Journal Article

Preliminary evidence for the importance of therapeutic alliance in MDMA-assisted psychotherapy for posttraumatic stress disorder

Wagner, Anne C., Ross, Stephen, Weiss, Brandon, Mithoefer, Michael C., Mithoefer, Ann T., Zeifman, Richard J., Kettner, Hannes

2024

Overview

MDMA-assisted psychotherapy (MDMA-AP) is a combined psychotherapeutic and pharmacologic intervention that shows promise in the treatment of posttraumatic stress disorder (PTSD). Although therapeutic alliance has been established as a key predictor across psychotherapies and is emphasised within MDMA-AP treatment manuals, research has not yet examined the relationship between therapeutic alliance and MDMA-AP treatment outcomes. Examine whether therapeutic alliance predicts changes in PTSD symptoms following MDMA-AP. Twenty-three individuals with chronic PTSD participated in a MDMA-AP clinical trial that included a randomised (MDMA vs. placebo) and open-label phase. The present analyses focused on participants who were administered MDMA over the course of the randomised and open-label phases (  = 22). Therapeutic alliance was assessed using the Working Alliance Inventory at sessions baseline (pre-session 3) and sessions 4 and 9. PTSD symptoms were assessed using the Clinician Administered PTSD Scale and the Impact of Events Scale-Revised. Controlling for baseline clinician-assessed PTSD severity, therapeutic alliance at sessions 4 and 9 (but not baseline) significantly predicted post-MDMA-AP clinician-assessed PTSD severity. Controlling for baseline self-reported PTSD severity, therapeutic alliance at baseline (although this did not survive correction for multiple comparisons) and sessions 4 and 9 predicted post-MDMA-AP self-reported PTSD severity. The present results provide the first preliminary evidence for the relationship between the therapeutic alliance and treatment outcomes within MDMA-AP for PTSD. These findings highlight the important role of psychotherapy, and common psychotherapeutic factors, within MDMA-AP. Replication in studies with larger and more diverse clinical samples remain necessary. ClinicalTrials.gov identifier: NCT00090064.

• Publisher: Taylor & Francis Group
• Subject: Double-Blind Method / Humans / MDMA / MDMA-assisted psychotherapy / mechanism of change / N-Methyl-3,4-methylenedioxyamphetamine - therapeutic use / Posttraumatic stress disorder / Psychotherapy / Stress Disorders, Post-Traumatic - drug therapy / Therapeutic Alliance / Trastorno de estrés postraumático