In any other context, it would have seemed unremarkable. The sound of a slamming door elsewhere in the surgery was certainly an unwelcome intrusion into our conversation, but one that appeared harmless enough. However, my client’s response was instantaneous: she flinched visibly, her eyes wide with alarm, her face contorted by the onslaught of intrusive memories.
‘What’s going on for you?’, I enquired, gently drawing attention to the dramatic change in her demeanour. But nothing could have prepared me for the harrowing description of her experiences of war and the brutal loss of those closest to her, all precipitated by an unexpected noise that had triggered memories she had worked tirelessly to suppress.
So-called flashbacks are a common feature of post-traumatic stress disorder (PTSD), along with traumatic nightmares, dissociation and emotional numbing. The condition is often caused by experiencing extreme danger or circumstances that are potentially life-threatening: natural disasters, domestic abuse, sexual assault or – as in the case of my client – the indiscriminate brutality of war. If left untreated, PTSD can have a devastating impact, causing profound depression, anxiety and social withdrawal. But how to treat the disorder is far from obvious. While pharmacological intervention in the form of anti-depressants and anxiolytics may bring some welcome relief, they offer little to address the underlying causes. Psychotherapy may provide an opportunity to begin talking about the precipitating events in a safe environment but risks repeatedly re-traumatising the client, given just how deeply such memories often lie buried.
It is against this backdrop that a recent study by Mitchell and colleagues (Nature Medicine (2021) 27:25-33) offers hope to those suffering from the disorder by investigating the unexpected benefits of psychedelic drugs such as MDMA, otherwise known as ecstasy. It is not the first time such drugs have been used therapeutically: in 2019 the FDA approved the use of esketamine for intervention in treatment-resistant depression. But MDMA is not a classic psychedelic. Instead, it is a so-called empathogen due to its ability to enhance a sense of empathy and connectedness among those who take it, suggesting it could be used in combination with psychotherapy for the treatment of PTSD. Somehow, MDMA creates a more pliable state of mind, allowing individuals to revisit traumatic memories without the associated anxiety. Through careful intervention from an experienced therapist, it may be feasible to help individuals perceive events differently, without feeling overwhelmed with emotion. And the results of the Mitchell trial are certainly encouraging: of the 90 participants recruited, 67% of those taking MDMA no longer presented with symptoms of PTSD at the end of the trial compared to 32% in the placebo group. Somehow, revisiting the past with a therapist and viewing events with a greater sense of empathy and connectedness enabled individuals to finally make peace with the past, freeing them from the tyranny of unexpected flashbacks.
(Image courtesy of Luca Upper and Unsplash)