An Interdisciplinary Approach to MDMA-Assisted Psychotherapy for PTSD

On August 16, 2017 the FDA announced MDMA as the “breakthrough therapy” that could very well be the drug to treat the psychological scars of war in the minds of the mass collective of America's veterans suffering from Post Traumatic Stress Disorder (PTSD).

What can the beneficial factors and adverse effects of MDMA-assisted psychotherapy help us understand about psychological healing in veterans living with PTSD?

This study requires interdisciplinary insights since this mental health, particularly for our nation’s veterans, remains a contentious field and the researchers studying MDMA face many complex questions.

PTSD is the third most prevalent psychiatric diagnosis among veterans using the Veterans Affairs (VA) hospitals. –Ravelski, et al

Researchers from many disciplines have rediscovered psychedelic drugs, particularly MDMA, for their unmatched ability to change the way the brain processes information. This is imperative data for many of today’s veterans as well as civilians suffering from mental health issues.

Thesis: The factors that lead to healing for veterans in MDMA-assisted psychotherapy should be refined and disseminated as more studies revealing the many complexities and mysteries of a much bigger story about the true mechanisms of human growth and healing emerge.

Why is this important?

I wanted to propose this research because there are at least 70% of adults in the U.S. who have experienced some kind traumatic event at least once in their lives. So, out of the 223.4 million or more people who suffer from a traumatic event, 20% of these people go on to develop PTSD. As of today, that’s over 31.3 million people who once were diagnosed or who currently struggle with PTSD.

The mental health statistics are even scarier for America’s veterans. At least 20 veterans commit suicide every day. My hope is that this research proposal brings awareness to those within the veteran community about new alternative psychotherapeutic methods which have success in treating rather pressing mental health disorders such as PTSD.

Recent sample of 600 veterans from Iraq and Afghanistan found: 14% post-traumatic stress disorder; 39% alcohol abuse; 3% drug abuse. Major depression also a problem. –Eisen et al.

PTSD is a serious public health problem that causes significant suffering and contributes substantially to health care costs. 

Choosing Insights From Relevant Disciplines

The Multidisciplinary Association for Psychedelic Studies is the main entity that clinically explores the potential risks and benefits of 3,4-methylenedioxymethamphetamine (MDMA).

I find it fascinating that the word multidisciplinaty is used in the title of this association instead of interdisciplinary as the practices and methodologies in their studies actually integrates views from one or more disciplines. However, there are some more disciplines who could have relevant outlooks on the issue of veterans with PTSD.  

The disciplines of psychotherapy within psychology, social work, and neuropsychopharmacology which is a sub-discipline of medicine, when integrated together provide the most imperative insights on this particular subject.

Social Work is, in my view, the most overlooked discipline related to this complex issue because Veteran Affairs health policies must shift progressively alongside contemporary medical practices to ensure the right patients, have access to this groundbreaking treatment.

Outlooks from sociology, communication arts, statistics, and philosophy still help us gain a comprehensive understanding through providing a more quantitative yet interpersonal scope of the issue surrounding PTSD. For example, I am using my own interdisciplinary concentration, Digital Rhetoric, to persuade you, via a blog post, to look more into the problem of veteran’s with mental health issues. Perhaps someone will see this and tell a friend and that person will then tell another peer, a veteran, to consider participation in these ongoing studies.

PTSD from a Medical Standpoint

Healthcare practitioners and researchers are at the forefront of compiling the data needed for more studies like the one I am proposing. Data from MAPS Phase 1 and Phase 2 trials suggest MDMA’s unique chemical makeup combined with a novel method of administration (pill or capsule form) in conjunction with psychotherapy, can improve upon first-line PTSD and anxiety treatments.

The adverse effects of MDMA, from a clinical perspective generally have not been associated with serious discomfort in healthy volunteers or in people from the MAPS Phase 2 studies. I find it comforting that the major health risks posed by some adverse effects of MDMA treatments were addressed in the trials by excluding people with pre-existing cardiovascular disease. This means that those with cerebrovascular disease or uncontrolled hypertension cannot participate in the continuing trials.

The findings of the MAPS trials infer MDMA’s efficacy, small side effect profile, and duration of effect offer a more reliable, though somewhat unconventional, remedy to those who have post-traumatic stress disorder.

Integrating Psychology Is Imperative For Patient Safety

Since MDMA is a psychoactive drug, there could be some adverse psychological side effects to this new treatment. However, overall the incidence of severe suicidal ideation or behavior in sponsor-supported studies is low. It occurred only in a few subjects post-MDMA treatment. The scores of their mental health inventories (psychology assesments) returned back to non-life-threatening scores within 24 hours while subjects were closely monitored.

Given that people suffering from severe PTSD are known to experience suicidal ideation and behavior, it is difficult to identify a single cause of the increase in suicidal thinking or behavior.

One place where this disciplinary insight may overlap with clinical Medicine’s is in the scenario of the exacerbation of PTSD symptoms related to medication withdrawal, or to the psychotherapeutic process, or from MDMA effects.

With 31 hours of contact with two therapists, medical monitoring, and overnight stays in a clinic, MDMA-assisted therapy is going to be much more expensive than basic exposure therapy, which typically involves 10-20 sessions with one therapist for 60-120 minutes. For these reasons, MDMA-assisted therapy will never be a first line treatment, especially with the VA, if it is conducted in this fashion. That being said, chronic PTSD is very expensive in the long-term.

Veteran Affairs Social Workers Are Critical To Progression and Suicide Prevention

These suffering veterans continue to flood their bodies with the cocktail of pills the VA doctor prescribes leaving them unable to work, later filing for disability. For Veterans who don’t respond to outpatient treatment, MDMA-assisted may be worth the out of pocket expense. 

For years leaders at the top levels of the government have acknowledged the high suicide rate among veterans and spent heavily to try to reduce it. But the suicides have continued, and basic questions about who is most at risk and how best to help them are still largely unanswered. –Dave Philipps, New York Times

Integrating more social workers in the Department of Veteran Affairs can help provide a more quantitative scope that is overlooked in the MAPS trials. This September 2015 New York Times article revealed a patient documentation tragedy within the Department of Veteran Affairs. The article claimed that some branches of the military do not keep fine-grained data or any data at all on veteran’s suicide rates.

This is problematic because is missing data whatsoever on the phenomena of veteran suicide due to a lack of resources, proving that there are not enough resources being put into the major element of a part to the solution to this complex problem. Philipps’ article  sadly notes there are these “battalion epidemics” of suicide in the military, which subsequently lead to exponentially higher rates of suicide and mental health problems within the veteran community

If you are a veteran reading this and you think you might need help with your mental health, you can click this link and it will bring you to the VA Social Work page.

The Real Issue

Will this “groundbreaking” new treatment help America’s veterans or not? In my view, if MDMA-assisted psychotherapy is beneficial and if there are veterans out there suffering from PTSD whose lives could change dramatically for the better from this tool, then researchers should develop this as fast as possible.

Some will respond to my conclusion saying that this form of treatment therapy is too controversial.

However, I believe the real controversy is in the fact that there are more people who have died returning from Afghanistan and Iraq because they have  committed suicide because of their untreated PTSD than have ever died out there in the conflict.

MDMA could be the modern miracle medicine that psychiatry has been vying for. Interdisciplinary researchers like myself owe more to the population of veterans suffering from PTSD, we owe them more research and more solutions because they are being failed.

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