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Psychedelics are being increasingly researched as a novel method of augmenting the effectiveness of psychotherapies for the treatment of mental health conditions. The most studied psychedelics to date include psilocybin and 3,4-methylenedioxymethamphetamine MDMA. Despite the effectiveness of current evidence-based treatments for PTSD and depression, many people do not benefit enough from these treatments. One exciting area of research is examining psychotherapy augmentation strategies with psychedelic drugs, a subclass of hallucinogenic drugs that trigger non-ordinary states of consciousness. They 'alter perception and mood and affect numerous cognitive processes' 1. Two specific psychedelic compounds, MDMA often referred to as a non-classic psychedelic and psilocybin, have received most of the research attention to date. While these are both still Schedule I substances—drugs with high abuse potential and no currently accepted medical use—ongoing research efforts have found support for using these compounds in conjunction with therapy to treat various mental health conditions, including PTSD. MDMA is a monoamine releaser and re-uptake inhibitor with indirect effects on neurohormone release. The effects of MDMA include reduced fear 2 , increased social engagement 3 , increased openness 4 , increased receptiveness to positive affect 5 , increased empathy and compassion 6,7 , increased feelings of closeness 8 , and increased disclosure of emotional content 9. MDMA targets memory reconsolidation and fear extinction processes, allowing for expanded perspectives and positive, affirming experiences. The premise for MDMA-AT is that the therapeutic effects of MDMA are the result of an interaction between the medicine, the psychotherapy component, and the mindset of the participant and the therapists involved. These key areas help individuals with PTSD to overcome avoidance and better address their PTSD symptoms while working through their trauma under the guidance of a therapist. To date, the greatest evidence base is for the Lykos Therapeutics 'Lykos'; formerly MAPS Public Benefit Corporation protocol 26 , which includes twelve min therapy sessions plus three hour medicine sessions. The medication sessions are separated by at least 21 days, and each requires the engagement of 2 therapists. There are three minute preparation sessions prior to the first medicine session and each medicine session is followed by three minute integration sessions during which the patient has an opportunity to process their experience with the therapist s. Two recent randomized placebo-controlled phase 3 trials of the Lykos MDMA-AT protocol have demonstrated treatment efficacy with large effect sizes. In both trials, PTSD symptom severity significantly decreased more for participants who were administered MDMA-AT than for participants who received placebo and therapy, supporting the therapeutic value of MDMA itself as an addition to psychotherapy Four additional phase 2 studies focused on dose response, with all studies finding that participants in MDMA-AT were more likely to achieve clinically significant PTSD reductions than those in the control group Although MDMA-AT has historically been used with a non-directive therapy approach to help individuals process traumatic memories, as of February , several studies are underway to explore whether MDMA-AT could be further enhanced by augmenting established evidence-based trauma-focused therapies that have been rolled out in VA. These studies will inform next steps for larger clinical trials and implementation. Psilocybin is the active ingredient in a variety of hallucinogenic mushrooms. When ingested, psilocybin is converted to psilocin, which then acts as an agonist at several serotonergic and non-serotonergic receptors. Psilocybin has been shown to have low physiological toxicity i. Individuals who take psilocybin report a wide range of experiences for hours depending on the dose, including visual imagery of multicolored geometric shapes, vivid imaginative sequences, synesthesia i. These psychedelic experiences are often of great personal significance Of note, psilocybin remains a Schedule I drug, although as of February , Australia, the states of Oregon and Colorado, and the Canadian state of Alberta have legalized psilocybin for medicinal purposes in supervised settings. Similar bills are currently underway in the states of California, Washington, New Jersey, and Massachusetts. Although psilocybin has shown efficacy for treating depression, anxiety, and substance use , there has been minimal research on its impact on PTSD symptoms. Psychedelics can also decrease amygdala reactivity during emotion processing 49,50 , which may reverse the heightened amygdala reactivity typically