By Marcela Ot'alora G., M.A., L.P.C.
After working with trauma for many years, I observed that one of the greatest challenges for people with PTSD is their distorted sense of self. Repeated exposure to painful memories reinforces the individual’s sense that he or she is a victim, and the corresponding experience of guilt and shame produces additional feelings of unworthiness. MDMA-assisted psychotherapy offers a new perspective for working with these destructive symptoms.
For the past 27 years, it has been my personal and professional passion to advocate for government approval of MDMA-assisted psychotherapy for the treatment of posttraumatic stress disorder (PTSD). I have looked forward to working as a clinician in a U.S. study since 1999, when I served as one of the co-therapists in an MDMA-assisted psychotherapy study in Spain. In the next few months, I will begin leading a new MAPS-sponsored study of MDMA-assisted psychotherapy in Boulder, Colorado.
Before the criminalization of MDMA and its placement as a Schedule I drug in 1985, I myself benefited from MDMA-assisted psychotherapy which helped restore my shattered trust, and allowed me to reclaim my sense of self-worth. This powerful experience led me to pursue a career in psychotherapy, and to advocate for the value of MDMA as a medicine in the treatment of PTSD.
After working with trauma for many years, I observed that one of the greatest challenges for people with PTSD is their distorted sense of self. Repeated exposure to painful memories reinforces the individual’s sense that he or she is a victim, and the corresponding experience of guilt and shame produces additional feelings of unworthiness. MDMA-assisted psychotherapy offers a new perspective for working with these destructive symptoms. Specifically, in the context of therapy MDMA reduces fear while increasing feelings of self-acceptance and compassion for self and others. These benefits enable the client to see and experience the difference between the distorted self produced by trauma and the accepting, compassionate, and worthy self within them.
PTSD often shatters one’s faith in one’s own innate wisdom. My hope in working with trauma is that through enhanced awareness, we can remember what was forgotten in the darkness of despair: that at our core we are worthy and free of blame, that the world has meaning, and that there is potential for growth in every situation.
PTSD frequently robs the individual of the ability to grieve. The meaning of the Greek word for trauma is “to wound.” A constantly aggravated wound has little chance to heal. When a loved one (or even a part of ourselves) dies the pain continues until we accept our loss—only then can we begin to grieve. Though difficult, the process of grieving comes with a sense of movement, and progress towards healing. This movement is the beginning of transformation.
This was my experience with taking MDMA in a therapeutic setting. Up to that time, the traumatic memories that constantly invaded my thoughts kept me stuck in pain; pain was my identity. Because of MDMA’s ability to increase trust and compassion while reducing fear, I was finally able to experience my loss and begin my grieving process. It was my own first glimpse at the possibility of recovery.
MDMA’s ability to reduce fear can allow people to explore their pain with trust and confidence. This enhanced trust and diminished fear creates a safe space in which the client can hold two perspectives at once: the recognition of their situation as their own and the possibilities for growth and healing out of that situation.
Another benefit of MDMA for therapeutic work is its role in facilitating self-acceptance. Since PTSD is the result of something being done to the individual (either directly or indirectly) it is easy for the person to identify as a victim. Helping the client realize that they are not to blame for their trauma is a major goal of psychotherapy for PTSD. The paradox of this approach is that if one is not to blame, someone else is—reinforcing the sense of victimization. Self-acceptance eliminates the need to blame or be blamed, creating the opportunity for positive growth.
By experiencing self-acceptance during an MDMA-assisted psychotherapy session (sometimes for the first time), clients can view their feelings from a different perspective, understand their origin, and begin seeing trauma through the lens of growth rather than victimization. By virtue of MDMA’s ability to allow the client to stay emotionally present without getting overwhelmed (a necessary combination and a useful advantage in the treatment of PTSD), integration of the experience can be obtained more successfully.
The most common treatments for PTSD try to help clients change how they think about the trauma and its aftermath. Eye Movement Desensitization (EMDR) tries to build new connections in the brain between traumatic memories and positive beliefs; Cognitive Behavioral Therapy (CBT) teaches how to replace harmful thoughts and cope with difficult memories; Prolonged Exposure (PE) targets the trauma in a way that reduces fear about the memories; and medications, specifically SSRIs, sometimes help with associated anxiety and depression.
Managing harmful thoughts, learning coping skills, and decreasing sensitivity to traumatic feelings are powerful tools that can help alleviate PTSD symptoms, and each plays a role in MAPS’ treatment method. Unfortunately, these common therapies are proven to have limited effectiveness. The goal of MAPS’ research is to increase our understanding of PTSD treatment in order to improve the lives of those suffering from this disorder.
The planned “intern study” to take place in Colorado, will include 12 subjects with chronic, treatment-resistant PTSD. This will be the first study using interns—students in training to be mental health practitioners—as part of the therapeutic process. The study builds on previous research by using two co-therapist teams rather than one, each comprised of an experienced clinician and a graduate-level intern.
In addition to adding to our knowledge of the risks and benefits of MDMA-assisted psychotherapy in the treatment of PTSD, the intern study will be a training opportunity for students with a professional interest in exploring new treatment modalities for trauma. Interns will have the unique opportunity to participate in an innovative therapeutic process, and will learn standards for conducting human trials. Participation in the study is also an opportunity for career development in a growing field, and to complete hours towards professional licensing. Interns will learn about self-care for therapists and how to work as a therapeutic team. We also anticipate that pairing students and trained therapists will be time-saving and cost-effective.
My hope is that the upcoming intern study of MDMA-assisted psychotherapy for the treatment of PTSD will improve the lives of people with PTSD, provide a more cost-effective approach to conducting research, and bring MDMA-assisted psychotherapy even closer to becoming a legal, effective treatment.