Reduction in social anxiety after MDMA-assisted psychotherapy with autistic adults: a randomized, double-blind, placebo-controlled pilot study

Danforth, A., Grob, C. S., Struble, C. M., Feduccia, A. A., Walker, N., Jerome, L., Yazar‐Klosinski, B., & Emerson, A. (2018). Reduction in social anxiety after MDMA-assisted psychotherapy with autistic adults: a randomized, double-blind, placebo-controlled pilot study. Psychopharmacology, 235(11), 3137-3148. https://doi.org/10.1007/s00213-018-5010-9

Publication date: 8 Sep 2018 Added to AutiHub: 7 Jul 2026 Type: Article Article language: English

This publication is integrated into AutiHub through:

Authors

Publication authors
8
Publication authors identified as autistic
1 / 8 (12.5%)

Abstract

RATIONALE: Standard therapeutic approaches to reduce social anxiety in autistic adults have limited effectiveness. Since 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy shows promise as a treatment for other anxiety disorders, a blinded, placebo-controlled pilot study was conducted. OBJECTIVES: To explore feasibility and safety of MDMA-assisted psychotherapy for reduction of social fear and avoidance that are common in the autistic population. METHODS: Autistic adults with marked to very severe social anxiety were randomized to receive MDMA (75 to 125 mg, n = 8) or inactive placebo (0 mg, n = 4) during two 8-h psychotherapy sessions (experimental sessions) in a controlled clinical setting. Double-blinded experimental sessions were spaced approximately 1 month apart with 3 non-drug psychotherapy sessions following each. The primary outcome was change in Leibowitz Social Anxiety Scale (LSAS) Total scores from Baseline to one month after the second experimental session. Outcomes were measured again six months after the last experimental session. RESULTS: Improvement in LSAS scores from baseline to the primary endpoint was significantly greater for MDMA group compared to the placebo group (P = 0.037), and placebo-subtracted Cohen's d effect size was very large (d = 1.4, CI - 0.074, 2.874). Change in LSAS scores from baseline to 6-month follow-up showed similar positive results (P = 0.036), with a Cohen's d effect size of 1.1 (CI - 0.307, 2.527). Social anxiety remained the same or continued to improve slightly for most participants in the MDMA group after completing the active treatment phase. CONCLUSIONS: This pilot trial demonstrated rapid and durable improvement in social anxiety symptoms in autistic adults following MDMA-assisted psychotherapy. Initial safety and efficacy outcomes support expansion of research into larger samples to further investigate this novel treatment for social anxiety. TRIAL REGISTRATION: clinicaltrials.gov identifier, NCT02008396.

Bibliography cited by this reference

Cited references are imported from external metadata sources when they are available. The list may be partial.

Bibliography inclusion overview

These indicators describe the cited bibliography imported for this publication. Cited-reference metrics use the cited-reference total as denominator. Cited-author metrics state whether they use all cited-author occurrences or only occurrences linked to authors already integrated in the AutiHub database. They use cached links between cited authors and authors integrated in the AutiHub database. Last computed: 16 Aug 2026 11:31.

