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Behavioural techniques can produce similar self-directed affiliation. For example, compassionate imagery CI and ecstasy reduce self-criticism and increase self-compassion to a similar extent, with the effects of CI enhanced in the presence of ecstasy. Here, we examine self-compassion and self-criticism in recreational users who consumed chemically verified MDMA in a within-subjects crossover study. Effects on state self-criticism, self-compassion and emotional empathy were assessed before and after MDMA use or over an extended baseline period on the occasion that MDMA was not consumed and reassessed after CI. Establishing the observed effects in controlled studies will be critical for determining the combined utility of these approaches in fostering adaptive self-attitudes in a therapeutic context. Its subjective interpersonal effects are well documented in recreational users Sumnall et al. Similar subjective effects are seen in controlled laboratory experiments with 3,4-methylenedioxymethamphetamine MDMA; Kamilar-Britt and Bedi , the primary constituent of most street ecstasy Brunt et al. MDMA may have unique potential as an adjunct to psychotherapy for disorders characterised by heightened interpersonal threat, concerns about social evaluation and deficits in understanding of interpersonal communication Danforth et al. A number of biological and neuropsychological mechanisms have been proposed to account for these potential therapeutic effects. Behavioural studies, for example, indicate that MDMA increases emotional empathy and reduces aspects of cognitive empathy Kamilar-Britt and Bedi In addition, evidence from multiple experimental paradigms e. Bershad et al. Since oxytocin is implicated in attachment behaviour, altruism and cooperation Campbell , its enhanced release could result in a strengthening of the therapeutic relationship and increase the willingness of patients to disclose private and painful memories during MDMA-assisted psychotherapy. In addition, MDMA might promote changes in dysfunctional self -referential attitudes, especially when used in conjunction with behavioural procedures that aim to modify these attitudes Kamboj et al. The goal of changing dysfunctional self-attitudes and beliefs e. In cognitive therapy, for example, this involves encouraging patients to generate compassionate responses to self-attacking thoughts Kelly et al. The inwardly directed affiliation promoted by techniques used in compassion-focused therapy, such as compassionate imagery, may also be generated or augmented by oxytocin release. In fact, intranasal oxytocin administration Rockliff et al. Such resilience can be inculcated through repeated and disciplined cognitive training regimes that enhance emotion regulation and down-regulate stress. An example of such training is mindfulness, although other approaches from Eastern meditative traditions—including compassion-oriented practices—have also been adopted in contemporary psychiatric and psychotherapy practice D'Silva et al. Despite the potential benefits of using compassion-oriented contemplative techniques as therapeutic strategies, individuals vary in their trait capacity for compassion and may find self-directed compassion-oriented strategies challenging, despite training. This has been conceptualised as a resistance to, or fear of, compassion and can represent a risk factor for psychopathology, or a barrier to successful treatment Gilbert et al. Neuropsychopharmacological augmentation e. Such augmentation has been highlighted as an important area for psychiatric treatment development, especially for patients who are unresponsive to single-modality treatments, or for those who have special risk factors Moss et al. In a recent preliminary study, we found that recreational ecstasy use—which increases circulating oxytocin levels Wolff et al. However, since street ecstasy is often composed of various psychoactive substances other than MDMA, and the presence of MDMA was not assessed in that study Kamboj et al. This necessarily imposes some limits on the strength of conclusions that can be drawn from studies conducted in such settings. These can then pave the way for more tightly controlled studies if promising effects are observed. Previous naturalistic drug studies Freeman et al. On the basis of our previous findings Kamboj et al. In addition, we examined the ostensibly separate and combined effects of MDMA and CI on general inter personal processing of criticism and compassion using a measure of emotional empathy that included critical and compassionate facial stimuli. Based on experimental studies of MDMA showing that it enhances emotional empathy in response to positive social stimuli Kamilar-Britt and Bedi , we predicted that it would enhance emotional arousal in response to compassionate facial expressions in the current study. Interested participants were asked to contact the research team for information about the study. Those expressing an interest in participating were telephone-screened. Those disclosing a history of serious mental health problem or physical illness i. Since our aim was to only include participants confirmed to have consumed MDMA, we over-recruited relative to our previous study Kamboj et al. Twenty-five participants began and completed the study 14 men; 11 women. Sixteen were smokers. The procedure closely followed that used in Kamboj et al. Protocol