MDMA (3,4-methylenedioxymethamphetamine, "Ecstasy") is a ring-substituted amphetamine structurally
similar to the psychostimulant methamphetamine and the psychedelic/hallucinogen mescaline. While it
possesses some stimulant-like and mildly psychedelic properties, it also possesses properties that distinguish
it from members of either of the drug classes listed above. MDMA is reported to produce an easily controlled
altered state of consciousness with increased sociability, empathy and sensual overtones (Anderson et al. 1978;
Greer and Tolbert 1986; Peroutka et al. 1988; Solowij et al. 1992; Vollenweider et al. 1998). Some researchers have classified MDMA and related drugs, such as its congener MDE, as belonging to a novel drug class, the
entactogens (Nichols and Oberlender 1986; Oberlender and Nichols 1990), a term meaning "to touch within."
A number of studies have examined the physiological and subjective effects of MDMA in humans (Cami et al.
2000; Gamma et al. 2000; Farre et al. 2004; Grob et al. 1996; Forsling et al. 2001; Harris et al. 2002; Hernandez-Lopez et al. 2002; Lamers et al. 2003; Lester et al. 2000; Liechti et al. 2001; Mas et al. 1999; Tancer and
Johanson 2001; Tancer and Johanson 2003; Vollenweider et al. 1998). The efficacy of MDMA-assisted psychotherapy in the treatment of posttraumatic stress disorder (PTSD) and other conditions has been described in
several anecdotal accounts and an uncontrolled study (Adamson 1985; d'Otalora 2001; Gasser 1994; Greer and
Tolbert 1998; 1986; Metzner and Adamson 2001; Widmer 1998). In Spain, six women with PTSD arising from
sexual assault were enrolled in a MAPS-funded study of MDMA-assisted psychotherapy that was subsequently
halted due to political pressure from the local anti-drug authority (Doblin 2002). A second MAPS-supported
study of the safety and efficacy of MDMA-assisted psychotherapy in people with PTSD is underway in South
Carolina. Additionally, FDA and the respective institutional review boards (IRBs) at Harvard Medical School's
McLean Hospital and the Lahey Clinic have approved or given permission for a proposed study of MDMA-assisted therapy in people with advanced stage cancer and diagnosis-related anxiety.
In addition to its potential value as an adjunct to psychotherapy, MDMA may also prove to be a valuable tool for
basic research. Research is basic if it is conducted chiefly
to learn more about the area under investigation without
specific plans for how to use this information to produce a
treatment, program or other immediately useful endeavor.
As is the case with psychedelic drugs, studying the effects
of MDMA in humans has the potential to provide a better
understanding of human cognition, affect (mood and emotion) and behavior. The research problems described below
are not intended to be an exhaustive list of possibilities.
Rather, they are intended as a sample of possible research
programs utilizing MDMA as a tool for exploring social
interaction and affect in humans.
The risks involved in administering MDMA to human
participants are considerably greater than the risks associated with participation in the typical social psychological
or psychophysiological experiment. However, these risks
can be minimized by carefully selecting study participants,
administering MDMA in a controlled setting, and monitoring physiological signs in each participant throughout
and shortly after the procedure. Using MDMA in research
in humans may always require collaboration between
psychologists interested in basic research and psychiatric researchers. However, I believe that the benefits to
be gained by performing human research with MDMA
outweigh the risks to participants and the difficulty for
researchers.
Some of the studies proposed below may be of immediate importance to those who wish to demonstrate the
therapeutic uses of MDMA, and these studies may be performed during or immediately after studies have examined
the efficacy of MDMA-assisted therapy. It is encouraging that ethics committees and regulatory agencies have
already approved and permitted studies into possible therapeutic uses of MDMA. These studies may pave the way
for basic research into the effects of MDMA on emotion,
cognition and social interaction. As well, some researchers are already interested in studying MDMA effects on
emotion and behavior toward others (see Fiske et al. 2004;
Hoshi et al. 2004).
In writing this essay, I hope to stimulate thought and
discussion about what human trials with MDMA might
contribute to psychology and neuroscience. I also hope to
encourage therapists and psychiatric researchers to design
and conduct studies that formally identify and quantify the
processes and effects deemed most important to the success
of MDMA-assisted therapy. Most importantly, I hope to
demonstrate the ways in which human trials with MDMA
could bring together researchers in different fields to the
benefit of all.