seen in PTSD 51 , thereby increasing the ability to process traumatic memories. Psilocybin also increases emotional empathy 51 , mindfulness-related capacities 52,53 acceptance, and connectedness while reducing avoidance 54 , which may all facilitate PTSD treatment. Alongside sessions of supportive psychotherapy, psilocybin administration may help those with PTSD tolerate challenging emotions and address the traumas that they have experienced, while also finding new perspectives on unhelpful or negative thoughts. P-AT is showing promise as a powerful treatment for a variety of mental health conditions including treatment-resistant unipolar depression 39 , depression and anxiety secondary to serious medical illnesses like cancer 40,55,56 , and substance use disorders 41, Typical P-AT protocols include a non-directive psychotherapy component focused on preparation and integration of the psychedelic experience, with some including established cognitive behavioral therapeutic modalities, such as Acceptance and Commitment Therapy 58 , as part of integration. Protocols typically have about six minute therapy sessions and one to two 6- to 8-hour administration sessions A recent meta-analysis on the effects of P-AT on anxiety and depression showed large and statistically significant reductions of anxiety In the placebo-controlled studies included in the meta-analysis, these results were maintained, indicating the therapeutic potential of psilocybin for treating anxiety and depression. Although there is currently no published data on psilocybin use for treating PTSD, the strong impact of psilocybin on conditions that often co-occur with PTSD, such as depression and anxiety, indicates the potential beneficial impact of the psilocybin augmented PTSD treatment. While clinical trial data are lacking, anecdotal clinical data from the ss suggests that psychedelic therapy can help individuals deal with severe trauma 61, More recently, a survey of U. Finally, preliminary data suggests that a single administration of psilocybin along with group psychotherapy can decrease symptoms of PTSD in older long-term AIDS survivors For a review of psilocybin use for treating trauma-related disorders, please see Khan et al. There are ongoing trials of P-AT for alcohol use disorder, depression, and obsessive-compulsive disorder, among others. Although these studies are oriented toward preliminary evaluation and establishing feasibility and thus have small sample sizes, the results of this research will inform future research studies in P-AT for PTSD, which may include larger-scale trials. While the double-blind randomized controlled trial RCT is considered the gold standard design for identifying treatment-specific effects, the strong physical and psychological effects of psychedelics create difficulties effectively conducting blinded, controlled trials. Participants and investigators can typically tell if the person received the investigational product or a placebo thus breaking the blind. Failing to keep patients and researchers and staff uncertain of treatment condition assignment i. If participants know they have received the psychedelic treatment they already believe will improve their symptoms, this alone can improve clinical outcomes i. Conversely, if participants know they received a treatment they already believe is unlikely to improve their symptoms, e. Use of 'active' placebos that mimic aspects of the psychedelic experience is essential, as is the use of masked assessors. Study staff also should be masked to the extent possible. The adequacy of masking for both patients and providers should be assessed, along with patients' treatment expectations before treatment. Despite the large effects of expectancies on treatment outcomes in psychedelic RCTs, baseline treatment expectancies and masking efficacy typically go unmeasured Indeed, many researchers report their psychedelic studies as 'double-masked' without testing such claims There is a critical need for trial designs with psychedelics to better manage expectancy effects Many existing studies on MDMA-AT and P-AT also include small sample sizes and maintain some risk of bias, particularly with lack of randomization and unexpectedly high response to low dose control conditions 59,73, Therefore, there is an urgent need for additional studies with Veteran participants within the VA medical setting, as well as additional studies on P-AT for PTSD and studies with larger, more diverse samples. Both MDMA-AT and P-AT protocols emphasize 'set and setting', or the preparation of the patients for medicine administration as well as the creation of a safe and welcoming environment for dosage, as essential to safety and effective treatment There are 2 essential components of set and setting, both of which influence the individual's