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What is Post-Traumatic Stress Disorder?
There are certain people in our world that have experienced extremely emotionally charged experiences that afterward, affect these people to the extent that the traumatic experience can ultimately impair their ability to function normally in our world. The traumatic event is said to be life threatening such as in the case of combat or military exposure, child sexual or physical abuse, sexual or physical assault, serious accidents, and exposure to natural disasters, such as a fire, tornado, hurricane, flood, or earthquake (http://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_what_is_ptsd.html).††
The memories of these experiences reflect a point in time when the individual was under tremendous physical and psychological strain. Afterward, the individuals can have flashbacks of the events, suffer from insomnia and deep depression, drug abuse, numbness, and intense anger or fear toward everything. All these aftereffects never get better but only worse to the point that the individual cannot function normally for the rest of their life. These people are said to suffer from an anxiety disorder called Post Traumatic Stress Disorder (PTSD). Scientists really havenít found a way to treat this disorder properly and effectively, until now.
How can we treat PTSD?
Recently, scientists have speculated and tested whether the use of methylenedioxymethamphetamine (MDMA) during psychotherapy can safely and effectively treat people who suffer from PTSD symptoms (http://ptsdcombat.blogspot.com/2007/11/ptsd-research-ecstatic-about-mdma.html). MDMA assisted psychotherapy is thought to reduce the effects of PTSD. People who suffer from PTSD show an amygdale response. The amygdale fires during times when people experience fear or defensiveness, similar to the mental states in PTSD patients. Through these studies, it has been shown that MDMA greatly reduces amygdala response, improving the PTSD patientís life in the future (http://www.maps.org/research/mdma/canada/protocol_09_08.pdf).
What is MDMA?
According to (http://www.erowid.org/chemicals/mdma/mdma.shtml), MDMA is commonly known as Ecstasy, ďEĒ, ďXĒ, XTC, rolls. It is a psychedelic amphetamine that is illegal and still considered one of the most popular recreational psychoactive drugs. The chemical comes from oil in the sassafras plant which, after being processed, being can come in many forms. It is most widely sold on the streets in pill form, but sometimes it can be found in its more powerful powder-capsule form (http://www.erowid.org/chemicals/mdma/mdma_dose.shtml). When using MDMA or Ecstasy people report feelings of euphoria, stimulation, and intense empathy and connection toward others. It is considered a social drug and is most widely consumed in clubs where the users are allowed to dance and socialize with each other (http://www.erowid.org/chemicals/mdma/mdma_basics.shtml). ††
What are the dosages, onsets, durations, and aftereffects of MDMA?
Typically, a standard dose of MDMA is between 80 and 150 mg. MDMA can take from 30 minutes to 2 hours to take effect. When users initially feel its effects, they begin to move toward an emotional ďpeakĒ. During the ďpeakĒ, an influx of serotonin surges through the body as the drug takes its full effect and the user reaches his most euphoric and intense emotional state of mind. After about 4 hours the userís emotions and bodily states begin to return back to normal. After usage, people have reported difficulty trying to sleep. During the subsequent days after usage, some people report a change in mood towards depression, while others report having a more lifted mood. It has been said that repeated use can damage the brain and lead to depression, reductions in memory, and increased in anxiety (http://www.erowid.org/chemicals/mdma/mdma_basics.shtml).
What is the problem with MDMA consumption?
According to (http://www.erowid.org/chemicals/mdma/mdma_basics.shtml), due to the growing popularity of the drug, it seems that more people in the population want it than is available to sell. In turn, drug dealers frequently mix it with other drugs that can be extremely dangerous drugs, such as speed and heroine, so that they can supply for such a high demand within the population. In addition, since the drug has such a delayed effect, it can kill users after they consume too much after thinking they need more. If too much MDMA is consumed and abused improperly, it can cause intense vomiting, paranoia, dehydration, jaw-clenching, eye-twitching, hyperthermia, and hyponatremia, and in some cases death (http://www.erowid.org/chemicals/mdma/mdma_basics.shtml).
Why use MDMA in psychotherapy to help PTSD patients?
