Autistic adults with severe social anxiety who received MDMA-assisted psychotherapy showed significantly greater improvement in social anxiety symptoms compared to those given an inactive placebo. The improvement was rapid and durable, with effects still present at a six-month follow-up. The study used two eight-hour psychotherapy sessions with either MDMA (75–125 mg) or placebo, plus three non-drug sessions after each. The effect size was very large at the primary endpoint and remained large at follow-up. Social anxiety stayed the same or continued to improve for most in the MDMA group after treatment ended. Initial safety and efficacy support larger studies.
A clinical trial of MDMA-assisted therapy for social anxiety in autistic adults began in spring 2014. MDMA has been administered to over 1133 individuals in research without unexpected serious adverse events requiring expedited FDA reporting. The authors argue that established safety parameters justify developing MDMA-assisted interventions to help autistic adults improve social adaptability. MDMA, like classic psychedelics, can catalyze lasting openness and introspection without ongoing administration, reducing adverse event frequency and improving the risk/benefit ratio compared to daily medications. Clinicians could employ new treatment models using one to several MDMA sessions within supportive psychotherapy for social anxiety or similar distress.