response to the drug and the overall experience during the medicine session. Set consists of the expectations and intentions that the patient comes in with, whereas setting refers to the physical, social, and cultural context in which the drug is taken Protocols also typically require the presence of 2 therapists for all medicine administration sessions, though only one is required to be present during other pre- and post-administration sessions in some cases It can be difficult to optimize both set and setting for a patient when attempting to implement psychedelic-assisted psychotherapy. Medicine sessions are optimal under specific physical settings, aspects of which may be hard to achieve if there is limited space available for private use for extended periods of time or restrictions on physical alterations that can be made to the space being used. It is important to note that current studies examining P-AT and MDMA-AT include rigorous medical and psychological eligibility criteria, with exclusion criteria preventing many individuals with PTSD from being eligible for the studies. While there will likely be fewer inclusion and exclusion criteria for clinical care, there will still be several medical conditions that would pose safety concerns if the patient were to take MDMA, such as uncontrolled hypertension, underlying cardiovascular or cerebrovascular disease 78 , and symptomatic liver disease. While P-AT protocols differ in some ways, administration sessions last an average of 7. The time demands of either treatment could serve as a barrier to patients with inflexible schedules due to work, childcare, other medical care, etc. It is also often required that 2 providers attend, at minimum, all medicine sessions with patients, which typically takes up the entire workday for both therapists. Information on the Lykos model and research can be found on the Lykos Therapeutics website. Veterans Crisis Line: Call: Press 1. Complete Directory. If you are in crisis or having thoughts of suicide, visit VeteransCrisisLine. Quick Links. Site Map.

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MDMA's first identified potential as a therapeutic catalyst was for couple therapy. Early work in the s and s explored its potential amongst seasoned psychotherapists and their clients. With the completion of the first pilot trial of MDMA-assisted psychotherapy with couples for PTSD, and as the possibility of conducting MDMA-assisted psychotherapy trials expands due to new regulatory frameworks, we have an opportunity to explore and investigate how and why MDMA-assisted couples therapy works. A model to support MDMA-assisted couple therapy is introduced, and future directions, including implications for intervention development and delivery, will be elucidated. Couple therapy offers the opportunity to heal, grow and change while in relationship. Given that people do not exist in isolation, it creates the context to change in the milieu in which people live their lives. The current paper offers an examination of the reasons for why, and how, a transtheoretical model of MDMA-assisted couple therapy may be an important contribution to couple therapy treatment options. This mini review provides an overview of MDMA, how MDMA functions in an interpersonal context, including its neurochemical, psychological and subjective effects, and how these effects translate into therapeutic outcomes in a transtheoretical approach to MDMA-assisted couple therapy. Potential pathways of action are introduced, and a model to support the enhancement of these treatment outcomes is outlined. Couple therapy can be utilized for primarily relationally-oriented presenting problems e. Findings from dyadic interventions for specific diagnoses demonstrate improvement in both mental health outcomes OCD, PTSD, depression , relationship satisfaction and functioning for both partners Baucom et al. Each of these presenting foci can be approached from a variety of therapeutic modalities e. Common factors among effective couple therapies include objective, shared understanding of the presenting concerns, decreasing emotion-driven dysfunctional behavior, increasing emotion-driven avoided behavior, improving communication and bolstering strengths and gains Benson et al. The impact of relational distress has ramifications not only on the relationship, but also each partner's mental health and the functioning of broader family systems Atkins et al. While couple therapy can reduce relationship distress and increase relationship satisfaction, many couples do not benefit or may not maintain gains over time Baucom et al. Alternative couple treatment options which can enhance common effective factors are therefore needed. The 5-HT2 receptor plays a contributing role in its effect Liechti et al. MDMA elevates