The Neuroscience Of MDMA-Assisted Psychotherapy For PTSD (Feduccia & Mithoefer, 2018)

Описание: This video explores the neurobiological mechanisms underlying MDMA-assisted psychotherapy for Posttraumatic Stress Disorder (PTSD). Based on a comprehensive review by Feduccia and Mithoefer (2018), we discuss how this breakthrough therapy combines pharmacological effects with psychotherapeutic techniques to process traumatic memories.

The following outline details the clinical context, therapeutic approach, and the specific brain mechanisms—such as memory reconsolidation and fear extinction—that contribute to the treatment's efficacy.

I. Clinical Context And Efficacy
MDMA-assisted psychotherapy is now in Phase 3 clinical trials.
The FDA designated it as a Breakthrough Therapy for PTSD.
Phase 2 trials demonstrated durable remission in participants.
68% of participants no longer met PTSD criteria after treatment.
Results showed large effect sizes compared to current medications.

II. The Therapeutic Structure
The treatment includes preparatory nondrug sessions to build rapport.
Active MDMA sessions last eight hours with a co-therapist team.
Participants alternate between introspection and talking to therapists.
The approach is non-directive and supports the client's process.
Integration sessions occur after dosing to process the experience.

III. Memory Reconsolidation Mechanisms
Reconsolidation is a process where memories become labile and changeable.
Reactivating a memory opens a window for it to be updated.
MDMA creates a mismatch between trauma recall and present safety.
This prediction error allows the memory to be rewritten with less fear.
Dopamine release may specifically help destabilize the memory trace.

IV. Facilitating Fear Extinction
Fear extinction involves learning to separate cues from fear responses.
MDMA reduces the urge to avoid traumatic memories.
It allows patients to engage with trauma without being overwhelmed.
Patients report viewing painful memories with a neutral perspective.
This facilitates the processing required for exposure-based therapies.

V. Neurobiological Impact On The Brain
MDMA reduces blood flow to the amygdala, the center of fear processing.
It increases connectivity between the amygdala and hippocampus.
This connectivity helps reorganize emotional information in the brain.
Reduced insula activity may help counter anxiety-related hyperarousal.
The drug acts on key pathways for emotion and memory processing.

VI. Neurochemistry And Hormones
Serotonin release induces positive emotional states and prosocial feelings.
Oxytocin levels increase, potentially strengthening therapeutic trust.
Cortisol release may enhance emotional engagement during therapy.
Norepinephrine increases arousal which is necessary for learning.
The chemical profile creates a state primed for emotional processing.

VII. Synaptic Plasticity And BDNF
BDNF is a protein essential for the growth of new neural connections.
Rodent studies suggest MDMA increases BDNF in the amygdala.
This supports synaptic plasticity and long-term memory changes.
Enhanced plasticity may help patients encode new perspectives on trauma.
Changes in openness may be linked to these neural modifications.

VIII. Resource Support
For additional resources, please see the NourishED NotebookLM Resource Support page that accompanies this publication (and video): https://notebooklm.google.com/noteboo...

IX. Source
Feduccia, A. A., & Mithoefer, M. C. (2018). MDMA-assisted psychotherapy for PTSD: Are memory reconsolidation and fear extinction underlying mechanisms? Progress in Neuro-Psychopharmacology and Biological Psychiatry, 84, 221–228. https://doi.org/10.1016/j.pnpbp.2018....

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