By Professor John Read and Jacqui Dillon, voice hearer and Chair of the UK Hearing Voices network.
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PTSD is a common comorbidity with psychosis, with some asserting that post-traumatic dissociative symptoms are often misdiagnosed as psychosis.
This makes treatment for PTSD symptoms an important response to traumatised patients, whatever their diagnosis. The current freely-available paper by Mithoeffer et al (Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study) shows there was significant improvement and no adverse outcomes from the treatment:
“In the initial study (Mithoefer et al., 2011), 20 subjects with treatment-resistant PTSD (in most cases from sexual abuse or assault) were randomly assigned to psychotherapy with the active drug (n = 12) or with an inactive placebo (psychotherapy-only; n = 8), each administered during two 8-hour sessions scheduled 3–5 weeks apart, accompanied by weekly non-drug sessions. The MDMA-assisted sessions were conducted in a comfortable setting, in which participants were encouraged to spend considerable time focused inward without talking, alternated with time spent talking to the therapists. The therapists took a non-directive approach to supporting their subjects in processing trauma-related material. More information concerning the nature of the psychotherapy is found in the Mithoefer et al. (2011) study, as well as in the author’s treatment manual (MAPS, 2011).
“At the end of this controlled study, the participants who had received the psychotherapy-only treatment were offered openlabel MDMA-assisted psychotherapy, using the same schedule of sessions as were used in the controlled study protocol. Of the eight therapy-only subjects, seven accepted and completed the crossover arm of the study, which resulted in 19 of the 20 study subjects receiving the MDMA-assisted psychotherapy treatment. The one therapy-only subject had recovered from PTSD symptoms with psychotherapy alone, and did not participate in the crossover. As allowed by a protocol amendment, the last eight subjects recruited (five in the double-blind stage and three in the crossover stage) also received a third MDMA-assisted psychotherapy session. This protocol change was sought because of tentative clinical impressions by the investigators that a third session would likely enhance the processing of trauma and the integration process that were essential to the treatment.
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