MDMA-Assisted Therapy for Social Anxiety Disorder

What is Social Anxiety Disorder?

We all know what it feels like to feel awkward or nervous in a social setting. Maybe you’ve felt jittery and noticed your heart speed up when introducing yourself to someone new. Perhaps you’ve noticed yourself blushing during a presentation at work or school. For most people, talking with a group of strangers or giving a public speech aren’t exciting scenarios, but they’d feel able to push through it. 

Yet, if you’re struggling with social anxiety disorder (SAD), the stress of these situations might feel overwhelming. The hallmark of SAD is experiencing a strong fear of judgment or scrutiny in social situations and frequently avoiding social contexts due to that fear. People with SAD often avoid social opportunities all together because the thought of common social interactions, like small talk or eating in front of other people, feels too uncomfortable. 

Social avoidance can result in work and relationship problems for affected people and can hugely impact their well-being. Many suffering from SAD also develop depression or a reliance on alcohol to cope with their anxiety. Over time, it is common that people with SAD feel incapable or fundamentally different from others and fear that this will be exposed.

How common is SAD? Can it be treated?

SAD is one of the most common mental health diagnoses among adults in the United States. Research suggests about 13% of Americans will experience SAD at some point in their life – in 2020 that was over 43 million people!

Fortunately, there are effective treatments for SAD. Evidence-based psychotherapies, like Cognitive Behavioral Therapy (CBT), have robust evidence for helping people reduce social anxiety and improve quality of life. Yet, there is still a lot of room for improvement. SAD often goes undiagnosed by healthcare professionals and at least one-third of people treated with CBT don’t experience the relief they’d hope for. In addition, many people aren’t offered the most effective treatments or aren’t interested in them, so we need more options that work.

MDMA Assisted Therapy: A promising avenue for future research

Exciting new research is exploring the use of MDMA (3,4-mehtylenedioxymethpamphetamine) to enhance traditional therapy approaches to help people recover from social anxiety disorder. 

Known as MDMA-Assisted Therapy (MDMA-AT), this new approach is gaining recognition as an effective treatment for posttraumatic stress disorder (PTSD) and has shown promising results in one study related to social anxiety. In this randomized-controlled trial, adults with autism who received MDMA-AT experienced reduced social anxiety symptoms and increased social behavior at the end of therapy (Danforth et al., 2018) and study researchers commented that many participants continued to report long-lasting benefits years later.

In current studies of MDMA-AT, the therapy consists of three phases: preparation, MDMA dosing sessions, and integration. During the MDMA sessions, clients meet with two therapists over an eight hour period, where they alternate between inner-directed attention and talking to the therapists about their experiences.  The preparation and integration phases are equally important pieces of the intervention, as therapists clients orient to the treatment and help them solidify integrate lessons from the MDMA sessions into daily life. This video gives some background for how these sessions look.

How might MDMA-AT help social anxiety? 

We don’t know for sure. Amidst the growing interest in MDMA-AT and other psychedelic therapies, we are planning at study testing various theories about how MDMA-AT might help people with SAD. This clinical trial examines both how well MDMA-AT works for social anxiety disorder, as well as how it works. Here are three examples of how we think MDMA-AT  may be helpful for people with SAD compared to traditional psychotherapy:

  1. MDMA-AT may help people process painful memories of past social experiences and face fears in a way that is healing. The unique tendency for MDMA to create feelings of safety, empathy, and connection to others can create a situation where people are able to face social fears and learn from them. People may arrive at new ways of viewing past experiences and feel able to practice new ways of interacting socially in a safe environment with their therapists. 
  1. One of the most common experiences people have when taking MDMA in clinical settings is an experience of pleasure, peace, and love. Many people with SAD report high levels of self-criticism and this experience of compassion, love, and safety often encountered in MDMA-AT may help them be more compassionate and accepting with themselves. 
  1. MDMA also seems to strengthen the relationship with the therapist, making it easier for people with SAD to talk openly about the difficulties and to be able to internalize the care and compassion they experience. This may help people to get at the root of their problems faster than in traditional therapy and allow people with SAD to accept both constructive criticism and praise with less struggle.

Portland Psychotherapy’s clinical trial examining MDMA Assisted Therapy for Social Anxiety Disorder is set to begin in Spring, 2022. If you are interested in learning more about the trial, please check out our website. To inquire about participating in the trial, please contact our research team here.   

Authors: Kati Lear, Ph.D., Sarah Smith, B.S., and Jason Luoma, Ph.D.

Author: Kati Lear, Ph.D.

Kati Lear, Ph.D. is a licensed psychologist, associate investigator, and continuing education coordinator at Portland Psychotherapy. Kati specializes in working with adults struggling with high levels of self-criticism and shame. Some of her specialty areas include social anxiety disorder, trauma and post-traumatic stress disorder, and depression.

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