a phenomenon called fear extinction and memory reconsolidation. You’re also rerouting how you recall memories: There is episodic memory, which is the memory for what happened, and then there is the emotional memory that gets attached to it. So you’ve got this memory of the trauma and the emotions are fear and anxiety and terror, and you carry that with you.”

“Under MDMA, activity in the amygdala—where we process fear—is reduced,” he says. “And in the prefrontal cortex—where you think logically—activity is increased with MDMA. So you’re able to think more logically and react less fearfully. You feel more bonded and connected. And you’re able to replace the emotion of fear that’s connected to the memory, because of the sense of peacefulness that you’re getting from MDMA—and because you’re releasing it.”

What is your ultimate goal?
“We’re more interested in mass mental health than in money. What I’m worried about, if you look at what pharma does in general—it’s not very focused on what’s best for the patient. It’s about how they make the most money. We want to demonstrate a new way to market drugs where we’re maximizing public benefit, not profit. The world is really in need of this kind of healing.”