Basic Research on Effects Relevant to Therapeutic Use
Several of the subjective effects
of MDMA that first attracted the
notice of psychotherapists have
yet to be formally verified in
controlled settings.
While recent investigations have produced a great deal
of valuable information concerning the physiological and
subjective effects of MDMA in humans, many questions
concerning these effects remain unanswered. Several of
the subjective effects of MDMA that first attracted the
notice of psychotherapists have yet to be formally verified
in controlled settings. For instance, research has not yet
determined whether MDMA increases feelings of empathy or compassion and whether MDMA induces people to
perform empathetic behaviors, such as helping or forgiving
others. Participants in at least one study have spontaneously reported increased feelings of closeness to others as
an acute effect of MDMA (Vollenweider et al. 1998), and
another controlled study found that people reported feeling friendlier and more talkative after 2 mg/kg MDMA
(Tancer and Johanson 2003). Retrospective reports from
ecstasy users and reports from an uncontrolled study of
MDMA-assisted therapy have consistently reported experiencing increased feelings of empathy, closeness to others
or sociality (Davison and Parrott, 1997; Greer and Tolbert,
1986; Liester et al. 1992; Peroutka et al. 1988; Solowij et
al. 1992; Siegel et al. 1986). Yet to date, the only study that
sought to assess self-reported empathy in people given 1.5
mg/kg MDMA did not detect an increase in empathetic
feelings (Harris et al. 2002). This study used only two
items from a larger questionnaire, suggesting that research
into MDMA effects on empathy may need to rely on more
extensive measures. Assessing people's behavior may be an
even better measure of empathy or increased closeness to
others. Such measures might include increased likelihood
of helping or cooperating with others, or sitting closer to
another person.
Secondly, therapists have reported in narrative and
anecdotal accounts that MDMA stimulated recall for
emotionally charged events (e.g. Adamson 1985; d'Otolara
2001; Greer and Tolbert 1986; Greer and Tolbert 1998),
yet no one has yet conducted a
systematic study of how and to
what degree MDMA alters recall for
intensely emotional events. Participants in some controlled studies
reported facilitated recall after
receiving MDMA (Vollenweider
et al. 1998), but this effect has not
been specifically measured within a
controlled clinical study. If it can be
shown that MDMA facilitates recall
for emotional events, and does a
better job at it than other psycho-therapeutic techniques, then this would lend support for
the use of MDMA in therapeutic contexts.
Lastly, studies examining the reported reduction in
anxiety (anxiolysis) after MDMA should be conducted.
MDMA has been reported to reduce anxiety, even while
simultaneously stimulating recall of unpleasant or upsetting thoughts or events (Greer and Tolbert 1998; 1986;
Liester et al. 1992). Individuals given MDMA in controlled studies reported that anxiety was reduced or did
not change after MDMA, although there was reported
increased anxiety in association with feelings of loss of
control (Liechti et al 2001; Vollenweider et al. 1998).
Similarities and differences between the anxiolytic (anxiety-reducing) effects of MDMA and that of another drug,
such as diazepam (Valium), or anxiolysis produced by a
behavioral method (such as relaxation techniques) have
yet to be investigated. Anxiety and facilitated recall occurring during an MDMA-assisted therapy session might also
be compared with the effects of other means of relaxation
and recall induction.
Relating Brain, Emotion and Behavior: Empathy
Social psychologists seek to understand social interactions and the thoughts, feelings and behaviors associated
with social interactions. Social psychologists interested
in understanding interpersonal relationships and interactions between dyads (pairs) have investigated the role
that feelings of closeness to others, intimacy and empathy
play in social interactions (Aron et al. 1997; Ickes 1990;
Ickes 1991; Reis and Clark 1988; Stotland 1969). These
psychologists are more interested in situationally produced
empathy, referred to by Duan and Hill as the empathic
experience, rather than trait empathy (Duan and Hill
1996), the tendency of an individual to feel empathetic.
Many people studying empathy hope to improve interpersonal and intergroup relations by understanding the bases
of empathy and the consequences of feeling empathetic
toward another person.
Researchers could
use functional
imaging to compare
changes in brain
activity seen after
MDMA-induced
empathy and
empathy produced
by other means.
Researchers interested in generating empathy in study
participants have relied on the use of direct instructions to
participants to feel empathetic, or they try to craft staged
events or occurrences intended to produce empathy (Duan
and Hill, 1996; Stotland, 1969, see, for example, Batson
and Moran, 1999; Batson et al.