When taken responsibly, it is speculated that MDMA not only has little or no permanent side-effects, but also allows PTSD patients to break down the barriers that hold their dark emotions, thoughts, and feelings inside them, which are the original causes of their post-traumatic stress (http://www.drugs-forum.com/forum/archive/index.php/t-50381.html).When bringing out traumatic events while in a euphoric state of mind while under the influence of MDMA, scientists speculate that this will allow patients to confront their traumatic event and allow them to find ways to cope with the trauma, eventually leading them to accept it, associate the event with the helpful and pleasant psychotherapy sessions, and eventually forget about it, allowing them to lead a normal healthy life once again.
MDMA use in psychotherapy with PTSD:
The Multidisciplinary Association for Psychedelic Studies (MAPS) has sponsored multiple recent studies where experimenters studied the effects of MDMA in psychotherapy for the treatment of PTSD. MAPSís ultimate goal is to get MDMA to become a prescription medication that is approved by the Food and Drug Administration and it is the only company sponsoring studies for MDMA research in the world. (http://www.maps.org/research/mdma/canada/protocol_09_08.pdf). The following information is an overview of one particular sponsored MAPS study conducted in Charleston, South Carolina.
Charleston, South Carolina Study:
One recent study, which was completed on September 18, 2008 but has not been published yet, was conducted by Dr. Michael Mithoefer in Charleston, South Carolina. The study analyzed MDMA-assisted psychotherapy over long periods of time in 21 patients who underwent previous forms of PTSD treatment with unsuccessful results (http://www.maps.org/research/mdma/canada/protocol_09_08.pdf).
††††††††††† The experimenters first established a baseline of PTSD severity by completing a Clinical-Administered PTSD Scale (CAPS) measurement. The CAPS is a structured interview that assesses PTSD severity by analyzing how the much their anxiety disorder impairs their ability to function normally (http://www.ncptsd.va.gov/ncmain/ncdocs/assmnts/clinicianadministered_ptsd_scale_caps.html).
After and before each MDMA-assisted psychotherapy session over months, the experimenter compared the patientsí CAPS score changes to determine their progression through the entire overall experiment of MDMA-assisted psychotherapy. The CAPS score was the primary measure of PTSD levels for this experiment, and the Beck Depression Inventory (BDI) was the secondary measure, with each patientís depression levels measured before and after MDMA-assisted psychotherapy sessions as well. The primary outcome measure (CAPS score) takes about an hour to complete and is said to be fairly valid, reliable and consistent across multiple testing sessions. The Beck Depression Inventory is a short self-report measure of depressive symptoms that serves as a scale to measure depression (http://www.minddisorders.com/A-Br/Beck-Depression-Inventory.html). The experimenter also used the Post-Traumatic Diagnostic Scale (PDS) which is based off PTSD symptoms from Diagnostic Statistical Manual (DSM) standards. There was one independent experimenter rating every single individual after each psycho therapy session using multiple testing measures. Also, two additional measure of cognitive functioning, The Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and the Paced Auditory Serial Addition Task (PASAT) was taken at baseline and six weeks after the third experimental session. The PASAT is a measure of information processing speed and efficiency (http://www.pasat.us/).This was probably used to test whether the MDMA usage was having any neurotoxic effects by impairing mental functioning. Participants going to Phase 2 of the experiment ( those going on to do an additional fourth MDMA-assisted psychotherapy session) will also be assessed on all scales six weeks after the their additional session. Participants only doing Phase 1 (no more than 3 MDMA-assisted psychotherapy sessions) did not have any additional assessment of PTSD symptoms (http://www.maps.org/research/mdma/canada/protocol_09_08.pdf).
At each of these sessions, the experimenter doing each of these scales was not present during MDMA-assisted psychotherapy sessions. This experimenter was an independent assessor who remained blind to all experimental subjects during non-drug or MDMA-assisted psychotherapy sessions (http://www.maps.org/research/mdma/canada/protocol_09_08.pdf).
††††††††††† During the MDMA-assisted psychotherapy sessions a Subjective Units of Distress (SUD) scale was used to asses psychological stress levels during various points of the MDMA-assisted psychotherapy session. These test assesed the patients stress levels during experimentation (http://en.wikipedia.org/wiki/SUDS). Also, to assess the participantís degree of choice toward the experiment and their overall participation in the experiment, the participants took the Reaction to Research Participation Questionnaire (RRPQ) after their final study visit (after Phase 1 or 2). This scale basically determined the participants overall experience as a research subject, their reasons for consenting to being a research participant, and their overall freedom to take part in the study (http://www.personal.utulsa.edu/~elana-newman/RRPQ-Rforpdf.pdf).
