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

There is promise for 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy as a highly effective and durable treatment for posttraumatic stress disorder (PTSD). However, the Food and Drug Administration rejected MDMA-assisted psychotherapy in its current form, expressing concerns about the lack of standardization and empirical basis of psychotherapy methods. This highlights the need to consider alternative psychotherapeutic approaches to integrate with MDMA for the treatment of PTSD. We propose that the evidence-based cognitive behavioral therapy, acceptance and commitment therapy (ACT), is particularly well-suited to be paired with the administration of MDMA for PTSD. Specifically: (1) the subjective effects of MDMA directly support key ACT processes; (2) ACT methods could help prepare patients for MDMA administration, increasingly the likelihood of efficacy and tolerability; (3) ACT provides a “process-directed” approach to assist the therapist and support the patient during MDMA administration sessions; and (4) ACT may help optimize the integration of MDMA experiences to shape adaptive functioning and promote quality of life following treatment. We provide examples of how ACT methods could be used for many of these goals. In sum, we believe ACT provides a highly scalable, structured yet flexible, evidence-based framework well-suited to be integrated with MDMA as a new treatment approach for PTSD.