Effects of MDMA on socioemotional feelings, authenticity, and autobiographical disclosure in healthy volunteers in a controlled setting

This double-blind, placebo-controlled study (n=12) investigated the effects of MDMA on socioemotional feelings and autobiographical disclosure, both of which increased following MDMA administration.

Abstract

“The drug 3,4-methylenedioxymethamphetamine (MDMA, “ecstasy”, “molly”) is a widely used illicit drug and experimental adjunct to psychotherapy. MDMA has unusual, poorly understood socioemotional effects, including feelings of interpersonal closeness and sociability. To better understand these effects, we conducted a within-subjects double-blind placebo controlled study of the effects of 1.5 mg/kg oral MDMA on social emotions and autobiographical disclosure in a controlled setting. MDMA displayed both sedative- and stimulant-like effects, including increased self-report anxiety. At the same time, MDMA positively altered evaluation of the self (i.e., increasing feelings of authenticity) while decreasing concerns about negative evaluation by others (i.e., decreasing social anxiety). Consistent with these feelings, MDMA increased how comfortable participants felt describing emotional memories. Overall, MDMA produced a prosocial syndrome that seemed to facilitate emotional disclosure and that appears consistent with the suggestion that it represents a novel pharmacological class.“

Authors: Matthew J. Baggott, Jeremy R. Coyle, Jennifer D. Siegrist, Kathleen Garrison, Gantt Galloway & John E. Mendelson

Notes

Another study by Baggott and colleagues (2019) compared MDA to MDMA data of this study.

Summary

Introduction

MDMA, a widely used illicit drug, has been shown to have socioemotional effects, including feelings of empathy, interpersonal closeness, and sociability. This may be because it lessens sensitivity to threatening stimuli, which allows stressful events and ideas to be addressed with reduced discomfort in psychotherapy.

Negative expressions are associated with decreased threat sensitivity, although this may partly be due to a mood congruent bias.

MDMA sometimes acutely increases rather than decreases anxiety, and it has little evidence that it has consistent clinically meaningful effects on anxiety.

MDMA, a widely used illicit drug, has unusual, poorly understood socioemotional effects, including feelings of interpersonal closeness and sociability. MDMA also increased self-report anxiety, while decreasing concerns about negative evaluation by others.

We sought to clarify MDMA’s self-report effects on anxiety and affective processing. We hypothesized that MDMA might specifically decrease social anxiety, and used a single VAS item to measure general anxiety.

MDMA may increase sociability and alter appraisal of others. This may be a psychological mechanism that contributes to the therapeutic alliance and meaningful interactions in couples therapy.

Research on MDMA effects on sociability has focused on appraisal of others, but little is known about how MDMA might alter self-appraisals. We therefore sought to measure changes in self-appraisal using the construct of authenticity.

We collected self-report measures of anxiety, sociability, and authenticity in the context of an autobiographical speech task to examine whether MDMA altered remembering and describing of positive and negative psychological material.

General study design

We used a double-blind, placebo-controlled, within-subject, gender-balanced design to study the effects of 1.5 mg/kg oral MDMA on body temperature, heart rate, blood pressure, and hydration status in 12 volunteers after an overnight hospital stay.

Power calculations

We used peak scores for the baseline corrected “Closeness to others” visual analog item to power the study, and found that n=12 would give us 80% power at p=0.05 in a paired two-sided analysis.

Participants

We recruited healthy, MDMA-experienced individuals through newspaper and on-line advertisements and word-of-mouth. Exclusion criteria included: dependence on MDMA or any other psychoactive drug, desire to quit or decrease MDMA use, history of adverse reaction to study drugs, and current supervision by the legal system.

Experimental measures

We developed a novel procedure to measure MDMA effects on autobiographical memory recall. Participants recounted memories from four different emotional categories to a researcher, and rated the experience of recounting each memory.

During drug administration sessions, beginning 1.5 – 2 h after MDMA/placebo, participants described autobiographical memories from four emotional categories to a researcher. The memories were randomized with the exception that Joy was always described last.

After describing each episode, participants gave ratings on how upsetting or comfortable it was to talk about the experience, how much they relived the emotions, how well they could remember the details of the experience, how well they could describe the emotions, and how well they understood the emotions.