Cited references
59
Total cited references integrated for this publication.
Cited references with an identified autistic author
0 / 59 (0.0%)
Cited author occurrences identified as autistic
0 / 284 (0.0%)
Among occurrences linked to AutiHub author records: 0 / 19 (0.0%). Distinct cited authors identified as autistic: 0 / 243 (0.0%).
Cited author occurrences linked to AutiHub author records
19 / 284 (6.7%)
Distinct linked cited authors: 14 / 243 (5.8%)
Linked cited-author occurrences not identified as autistic
19 / 19 (100.0%)
Among linked cited-author occurrences only. Across all cited-author occurrences: 19 / 284 (6.7%). Distinct linked cited authors not identified as autistic: 14 / 14 (100.0%).
  1. M. Edward Davis , Mark H. Davis , M. Edward Davis , M. E. Davis , Mark M. Davis , Mark M. Davis et al. (1980). A multidimensional approach to individual differences in empathy . Medical Entomology and Zoology, 10, 85.
    Type: Article OpenAlex: https://openalex.org/W85091029
    OpenAlex
  2. Ralph Adolphs , Frederic Gosselin , Tony W. Buchanan , Daniel Tranel , Philippe Schyns , Antonio R. Damasio (2005). A mechanism for impaired fear recognition after amygdala damage . Nature, 433(7021), 68-72. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  3. Michael C Mithoefer , Ann T Mithoefer , Allison A. Feduccia , Lisa Jerome , Mark Wagner , Joy Wymer et al. (2018). 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder in military veterans, firefighters, and police officers: a randomised, double-blind, dose-response, phase 2 clinical trial . The Lancet Psychiatry, 5(6), 486-497. Elsevier BV.
    Crossref OpenAlex OpenCitations
  4. M M Linehan (1993). Dialectical behavior therapy for treatment of borderline personality disorder: implications for the treatment of substance abuse. PubMed, 137, 201-16.
    Type: Article OpenAlex: https://openalex.org/W151311569
    OpenAlex
  5. González Moreno, Andrés Santiago (2013). Diagnostic and Statistical Manual of Mental Disorders . American Psychiatric Association.
    Crossref OpenAlex OpenCitations
  6. Michael C Mithoefer , Mark T Wagner , Ann T Mithoefer , Lisa Jerome , Rick Doblin (2011). The safety and efficacy of ±3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study . Journal of Psychopharmacology, 25(4), 439-452. SAGE Publications.
    Crossref OpenAlex OpenCitations
  7. Andrea L. Roberts , Karestan C. Koenen , Kristen Lyall , Elise Robinson , Marc G. Weisskopf (2015). Association of autistic traits in adulthood with childhood abuse, interpersonal victimization, and posttraumatic stress . Child Abuse & Neglect, 45, 135-142. Elsevier BV.
    Crossref OpenAlex OpenCitations
  8. R.Michael Bagby , Graeme J. Taylor , James D.A. Parker (1994). The twenty-item Toronto Alexithymia scale—II. Convergent, discriminant, and concurrent validity . Journal of Psychosomatic Research, 38(1), 33-40. Elsevier BV.
    Crossref OpenAlex OpenCitations
  9. Matthew G. Kirkpatrick , Sunday M. Francis , Royce Lee , Harriet de Wit , Suma Jacob (2014). Plasma oxytocin concentrations following MDMA or intranasal oxytocin in humans . Psychoneuroendocrinology, 46, 23-31. Elsevier BV.
    Crossref OpenAlex OpenCitations
  10. Charles D. Spielberger , Richard L. Gorsuch , Robert E. Lushene (1970). Manual for the State-Trait Anxiety Inventory .
    Type: Article OpenAlex: https://openalex.org/W1607171655
    OpenAlex
  11. Jennifer A. Bartz , Eric Hollander (2006). The neuroscience of affiliation: Forging links between basic and clinical research on neuropeptides and social behavior . Hormones and Behavior, 50(4), 518-528. Elsevier BV.
    Crossref OpenAlex OpenCitations
  12. Kelly Posner , Maria A. Oquendo , Madelyn Gould , Barbara Stanley , Mark Davies (2007). Columbia Classification Algorithm of Suicide Assessment (C-CASA): Classification of Suicidal Events in the FDA’s Pediatric Suicidal Risk Analysis of Antidepressants . American Journal of Psychiatry, 164(7), 1035-1043. American Psychiatric Association Publishing.
    Crossref OpenCitations
  13. Philip Kamilar-Britt , Gillinder Bedi (2015). The prosocial effects of 3,4-methylenedioxymethamphetamine (MDMA): Controlled studies in humans and laboratory animals . Neuroscience & Biobehavioral Reviews, 57, 433-446. Elsevier BV.
    Crossref OpenAlex OpenCitations
  14. Jojanneke A. Bastiaansen , Harma Meffert , Simone Hein , Petra Huizinga , Cees Ketelaars , Marieke Pijnenborg et al. (2011). Diagnosing Autism Spectrum Disorders in Adults: the Use of Autism Diagnostic Observation Schedule (ADOS) Module 4 . Journal of Autism and Developmental Disorders, 41(9), 1256-1266. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  15. R. L. Carhart-Harris , M. B. Wall , D. Erritzoe , M. Kaelen , B. Ferguson , I. De Meer et al. (2014). The effect of acutely administered MDMA on subjective and BOLD-fMRI responses to favourite and worst autobiographical memories . The International Journal of Neuropsychopharmacology, 17(04), 527-540. Oxford University Press (OUP).
