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ViewAttendees 6

Symposia

Treatment - Other

Understanding the Experiences of Providers and Patients in Psychedelic-Assisted CBTs

3 - (SYM 37) Initial Implementation Findings from the First Open Pilot Trial of Mdma-assisted Conjoint Therapy for PTSD in the VA Healthcare System

Friday, November 15, 2024
12:30 PM – 1:30 PM EST
Location: 401/402, Level 4, Downtown Marriott
Abstract Body

Cognitive-behavioral conjoint therapy for PTSD (CBCT) and its brief version (bCBCT) are effective approaches to treating PTSD that leverage veterans’ intimate relationships to enhance recovery, and are in widespread use across the Veterans Affairs (VA) Healthcare System. MDMA (3,4-methylenedioxymethamphetamine)-assisted therapy is also emerging as a breakthrough treatment for PTSD. Given MDMA’s empathogenic properties, it may be a particularly good fit for couple-based PTSD treatments. One pilot study of MDMA-assisted CBCT in the community found large impacts on PTSD and relationship functioning, and follow-up clinical trials are underway. The current study is the first pilot of MDMA-assisted bCBCT in the VA. In addition to evaluating preliminary efficacy with VA-enrolled veterans, this study addresses implementation questions and challenges unique to this healthcare system and population, including using a single- rather than dual-dosing medicine model, creating flexibility for intensive treatment within a managed care system, and recruitment and eligibility within a medically complex population. This talk will present data on recruitment, feasibility, and implementation from the first several couples enrolled in this open pilot trial, including qualitative feedback from participants; two couples have been enrolled at the time of this submission, with an additional five expected by the time of the conference. Initial findings show a low rate of conversion from referral to enrollment, with the most common reasons for exclusion being inability to commit to the time requirement, not meeting rigorous medical inclusion criteria, and relationship characteristics (e.g., presence of IPV, insufficient commitment). Among patients enrolled in the study, frequent challenges included scheduling inflexibility, high life stress, and stigma or legal concern about psychedelic use. At the same time, participants expressed a high level of approval of the treatment, including a desire for more veterans to be able to access the powerful healing opportunity. Clinical providers in the study expressed strong favorability of this treatment relative to standard outpatient PTSD care. The benefits and challenges of including partners in the intervention despite being unable to provide MDMA to non-veteran partners will be discussed. Finally, this talk will address the regulatory processes required to implement this study within the VA San Diego healthcare system, identifying barriers to future scalable implementation and needed solutions.