We digitally recorded and transcribed autobiographical memories and analyzed them using Pennebaker’s 2007 LIWC (version 1.11), which matches text against an extensive dictionary and provides the percent of words in a large set of well-validated categories.

Self-report measures

We measured self-report drug effects using visual analog items. Participants clicked a location on a digital line to indicate how intensely they were experiencing each item in the last few minutes.

We measured social anxiety using the Brief Fear of Negative Evaluation – revised (BFNE), a 12-item Likert scale questionnaire. MDMA-experienced participants gave very low ratings on this measure, so we modified the instrument to use a five-point Likert scale.

We measured MDMA effects using the 45-item Authenticity Inventory, which seeks to measure feelings of “unimpeded operation of one’s true- or core- self”. The Authenticity Inventory was given 2.5 h after drug administration, shortly after the autobiographical memory task was completed.

We measured interpersonal functioning using the Interpersonal Adjectives Scale-Revised (IASR), which has eight subscales that can be labeled as Dominance and Nurturance. The IASR was given 2.5 h after drug administration, shortly after the autobiographical memory task was completed.

Autobiographical memory task

Autobiographical memories of fear, joy, sadness, and safety did not significantly differ between the two conditions based on measures of their recency and impact.

Participants reported feeling more comfortable talking about emotional memories while on MDMA, and memories of Joy were rated as significantly easier to recount than memories of other emotions. MDMA did not otherwise appear to significantly alter participants’ reports of their abilities to remember, understand, or experience their emotional memories.

Analysis of narratives

MDMA decreased the number of words participants spoke and altered word choice in several categories. MDMA increased use of present tense, words showing assent, and words relating to family.

Fourteen of 43 LIWC categories showed significant effects of category of emotional memory being recalled, with five more general categories also showing effects.

Self-report measures

Eight VAS items were missing from one participant’s self-report data due to a computer failure, and one participant’s Self-conscious VAS item was missing due to a version control error.

Visual analog measures

When visual analog measures were examined, we found MDMA produced robust increases in measures of general drug effects, stimulant- and sedative-like effects, and changes in emotional measures of love and kindness.

MDMA increased feelings of love and kindness, but not of adventure, amusement, closeness to others, contentment, insightful, proud, passionate, self-conscious, or trust.

MDMA increased reported affiliative feelings, as measured by an increase in the Gregarious subscale. This increase was mainly caused by significant increases in the Nurturance/Communion dimension.

Discussion

We conducted a double-blind placebo-controlled preliminary study of MDMA’s effects on social emotions and autobiographical disclosure. MDMA increased feelings of authenticity and decreased social anxiety.

MDMA increased self-report anxiety and decreased social anxiety, but increased duration of social interaction and decreased anxiety-related behaviors in the emergence and elevated plus-maze tests.

MDMA may facilitate an affiliative “tend-and-befriend” style of response to stressors, which involves stress-induced caregiving and prosocial behavior. This response is consistent with the theory that MDMA could aid psychotherapy by improving the therapeutic alliance.

Participants reported feeling more comfortable disclosing emotional autobiographical episodes after MDMA compared to after placebo, but we could not detect other effects of MDMA on remembering, describing, or understanding emotional memories.

We detected changes in speech that only partly overlapped with those seen in past studies. These differences may be the result of task differences, relative lack of power in the current study, or type II errors.

Participants reported feeling greater authenticity after MDMA, which is associated with greater well-being, more honesty, and lessened defensiveness. This effect seems to distinguish MDMA from classical psychedelics such as lysergic acid diethylamide (LSD) and psilocybin.

This study had several limitations, including a modest sample size, underpowered to detect less-than-robust effects, and failure to control for temporal duration (and resulting narrative complexity) of memories. It would be worthwhile to measure MDMA effects with other measures of social anxiety and authenticity.

Research on MDMA continues to be challenged by the difficulties of reliably measuring the unusual effects of MDMA.

In this study, MDMA decreased social anxiety, increased sociability and feelings of authenticity, and enhanced comfort disclosing autobiographical material. These effects occurred against a background of both stimulant-like and sedative-like self-report effects.