Greater empathy in MDMA users

This observational cohort study (n=67) compared the long-term effects of repeated MDMA use on empathy and the experience of social pain between MDMA, alcohol, and poly-drug users. MDMA users exhibited greater cognitive and emotional empathy compared with non-MDMA poly-drug users.

Abstract

“Background: 3,4-Methylenedioxymethamphetamine (MDMA) is widely known for its positive acute effects on social behaviour, such as increasing empathy, whilst also attenuating the negative impact of social exclusion. However there is a scarcity of research that investigates the long-term impact of recreational MDMA use on these fundamental social processes.

Method: Sixty-seven individuals were split into three groups based on their drug-use history: poly-drug MDMA users (n = 25), poly-drug users who do not use MDMA (n = 19), alcohol-only users (n = 23), and were tested in an independent groups design. Participants completed both a self-report measure of emotional and cognitive empathy, along with the Multifaceted Empathy Task – a computerised assessment of empathy – and the Cyberball Game – a social exclusion paradigm.

Results: MDMA users had significantly greater subjective emotional empathy, and greater cognitive empathy on the computer task compared with the poly-drug users who do not use MDMA. There were no significant differences in subjective responses to social exclusion between the groups. Indices of MDMA use did not correlate with empathy.

Conclusions: Long-term MDMA users in this sample exhibited normal psychosocial functioning in regard to empathy and social pain and had higher subjective emotional empathy. This conflicts with previous suggestions that moderate, long-term MDMA use may cause heightened social distress, and is further evidence of the safety of the drug, which is relevant to considerations of its therapeutic use.“

Authors: Molly Carlyle, Tobias Stevens, Leah Fawaz, Beth Marsh, Sophia Kosmider & Celia JA Morgan

Summary

Introduction

3,4-Methylenedioxymethamphetamine (MDMA) has been approved for Phase III clinical trials of post-traumatic stress disorder (PTSD). It has been suggested that MDMA can improve clinical outcomes in PTSD when given as an adjunct to psychotherapy, and can also reduce the experience of social pain.

MDMA has been found to increase empathy, with particular enhancements to the emotional component (experiencing the emotional state of others) more so than the cognitive component (understanding the perspective of others). MDMA has also been found to reduce the drop in mood and self-esteem experienced after being socially excluded during the Cyberball Game.

3,4-Methylenedioxymethamphetamine (MDMA) increases social behaviour.

MDMA elicits serotonin, dopamine and noradrenaline release, but its actions at the 5-HT transporter and induction of hormones like oxytocin are thought to be responsible for its prosocial effects. MDMA may affect the serotonergic system, and serotonergic depletion may have a downstream effect on empathy and other social processes. However, it is unknown whether pre-existing group differences or a reversible neuroadaptation account for the reduction in density of 5-HT transporter markers seen in chronic MDMA users.

To our knowledge, only one human study has investigated the potential link between chronic MDMA use and increased empathy. However, this study found that empathy deteriorated with heavier use, and the acute effects of MDMA on empathy may help promote long-term changes in reducing distress.

The current study aimed to investigate whether repeated use of MDMA was associated with any changes to social functioning. It was hypothesised that chronic MDMA use would reduce empathic processes and heighten sensitivity to social pain, compared with non-MDMA poly-drug users and alcohol-only users.

Design and participants

75 participants were recruited from a community sample via advertisements on posters and word of mouth, along with snowball sampling, and were asked to abstain from drugs and alcohol for 24 hours prior to study participation. They were not aware the study was specifically investigating MDMA use, empathy, or social pain.

Measures

The Multifaceted Empathy Test (MET) involves showing participants 40 photographs of people with emotionally charged expressions and asking them to identify the correct mental state of the subject in each scene by picking one from a choice of four emotion labels.

Participants played a computerised game where two other participants were programmed to socially exclude them. They received one-third of the ball throws in the inclusion condition, and one-sixth in the exclusion condition.

The Post-Ostracism Cyberball Questionnaire (POCQ) is a 25-item scale used to assess positive and negative affect, belongingness, self-esteem, control, meaningful existence, anger, and hurt feelings.