outline. All the participants completed both sessions. T3 was post-CI both sessions. Procedure and assessment time points were the same on both sessions with the exception that no MDMA was self-administered and additional trait and drug-use history measures were completed from T1 to T2 on the CI-only session. The participants were asked to refrain from any drugs except caffeine and nicotine for 24 h prior to the testing session. A urine sample was provided at the start of each of the two sessions. ECG electrodes were attached and a period of stabilisation allowed. Since MDMA effects are close to peak levels after 1 h Tancer and Johanson , this was the fixed time interval used between T1 and T2 assessments, regardless of the route of administration. Between T1 and T2, the participants read or listened to music. A 1-h interval also separated T1 and T2 on the CI-only session. As such, T2 assessments served as an additional baseline in the CI-only session see Fig. The mean weight of consumed MDMA was 0. Note, the latter amount was an outlier see below. After repeating the state affect assessments at T2, the participants listened to guided CI instructions and then completed the state affect measures again at T3. The aim of the assessments at T1 and T2 was to assess state affect, self-compassion and self-criticism following MDMA use alone i. A series of visual analogue scales assessed ecstasy-related mood and symptoms. It consists of five scenarios designed to induce negative self-referential thinking. This yields maximum subscale scores of for self-criticism and for self-compassion. The participants responded to items in relation to how they currently felt. Higher scores are indicative of higher levels of comfort in depending on others an analogue of secure attachment and lower scores, greater discomfort an analogue of insecure attachment. These subscale scores were entered as separate covariates to examine moderation of effects on self-compassion by individual differences in adult attachment. Participants indicated whether they had consumed alcohol, tobacco, ecstasy, cannabis, cocaine, ketamine, hallucinogens, mephedrone or amphetamine in the past 24 h and previous 2 weeks. Urine samples were tested for the presence of these common recreational drugs Alere, Abingdon, Oxfordshire, UK. Recent alcohol use was assessed using a breathalyser Lion Instruments, UK at the start of both sessions. We adapted this task from the one originally described by Ali et al. The Empathy Assessment Task using the Self-Assessment Manikin EAT-SAM was programmed in PsychoPy Peirce and involved presenting and recording subjective arousal and valence responses evoked by facial affect stimuli comprising photographic images of basic anger and happiness and complex interpersonal criticism and compassion emotions see Ali et al. Anger and happiness stimuli were drawn from the NimStim series Tottenham et al. Since there are currently no similar standard stimuli of critical and compassionate faces, we used a new stimulus set consisting of nine facial expression of each, developed as part of a different project Falconer et al. The approach we used in generating these stimuli is outlined in detail in Tiddeman et al. Briefly, we first created neutral facial stimuli of nine different female identities, each of which was itself generated by averaging the photographed faces of three female actors using the image averaging software, PsychoMorph Tiddeman et al. This software allows facial features from photographs to be registered with markers and then averaged into a composite of those features captured as a new image and therefore new identity. The second stage involved morphing the facial features of the new averaged identities towards a composite prototype image of a face expressing either compassion or criticism Perrett et al. These compassionate and critical facial stimulus composites were generated from 10 photographic images out of an initial set of different images of different actors expressing compassion and criticism following an emotion-induction task relevant to generating these states. The selected photographs were those rated by 70 raters as most representative of compassionate and critical expressions representative images available upon request from author CJF. Immediately before the task, the participants were instructed on the meaning of the Self-Assessment Manikin SAM pictograms in terms of rating their current feelings on dimensions of arousal and valence, based on standard instructions for the SAM Bradley and Lang The task was deployed on a PC when the participant indicated they understood the instructions. There were no practice trials. Individual facial expression images were preceded by a central fixation cross 1 s and presented in randomised order on a in. The next trial then began. Each scale was displayed below each affect image and consisted of nine radio buttons along with manikin-form anchors Bradley and Lang The subjective arousal response to the affective displays of other people is considered an implicit measure of emotional empathy Ali et al. Participants completed a guided CI exercise, as previously described Kamboj et al. Briefly, the participants listened to standardised audio-recorded instructions presented through headphones describing the nature of compassion and the qualities of an ideal compassionate being. The participants were told that this compassionate being could take