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5% of the US population is
affected by PTSD each year.
I’ve recently been immersing myself in virtual stacks of studies and scholarly articles. It’s not
easy for a civilian like me to grasp the technical language and intricate concepts within fields
such as neuroscience, pharmacology, psychology, and philosophy. Nevertheless, it feel like a
worthwhile endeavor to learn more about issues that affect us all.
One study, published in the British scientific journal Nature, highlights promising advancements in the treatment of post-traumatic stress disorder (PTSD) using MDMA-assisted therapy. This article, written by Mitchell et al. (2023), is called “MDMA-Assisted Therapy for Moderate to Severe PTSD: A Randomized, Placebo-Controlled Phase 3 Trial.” And while the title is unlikely to cause great upheaval, the results just might.
According to U.S. Department of Veterans Affairs, 5% of the US population is affected by PTSD each year. That’s equivalent to every NFL stadium being filled to capacity 17 times over. It’s also approximately equal to the combined populations of New Jersey and Virginia. In 2018 alone, the total excess US economic burden of PTSD was $232 billion (Davis et al., 2022 ).
Everyone experiences trauma, some much more severely than others. And everyone processes their trauma in different ways, some more effectively than others. Dr. Besser van der Kolk is one of the authors of the study we’re discussing today. In his groundbreaking book on trauma, The Body Keeps the Score, Dr. van der Kolk says, “While we all want to move beyond trauma, the part of our brain that is devoted to ensuring survival (deep below our rational brain) is not very good at denial. Long after a traumatic experience is over, it may be reactivated at the slightest hint of danger and mobilize disturbed brain circuits and secrete massive amounts of stress hormones. Feeling out of control, survivors of trauma often fear that they are damaged to the core and beyond redemption.”
When trying to better understand complex topics such as the way in which trauma affects us, I often find myself wrestling with analogies. Today, in late-November 2023, the threat of a volcanic eruption in Iceland made me think about how a volcano might be similar to PTSD: a traumatic experience—or an accumulation of such experiences—builds beneath the surface like a magma chamber, with comorbidities such as sleeplessness, substance use disorders, and anxiety acting as warning signs. Then an eruption of flashbacks, anger, or panic attacks occurs. Where this analogy fails is regarding the possibility of controlling or even rendering dormant these symptoms with new treatments that could soon become widely accessible.
By the end of the study in November 2022, 37 of the 52 (71.2%) participants from the MDMA group no longer met the criteria for PTSD
In Mitchell et al.’s (2023) study, 104 participants with moderate to severe PTSD were initially
recruited. However, nine participants withdrew before the study concluded. Of the 95
participants who completed the study, 52 were given MDMA-assisted therapy and 43 received a placebo (one participant from the placebo group was excluded from the final results). The results showed that, with three treatment sessions, 45 of 52 (86.5%) of the MDMA-assisted therapy group participants experienced “clinically meaningful improvement” (as specified by the study’s protocol) during the 18-week period after beginning the treatment versus 29 of 42 (69%) participants from the placebo-assisted therapy group. By the end of the study in November 2022, 37 of the 52 (71.2%) participants from the MDMA group no longer met the criteria for PTSD, versus 20 of the 42 (47.6%) participants from the placebo group. At the end of the study, 24 of the 52 (46.2%) participants in the MDMA group met the criteria for remission, versus 9 of the 42 (21.4%) participants in the placebo group. In this study, neither the participants nor the researchers knew who received or did not receive the MDMA- or placebo-assisted therapies.
There are some interesting aspects of this study that should be noted. For example, ethnically or racially diverse participants comprised approximately half of the sample. This is especially important because, according to a study by de Silva et al. (2021), “There is evidence that African Americans experience higher rates of PTSD and are more likely to develop PTSD following trauma exposure than Whites, and discrimination may be one reason for this disparity.” What is also relevant to the US and other countries globally is that “refugees and asylum seekers often report experiencing direct exposure to multiple types of complex traumatic experiences (Teodorescu et al., 2012), including sexual violence, torture, imprisonment, enforced isolation, physical assault, and the murder of friends or family members” (Liddell, et al., 2019).
Trauma mostly happens unexpectedly, and these experiences can affect us in equally
unexpected ways. Josef Breuer and Sigmund Freud (1893) said that “the psychical trauma—or more precisely memory of the trauma—acts like a foreign body which long after its entry must continue to be regarded as an agent that still is at work.”
Despite our ongoing ambivalence about psychedelics, especially those that are listed or have been listed as Schedule I drugs, the best options for removing those “agents,” as Breuer and Freud called them, must be made available to those who need them the most no matter our perception of the substances, as long as we're certain of their safety. Thanks in large part to clinical trials like this one, it is expected that MDMA’s use in psychotherapy will be given Federal Drug Administration (FDA) approval sometime in 2024. We can hope that they will be made widely available by 2025.
One aspect of the study that I thought could have been clearer is the efficacy rate of MDMA-assisted therapy compared, not just to the placebo-assisted group, but to a psychotherapy-only group as well. Would the psychotherapy-only group have yielded the same results as the placebo-assisted group? Is that an assumption we should read into the study? Either way, the placebo-assisted group data seems to indicate that we have the ability to open our own pathways to healing when combined with therapy and strong integration protocols.
This and other studies like it should offer a beacon of hope for all those grappling with PTSD, as it suggests promising methods for neutralizing the threat of the volcano within before a cataclysmic eruption can happen.
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