MDMA-assisted Acceptance and Commitment Therapy for Posttraumatic Stress Disorder: Rationale for a New Approach

There is promise for 3,4-Methylenedioxymethamphetamine (MDMA)-assistedpsychotherapy as a highly effective and durable treatment for posttraumatic stress disorder(PTSD). However, the Food and Drug Administration rejected MDMA-assisted psychotherapy inits current form, expressing concerns about the lack of standardization and empirical basis ofpsychotherapy methods. This highlights the need to consider alternative psychotherapeuticapproaches to integrate with MDMA for the treatment of PTSD. We propose that the evidencebased cognitive behavioral therapy, Acceptance and Commitment Therapy (ACT), is particularlywell-suited to be paired with the administration of MDMA for PTSD. Specifically: 1) thesubjective effects of MDMA directly support key ACT processes; 2) ACT methods could helpprepare patients for MDMA administration, increasingly the likelihood of efficacy andtolerability; 3) ACT provides a “process-directed” approach to assist the therapist and help thepatient during MDMA administration sessions; and 4) ACT may help optimize the integration ofMDMA experiences to shape adaptive functioning and promote quality of life followingtreatment. We provide examples of how ACT methods could be used for many of these goals. Insum, we believe ACT provides a highly scalable, structured yet flexible, evidence-basedframework well-suited to be integrated with MDMA as a new treatment approach for PTSD.