MDMA-Assisted Therapy as a Means to Alter Affective, Cognitive, Behavioral, and Neurological Systems Underlying Social Dysfunction in Social Anxiety Disorder

This review (2021) explores the potential of MDMA-assisted therapy for treating the various symptoms of social anxiety disorder (SAD). The authors hypothesize how disruptions in neurological, perceptual, receptive, and expressive systems regulating social behavior in SAD may take place as a result of MDMA-assisted therapy, thereby acting as a stimulus for further research.

Abstract

“Social anxiety disorder (SAD) is a prevalent and often debilitating psychiatric disorder that can assume a chronic course even when treated. Despite the identification of evidence-based pharmacological and behavioral treatments for SAD, much room for improved outcomes exists and 3,4-methylenedioxymethamphetamine (MDMA) has been proposed as a promising adjunctive treatment to psychological interventions for disorders characterized by social dysfunction. A small randomized, placebo-controlled trial of MDMA-assisted therapy (MDMA-AT) for social anxiety in autistic adults offered encouraging results, but more research is sorely needed to explore the potential for MDMA-AT in treating SAD. This review aims to stimulate future study by summarizing research on disruptions in neurological, perceptual, receptive, and expressive systems regulating social behavior in SAD and proposing how MDMA-AT may alter these systems across four domains. First, we review research highlighting the roles of social anhedonia and reduced social reward sensitivity in maintaining SAD, with specific attention to the reduction in positive affect in social situations, infrequent social approach behaviors, and related social skills deficits. We posit that MDMA-AT may enhance motivation to connect with others and alter perceptions of social reward for an extended period following administration, thereby potentiating extinction processes, and increasing the reinforcement value of social interactions. Second, we review evidence for the central role of heightened social evaluative threat perception in the development and maintenance of SAD and consider how MDMA-AT may enhance experiences of affiliation and safety when interacting with others. Third, we consider the influence of shame and the rigid application of shame regulation strategies as important intrapersonal processes maintaining SAD and propose the generation of self-transcendent emotions during MDMA sessions as a mechanism of shame reduction that may result in corrective emotional experiences and boost memory reconsolidation. Finally, we review research on the role of dysfunctional interpersonal behaviors in SAD that interfere with social functioning and, in particular, the development and maintenance of close and secure relationships. We discuss the hypothesized role of MDMA-AT in improving social skills to elicit positive interpersonal responses from others, creating a greater sense of belonging, acceptance, and social efficacy.”

Authors: Jason Luoma & M. Kati Lear

Notes

Anxiety disorders can severely impact a person’s ability to carry out day-to-day tasks and live a normal life. The increasing global prevalence of anxiety disorders is beginning to outpace our ability to provide effective evidence-based treatments for these disorders. Psychedelics are tipped to be the next big thing in mental health care and based on emerging evidence, these psychoactive drugs are showing promise for treating anxiety disorders.

In the present study, the authors review the current state of research regarding the potential of psychedelics to treat a form of anxiety disorder known as social anxiety disorder (SAD). Specifically, the authors discuss how MDMA-assisted therapy may disrupt the neurological, perceptual, receptive, and expressive systems regulating social behaviour in SAD and the proposed mechanism by which MDMA may alter these systems.

What the review hypothesizes:

  • In terms of social anhedonia (disinterest in social contact) and reduced social reward sensitivity, the authors suggest that MDMA may enhance a person’s willingness to connect with others and positively alter perceptions of social reward for an extended period.
  • People with SAD tend to perceived social stimuli as threatening. The authors hypothesize that MDMA helps people feel safer with others and experience greater ease in relating to both close and more distant relationships for weeks after administration.
  • Shame is thought to underlie the maintenance of heightened social threat in SAD. MDMA-assisted therapy may help to increase feelings of self-compassion and reduce self-criticism. MDMA may also result in corrective emotional experiences and boost memory consolidation.
  • A variety of social behaviours which aim to decrease anxiety in social situations but inadvertently induce discomfort in others are present in those with SAD. It is believed that MDMA helps to improve social skills which elicits positive interpersonal responses from others, ultimately enhancing social efficacy.

This review provides a comprehensive overview of how MDMA-assisted therapy may be of great benefit to those with social anxiety disorder (SAD). Currently, there are no studies that have looked at MDMA for SAD directly. Earlier studies have found that MDMA has positive effects for autistic adults, but no changes in anxiety for those with a life-threatening illness. As one in eight has suffered from SAD sometime in their life, and 7% of the US experiences SAD in each given year, this may be a fruitful line of research to pursue further.

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