Questionnaires

The Interpersonal Reactivity Index (IRI) is a 28-item scale that assesses trait empathy. It differentiates between subjective emotional and cognitive empathy, and is based on the ability to feel sympathy and concern towards another individual’s emotional state.

In an interview, participants were asked about their drug use history and about their drug use over the past two weeks. Those who met the criteria for the chronic MDMA user group were asked further questions about their MDMA use.

Participants completed a subjective questionnaire, a computerised task, and a game that measured empathy, and then provided a history of their licit and illicit drug use.

Statistical analysis

Group differences in empathy were assessed using a subjective questionnaire and a computerised task. Chi-squared tests were used to assess dichotomous, categorical dependent variables, and Pearson’s correlations were used to assess exploratory relationships between key psychological variables and drug use.

Demographics and drug use (Table 1)

The MDMA poly-drug user group appeared to have a higher prevalence of historical treatment for mental health problems, but this did not reach the threshold for significance. There were minor reports of MDMA use in the non-MDMA poly-drug user group, however, no recent reports of MDMA use.

Empathy

Subjective empathy was higher in MDMA users than in non-MDMA users, but not in alcohol-only users. There were no significant differences between non-MDMA drug- and alcohol-only users on the personal distress subscale.

When looking at cognitive empathy, MDMA users scored higher than non-MDMA users, but no differently to the alcohol-only group. There were no significant group differences in emotional empathy.

Social pain

A mixed repeated measures ANOVA was used to compare the effect of group and inclusion status on the following dependent variables: positive affect, negative affect, self-esteem, control, and perceived percentage of ball throws received.

Positive affect, self-esteem, control, and perceived percentage of ball throws decreased from inclusion to exclusion. There were no significant interactions between group or inclusion status.

Exploratory analyses

Thirteen cases were identified where MDMA was used in the two weeks prior to testing. MDMA use was not significantly correlated with emotional empathy on the MET, nor was it significantly correlated with cognitive empathy on the MET.

There was no significant difference between those who had used MDMA in the past and those who had never used MDMA on empathic concern on the IRI. There was a near-significant effect on emotional empathy between the MDMA poly-drug, non-MDMA poly-drug, and alcohol-only groups.

Discussion

The current study found that repeated MDMA use increased subjective emotional empathy but did not increase cognitive empathy. There were no group differences in the experience of social pain.

Researchers found that people with reported repeated use of MDMA showed greater self-reported emotional empathy and cognitive empathy compared to poly-drug users who do not take MDMA. In a study of long-term but mild users of MDMA, the authors found that cognitive empathy was inversely related to hair concentrations of MDMA, and that lighter MDMA users had greater cognitive empathy. However, they did not find a correlation between self-reported MDMA use and cognitive empathy.

Studies have found that MDMA enhances emotional empathy, but not cognitive empathy. Differences observed in emotional empathy may be down to pre-existing group differences that draw some users to take the substance.

MDMA users report greater self-reported emotional empathy following repeated doses, which may be down to autobiographical memories of heightened emotional experiences under the acute effects of the drug.

In the current study, MDMA users exhibited heightened emotional empathy compared to non-MDMA users, but this was only observed using the subjective measure. The computerised task did not measure empathy, and this may have been due to differences in how both measures operationalise empathy.

Repeated MDMA use was not found to impact on the experience of social exclusion, and may even improve cognitive empathy. However, the ability to draw conclusions from the Cyberball Game is limited, as there are no differences between the three groups on responses to social exclusion.

The findings of this study contradict previous suggestions that long-term MDMA use may cause heightened social distress. Although many MDMA users reported experiencing a lowered mood in the days following MDMA, this may be due to the drug set and setting associated with recreational use.

The present study had several limitations, but it was conducted on low-level MDMA users who used the substance regularly and included a non-MDMA poly-drug user group. It is possible that the three-group design was underpowered to detect other important group differences.

The current study suggests that mild, repeated use of MDMA is not associated with any impairment to interpersonal functioning, but rather enhanced levels of subjective emotional empathy and greater cognitive empathy on a computer task.