PTSD in adolescence causes much suffering and has substantial health-care costs. Many patients with severe PTSD do not respond to psychotherapy or continue to have symptoms despite trauma-focused psychotherapies and psychopharmacological treatment. A recent alternative in the search for cost-effective treatments for PTSD in adults is 3,4-methylenedioxymethamphetamine-assisted psychotherapy (MDMA-assisted psychotherapy). However, no research has yet been conducted on the therapeutic potential of MDMA for adolescents.
Aims of the study
The purpose of this study is to investigate the perspectives of adolescents, parents, and clinicians about the possible clinical application of MDMA-assisted psychotherapy for adolescents with PTSD.
Method
We performed focus groups in three samples: (a) 16–24-year-olds who had undergone trauma therapy (N = 9), (b) parents of traumatized children (N = 4), and (c) trauma clinicians (N = 6). Focus group topics included: perception of and associations with MDMA, opinions on MDMA-assisted psychotherapy, risks/benefits, and precautions to take prior to possible adolescent clinical trials with MDMA-assisted psychotherapy.
Results
In all groups, initial participant attitudes towards MDMA were predominantly unfavorable, except for several adolescents who had conducted preliminary research on the subject. After a standardized explanation of MDMA-assisted psychotherapy, provided in each group, all but one participant changed their minds and supported the idea of implementing MDMA-assisted psychotherapy for adolescents. They all emphasized the importance of conducting research first.
Conclusion
Our findings suggest that when provided with information on what MDMA-assisted psychotherapy entails, adolescents, parents, and clinicians are open to the idea of exploring this type of treatment for adolescents.
AlisicEvan der SchootTAvan GinkelJR, et al. (2008) Trauma exposure in primary school children: Who is at risk?Journal of Child & Adolescent Trauma1: 263–269. doi:10.1080/19361520802279075
2.
AlisicEZaltaAKVan WeselF, et al. (2014) Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: Meta-analysis. The British Journal of Psychiatry204(5): 335–340.
3.
American Psychiatric Association DSMTF & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5, No. 5). Washington, DC: American psychiatric association.
4.
AppelbaumPS (2007) Assessment of patients’ competence to consent to treatment. New England Journal of Medicine357(18): 1834–1840.
5.
BirdCIVModlinNLRuckerJJH (2021) Psilocybin and MDMA for the treatment of trauma-related psychopathology. International Review of Psychiatry33(3): 229–249.
6.
BissonJIRobertsNPAndrewM, et al. (2013) Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews (12). Art. No.: CD003388. https://doi.org/10.1002/14651858.CD003388.pub4
7.
BoeijeH (2014) Analyseren in Kwalitatief Onderzoek. Den Haag, Nederland: Boom Lemma uitgevers.
8.
CostelloEJErkanliAFairbankJA, et al. (2002) The prevalence of potentially traumatic events in childhood and adolescence. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies15(2): 99–112.
9.
DavisAKAgin-LiebesGEspañaM, et al. (2022) Attitudes and beliefs about the therapeutic use of psychedelic drugs among psychologists in the United States. Journal of Psychoactive Drugs 54(4): 309–318.
10.
DevlinASArneillAB (2003) Health care environments and patient outcomes. Environment and Behavior35(5): 665–694.
11.
DohleSSiegristM (2014) Fluency of pharmaceutical drug names predicts perceived hazardousness, assumed side effects and willingness to buy. Journal of Health Psychology19(10): 1241–1249.
12.
FeducciaAAMithoeferMC (2018) MDMA-assisted psychotherapy for PTSD: Are memory reconsolidation and fear extinction underlying mechanisms?Progress in Neuro-Psychopharmacology and Biological Psychiatry84(Pt A): 221–228.
13.
FeducciaAAHollandJMithoeferMC (2018) Progress and promise for the MDMA drug development program. Psychopharmacology235(2): 561–571.
14.
