MDMA-assisted therapy for PTSD

Domain VII · Transpersonal, psychedelic & altered states · Michael Mithoefer, Annie Mithoefer, Lisa Jerome · 2010

What it is

MDMA-assisted therapy (MDMA-AT; called "MDMA-assisted psychotherapy" in older documents) is a manualised psychotherapy for chronic PTSD. A two-therapist team gives three kinds of session: non-drug preparatory sessions, all-day "experimental" sessions in which the participant has received MDMA in a…

Format

• Total course. Phase 3 (MAPP1): about 12 weeks of treatment after the 3 preparatory sessions, i.e. 3 medicine sessions each followed by 3 integrative sessions. The 2010 phase 2 manual described daily phone contact for about a week after each session; the phase 3 protocol uses scheduled check-ins…
• Recording. Participants must agree to video recording of all sessions.

Who practises it, and how they are trained or regulated

• Training. Therapy teams are trained on the manual and supervised by the sponsor through open-label lead-in protocols. The MAPP1 protocol notes that one phase 2 study was stopped early partly because therapy-team training was insufficient. MAPS also publishes an Adherence Ratings Manual (Version 6, 3 Aug 2021).
• Legal and regulatory status (checked October 2026).
• What this means for clinicians. MDMA-AT is lawful only inside authorised trials or regulated programmes. With clients who use MDMA elsewhere, the clinician's role is harm reduction and integration support (see 4.27), never facilitation.

Evidence status, as the guide reports it

• For a new trial, the FDA recommended a randomised double-blind design, exclusion of prior MDMA users, pre-specified retreatment criteria, full adverse-event reporting and a third-party data audit. Psychiatric Times adds that the letter suggested considering a low-dose comparison arm.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• constant avoidance, or constant flooding.
• a single standard approach applied to everyone.
• contraindications to further sessions; new risk.
• fears that are not voiced. Ask about them directly.
• isolation, or relationships that may react with hostility.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.