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Treatment - Interpersonal Therapies

Preliminary evidence for the importance of therapeutic alliance in MDMA-assisted psychotherapy for posttraumatic stress disorder

(PS3-92) Preliminary Evidence for the Importance of Therapeutic Alliance in Mdma-assisted Psychotherapy for Posttraumatic Stress Disorder

Friday, November 15, 2024
11:30 AM – 12:30 PM EST
Location: Franklin Hall, Level 4, Marriott Downtown
Abstract Text:

Background: MDMA-assisted psychotherapy (MDMA-AP) is a combined psychotherapeutic and pharmacologic intervention that shows promise in the treatment of posttraumatic stress disorder (PTSD). Although therapeutic alliance has been established as a key predictor across psychotherapies and is emphasized within MDMA-AP treatment manuals, research has not yet examined the relationship between therapeutic alliance and MDMA-AP treatment outcomes. The objective of this research was to examine whether therapeutic alliance predicts changes in PTSD symptoms following MDMA-AP.
 


Method: Twenty-three individuals with chronic PTSD participated in a MDMA-AP clinical trial that included a randomized (MDMA vs. placebo) and open-label phase. The present analyses focused on participants who were administered MDMA over the course of the randomised and open-label phases (N = 22). Therapeutic alliance was assessed using the Working Alliance Inventory at sessions baseline (pre-session 3) and sessions 4 and 9. PTSD symptoms were assessed using the Clinician Administered PTSD Scale and the Impact of Events Scale-Revised.
 


Results: Controlling for baseline clinician-assessed PTSD severity, therapeutic alliance at sessions 4 (R2 = .29; Fchange = 6.77, p = .019, p-FDR = .038) and 9 (R2 = .26; Fchange = 5.89, p = .026, p-FDR = .039) (but not baseline) significantly predicted post-MDMA-AP clinician-assessed PTSD severity. Controlling for baseline self-reported PTSD severity, therapeutic alliance at baseline (although this did not survive correction for multiple comparisons: R2 = .22; Fchange = 4.54, p = .047; p-FDR = .056), and sessions 4 (R2 = .40; Fchange = 10.56, p = .005, p-FDR = .030) and 9 (R2 = .29; Fchange = 6.70, p = .019, p-FDR = .038) predicted post-MDMA-AP self-reported PTSD severity.
 


Conclusions: The present results provide the first preliminary evidence for the relationship between the therapeutic alliance and treatment outcomes within MDMA-AP for PTSD. These findings highlight the important role of psychotherapy, and common psychotherapeutic factors, within MDMA-AP. Replication in studies with larger and more diverse clinical samples remain necessary.