serum oxytocin Wolff et al. MDMA causes a decrease in cerebral blood flow to the amygdala and hippocampus, an increase in activity in the prefrontal cortex, action in the occipital cortex and insula, and a decrease in functional connectivity between the hippocampus and prefrontal cortex, and an increase between the hippocampus and amygdala Gamma et al. Greer and Tolbert , conducted a series of cases of MDMA-assisted psychotherapy, including with couples, that demonstrated improvements in fear of emotional hurt and improved communication and introspection. Reports suggest that MDMA had broad use by psychotherapists in non-research settings e. With recent re-initiation of MDMA-assisted therapy research, long term follow-ups of individual MDMA-assisted psychotherapy for posttraumatic stress disorder PTSD demonstrate that almost two thirds of participants reported improved relationships with loved ones following treatment Jerome et al. Findings from the study include improved PTSD scores, relationship satisfaction, posttraumatic growth, and improved social intimacy for the partner with PTSD Monson et al. These pilot trial results are promising, and suggest the potential for non-diagnostic specific MDMA-assisted couple therapy, given the significant improvements in relationally oriented outcome measures. MDMA's empathogenic qualities have made it a prime candidate as an adjunct to psychotherapy. When considering the couple therapy context, understanding the neurochemical experience related to romantic love illuminates this potentially catalytic combination. The hormones and neurotransmitters most closely associated with the experience of love include oxytocin and vasopressin linking to attachment and bonding , dopamine and serotonin causing pleasure and positive mood , and the brain areas most impacted include the amygdala registering threat, happiness and fear , prefrontal cortex related to reasoning and the hippocampus engagement with thoughts and memories , as well as the caudate nucleus registering love and the hypothalamus registering lust e. The similarities in these areas of action, and notably the release of oxytocin which can help facilitate interpersonal trust, attachment, bonding, forming affection Kosfeld et al. Notably, several studies have failed to show a relationship between the social effect of MDMA and oxytocin e. Additionally, the increase in cortisol and noradrenergic response with MDMA can raise levels of arousal Mas et al. Synthesizing the literature on the psychological, subjective and perceived effects of MDMA, the following offers a distillation of pathways in which MDMA may assist couple therapy. In experimental contexts of emotion processing, including fMRI, psychophysiological measures and self-report studies, MDMA has been found to facilitate the perception of positive emotional expressions, empathy, and reduce the social pain associated with negative emotional expressions perceived from others and social rejection Bedi et al. MDMA has been found to improve identification of emotions in others, as well as increase prosocial feelings Bedi et al. MDMA has also been found to increase attention to positive emotional cues Bershad et al. In therapeutic contexts, MDMA allows for the experiencing of challenging emotions, as well as increased compassion and decreased defensiveness e. MDMA has also demonstrated a reduction in anxiety in therapeutic contexts e. In couple therapy, facilitating the sharing of emotional content leads to improved closeness and satisfaction e. MDMA can support this experience. Painful feelings can be seen as useful in the therapeutic process, feelings of love and deep appreciation can emerge, and attenuating the fear response to threat of emotional integrity can help support the full experience of emotion by reducing defensiveness Metzner and Adamson, ; Stolaroff, MDMA is associated with seeing others as empathetic and caring, beyond the effects of oxytocin release alone Hysek et al. The experience of feeling empathetic toward oneself and others when in an MDMA session allows for an unfettered experience of the emotion and present moment, which outside of this context often gets marred by the presence of old memories, the drive to be right or heard, or distress, pulling the person out of the moment. The perceived psychological cognitive effects of MDMA include being able to engage with difficult memories, likely due to a reduction in perceived threat and increased interpersonal trust Kosfeld et al. Neuroimaging results demonstrate that negative memories may be perceived as more tolerable following MDMA Carhart-Harris et al. Additionally, memories, including those with strong emotional content, can be engaged with differently and fear extinction can occur when engaged in the memory Young et al. MDMA also