Amanda Morales

PSY-365: DHB
Golski
Article Dissection #2
4/29/10
1) Citation
Bouso, J., Doblin, R., Farr, M., Alczar, M., & Gmez-Jarabo, G. (2008). MDMA-assisted
psychotherapy using low doses in a small sample of women with chronic posttraumatic stress
disorder. Journal of Psychoactive Drugs, 40, 225-236.
2) Why we should care
Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that develops after experiencing a
particularly traumatic event like going to war, being sexually abused or raped, having someone close die
in a horrific situation (like 9/11), etc. The prevalence of PTSD is increasing, especially with the
increasing amount of soldiers going into active duty over seas. This research explores the use of
Methylenedioxymethamphetamine, or MDMA (also known as ecstasy), in conjunction with therapy for
those with PTSD. With cases of PTSD increasing, it would make sense to find the most effective
treatment plan possible so that its sufferers of this disorder can heal.
3) 3 background facts/findings
It is estimated that before its ban by the U.S., over 500,000 doses of MDMA were used in
psychotherapeutic settings. It was primarily used to treat anxiety and psychosis, but it was also used in
individual, group, and couples therapy as well.
In PTSD therapy, MDMA works by temporarily dissolving all fears surrounding a situation, which
helps patients to get in touch with their emotions as well as communicating these emotions to their
therapist.
A study in Switzerland had followed 121 patients who had, on average, three years of therapy with
70 non-drug sessions and 7 sessions accompanied by either LSD or MDMA. After their therapy, 65%
reported having good improvement and another 26% had reported experiencing a slight
improvement.
4) Research questions
What dose of MDMA is not only safe to use in a therapy session, but effective as well? The amount of
MDMA administered was manipulated (50 mg, 75 mg, 100 mg, 125 mg, 150 mg), and in each group there
were at least two participants who received the placebo.
5) Methodology
The study was conducted as a double-blind experiment. All participants were screened before
beginning the study, and had to be diagnosed solely with PTSD, have had no prior use of MDMA, could
not be pregnant, and must be in overall good physical health. A short survey of demographic questions
regarding their self and their rape experience was acquired. Twenty-nine participants were recruited, but
because of political pressures the study had to stop after only six participants completed testing.
Participants attended seven 90-minute therapy sessionsthree non-drug sessions, one MDMA assisted
session, followed by three more non-drug sessions. A psychological assessment was done both before and
after testing took place.
6) 3 specific results
The participant of the placebo group improved by 4.5 points on their psychological assessment, while
the 50 mg group improved 9 points, and the 75 mg group improved 16 points. Although no strong
assertions can be made because of the small sample size, these select participants show that there is a very

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good possibility that MDMA can be used effectively in therapy sessions to alleviate the symptoms of
PTSD.
It was also found that side effects were fairly mild, and were reported in two of the participants. This
shows that MDMA has the potential of being a safe drug to administer during therapy at these low doses.
All but two participants correctly guessed the amount of MDMA that was assigned to them. The one
participant who guessed wrong believed that he had received the placebo pill, when in fact he received 50
mg of MDMA. The other participant who guessed their dosage incorrectly was one who had received the
placebo pill, but believed he had taken 50 mg of MDMA. This shows the possibility of top-down
processing in MDMA use; although the higher dose of 70 mg still was significantly more effective than
the placebo.
7) Take home message
The use of drugs, particularly MDMA, should be investigated further to evaluate its effectiveness in
PTSD therapy. From this study, we vaguely see its potential, but there is a glimpse of the possibility with
the significant findings among the six participants. Participants who received the higher doses of MDMA
(70 mg) had the most successful treatment outcomes, making this dosage a viable one for future therapy.
8) Critique
a. 2 lingering questions/unfamiliar terms
I am still not absolutely clear what MDMA having an ameliorative effect means, but
after looking ameliorative up, I have made some assumptions. According to the dictionary,
ameliorative means to make better or improve. So when this research article refers to the
ameliorative effect of MDMA, I think they might be referring to how its use during therapy can
improve the quality of the therapy session or the outcome of therapy overall.
This does not have to do with the structure of the study in any way, but after reading this
research article I was left wondering why it had claimed (at least twice) that it was the first
study in the world to look at MDMA as a supplement to therapy, when it had referenced
previous research along these lines several times as well?
b. Confounds/critiques
Since only six participants were tested completely (out of 29), the strength of this study is
relatively weak because of the small sample size. Also, the highest dosage of MDMA
administered was 75 mg, when the original study called for higher doses such as 100 mg and
125 mg. Since these groups were not able to be tested, it is hard to say with certainty that 75 mg
is an efficient amount to administer during therapy. This study is also lacking in external
validity, since the participants were all women with PTSD who have experienced a traumatic
sexual event. It is then hard to generalize these results to other populations with PTSD since
they were not included in this research.
c. Suggestions for improvement
Further work needs to be done during a time when political pressures will not stop this
research at the very beginning. It may have helped to give a more in-depth explanation as to
why this research should be donethe introduction is filled with the use of MDMA in therapy
and other settings in the past, but there are no definitive statements as to why it should be tested.
Based on the relatively weak introduction, this may have been the reason why the researchers
were being pressured politically, because they may not have been able to provide an adequate
answer for the meaning behind their research.
9) Content tie-in
This article brings to light the many difficulties surrounding drug research; this is especially true
considering it involved drug research as a means of therapy. As previously stated, this research was

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terminated after only six of the 29 participants were tested because of what the researchers describe as
political pressures. These pressures could have stemmed out of the stigma that often encompasses drug
research. This stigma not only surrounds the participants of the study, but the researchers as well
especially since MDMA is deemed a Schedule I drug (it is illegal because it is considered highly addictive
and is not safe or medical use). With this stigma also comes a lack of funding for research. Those who
typically fund research may be hesitant to do so if they know that their money would be going to research
that will be testing an illegal substance on people. There may also be problems with self-report. All
participants were screened to include only those who have never used MDMA, and tests were ran to
ensure they did not have it in their systems one month prior to the beginning of testing. The study,
however, did not screen the participants for their potential use of other drugs. If other drugs were in their
system during the time of testing, this could have significantly altered their responses that helped
researchers rate the effectiveness of therapy and MDMA. Another concern with drug testing can be the
researchs external validity or generalizability. In this study, for example, only women who had
experienced some form of sexual abuse or rape from which they then contracted PTSD. Because
researchers can be very particular about who they use as participants in their studies, their results may not
apply to the rest of the population.
It is especially important for research such as this to carefully examine the side effects (both short and
long-term) of MDMA in these doses. One side effect of MDMA that we learned about in class was the
killing of brain cells, especially with repeated use. MDMA causes increased body temperature, and in
some cases, hyperthermia (extremely high body temperature). This extra body heat is not good for the
body; especially the brain and can contribute to the loss of brain cells. Hyperthermia is not the sole cause
of the loss of brain cells, however. MDMA itself can do the job on its own. John Hopkins University
looked into MDMA use and how it effected the brain. These studies were called the Ricaurte studies.
They found that MDMA users (who had been clean for at least 3 weeks) had destroyed nerve endings
which affected the reuptake mechanism of substances. If reuptake cannot occur, a substance or
neurotransmitter will stay in the synapse longer, possibly prolonging its effects and potentially causing a
variety of other problems. It was also found that women who used MDMA were more susceptible to
developing clinical depression.