MDMA with cognitive-behavioural conjoint therapy

Domain VII · Transpersonal, psychedelic & altered states · Candice Monson, Steffany Fredman, Michael Mithoefer · 2017

What it is

MDMA-facilitated cognitive-behavioural conjoint therapy (CBCT + MDMA) is a research protocol, not an approved treatment. It combines CBCT for PTSD, a manualised couple/dyadic therapy (Candice Monson, Steffany Fredman), with two day-long MDMA-assisted sessions run in the non-directive MAPS style…

Format

• Format. Dyads in which one member has chronic PTSD (the "PTSD+" partner) and the other is a concerned significant other (CSO; romantic or non-romantic in the protocol; all six completers were romantic, heterosexual couples). Both are clients, not helpers. Co-therapy team: one therapist trained in…
• Standard CBCT phases (15 sessions; titles as in the published manual):

Who practises it, and how they are trained or regulated

• Single-partner variant (not followed here): Morland et al. (2024) set out a VA pilot protocol (8 veterans with PTSD and their partners) in which only the veteran receives MDMA. Brief CBCT has eight 75-minute sessions in two phases (relational safety; then relationship satisfaction and PTSD-related distress); sessions 1–3 and 4–5 are each combined into one longer session and sessions 6–8 are weekly. A 90-minute…
• Version followed: MAPS study MPVA-1 ("MDMA-Assisted Cognitive-Behavioral Conjoint Therapy in Dyads in which 1 Member has Chronic PTSD", Phase 1/2 open-label protocol, Amendment 4 v1, 8 May 2017; clinical investigator Michael Mithoefer, sub-investigator Candice Monson), as delivered and reported by Monson et al. (2020) and Wagner et al. (2019, 2021), in which both partners take part in the MDMA sessions…
• Legal and regulatory status (as of sources). MDMA is a controlled substance in essentially all jurisdictions; MDMA-assisted therapy is available only inside approved research or, where permitted, specially authorised medical frameworks. USA: MDMA "is currently a Schedule I drug in the United States" and not clinically available for any medical use, including PTSD; clinical use would require both FDA approval and DEA…

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

• acceptance heard as resignation.
• tracking only the other partner's anger.
• partners processing a conflict overnight without support.
• only anger expressed (explore softer feelings underneath); flooding.
• the CSO's own appraisals are also targets, not only the PTSD+ partner's.

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.