Abstract

With approval of MDMA-assisted psychotherapy (MDMA-AP) for PTSD in adults likely soon, the question of extending this treatment to adolescents is increasingly relevant. I present the rationale and motivation for carefully exploring the applicability of MDMA-AP for young people approximately 15-17 years of age. I further consider possible risks and considerations in potentially applying and adapting MDMA-AP for traumatized adolescents.

PTSD is not uncommon among adolescents. While effective trauma-focused treatments have been developed, inadequate response, dropouts, and inability to engage in the potentially distressing trauma processing are notable problems. New forms of treatment are sorely needed for adolescents, too.

MDMA-AP could hold potential for adolescents. In emotional processing of trauma, the effects of MDMA may be helpful for changing maladaptive trauma-related beliefs and appraisals and for enhancing fear extinction and inhibitory learning. Increased feelings of safety and closeness and attenuated fear and avoidance could increase willingness and ability to process the trauma and help in forming a trusting therapeutic alliance, which is often especially challenging with traumatized adolescents.

Risks and harms of administering MDMA and MDMA-AP specific to adolescents are largely unknown and should be carefully studied. Acute physiological risks may be similar for (late) adolescents as for adults and manageable with careful planning and pre-screening. For anticipating and minimizing other risks, factors such as adolescents’ higher negative emotionality and intense emotional life, limited emotion and behavior regulation skills, and increased tendency for risk-taking and impulsivity do call for special consideration. Questions of informed consent, competence, and autonomy are complex for adolescents. The involvement of family in treatment presents both challenges and opportunities. I provide examples of ways in which inspiration could be drawn from existing trauma-focused treatments for adolescents, such as TF-CBT, PE-A, and KidNET, when tailoring the psychotherapy component of MDMA-AP for use with adolescents.

Instead of off-label use or extrapolating from results in adult studies, I suggest measured studies of exceptionally high ethical standards are called for to determine the safety, feasibility, and effectiveness of MDMA-AP among adolescents.