any form they wished and that it would emanate compassion, directed at them. Each sample was weighed, labelled and dissolved in deuterated methanol 0. Data was examined graphically and statistically for normality and outliers. Parametric statistical analyses were therefore applied. For the latter, the Time factor had only two levels T2, T3 and separate analyses were conducted for basic angry; happy and complex emotions critical; compassionate because these pairs of stimuli were drawn from different sources. As such, the Emotion factor also had two levels angry and happy or critical and compassionate. Specifically, indices of dispositional avoidant attachment closeness and dependence scores on the AAS were entered as covariates. Planned comparisons were used to follow up the main analyses on self-compassion and self-criticism. As reflected in the reported dfs, the analyses were based on complete data, except for heart rate, which, due to technical difficulties, was missing at one or more time points for two participants. Key analyses were repeated excluding the participant with the outlying MDMA dose 0. Similarly, re-analyses was conducted by excluding the three participants who insufflated their MDMA. The patterns of means, effect sizes and statistical significance i. The mean age of the participants 12 men, 8 women was They had All the participants provided 0. All participants reported abstinence from drugs including alcohol in the 24 h prior to both testing sessions, but all also reported use of some illicit substance in the 2 weeks preceding one or both sessions. As such, it is unlikely that differential effects reported below across sessions and between T2 and T3 the period when the CI task was performed can simply be attributed to continued increases in response to MDMA between T2 and T3, rather than to the additional effects of CI. Specifically, compared to T1, heart rate was Overall, this pattern of effects is consistent with enhancement of the effects of CI on self-compassion in the presence of MDMA. Even when considering only the first two time points i. Kamboj et al. This suggests an increase in arousal in response to critical faces after either intervention separately, although the effect of CI alone was substantially smaller than that of MDMA. Possible associations were examined between EAT-SAM arousal and valence ratings to critical faces at T2 and T3, with Self-Compassion and Self-Criticism scores at the same time points but no significant correlations emerged. In this report, we extend previous findings on the effects of recreational ecstasy and compassionate imagery CI on self-attitudes. The primary findings in the current study were that MDMA and CI appeared to produce similar small to medium increases in self-compassion when administered separately. Note however that these effects were not based on placebo-controlled comparisons and must therefore be considered provisional. It has been suggested that arousal ratings in tasks such as the EAT-SAM represent an implicit index of emotional empathy Dziobek et al. As such, our main findings are not entirely consistent with a simple generalised enhancement of positive affect or demand characteristics. Although previous studies have also examined the effects of MDMA on emotional empathy, these have tended to use situational rather than facial stimuli reviewed by Kamilar-Britt and Bedi and have not specifically examined compassion and criticism. Unlike these previous studies, we did not find a generalised increase in emotional empathy or the more specific hypothesised increase in response to compassionate expressions in the presence of MDMA cf Kamilar-Britt and Bedi The specific effects of MDMA on critical i. This divergence may relate to our use of facial rather than situational affective stimuli generally or critical facial expressions in particular, which have not been used in previous studies. The apparently similar effects of CI and MDMA on state self-compassion rather than positive affect more generally, and on arousal to critical facial stimuli, rather than other emotion expressions might suggest a common biopsychological mechanism through which some behavioural and pharmacological strategies increase aspects of self-affiliation and emotional empathy. Alternatively, given its ostensible role in self- affiliation Rockliff et al. Our current and previous Kamboj et al. Whether the observations reported here have therapeutic relevance, however, remains an open question and would need to be the subject of separate careful study. A primary concern in such studies would be to determine if lasting beneficial effects on self-attitudes would be observed after a small number of doses of MDMA in combination with a compassion-oriented psychosocial strategy such as CI. If so, this would be in line with the existing model of MDMA-assisted psychotherapy for posttraumatic stress disorder Mithoefer et al. Moreover, it may be that such combination treatments would be applicable in those with specific vulnerabilities e. While our assessment of MDMA composition represents a methodological improvement to our previous study design, naturalistic studies have some clear limitations and can only be considered to be a starting point, paving the way for investigating the relevant phenomena in tightly controlled experimental contexts. The setting within which this study was conducted and critically, the participant group in whom it was