1999; Batson et al. 1997; Macrae
and Milne 1992). Participants are
instructed to imagine how another
person might feel in a given situation, or they are asked to imagine
themselves in the place of another.
Instructions and situational manipulation seem to produce empathetic
behaviors, such as cooperating on a
"prisoner's dilemma" task (Batson
and Moran 1999) or allocating
resources to another individual, even at the expense of
the self (Batson et al. 1999). However, there is a risk that
people are behaving in accordance with sociocultural rules
on how empathetic people ought to behave in such situations, without actually feeling empathetic. In contrast,
MDMA is reported to produce feelings of closeness to
others or empathy directly, presumably through its actions
on the brain. Setting is probably important, but it appears
that ecstasy (material represented as MDMA) and MDMA
consistently produce empathy and feelings of closeness to
others in disparate settings. Researchers studying empathy and social interaction might benefit by performing a
number of comparative or exploratory studies with MDMA
and at least one other form of empathy induction. For
instance, a comparison could
be made between empathy-related feelings and actions
occurring after MDMA,
and after people have been
directed to imagine another
person's feelings.
Researchers could use
functional imaging to
compare changes in brain
activity seen after MDMA-induced empathy and
empathy produced by other
means.
Such comparisons
might identify the types
of brain activity associated
with feelings of empathy
or compassion. Functional
brain imaging would be
able to detect similarities and differences in brain activity
across both empathy-producing conditions. At least one
behavioral researcher has proposed using functional imaging to study the effects of MDMA on human bonding and
empathy (Fiske et al. 2004).
By varying one or more aspect of the environment,
investigators could discover what elements of setting most
enhance commonly reported subjective effects of MDMA,
such as decreased anxiety or increased feelings of closeness to others. Investigations into aspects of setting that
promote MDMA-induced empathy could lead to a model of
how MDMA produces this effect. These findings, in turn,
might shed light on how other methods create or enhance
empathy. For instance, factors such as the proximity of
another individual, presence versus absence of direct "face
to face" communication versus less direct routes of communication, and the presence or absence of prior commitment
to imagining another's feelings may all be compared across
conditions, using MDMA-induced empathy and some other
means of inducing empathy as treatment conditions.
Researchers specifically interested in social interactions
in dyads (pairs) or small groups have studied interactions
between strangers, friends and romantic partners by videotaping
people interacting, and then asking both the participants and
independent observers to watch and code the
videotaped interactions (Ickes et al. 1991; Levenson and
Ruef 1992). This time-consuming and complex method
of behavioral analysis has allowed researchers to generate
and test hypotheses concerning cognition and behavior
that shape the social interaction. This research has demonstrated that people are sometimes especially good at
assessing the actual thoughts and feelings of another, a state
referred to as "empathic accuracy." (Ickes 1994). Other
researchers studying social interaction via this method
have found that interaction between pairs of people go
smoothly when the non-verbal behaviors of one partner
tends to mirror or move in harmony with the behaviors
exhibited by the other partner. Sharing information about
the self is with another is reported to enhance intimacy
between individuals, with higher rates of sharing information (mutual disclosure) associated with greater feelings of
intimacy between individuals (Aron et al. 1997; Clark and
Reis 1988). Researchers have found that feelings of closeness toward another can be produced by instructing both
members of a pair to disclose increasingly personal information to their partner (Aron et al. 1997), indicating that
reciprocal self-disclosure can produce feelings of intimacy.
Behavioral researchers could arrive at a better understanding of empathy and the similarities and differences
between naturally existing, behaviorally induced and
pharmacologically induced feelings of empathy through
examining one or more specific behavior in people given a
fully active dose of MDMA versus those given a threshold
(or barely active) dose of MDMA. Behaviors worth examining might be imitation or reflection of another's nonverbal behavior, accurate perception of another's thoughts
or feelings, or mutual self-disclosure of personal information. These behaviors would then be measured in both
situations in order to discover whether MDMA increases
empathy by leading people to behave in ways that tend to
enhance empathy. For instance, people given a full dose of
MDMA might be more
likely to share personal information with
another person than
people given a threshold
dose, or they might grow
more accurate in assessing another's feelings. A
naturalistic study that
compared people who
reportedly used ecstasy
with people who used
other substances (mostly
alcohol and cannabis)
found that ecstasy made
people more accurate
at recognizing facial
expressions of fear, while
the same people were less
accurate at detecting fear
four days later (Hoshi
et al. 2004). Perhaps MDMA-induced changes in attention or other-directed behavior (such as talk) might play
a role in generating or increasing empathy. Investigators
would first have to establish that MDMA induces specific
shifts in attention or behavior, and then demonstrate that
these changes in attention or behavior are associated with
This ability of MDMA
to stimulate many of
the physiological and
immunological aspects
of the stress response
without producing
the subjective effects
usually associated with
experiencing stress
deserves further study.