Feduccia AA, Jerome L, Klosinski B, et al. (2019) Breakthrough for trauma treatment: safety and efficacy of MDMA-assisted psychotherapy compared to paroxetine and sertraline. Frontiers in Psychiatry, 10, 650.
15.
Foa EB, Keane TM, Friedman MJ, and Cohen JA (Eds.). (2010). Effective treatments for PTSD: practice guidelines from the International Society for Traumatic Stress Studies. New York: Guilford Press.
16.
Glaser B and Strauss A (1999). Discovery of Grounded Theory: Strategies for Qualitative Research (1st ed.). New York: Routledge. https://doi.org/10.4324/9780203793206
17.
Grootens-WiegersPHeinIMvan den BroekJM, et al. (2017) Medical decision-making in children and adolescents: Developmental and neuroscientific aspects. BMC Pediatrics17(1): 120.
18.
GutnerCAGallagherMWBakerAS, et al. (2016) Time course of treatment dropout in cognitive–behavioral therapies for posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy8(1): 115–121.
19.
HearnBGBrubakerMDRichardsonG (2022) Counselors’ attitudes toward psychedelics and their use in therapy. Journal of Counseling & Development100(4): 364–373.
20.
HeinIMTroostPWLindeboomR, et al. (2014) Accuracy of the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) for measuring children’s competence to consent to clinical research. JAMA Pediatrics168(12): 1147.
21.
HendriksJStamsGJ (2016) Forensisch orthopedagogische behandeling: Een kritische beschouwing. Orthopedagogiek: Onderzoek En Praktijk55(9/10): 214–222.
22.
HoogstederLMten ThijeLSchippersEE, et al. (2022) A meta-analysis of the effectiveness of EMDR and TF-CBT in reducing trauma symptoms and externalizing behavior problems in adolescents. International Journal of Offender Therapy and Comparative Criminology66(6–7): 735–757.
23.
HundtNEEckerAHThompsonK, et al. (2020) “It didn’t fit for me:” A qualitative examination of dropout from prolonged exposure and cognitive processing therapy in veterans. Psychological Services17(4): 414–421.
24.
IllingworthBJLewisDJLambarthAT, et al. (2021) A comparison of MDMA-assisted psychotherapy to non-assisted psychotherapy in treatment-resistant PTSD: A systematic review and meta-analysis. Journal of Psychopharmacology35(5): 501–511.
25.
JamesACJamesGCowdreyFA, et al. (2013) Cognitive behavioural therapy for anxiety disorders in children and adolescents. In: JamesAC (ed.) Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd. https://doi.org/10.1002/14651858.CD004690.pub3
26.
JensenTKBraathuNBirkelandMS, et al. (2022) Complex PTSD and treatment outcomes in TF-CBT for youth: a naturalistic study. European Journal of Psychotraumatology13(2). https://doi.org/10.1080/20008066.2022.2114630
27.
JeromeLFeducciaAAWangJB, et al. (2020) Long-term follow-up outcomes of MDMA-assisted psychotherapy for treatment of PTSD: A longitudinal pooled analysis of six phase 2 trials. Psychopharmacology237(8): 2485–2497.
28.
KimSRushBSRiceTR (2021) A systematic review of therapeutic ketamine use in children and adolescents with treatment-resistant mood disorders. European Child & Adolescent Psychiatry 30: 1–17. doi:10.1007/s00787-020-01542-3
29.
LenzASHollenbaughKM (2015) Meta-analysis of trauma-focused cognitive behavioral therapy for treating PTSD and co-occurring depression among children and adolescents. Counseling Outcome Research and Evaluation6(1): 18–32.
MarseilleEKahnJGYazar-KlosinskiB, et al. (2020) The cost-effectiveness of MDMA-assisted psychotherapy for the treatment of chronic, treatment-resistant PTSD. PLOS ONE15(10): e0239997.
32.
MichaelCMithoeferMD (2017) A manual for MDMA-assisted psychotherapy in the treatment of posttraumatic stress disorder.Retrieved fromwww.maps.org
33.