††††††††††† Finally, all subjects in MDMA-assisted psychotherapy sessions were recoded on audio and video devices throughout every single session. The recordings were later used for further study to analyze the overall experiment in general including patient reactions with overall change and the experimentersí ability to perform procedures correctly and efficiently (http://www.maps.org/research/mdma/canada/protocol_09_08.pdf).
What were the conditions of the study and what were the procedures of MDMA assisted psychotherapy sessions?
Randomization, Pre-therapy Conditions, and Experimental and Control Conditions:
When the 21 participants started the study, they were each randomly assigned to one of two experimental groups. The two groups were an experimental group and an active placebo group. Each participant had a 66.6% chance to be in the experimental group and a 33.3% chance to be assigned to the active-placebo group. The experimental group, during each psychotherapy session first took a 125mg dosage of MDMA on an empty stomach with just liquids being consumed by each participant the at 12:00 AM before the experimental sessions. After the initial dose, the experimental group was then given a 62.5mg dosage (half the initial dosage of 125mg) 1.5 hours to 2.5 hours after initial consumption of the MDMA.
The active placebo group had the same pre-experimental conditions as the experimental group. Yet, this group first took a dosage of 25mg and a following dosage of 12.5 mg of MDMA 1.5 hours to 2.5 hours after the initial do the initial dose (http://www.maps.org/research/mdma/canada/protocol_09_08.pdf).
††††††††††† All participants underwent a course of psychotherapy sessions, two of which were non-drug sessions prior to the first experimental session. These sessions were sixty to ninety minute long introductory sessions. These introductory sessions were used to prepare for the MDMA-assisted experimental sessions by allowing the patient to develop a therapeutic bond with the experimenters they shared their entire overall experiences with. The experimenters consisted of a male and a female therapist. The prior sessions are also used to create a pleasant place for the participant to later confront unpleasant memories and experiences to the experimental therapists. (http://www.maps.org/research/mdma/canada/protocol_09_08.pdf).
††††††††††† All participants underwent three to five double-blinded experimental sessions which were three to five weeks apart. According to the study, each individual experimental MDMA-assisted session lasted about eight hours. All prior and experimental sessions were the same across each session and all procedure except drug dosage were the same for each participant assigned to either the experimental or active placebo group.
††††††††††† Each session started at 10:00 AM and took place at the offices of the principal investigator. The participants were not allowed to eat anything by mouth except alcohol-free liquids since 12 AM the night before. Initially, each participant arrived at approximately 9 AM so that experimenters could collect a urine specimen to check for drugs and pregnancy. If there were no other drugs detected and a negative pregnancy result, the procedures continued. If any of the urine tests came out positive, the participant was immediately withdrawn from the experiment (http://www.maps.org/research/mdma/canada/protocol_09_08.pdf).
††††††††††† The experimenters and the patients completed the SUD prior to the patientís initial dose and also discussed their goals, intentions and concerns along with the participantís thoughts about the effects of their MDMA sessions. The dosage started at 10 AM with each participant drinking a glass of water to help swallow the MDMA properly. After consumption, the sessions started with the participant lying down flat in a chair wearing sunglasses if preferable with their eyes closed. They listened to a program of music that was acceptable and soothing to the overall atmosphere of the experiment. The music was used to support and ease their experience by aiding in relaxation and later inducing deep emotions and the release of unconscious thoughts. Through the participantís experience, the experimenter was constantly supporting the participantís emotional states and processing and resolving any other psychological thoughts that were coming out. The review article (http://www.maps.org/research/mdma/canada/protocol_09_08.pdf) also stated that the therapists, at times throughout the sessions, would encourage moments of silence and reflection. This allowed the participant to focus inward to allow for the emergence of even more deeper inner experience. Water containing liquids, along with blood pressure measurements every half hour or so, were available and used in order to ensure a safe and healthy in the MDMA-assisted psychotherapy sessions (http://www.maps.org/research/mdma/canada/protocol_09_08.pdf).