increased feelings of empathy or closeness to others. If
it turns out that MDMA does shift the type or degree of
attention given to others, or alters specific types of behavior
toward others, then investigators could try to produce
empathy in people not given MDMA by instructing them
to behave in the same way as the people who got MDMA.
These findings could help us learn how to enhance or
accentuate feelings of empathy or compassion within and
outside of a psychotherapy session.
Research comparing feelings of empathy and empathy-related
processes in people who have received MDMA and
people who have not has the potential to make a strong
contribution to an understanding of the links between
brain, behavior, thought and emotion or affect. Specifically,
such research might locate the common pathways shared
by apparently separate routes for inducing feelings of
empathy. Conversely, such research might also discover the
differences between MDMA-induced changes in feelings
toward others and similar emotional changes produced
through some other process. It might also prove interesting to compare and contrast pre-existing feelings people
have for each other and their feelings for one another after
MDMA.
Physiological Effects Versus Psychological Effects:
The "Stress Response" and Emotion Research
Paradoxically, MDMA tends to reduce anxiety, yet its
physiological effects are similar to those seen when people
are under stress. Though effects on the cardiovascular,
immune, and neuroendocrine systems are similar to those
seen in the human stress response, effects on mood are
generally positive (Grob et al. 1996; Lester et al. 2000;
Liechti et al. 2001; Mas et al. 1999; Pacifici et al. 1999;
Pacifici et al. 2000; Pacifici et al. 2001; Vollenweider et al.
1998). People receiving MDMA usually do not feel any
more anxious than they would without pharmacological
challenge (Grob et al. 1996; Vollenweider et al. 1998), and
in some cases they report feeling less anxious than usual
(Greer and Tolbert, 1986). Yet MDMA increases heart rate
and blood pressure (Grob et al. 1996; Lester et al. 2000;
Mas et al. 1999; Tancer and Johanson 2001; Vollenweider
et al. 1998), and MDMA is associated with the release of
stress hormones such as ACTH and cortisol in rats and
humans (Grob et al. 1996; Harris et al. 2002; Mas et al.
1999; Nash et al. 1988). MDMA also acutely produces a
number of immunological changes in humans, including
decreased CD4 cell count, increased NK cell count and
increase in the ratio of Th1 cytokines to Th2 cytokines
(Pacifici et al. 1999; Pacifici et al. 2000; Pacifici et al.
2001). These immunological effects, lasting no more than
48 hours, are similar to the immunological effects of a
psychological stressor (Cacioppo, 1994; Cacioppo, 1996;
Pacifici et al. 2000). This ability of MDMA to stimulate
many of the physiological and immunological aspects
of the stress response without producing the subjective
effects usually associated with experiencing stress deserves
further study. Similar, though not identical, immunological
changes are produced by other psychoactives, such as alcohol
(Pacifici et al. 2000), raising questions as to whether
these immunological changes can be considered an accurate marker of experiencing psychological distress.
Researchers who study the outcomes of stress in
humans could test hypotheses concerning the contributions of physiological versus psychological stress to the
stress response by comparing the effects of MDMA with
the effects of other stressors. Explanations of the effects of
stress on health usually trace effects directly to physiological changes produced by experiencing stress, and several
psychological stressors, such as making a public speech, do
exhibit physiological effects (Cacioppo, 1994). It is difficult to separate the acute psychological effects of a stressor,
such as anxiety or feelings of frustration or powerlessness,
from physiological effects, such as increased stress hormones, increased sympathetic activity, or immunological
changes. Researchers do not yet know whether negative
feelings like anxiety or frustration may, in and of themselves, produce direct or indirect effects on outcomes after
stress (as by altering health-related behaviors or producing
additional physiological effects). Comparing physiological or immunological effects of MDMA with effects from
psychological stressors offers researchers the opportunity
to examine what happens when physiological effects
associated with the stress response appear in tandem with
elevated mood and unchanged or reduced anxiety. It is
possible that MDMA and acute stressors produce the same
outcomes in healthy humans. However, it is also possible
that comparisons of psychological stressors with MDMA
may demonstrate that subjective feelings of distress may
produce effects that would be absent under MDMA and
present after a psychological stressor.
