In MDMA studies, participants report improved self‐knowledge, sleep regulation, accuracy in perceiving mental states of others, coping strategies, emotion regulation, and cognitive insights. Objective measures support attenuated impact of social rejection and reduced amygdalar response to angry or fearful faces. These changes provide insight into potential indications for MDMA‐assisted psychotherapy, which may enhance secure attachment and engagement of cognitive and positive valence systems, with corresponding reduction in negative valence. MDMA‐assisted psychotherapy could be useful in the treatment of disorders associated with attachment insecurities, including PTSD, depression, anxiety disorders, obsessive‐compulsive disorder, suicidality, substance use disorders, and eating disorders. In phase II PTSD studies, 2 months after two to three active‐dose MDMA treatments, 55% of chronic PTSD subjects no longer met the PTSD Diagnostic Criteria (N = 100) and 66.2% were in remission at least 12 months post-drug (N = 65). Clinical effects are rapid‐onset but not rapid offset, with durable treatment outcomes reported long after MDMA had been eliminated from the body.
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