Current Perspective on MDMA-Assisted Psychotherapy for Posttraumatic Stress Disorder

The present paper discusses the current literature with regard to substance-assisted psychotherapy with Methylenedioxymethamphetamine (MDMA) for posttraumatic stress disorder (PTSD). The aim of the paper is to give a comprehensive overview of the development from MDMA’s early application in psychotherapy to its present and future role in the treatment of PTSD. It is further attempted to increase the attention for MDMA’s therapeutic potential by providing a thorough depiction of the scientific evidence regarding its theorized mechanism of action and potential harms of its application in the clinical setting (e.g., misattribution of therapeutic gains to medication instead of psychological changes). Empirical support for the use of MDMA-assisted psychotherapy, including the randomized, double-blind, placebo-controlled trails that have been conducted since 2008, is discussed. Thus far, an overall remission rate of 66.2% and low rates of adverse effects have been found in the six phase two trials conducted in clinical settings with 105 blinded subjects with chronic PTSD. The results seem to support MDMA’s safe and effective use as an adjunct to psychotherapy. Even though preliminary studies may look promising, more studies of its application in a psychotherapeutic context are needed in order to establish MDMA as a potential adjunct to therapy

Psychedelic trip sitting, dosages and intensities: Supplementing clinical studies with anecdotal reports

Background and aims: Online communities provide insights into psychedelic consumption, assisting in identification of trends, informing both harm reduction provisions and clinical research. This study extracts forum data on psychedelic substances, dosages, and administration routes, categorising and analysing self-reported consumption to inform care services and guide clinical work with psychedelics. Methods: Posts (n = 660) from online psychedelic forums (The Shroomery and DMT Nexus) on \u27trip sitting\u27 were analysed. Using a Delphi-style expert panel review facilitated by LE, we created drug weight and intensity charts (threshold, light, common, strong and heavy dosages) for psychedelics discussed in these posts. The psychedelic substance, dosage intensity and route of administration [ROA] (smoked/vaporised, oral, injected, insufflated and undisclosed) frequencies and exploring correlations with perceived need for assistance from a psychedelic carer were mapped and correlated with perceived need for psychedelic care. Results: Psychedelics appearing in our data were 5-MeO-DMT, ayahuasca, changa, LSA, LSD and psilocybin. There was greater commonality between clinical studies and \u27common\u27 doses determined through the Delphi method, for more extensively researched substances like LSD and psilocybin. Many posts indicated opinions that psychedelic care was unnecessary or optional for consumers, particularly for LSD and LSA. 5-MeO-DMT was strongly associated with a perceived need for care. A correlation was identified between greater psychedelic purity, dosage intensity, and a perceived need for care. Oral administration, the most common ROA, showed lower dosage intensity. Conclusion: More research is needed to understand factors influencing psychedelic care practices. Educational information, emphasizing risk management strategies, should be provided to psychedelic consumers, emphasising psychedelic products and administration methods more likely to be dosed at a strong or heavy intensity

Current perspective on the therapeutic preset for substance-assisted psychotherapy

The present narrative review is the first in a series of reviews about the appropriate conduct in substance-assisted psychotherapy (SAPT). It outlines a current perspective on preconditions and theoretical knowledge that have been identified as valuable in the literature for appropriate therapeutic conduct in SAPT. In this context, considerations regarding ethics and the spiritual emphasis of the therapeutic approaches are discussed. Further, current methods, models, and concepts of psychological mechanism of action and therapeutic effects of SAPT are summarized, and similarities between models, approaches, and potential mediators for therapeutic effects are outlined. It is argued that a critical assessment of the literature might indicate that the therapeutic effect of SAPT may be mediated by intra- and interpersonal variables within the therapeutic context rather than specific therapeutic models per se. The review provides a basis for the development and adaptation of future investigations, therapeutic models, training programs for therapists, and those interested in the therapeutic potential of SAPT. Limitations and future directions for research are discussed

Therapeutic Frameworks in Integration Sessions in Substance-Assisted Psychotherapy: A Systematized Review

Serotonergic psychedelics and related substances have been explored as potential adjuncts in substance-assisted psychotherapy (SAPT) for treating various disorders. SAPT can be divided into three phases: preparation, administration, and integration. Integration is commonly defined as the comprehension and effective application of insights from psychedelic experiences into everyday life. However, there is limited research regarding the most appropriate therapeutic approach during integration sessions in SAPT. In this article, we discuss the current evidence for different therapeutic frameworks for integrations sessions when serotonergic psychedelics and entactogens are used as adjuncts to psychotherapy. We conducted a systematized review of the literature following PRISMA guidelines and searched PsycINFO, MEDLINE, and Cochrane Library databases. The final synthesis included 75 clinical trials, mixed-methods investigations, treatment manuals, study protocols, quasi-experiments, qualitative investigations, descriptive studies, opinion papers, reviews, books and book chapters, published until November 11, 2022. The effects that various therapeutic approaches for integration sessions have on therapeutic outcome have not been investigated by means of rigorous research. Most of the available evidence we retrieved was not supported by empirical data, thus limiting any conclusive statements regarding appropriate therapeutic frameworks for integration sessions for SAPT. Current clinical studies have used a range of therapeutic frameworks with the majority drawing from the humanistic-experiential tradition. While integration is regarded as crucial for the safe application of SAPTHowever, there is currently an insufficient evidence base to suggest that any type of therapy is most effective for guiding integration sessions. Systematic investigation of different therapeutic frameworks for integration and additional therapy-related factors is needed

Neutrophils mediate early cerebral cortical hypoperfusion in a murine model of subarachnoid haemorrhage

Cerebral hypoperfusion in the first hours after subarachnoid haemorrhage (SAH) is a major determinant of poor neurological outcome. However, the underlying pathophysiology is only partly understood. Here we induced neutropenia in C57BL/6N mice by anti-Ly6G antibody injection, induced SAH by endovascular filament perforation, and analysed cerebral cortical perfusion with laser SPECKLE contrast imaging to investigate the role of neutrophils in mediating cerebral hypoperfusion during the first 24 h post-SAH. SAH induction significantly increased the intracranial pressure (ICP), and significantly reduced the cerebral perfusion pressure (CPP). At 3 h after SAH, ICP had returned to baseline and CPP was similar between SAH and sham mice. However, in SAH mice with normal neutrophil counts cortical hypoperfusion persisted. Conversely, despite similar CPP, cortical perfusion was significantly higher at 3 h after SAH in mice with neutropenia. The levels of 8-iso-prostaglandin-F2α in the subarachnoid haematoma increased significantly at 3 h after SAH in animals with normal neutrophil counts indicating oxidative stress, which was not the case in neutropenic SAH animals. These results suggest that neutrophils are important mediators of cortical hypoperfusion and oxidative stress early after SAH. Targeting neutrophil function and neutrophil-induced oxidative stress could be a promising new approach to mitigate cerebral hypoperfusion early after SAH