A Systematic Review of MDMA’s Effects on Social Functioning in Placebo-Controlled Trials
May 4, 2026 Victoria Burmester, Laura Aggett, David J Nutt et al. preprint
MDMA reliably enhances subjective social feelings such as sociability, emotional openness, closeness, and emotional empathy, but these changes do not consistently translate into observable prosocial behaviors like cooperation or trust, which remain highly context dependent. The most robust social effect is a reduction in the processing of social threat, including diminished sensitivity to negative social cues and impaired recognition of fear and anger. This divergence between felt and enacted social effects helps explain variability in laboratory findings and underscores the importance of context and measurement. These mechanisms may inform MDMA's therapeutic use for conditions involving heightened social threat and avoidance.