conducted are important considerations. As a result, we cannot know, for example, the degree to which the findings would generalise to MDMA-naive participants or to those with whom compassion-oriented strategies are typically used in the context of psychopathology Gilbert Moreover, while highly controlled laboratory settings are clearly the preferred context within which to test drug effects, when subjective rather than implicit behavioural effects are the primary outcome, concerns about expectancy are not eliminated. In addition, since participants chose the amount of MDMA they consumed presumably based in their previous experience with the drug, and expectations about its likely effects on them , this inevitably introduced some variability in the effects of the drug. However, another potential limitation was that, while the participants indicated verbally that they had not consumed any drugs in the 24 h prior to testing, a sizeable proportion provided positive urine screens for illicit drugs. However, the slow clearance of some drugs means that their presence in urine does not necessarily imply non-compliance with abstinence instructions in the preceding 24 h. THC and benzodiazepines in particular have prolonged elimination kinetics Moeller et al. However, apart from alcohol which all the participants provided negative readings for , a more fine-grained quantitative analysis of recent drug use was not employed here. We aimed to use the most efficient design possible to preliminarily test our hypotheses. As such, additional control conditions e. Future tests of these ideas in laboratory-controlled experiments would need to carefully consider the issue of the number of control conditions and experimental sessions, as it is unclear whether the outcome measures used here would retain sensitivity to change within a more intensive testing schedule. Alternatively, less efficient between-subjects designs would be required. Overall, our findings suggest that further research on adaptive modification of intrapersonal attitudes following MDMA and its combined use with compassion-oriented behavioural strategies is warranted. Future related studies should employ randomised, double-blind controlled designs. Ali, F. Empathy deficits and trait emotional intelligence in psychopathy and Machiavellianism. Personality and Individual Differences, 47 , — Article Google Scholar. Beck, A. San Antonio: Psychological Corporation. Google Scholar. Bershad, A. Oxytocin receptor gene variation predicts subjective responses to MDMA. Social Neuroscience, 11 , — Bradley, M. Measuring emotion: the Self-Assessment Manikin and the semantic differential. Journal of Behavior Therapy and Experimental Psychiatry, 25 , 49— Article PubMed Google Scholar. Brunt, T. Linking the pharmacological content of ecstasy tablets to the subjective experiences of drug users. Psychopharmacology, , — Campbell, A. Oxytocin and human social behavior. Personality and Social Psychology Review, 14 , — Clark, C. Acute effects of MDMA on autonomic cardiac activity and their relation to subjective prosocial and stimulant effects. Psychophysiology, 52 3 , — Collins, N. Working models of attachment: implications for explanation, emotion, and behavior. Journal of Personality and Social Psychology, 71 , — Danforth, A. MDMA-assisted therapy: a new treatment model for social anxiety in autistic adults. Progress in Neuropsychopharmacology and Biological Psychiatry, 64 , — Neurocognitive performance following acute mephedrone administration, with and without alcohol. Journal of Psychopharmacology, 30 , — D'Silva, S. Mind-body medicine therapies for a range of depression severity: a systematic review. Psychosomatics, 53 , — Dziobek, I. Journal of Autism and Developmental Disorders, 38 , — Englund, A. Cannabidiol inhibits THC-elicited paranoid symptoms and hippocampal-dependent memory impairment. Journal of Psychopharmacology, 27 , 19— Publications Office of the European Union, Luxembourg. Falconer, C. Embodying compassion: a virtual reality paradigm for overcoming excessive self-criticism. PLoS One, 9 , e Demonstrating mood repair with a situation-based measure of self-compassion and self-criticism. Psychology and Psychothotherapy, 88 , — Francis, S. Urinary and plasma oxytocin changes in response to MDMA or intranasal oxytocin administration. Psychoneuroendocrinology, 74 , 92— Freeman, T. Addiction, , — Gilbert, P. An introduction to compassion focused therapy in cognitive behavior therapy. International Journal of Cognitive Therapy, 3 , 97— Feeling safe and content: a specific affect regulation system? Relationship to depression, anxiety, stress, and self-criticism. Journal of Positive Psychology, 3 , — Fears of compassion and happiness in relation to alexithymia, mindfulness, and self-criticism. Psychology and Psychotherapy, 85 , — Isgett, S. Common variant in OXTR predicts growth in positive emotions from loving-kindness training. Psychoneuroendocrinology, 73 , — Kamboj, S. Journal of Psychopharmacology, 29 , — Kamilar-Britt, P. The prosocial effects of 3, 4-methylenedioxymethamphetamine MDMA : controlled studies in humans and laboratory animals. Neuroscience and Biobehavioral Reviews, 57 , — Kelly, A. Soothing oneself and resisting self-attacks: the treatment of two intrapersonal deficits in depression vulnerability. Cognitive Therapy and Research, 33 , Lenhard, W. Calculation of effect sizes. Psychometrica: Institut fur psychologische Diagnostik. Accessed 1 Feb Mennin, D. The importance of targeting negative self-referential processing. Clinical Psychology Science and Practice, 20 , — Mithoefer, M. Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3, 4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study. Journal of Psychopharmacology, 27 , 28— Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA. Lancet Psychiatry, 3 , — Moeller, K. Urine drug screening: practical guide for clinicians. Mayo Clinic Proceedings, 83 , 66— Morgan, C. Impact of cannabidiol on the acute memory and psychotomimetic effects of smoked cannabis: naturalistic study. British Journal of Psychiatry, , — Moss, A. Bringing together pharmacological and psychological approaches to mental health research. The Lancet Psychiatry, 3 , — Nutt, D. Effects of Schedule I drug laws on neuroscience research and treatment innovation. Nature Reviews Neuroscience, 14 , — Peirce, J. PsychoPy—psychophysics software in Python. Journal of Neuroscience Methods, , 8— Perrett, D. Facial shape and judgements of female attractiveness. Nature, , — Effects of sexual dimorphism on facial attractiveness. Ricard, M. Mind of the meditator. Scientific American, , 38— Richter, P. On the validity of the Beck Depression Inventory. A review. Psychopathology, 31 , — Rockliff, H. Emotion, 11 , Seara-Cardoso, A. Investigating associations between empathy, morality and psychopathic personality traits in the general population. Personality and Individual Differences, 52 , 67— Sprengelmeyer, R. The cutest little baby face: a hormonal link to sensitivity to cuteness in infant faces. Psychological Science, 20 , — Stellar, J. Affective and physiological responses to the suffering of others: Compassion and vagal activity. Journal of Personality and Social Psychology, 4 , Sumnall, H. The varieties of ecstatic experience: an exploration of the subjective experiences of ecstasy. Journal of Psychopharmacology, 20 , — Tancer, M. Drug and Alcohol Dependence, 72 , 33— Tiddeman, B. Prototyping and transforming facial textures for perception research. Tottenham, N. The NimStim set of facial expressions: judgments from untrained research participants. Psychiatry Research, , — Watson, L. New age seekers: MDMA use as an adjunct to spiritual pursuit. Journal of Psychoactive Drugs, 23 , — Wolff, K. Vasopressin and oxytocin secretion in response to the consumption of ecstasy in a clubbing population. Zinberg, N. Drug, set, and setting: the basis for controlled intoxicant use. New Haven: Yale University Press. Download references. Sunjeev K. Kamboj, Ylva S. Majdah Raji Alotaibi, Ian S. You can also search for this author in PubMed Google Scholar. SKK designed the study, performed data analyses and wrote the paper. YSEW designed the study, executed the study and collaborated on writing and editing the final manuscript. CJF designed the study, executed the study, collaborated on writing and edited the final manuscript. MRA collaborated on the design, analysed the data medicinal chemistry and wrote part of the results. ISB collaborated on the design, analysed the data medicinal chemistry and wrote part of the results. SMH collaborated on the design, analysed the data medicinal chemistry , wrote part of the results and edited the final manuscript. TPF designed the study, executed the study and collaborated on writing and editing the final manuscript. Correspondence to Sunjeev K. All procedures were performed in accordance with the ethical standards of the institutional and were in line with the Declaration of Helsinki. All the participants gave written informed consent at the start of the first session; all were made aware that they could withdraw from the study at any time without needing to give a reason. Reprints and Permissions. Mindfulness 9, — Download citation. Published : 04 November Issue Date : August Search SpringerLink Search. Download PDF. Procedure The procedure closely followed that used in Kamboj et al. Full size image. Results The mean age of the participants 12 men, 8 women was Discussion In this report, we extend previous findings on the effects of recreational ecstasy and compassionate imagery CI on self-attitudes. Limitations While our assessment of MDMA composition represents a methodological improvement to our previous study design, naturalistic studies have some clear limitations and can only be considered to be a starting point, paving the way for investigating the relevant phenomena in tightly controlled experimental contexts. References Ali, F. Article Google Scholar Beck, A. Google Scholar Bershad, A. Article Google Scholar Francis, S. Article Google Scholar Gilbert, P. Article Google Scholar Lenhard, W. Article Google Scholar Sprengelmeyer, R. Article Google Scholar Tottenham, N. Author information Author notes Tom P. Husbands Authors Sunjeev K. Kamboj View author publications. View author publications. Ethics declarations Conflict of Interest The authors declare that they have no conflicts of interest. Ethics Statement All procedures were performed in accordance with the ethical standards of the institutional and were in line with the Declaration of Helsinki. Informed Consent All the participants gave written informed consent at the start of the first session; all were made aware that they could withdraw from the study at any time without needing to give a reason. About this article. Cite this article Kamboj, S.

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