††††††††††† Based on the experience the participants had on MDMA, the therapists often employed other touching techniques designed to heighten the participants experience and place them in an overall better state of mind. These techniques relaxed the patients and comforted them through tense moments of pain and resistance. These touching techniques were always performed only after the participantsí consent, always respecting patient-therapist professional boundaries. SUD scales were conducted prior to each session and every sixty to ninety minutes during the sessions (http://www.maps.org/research/mdma/canada/protocol_09_08.pdf).
††††††††††† The patients underwent an integrative ninety minute psychotherapy session the day after the experiment and on a weekly basis during the time after the MDMA-assisted psychotherapy sessions. During these sessions, the experimenters tried to influence and support the participantís creation of new perspectives of their experiences of the sessions and also discussed the overall understanding of the events the day before during the MDMA-assisted sessions. The experimenter did this to resolve any of the patientís negative attitudes about their experience by comforting them in any way to ensure an overall beneficial and more positive MDMA-assisted psychotherapy experience
††††††††††† Overall after the sessions the goal was to restructure the participants mind cognitively by allowing the release of tensions, changing emotions within their minds, increasing their awareness of †past and present experiences, and lastly, making the participants create an overall new positive association of the traumatic experiences with a more pleasant emotional experience through the MDMA-assisted psychotherapy sessions. In other words, the participants were re-associating there traumatic experience with a more acceptable and enjoyable one, allowing for the dampening and potential treatment of post-traumatic stress symptoms and experiences. The entire experiment as a whole can almost be considered a form of operant behavioral conditioning therapy because it intended to make patients associate bad traumatic experiences of an event with new pleasant experiences during their sessions of MDMA-assisted psychotherapy treatment
††††††††††† Since this study was just recently completed on September 18, 2008, the experimental report has not even been published yet. This article (http://www.maps.org/mdma/swissptsd/protocol011806.pdf) states that the Charleston, South Carolina Study showed that all MDMA-assigned participantís CAPS scores were greatly reduced two months after the second experimental session, while only one out of the four active-placebo participants showed an improvement in their CAPS score. These results support the fact that MDMA-assisted psychotherapy helped alleviate PTSD patients who were assigned to the experimental group because most of the active-placebos didnít see reduction of their PTSD symptoms and experiences.
Other experiments sponsored by MAPS that were conducted in Israel and Switzerland all show similar results. These other experiments were conducted with the exact same procedures and tests for the same duration of time. The experimenters analyzed their data by graphing the time course of their CAPS scores from their baseline values. †They found an association between CAPS score changes and time in MDMA- assisted psychotherapy sessions for the experimental group, with little of no association between placebo-control groups and their time across sessions. These other experiments were conducted in the same fashion so that meta-analysis can be applied across different MDMA-assisted psychotherapy experiments. With meta analysis across studies, scientists have a more accurate and valid way of determining whether MDMA-assisted psychotherapy can truly treat patients suffering from PTSD (http://www.maps.org/mdma/israel_protocol_3.16.05.pdf).
Based on the fact that the experimental and active placebo groups of the South Carolina study were so small, it is hard to determine whether MDMA-assisted psychotherapy treatment truly can treat and possibly sure PTSD victims. After more studied using the same procedures, experimenters will be able to generalize their findings and find the answer they are looking for. These results suggest that in the future, further studies will lead to the similar results, possibly allowing MDMA to become FDA approved and eventually produced on the pharmaceutical market as a valid treatment for PTSD when used in conjunction with psychotherapy. The drug will never be prescribed and distributed to PTSD patients by physicians because of the fact that MDMA can me a mentally (not physically) addicting controlled substance that must be used with extreme caution and care under the supervision of professional therapists and experimenters (http://www.maps.org/mdma/swissptsd/protocol011806.pdf).
Hopefully, the government will realize that although dangerous when abused, the benefits of MDMA-assisted psychotherapy definitely outweigh its cons. The government is spending billions of dollars at the moment to treat patients with PTSD through the use of ineffective psychological therapy. With the production and acceptance of MDMA-assisted psychotherapy into society, government costs would be greatly reduced by hundreds of billions of dollars. Based on the state of our economy, and the overall increase in PTSD patients from exposure to war in Iraq, it is an issue that the government should definitely look into in order to both save us government spending and help treat victims of this untreatable psychological anxiety disorder (http://ptsdcombat.blogspot.com/2007/11/ptsd-research-ecstatic-about-mdma.html).
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