A better understanding of the stress response could
also be reached by comparing brain activity after MDMA
with brain activity after a specific stressor. Studies might
compare MDMA with at least one other stressor, such as
preparing for and performing a public speech. Anxiety
and distress could be measured, along with cardiovascular
and immune responses to the stimulus, and these could be
correlated with brain activity. Similarities and differences
between the two treatments could be measured across
. . . a number of researchers and commentators, including the editors of a
major neuropsychological journal, have concluded that the risks involved in
conducting controlled clinical trials with MDMA are minimal
subjects or across conditions. Such research might be able
to locate the processes involved in producing the subjective
effects of stress, and the processes that might dampen these
feelings in humans.
While some researchers might be interested in examining the effects of physiological "stress" in the absence
of psychological stress, psychologists and neuroscientists
studying emotion might also use MDMA to test hypotheses concerning the role of physiological feedback in the
generation of emotion. Some models posit that emotions
begin as non-conscious responses to things or situations,
and that conscious experience of an emotion arises via
feedback about somatic (bodily) processes that are already
taking place in response to those stimuli (LeDoux, 1998;
Damasio, 1999). MDMA may mimic some physiological
and neuroendocrine cues associated with stressful events,
but that this feedback is apparently not associated with
subjective feelings of distress. Or it may be that increases
and decreases in anxiety seen after MDMA follow the
time course of specific physiological changes. Hypotheses
concerning the relationship
between specific physiological processes, emotion
generation, and a person's
awareness of his or her own
emotions might be tested
by comparing the effects of
MDMA with the effects of
other procedures known to
alter mood, including mood
induction or exercise. Brain
activity could be imaged after MDMA and after another
mood induction procedure, with brain activity then correlated with changes in self-reported mood and physiological
state.
Risks to Research Subjects and Difficulties involved in Conducting Research
Investigating the effects of MDMA on how
we think, feel and act, and investigating the
paradoxical effects of MDMA on mood and
physiology offer opportunities for bridging
across these domains.
The risks of administering nearly any pharmacological
agent to humans are higher than the risks of participating in the typical cognitive or social psychological study.
Hence it is important to weigh the risks of administering
psychoactive substances like MDMA to humans against
the potential benefits that might result from performing
the research, and to reduce risks to participants whenever possible. Most risks to participants in typical social
psychological studies of empathy and social interaction
result from deception practiced by the experimenter.
Psychologists sometimes mislead participants about the
nature of the research, or about some aspect of the study,
to keep people from learning what the research hypothesis
is, and to engage the participant in a "real" situation rather
than relying on self-reports about hypothetical behavior
(Aronson et al. 1990). Researchers may not want people
to know what their study is about because people might
change how they respond if they knew the hypothesis,
either to "help" the researcher or to make themselves look
better. Risks posed to participants by deception include
not being fully informed about the nature of the study and
possible distress arising either from being deceived or from
a participant behaving in a way that he or she may find
painful or embarrassing. These risks are usually countered
by providing each participant with information about the
nature of the study and an opportunity to express feelings
about participation upon completion of an experimental
session. Studies of the stress response also involve psychological and physiological discomforts. However, the risks
described above are comparatively minor compared to risks
associated with drug challenge studies, which can include
risks of experiencing potentially life-threatening adverse
events. These include risks posed by the acute physiological effects described above and the potential for long-term
effects to occur after administration of MDMA. While
MDMA has not produced any serious adverse events in
controlled studies to date, the typical psychological study
possesses far fewer potential
risks.
There is concern that
administering MDMA
to humans could expose
participants to long-term
health risks. People who
repeatedly use ecstasy have
lower scores on measures
of memory and executive
function, often defined as
planning and decision-making (see for example Croft et
al. 2000; Gouzoulis-Mayfrank et al. 2003; Morgan 1999;
Thomasius et al. 2003). Several reviews have examined and critiqued this body of research (Baggott et al.