MillenkyMSchwartzSEORhodesJE (2014) Supporting the transition to adulthood among high school dropouts: An impact study of the national guard youth challenge program. Prevention Science15(4): 448–459.
34.
MitchellJMBogenschutzMLiliensteinA, et al. (2021) MDMA-assisted therapy for severe PTSD: A randomized, double-blind, placebo-controlled phase 3 study. Nature Medicine27(6): 1025–1033.
35.
MorinaNKoerssenRPolletTV (2016) Interventions for children and adolescents with posttraumatic stress disorder: A meta-analysis of comparative outcome studies. Clinical Psychology Review47: 41–54.
36.
NicholasCRWangJBCokerA, et al. (2022) The effects of MDMA-assisted therapy on alcohol and substance use in a phase 3 trial for treatment of severe PTSD. Drug and Alcohol Dependence233: 109356.
37.
OrmhaugSMJensenTK (2018) Investigating treatment characteristics and first-session relationship variables as predictors of dropout in the treatment of traumatized youth. Psychotherapy Research28(2): 235–249.
38.
RajwaniK (2022) Should adolescents be included in emerging psychedelic research?Canadian Journal of Bioethics5(2): 36–43.
39.
RobbASCuevaJESpornJ, et al. (2010) Sertraline treatment of children and adolescents with posttraumatic stress disorder: A double-blind, placebo-controlled trial. Journal of Child and Adolescent Psychopharmacology20(6): 463–471.
40.
RossSLSharma-PatelKBrownEJ, et al. (2021) Complex trauma and trauma-focused cognitive-behavioral therapy: How do trauma chronicity and PTSD presentation affect treatment outcome?Child Abuse & Neglect111: 104734.
41.
RossouwJSharpTHalliganS, et al. (2022) Psychotherapeutic interventions for childhood posttraumatic stress disorder: An update. Current Opinion in Psychiatry35(6): 417–424.
42.
SchwartzSEORhodesJESpencerR, et al. (2013) Youth initiated mentoring: Investigating a new approach to working with vulnerable adolescents. American Journal of Community Psychology52(1–2): 155–169.
43.
SessaBHigbedLO’BrienS, et al. (2021) First study of safety and tolerability of 3,4-methylenedioxymethamphetamine-assisted psychotherapy in patients with alcohol use disorder. Journal of Psychopharmacology35(4): 375–383.
44.
SkarA-MSBraathuNJensenTK, et al. (2022) Predictors of nonresponse and drop-out among children and adolescents receiving TF-CBT: Investigation of client-, therapist-, and implementation factors. BMC Health Services Research22(1): 1212.
45.
StewartLFergusonBMorganC, et al. (2014) Effects of ecstasy on cooperative behaviour and perception of trustworthiness: A naturalistic study. Journal of Psychopharmacology28(11): 1001–1008.
46.
StraussALCorbinJ (1998) Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, CA: Sage Publications.
47.
StraussALCorbinJ (2007) Grounded theory methodology: An overview. In: DenzinNKLincolnYS (eds.) Handbook of Qualitative Research. Sage, pp. 273–285.
48.
Jensen TK, Braathu N, Skogbrott Birkeland M, et al. (2022) Complex PTSD and treatment outcomes in TF-CBT for youth: a naturalistic study. European Journal of Psychotraumatology 13: 2.
49.
VolkowNDGordonJAKoobGF (2021) Choosing appropriate language to reduce the stigma around mental illness and substance use disorders. Neuropsychopharmacology46(13): 2230–2232.
50.
WeiszJRKuppensSNgMY, et al. (2017) What five decades of research tells us about the effects of youth psychological therapy: A multilevel meta-analysis and implications for science and practice. American Psychologist72(2): 79–117.
WolfsonPEAndriesJAhlersD, et al. (2023) Ketamine-assisted psychotherapy in adolescents with multiple psychiatric diagnoses. Frontiers in Psychiatry14: 421.
ZimringCJosephAChoudharyR (2004) The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity. Concord, CA: The Center for Health Design, p. 311.
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