increases reported perceptions of trust Stewart et al. There is evidence that there is a reopening of a critical learning period for social interaction with MDMA in mice, allowing for new learning about social interactions to occur Nardou et al. If translatable to humans, this offers an immense opportunity for new learning to occur, which then spans into the next category, behavior. MDMA has been shown to alter speech, increasing social and sexual words and a willingness to disclose personal information Baggott et al. MDMA has also been shown to increase cooperation Gabay et al. Therapeutically, MDMA can create a reduction in experiential avoidance and engagement in challenging content emotional and cognitive without disorientation, including a desire to communicate Feduccia and Mithoefer, ; Wagner et al. Increased openness to experience, which can facilitate greater engagement and risk-taking in vulnerability in interpersonal relationships, has been shown to increase following MDMA-assisted psychotherapy Wagner et al. Reports of increased introspection and improved communication collectively create a behaviorally rich opportunity for relational processing and engagement for the couple e. The somatic effects of MDMA, specifically linked to psychological processes, can include strong physiological sensations related to past experiences, which are helpful to re-experience in the supportive container of the therapeutic setting Mithoefer et al. Somatic effects can be linked to any of the cognitive or emotional content arising, including memories Wagner et al. Additionally, soothing or calming somatic effects can occur, which can offer supportive experiences for the couple. Reduced fear response and increased feelings of closeness may help amplify these supportive somatic experiences, and allow for immersion into difficult ones as needed. Results from brain imaging after MDMA demonstrate greater reward from happy facial expressions and less reactivity to angry facial expressions Bedi et al. Principles are derived from effective couple therapy Benson et al. Functionally, it is recommended that practitioners begin with a thorough assessment process to understand the commitment levels and distress of the clients, any co-occurring mental health challenges, the couples' history and to understand their goals for the therapeutic process. Following assessment, feedback and a collaborative case conceptualization with the couple are recommended to understand their particular strengths and challenges. Preparation for the MDMA-assisted sessions would then occur across a series of psychotherapy sessions ranging from one multi-hour session to several shorter sessions, depending on the needs of the clients. Preparation consists of creating a shared language for the sessions through the learning and practice of empathic communication skills, emphasizing the softening of language to facilitate empathy. Intention setting, and practical preparation for the session should be covered. The MDMA sessions themselves allow for an open experience without agenda, with the therapist s serving as facilitator for conversations, and navigating the needs of both individuals to ensure both have the opportunity for deep internal reflection as well as communication together. Integrative sessions allow for processing of the experience in the MDMA sessions, inquiry regarding insights, empathy and shared experiences, and application and exploration of learnings to the couples' stated goals and future. The therapeutic process with MDMA-assisted therapy offers the unique opportunity to create a framework to support an experience that will then be able to serve as a template for future interactions, with MDMA sessions themselves serving as a catalyst. See Figure 1 for a summary of the therapeutic process. Creating a safe setting physically and emotionally , as has been well described in psychedelic-assisted therapy literature e. For couples, this includes discussions of safety related to disagreements encouraging a process of stopping disagreements before they escalate and returning to conversations when they are more settled , and of no interpersonal violence. This also extends to safety and the structure of approaching the experience together, including the development of shared intentions for the sessions, and the safety of knowing they will have space to integrate together afterwards. Introducing and practicing communication skills can allow for a shared language and understanding of how to communicate effectively. This structure may allow for a deeper experience in the MDMA session, knowing there is a scaffold to tether to in terms of how to discuss what emerges, which can help mitigate fear, and create safety. Fostering an environment of curiosity, openness and non-avoidance experientially, emotionally