Psychedelic Research

Thirdly, stress-related release of norepinephrine and cortisol is essential to trigger emotional learning, including fear extinction (Quirk and Mueller, 2008). MDMA increases norepinephrine and cortisol release (Green, et al., 2003) and this may induce emotional engagement that could help with eliciting emotional recall of traumatic experiences and enhance the rate of extinction learning. Administration of cortisol before exposure therapy has been shown to enhance extinction learning in some anxiety disorders (Myers, et al., 2007; Quirk and Mueller, 2008). Pharmaceutical compounds that acutely increase norepinephrine may increase emotional activation (Southwick, et al., 1999) and also enhance extinction learning (Mueller, et al., 2008), but such compounds may also temporarily increase anxiety in people with PTSD (Southwick, et al., 1999). Conversely, anxiety-reducing treatments, which decrease activation in response to stress, can actually interfere with extinction learning (McNally, 2007; Myers, et al., 2007). A goal during exposure therapy for PTSD is to recall distressing experiences while at the same time remaining grounded in the present (Foa, 2006). Emotional avoidance is the most common obstacle in exposure therapy for PTSD (Foa and Kozak, 1986), and high within session emotional engagement predicts better outcome (Jaycox, et al., 1998). Reduction of avoidance behaviour linked to emotions is a common treatment target for all anxiety disorders. MDMA has a combination of pharmacological effects that, in a therapeutic setting, could provide a balance of activating emotions while feeling safe and in control, as has been described in case reports of MDMA-augmented psychotherapy. Basic research studies in animals and humans could more closely examine the acute effects of MDMA on behavioural, endocrine and brain activation responses to social and emotional stimuli, particularly during fear extinction. Future clinical trials could combine MDMA with evidence-based treatment programs for disorders of emotional regulation, such as prolonged exposure therapy for PTSD.