Borderline personality disorder is a complex psychiatric condition with limited and often ineffective treatment options, high variability in patient response, and frequent dropout from therapy. This review considers the potential of MDMA-assisted psychotherapy (MDMA-AP) as a new or complementary treatment. Based on MDMA-AP's promise in treating overlapping disorders like posttraumatic stress disorder, the authors propose initial treatment targets and hypothesized mechanisms of change grounded in prior literature and theory. They also outline considerations for designing clinical trials to investigate the safety, feasibility, and preliminary effects of MDMA-AP for borderline personality disorder.
Psilocybin therapy may improve mental health by reducing experiential avoidance—the tendency to suppress or avoid distressing thoughts and feelings. In a quasi-experimental study with 28 healthy individuals, a high dose (25 mg) of psilocybin led to significant reductions in experiential avoidance at 2 and 4 weeks, sustained at 3 months but not at 6 months, while a very low dose (1 mg) did not. These reductions predicted improvements in well-being and decreases in depressed and anxious mood. In a randomized controlled trial with 59 people with major depressive disorder, psilocybin therapy reduced experiential avoidance more than the antidepressant escitalopram, and these reductions indirectly improved well-being, depression severity, suicidal ideation, and trait anxiety. The findings suggest experiential avoidance is a key mechanism in psilocybin therapy's effects.