and behaviorally to support the relationship and prevent difficulties rooting over time in preparation before, during the MDMA session, and throughout integration, encourages a full experience of emotions, their expression and communication. Facilitating the process of recapping the insights, shifts, and gains throughout the therapeutic process can help orient the couple to their unfolding experience, and can help solidify their learnings, as there can be a tendency to revert to old patterns in any couple process over time. Encouraging the exploration of difficult conversations and highlighting the shared experience they are having can help to create the conditions for empathy and bonding, as well as perceptions of social support. Through this process, the couple is creating a template for how to communicate effectively, how to debrief together, and how to navigate intense emotional experiences for the future. By establishing a stance of fostering trust and openness to whatever emerges in the therapy process, this can help model the experience for their relationship. Supporting non-avoidance and highlighting strengths in the relationship, as well as their ability to navigate stressors, can help foster trust in themselves and each other. This synthesis of the literature demonstrates the potential usefulness of MDMA as a catalyst to couple therapy, given its neurochemical actions, and emotional, cognitive, behavioral and somatic effects. These principles are suggested as common factors that can enhance and guide the MDMA-assisted couple therapy experience, and future research is needed to test this framework in application. Additionally, future research can investigate, in both interventional and experimental contexts, the neurochemical and subjective experiences of MDMA in a dyadic context, as the majority of research has been conducted with individuals, not as couples. This synthesis also has implications for treatment development, including the testing of MDMA-assisted couple therapy for the reduction of relationship distress and enhancement of relationship satisfaction. In the recent resurgence of MDMA-assisted therapy research, the majority has been to treat psychiatric disorders, such as PTSD, social anxiety and anxiety related to life-threatening illness Danforth et al. MDMA-assisted couple therapy is a prime opportunity to extend these investigations beyond psychiatric diagnosis, while targeting outcomes that have broad and important impact on peoples' lives. Notably, very limited MDMA-assisted couple therapy has been conducted in a research context, and therefore this mini review and proposed model is limited in scope to theorized mechanisms and pathways of action, and is preliminary in nature. Altogether, this review suggests that the neurobiological and neurochemical effects of MDMA in a relational context, and the emotional, behavioral, cognitive and somatic effects within a dyadic frame guided by the SET model can be harnessed to facilitate meaningful interpersonal healing and growth. The author confirms being the sole contributor of this work and has approved it for publication. The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Atkins, D. Couple discord and depression in couples during couple therapy and in depressed individuals during depression treatment. Baggott, M. Intimate insight: MDMA changes how people talk about significant others. Bartz, J. The neuroscience of affiliation: forging links between basic and clinical research on neuropeptides and social behavior. Baucom, D. Empirically supported couple and family interventions for marital distress and adult mental health problems. Couple-based interventions for psychopathology: couple-based interventions for psychopathology. Bedi, G. A window into the intoxicated mind? Speech as an index of psychoactive drug effects. Neuropsychopharmacology 39, — Biol Psychiatry 68, — Effects of MDMA on sociability and neural response to social threat and social reward. Psychopharmacology , 73— Benson, L. Common principles of couple therapy. Bershad, A. Effects of MDMA on attention to positive social cues and pleasantness of affective touch. Neuropsychopharmacology 44, — Borissova, A. Acute effects of MDMA on trust, cooperative behaviour and empathy: a double-blind, placebo-controlled experiment. Carhart-Harris, R. The effects of acutely administered 3, 4-methylenedioxymethamphetamine on spontaneous brain function in healthy volunteers measured with arterial spin labeling and blood oxygen level-dependent resting state functional connectivity. Psychiatry 78, — Carter, C. Christensen, A. Marital status and satisfaction five years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy. New York, NY: W. Google Scholar. Interventions for couples. Danforth, A. Reduction in social anxiety