MDMA against social anxiety

Landmark study finds MDMA may be an effective tool
to treat social anxiety disorders in autistic people

Socializing doesn’t come naturally to those of us on the autism spectrum, and this is the cause of much suffering. In fact, about 40% of autistic people aged 17 and under have some form of chronic social anxiety disorder (aptly abbreviated as SAD).^[1]Anxiety and Autism Spectrum Disorders | Indiana Resource Center for Autism Additionally, autistic people are more likely to experience repeated rejection due to the impact of autism on social interactions.

And, until recently, researchers haven’t looked into how post-traumatic stress disorder (PTSD) manifests in autistic individuals as compared to the general population, leading psychiatric and academic institutions to turn a blind eye to the link between PTSD and autism.^[2]Does Autism Raise the Risk of PTSD? | Scientific American You can read more about that in the following post:

The link between autism & PTSD

However, researchers at MAPS (Multidisciplinary Association for Psychedelic Studies)—a group dedicated to studying the healing effects of entheogens (mind-altering substances used for spiritual or religious reasons) and empathogens (a class of psychoactive drugs that produce experiences of relatedness, oneness, emotional communion, and emotional openness)—published a study on how 3,4-methylenedioxymethamphetamine (MDMA, ecstasy, Molly) could help autistic participants with their social anxiety. The study was authored by Charles Grob and Alicia Danforth, and published in the Journal Psychopharmacology.^[3]MDMA-Assisted Therapy for the Treatment of Social Anxiety in Autistic Adults | MAPS

To go straight to the results, scroll down to the section entitled ‘Promising results’.

A party drug for (non-)party people

You may be wondering how a drug associated with very bright and noisy raves full of drugged-up sweaty flailing people could ever be helpful to autistics with social anxiety—and your hypothetical point is well-taken. It all has to do with how MDMA works.

MDMA is classified as an empathogen (colloquially referred to as the “love drug”) because of its ability to make people want to be more social and—you guessed it—empathetic towards others. Additionally, MDMA quiets the amygdala, which stimulates fight–flight–freeze responses.^[4]LA BioMed Launches Study of MDMA-Assisted Therapy for Social Anxiety in Autistic Adults | MAPS Altogether, MDMA allows people to open themselves up to others through increased serotonin and oxytocin levels and reduced fear responses. The psychophysiological mechanisms of MDMA have yet to be discovered, but the data looks promising.^[5]MDMA, Or Ecstasy, Shows Promise As A PTSD Treatment | NPR

Alicia Danfort reported that 72% of the more than 100 autistic adults she surveyed reported feeling “more comfort in social settings” as a result of using MDMA recreationally, and 77% found it “easier than usual to talk with others.”^[6]LA BioMed Launches Study of MDMA-Assisted Therapy for Social Anxiety in Autistic Adults | MAPS

If you want to learn more about how MDMA and autism interact, I suggest you check out Embrace ASD’s earlier post on the topic:

MDMA-assisted therapy for autistic people

Methodology

The aforementioned study from 2019 employed a randomized and placebo-controlled double-blind methodology. Essentially, this means that all the study’s participants and their therapists are unaware of which participant received a dose of MDMA versus a placebo.

The participants were selected based on an autism diagnosis and if they scored moderate or severe baseline anxiety levels on the Leibowitz Social Anxiety Scale (LSAS), which assesses the severity of SAD.

The study has a limited sample size of 12 participants in total, with 8 participants receiving MDMA, and the remaining 4 receiving a placebo. Their average age is 31.3 years, and 2 participants are female.^[7]MDMA-Assisted Therapy for the Treatment of Social Anxiety in Autistic Adults | MAPS

Set and setting

Whenever one is under the influence of any mind-altering substance, it’s important to note one’s mental state and physical setting. A bad mindset, often referred to as “set” will likely result in a bad trip; likewise, a scary or overwhelming setting will increase the likelihood of a trip going awry. So, the team of researchers took care to create an environment conducive to a good experience for the study’s participants. To accomplish this, the team enlisted help from members of the autism community.^[8]MDMA-Assisted Therapy for the Treatment of Social Anxiety in Autistic Adults | MAPS

Rooms where the participants would go for therapy sessions (MDMA-assisted therapy for those in the MDMA group) had soft lighting and noise abating accommodations. Stim toys were also accessible to the participants as needed. Indeed, great care was taken to ensure that the therapy was as effective as possible.^[9]MDMA-Assisted Therapy for the Treatment of Social Anxiety in Autistic Adults | MAPS

Promising results

After the course of the study, the MDMA group showed significant improvements when compared to the control group.

Both groups saw improvement in their LSAS scores. In other words, they weren’t as SAD anymore! No, but really, they scored lower on the LSAS by the end of the study. The cutoff LSAS score to participate in the study was 60. Lower scores imply less severe social anxiety. The baseline average LSAS scores were 83.3 and 91.8 for the control and MDMA groups respectively.

Six months after the final experimental session, the control group’s average score was about 60, nearly matching the cutoff limit. In contrast, the MDMA group averaged an LSAS score of 45, significantly lower than the controls. Overall, the MDMA group across the board saw significant reductions in SAD symptoms:^[10]MDMA-Assisted Therapy for the Treatment of Social Anxiety in Autistic Adults | MAPS

…of seven participants in the MDMA group completing treatment, all dropped 2–4 levels in severity category, whereas the four participants in the placebo group dropped 0–3 levels in severity.

In addition, six of seven participants in the MDMA group had a >20-point drop in LSAS scores compared to two of four participants in the placebo group.

So, what comes of this research?

With a sample size of twelve—and with one of those participants not even completing the study—more research is definitely warranted. However, aside from improving the lives of those who participated in the study, this research is groundbreaking. The topic of entheogen/empathogen-assisted therapies to help those on the autism spectrum is novel. Frankly, research into therapeutic methods to help autistic people with social integration is lacking in general.

This study, however, touches on many aspects that are underexplored in autistics: PTSD, anxiety, social difficulties, and the effects of mind-altering substances on the autistic brain. Hopefully, this will inspire further research on autism and social integration.