2001; Cole and Sumnall 2003; Gamma 2000), but the
fact remains that many studies continue to find differences between at least some groups of ecstasy users and
non-ecstasy user controls. Furthermore, a spate of studies
published in 2003 and 2004 suggest that moderate ecstasy
use is not associated with impaired memory or executive
function (Gouzoulis-Mayfrank et al. 2003; Halpern et al.
2004). Studies using radioactive drugs attracted to the
serotonin transporter have also found fewer serotonin
transporter sites in the brains of current ecstasy users
(see for example Buchert et al. 2004; McCann et al. 1998;
Reneman et al. 2001), though it is notable that more recent
studies report a comparably small decline in transporter
sites when compared with initial reports. Hence the potential for long-term effects to occur with regular, frequent
use of illicit ecstasy cannot be dismissed. However, even
before the appearance of recent studies finding little or
no effects in moderate users, a number of researchers and
commentators, including the editors of a major neuropsychological journal, have concluded that the risks involved
in conducting controlled clinical trials with MDMA are
minimal (Aghajanian and Lieberman, 2001: Lieberman
and Aghajanian, 1999; Vollenweider et al. 1999; Vollenweider et al. 2001). These authors have noted that as
of now, no studies exist that examine the effects in non-human
animals of one or two administrations MDMA in
doses equivalent to those used in humans (Aghajanian et
al. 2001; Vollenweider et al. 1999). Furthermore, researchers in Switzerland have failed to find changes in serotonin
transporter sites or in measures of cognitive function
in individuals who had
received a single dose
1.5 mg/kg or 1.7 mg/kg MDMA as part of a
research study (Ludewig
et al. 2003; Vollenweider
et al. 2000). Altogether,
these findings seem to
suggest that there is little
or no risk of experiencing
cognitive deficits for people
given one or two doses of
MDMA in controlled settings.
While the risks
described above should
not be considered lightly
by researchers interested
in human research with
MDMA, they are not
unique to MDMA or other
entactogens. Substances
posing similar risks to
research participants have
been employed by several
research teams, including the psychostimulants
amphetamine, methamphetamine and cocaine (e.
g. Gouzoulis-Mayfrank et
al. 1999a; Gouzoulis-May-frank et al. 1999b; Justice
and DeWit, 1999; Rush
et al. 1999) and fenfluramine (e.g. Mortimore and
Anderson, 2000). Like
MDMA, psychostimulants activate the sympathetic system and may produce psychological distress in
some cases. Furthermore, studies in non-human animals
suggest that fenfluramine possess the same risks to the
serotonin system as MDMA (Schecter, 1990; Series et al.
1994, see also Whitaker-Azmitia and Peroutka, 1990),
and methamphetamine may harm the dopamine system
(see for example Clemens et al. 2003; Fornai et al. 2003;
Miller and O'Callaghan 1996; Seiden and Kleven 1989).
Despite these findings, fenfluramine is frequently used as
a pharmacological challenge, and was even used in studies
comparing ecstasy users with non-users (Gerra et al. 1998;
Gerra et al. 2000; Gijsman et al. 2002). Investigators who
administer psychoactive drugs to humans reduce risk by
including only healthy participants who lack a history of
major mental or physical illness, and by monitoring for
cardiovascular effects if it is deemed necessary. In some
studies, participation is further restricted to individuals
with previous experience with the drug the researchers are
studying (Rush et al. 1999). After taking these steps, the
risks facing participants in human MDMA studies should
be greatly reduced.
Other Challenges to Conducting Basic Human Research with MDMA
Because most lack the
necessary equipment
and training, it is likely
that psychologists
interested in using
MDMA as a basic
research tool in
humans will have to
work within a team of
psychiatric or medical
researchers . . . the
teamwork required
of investigators from
different disciplines
may enrich a research
project and may allow
each worker to gather
relevant data from
one study.
There are other obstacles to conducting the research
described above. Equipment for measuring blood pressure
and heart rate is often unavailable in the typical psychological laboratory outside the realm of psychiatric research,
and it is likely that only psychiatrists and clinical psychologists currently possess training on how to intervene in
cases of intense psychological distress. Because most lack
the necessary equipment and training, it is likely that psychologists interested in using MDMA as a basic research
tool in humans will have to work within a team of psychiatric or medical researchers. Working in such teams may
slow the pace of research and make it more difficult. On
the other hand, the teamwork required of investigators
from different disciplines may enrich a research project
and may allow each worker to gather relevant data from
one study.