after MDMA-assisted psychotherapy with autistic adults: a randomized, double-blind, placebo-controlled pilot study. Psychopharmacology , — Domes, G. Oxytocin attenuates amygdala responses to emotional faces regardless of valence. Psychiatry 62, — Doss, M. MDMA impairs both the encoding and retrieval of emotional recollections. Neuropsychopharmacology 43, — Dumont, G. Increased oxytocin concentrations and prosocial feelings in humans after ecstasy 3,4-methylenedioxymethamphetamine administration. Repeated doses administration of MDMA in humans: pharmacological effects and pharmacokinetics. Feduccia, A. Psychiatry 84, — Fischer, M. Cognitive-behavioral couple therapies: review of the evidence for the treatment of relationship distress, psychopathology, and chronic health conditions. Fisher, H. Reward, addiction, and emotion regulation systems associated with rejection in love. Frye, C. MDMA decreases the effects of simulated social rejection. Gabay, A. MDMA increases cooperation and recruitment of social brain areas when playing trustworthy players in an iterated Prisoner's Dilemma. Gamma, A. Neuropsychopharmacology 23, — Greer, G. Subjective reports of the effects of MDMA in a clinical setting. Psychoactive Drugs 18, — A method of conducting therapeutic sessions with MDMA. Psychoactive Drugs 30, — Grob, C. Psychobiologic effects of 3,4-methylenedioxymethamphetamine in humans: methodological considerations and preliminary observations. Brain Res. Hake, H. Harris, D. Subjective and hormonal effects of 3,4-methylenedioxymethamphetamine MDMA in humans. Hasler, F. Holland, J. Hysek, C. Effects of the alpha 2 -adrenergic agonist clonidine on the pharmacodynamics and pharmacokinetics of 3,4-methylenedioxymethamphetamine in healthy volunteers. MDMA enhances emotional empathy and prosocial behavior. Jerome, L. Johnson, S. Relating process to outcome in marital therapy. Marital Fam. Kosfeld, M. Oxytocin increases trust in humans. Nature , — Kuypers, K. No evidence that MDMA-induced enhancement of emotional empathy is related to peripheral oxytocin levels or 5-HT1a receptor activation. Multifaceted empathy of healthy volunteers after single doses of MDMA: a pooled sample of placebo-controlled studies. Liechti, M. Which neuroreceptors mediate the subjective effects of MDMA in humans? A summary of mechanistic studies. Mas, M. Cardiovascular and neuroendocrine effects and pharmacokinetics of 3, 4-methylenedioxymethamphetamine in humans. PubMed Abstract Google Scholar. Metzner, R. Mithoefer, M. MDMA-assisted psychotherapy for treatment of PTSD: study design and rationale for phase 3 trials based on pooled analysis of six phase 2 randomized controlled trials. Monson, C. Effect of cognitive-behavioral couple therapy for PTSD: a randomized controlled trial. JAMA , — MDMA-facilitated cognitive-behavioral conjoint therapy for posttraumatic stress disorder: an uncontrolled trial. Nardou, R. Oxytocin-dependent reopening of a social reward learning critical period with MDMA. Passie, T. Drug Sci. Policy Law Phelps, E. Activation of the left amygdala to a cognitive representation of fear. Sanford, K. Hard and soft emotion during conflict: investigating married couples and other relationships. Stewart, L. Effects of ecstasy on cooperative behaviour and perception of trustworthiness: a naturalistic study. Stolaroff, M. The Secret Chief Revealed. Neuropsychopharmacology 36, — Wagner, A. Psychiatry Psychoactive Drugs 51, — Wagner, M. Therapeutic effect of increased openness: investigating mechanism of action in MDMA-assisted psychotherapy. Walpola, I. Altered insula connectivity under MDMA. Neuropsychopharmacology 42, — Wardle, M. MDMA alters emotional processing and facilitates positive social interaction. Wolff, K. Vasopressin and oxytocin secretion in response to the consumption of ecstasy in a clubbing population. Wolfson, P. MDMA-assisted psychotherapy for treatment of anxiety and other psychological distress related to life-threatening illnesses: a randomized pilot study. Sci Rep. Young, M. Psychiatry 5, 1—8. Inhibition of serotonin transporters disrupts the enhancement of fear memory extinction by 3, 4-methylenedioxymethamphetamine MDMA. Zeki, S. The neurobiology of love. FEBS Lett. The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Wagner, dr. Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. Top bar navigation. About us About us. Sections Sections. About journal About journal. Article types Author guidelines Editor guidelines Publishing fees Submission checklist Contact editorial office. Anne C. Introduction Couple therapy offers the opportunity to heal, grow and change while in relationship. Table 1. Areas of focus for MDMA-assisted couple therapy outcomes. Figure 1. MDMA-assisted couple therapy structure.

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