The potential benefits of conducting psychological or
human neuroscience studies with MDMA have already
been listed above, and include learning more about emotions, social cognition, and the link between emotions and
the immune system. This knowledge could help clinical
psychologists and psychiatrists find ways of helping people
who are anxious or under stress, and it may help us learn
more about how to ease or reduce conflict between people.
If MDMA is found to have therapeutic uses, this research
will also provide therapists and psychiatric researchers
with an understanding of the processes that lie behind its
efficacy as an adjunct to psychotherapy. These benefits are
worth the minimal risks faced by carefully selected participants
in a study involving the administration of one or two
doses of MDMA.
Reuniting Brain, Cognition-Emotion and Behavior
Perhaps the greatest benefit to be gained from basic
research studies examining the effects of MDMA in
humans is the potential to draw together researchers operating in several different fields or disciplines, including
clinical psychology, social psychology and psychophysiology. While researchers in each area study human thoughts,
feelings and actions, each area of research operates at a
specific level of analysis and uses a specific set of research
tools, making communication across research domains
both difficult and infrequent. Investigating the effects of
MDMA on how we think, feel and act, and investigating
the paradoxical effects of MDMA on mood and physiology
offer opportunities for bridging across these domains. As
a result of the potential (and necessity) for collaboration
across research domains, the hypotheses and models that
might arise from human research with MDMA are liable
to inform broad areas of neuroscience and psychology.
Both psychotherapists and social psychologists are likely to
appreciate more information about the empathic experience. Clinical psychologists might better understand
relationships between "psychological" and "neurochemical" sources of emotion and awareness of emotion, and
researchers interested in psychoneuroimmunology might
learn more about the nature of the stress response. A
clearer and more accurate model of empathy or of emotion
generation and perception might, in turn, assist in improving behavioral or psychotherapeutic interventions that
increase empathy or alleviate depression.
References
To read the references for this article, please see
http://www.maps.org/news-letters/mdma_basic_resarch_refs.html
Neurocognitive Profile of Long-Term Ecstasy Users: Proposed Research
by Philipp Ruessli
There is some evidence that MDMA causes neuropsychological deficits in long-term users. The most examined of these
are memory, attention, executive functions and the speed of information processes. Although the research field concerning
the neurocognitive aspects of MDMA is growing, there is little consensus about where the changes in these domains come
from. Some researchers suggest that these are premorbid differences in the subjects, others say that it has to do with the
lifestyle of the typical ecstasy users (excessive, all-night rave parties and their side effects) and others argue that it is the result of a neurotoxic effect of MDMA. There are a number of fMRI and PET studies, which examine the relation between changes in brain functions or neuropharmacological markers and changes in different neuropsychological aspects. However, there is, as far as I know, only one MRI study (Cowan R.L. et al., Drug and Alcohol Dependence 72, 2003) which was
done together with MDMA. This study was not specifically intended to investigate the relationship between changes in
neuropsychological markers and the according anatomical areas.
Our proposed study has several purposes. First, we hope to examine the neurocognitive profile of long-term ecstasy users
in several aspects (TAP, VLMT, DCS and so on). Thereby we try to rule out some of the well known confounding variables,
like the consumption of Cannabis and others. Second, with our MRI design, which includes diffusion tensor imaging (DTI),
we would like to examine the relationship between changes in the cognitive domains (if there are any) to changes in the
anatomy. We would also like to investigate if there are changes in the white matter concentration. Specifically, we are
interested in areas which are responsible for the mentioned neurocognitive domains. Third, we want to examine/replicate
the results of Cowan et al., which no one has yet attempted.
The study design is not yet fully complete. We would like to have three different groups: long-term MDMA users, who
have been abstinent for some time (former users), long-term users who are still active consumers (current users), and a
control group which matches the other two groups. There are already some people who are interested in participating in the
study, but because the procedure will take several hours, we need to offer compensation in order to recruit subjects. I am
asking for donations in order to reach our goal of enrolling thirty people, ten in each group. We are seeking a total of about $4000. Of course, we appreciate every little donation.
If you have any questions concerning the study design, the purpose, or other things,
please contact me
or my adviser by email or at:
Psychologisches Institut Lehrstuhl fur Neuropsychologie
Treichlerstr. 10
CH-8032 Zurich, Switzerland
Tel.: 0041-1-634 2192 Fax: 0041-1-634 4342
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