    Crossref OpenAlex OpenCitations
  16. Annelies A. Spek , Nadia C. van Ham , Ivan Nyklíček (2013). Mindfulness-based therapy in adults with an autism spectrum disorder: A randomized controlled trial . Research in Developmental Disabilities, 34(1), 246-253. Elsevier BV.
    Crossref OpenAlex OpenCitations
  17. Aaron T. Beck , Robert A. Steer , Roberta Ball , William F. Ranieri (1996). Comparison of Beck Depression Inventories-IA and-II in Psychiatric Outpatients . Journal of Personality Assessment, 67(3), 588-597. Informa UK Limited.
    Crossref OpenAlex OpenCitations
  18. Kelly Posner , Gregory K. Brown , Barbara Stanley , David A. Brent , Kseniya V. Yershova , Maria A. Oquendo et al. (2011). The Columbia–Suicide Severity Rating Scale: Initial Validity and Internal Consistency Findings From Three Multisite Studies With Adolescents and Adults . American Journal of Psychiatry, 168(12), 1266-1277. American Psychiatric Association Publishing.
    Crossref OpenAlex OpenCitations
  19. A Gamma (2000). 3,4-Methylenedioxymethamphetamine (MDMA) Modulates Cortical and Limbic Brain Activity as Measured by [H215O]-PET in Healthy Humans . Neuropsychopharmacology, 23(4), 388-395. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  20. Gillinder Bedi , K. Luan Phan , Mike Angstadt , Harriet de Wit (2009). Effects of MDMA on sociability and neural response to social threat and social reward . Psychopharmacology, 207(1), 73-83. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  21. Susanne Bejerot , Jonna M. Eriksson , Ewa Mörtberg (2014). Social anxiety in adult autism spectrum disorder . Psychiatry Research, 220(1-2), 705-707. Elsevier BV.
    Crossref OpenAlex OpenCitations
  22. Kazuhiko Nakamura , Yoshimoto Sekine , Yasuomi Ouchi , Masatsugu Tsujii , Etsuji Yoshikawa , Masami Futatsubashi et al. (2010). Brain Serotonin and Dopamine Transporter Bindings in Adults With High-Functioning Autism . Archives of General Psychiatry, 67(1), 59. American Medical Association (AMA).
    Crossref OpenAlex OpenCitations
  23. Anya K. Bershad , Jessica J. Weafer , Matthew G. Kirkpatrick , Margaret C. Wardle , Melissa A. Miller , Harriet de Wit (2016). Oxytocin receptor gene variation predicts subjective responses to MDMA . Social Neuroscience, 11(6), 592-599. Informa UK Limited.
    Crossref OpenAlex OpenCitations
  24. Robin L. Carhart-Harris , Kevin Murphy , Robert Leech , David Erritzoe , Matthew B. Wall , Bart Ferguson et al. (2015). The Effects of Acutely Administered 3,4-Methylenedioxymethamphetamine on Spontaneous Brain Function in Healthy Volunteers Measured with Arterial Spin Labeling and Blood Oxygen Level–Dependent Resting State Functional Connectivity . Biological Psychiatry, 78(8), 554-562. Elsevier BV.
    Crossref OpenAlex OpenCitations
  25. Mark H. Davis (1983). Measuring individual differences in empathy: Evidence for a multidimensional approach. Journal of Personality and Social Psychology, 44(1), 113-126. American Psychological Association (APA).
    Crossref OpenAlex OpenCitations
  26. Patrick C. Dolder , Felix Müller , Yasmin Schmid , Stefan J. Borgwardt , Matthias E. Liechti (2018). Direct comparison of the acute subjective, emotional, autonomic, and endocrine effects of MDMA, methylphenidate, and modafinil in healthy subjects . Psychopharmacology, 235(2), 467-479. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  27. Sheldon Cohen , Tom Kamarck , Robin Mermelstein (1983). A Global Measure of Perceived Stress . Journal of Health and Social Behavior, 24(4), 385. SAGE Publications.
    Type: Article DOI: 10.2307/2136404 OpenAlex: https://openalex.org/W1996299251
    Crossref OpenAlex OpenCitations
  28. Cédric M. Hysek , Gregor Domes , Matthias E. Liechti (2012). MDMA enhances “mind reading” of positive emotions and impairs “mind reading” of negative emotions . Psychopharmacology, 222(2), 293-302. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  29. Suzanne Coghlan , Jamie Horder , Becky Inkster , María Andreina Méndez , Declan Murphy , David J. Nutt (2012). GABA system dysfunction in autism and related disorders: From synapse to symptoms . Neuroscience & Biobehavioral Reviews, 36(9), 2044-2055. Elsevier BV.
    Crossref OpenAlex OpenCitations
  30. Cédric M. Hysek , Linda D. Simmler , Nathalie Schillinger , Nicole Meyer , Yasmin Schmid , Massimiliano Donzelli et al. (2014). Pharmacokinetic and pharmacodynamic effects of methylphenidate and MDMA administered alone or in combination . The International Journal of Neuropsychopharmacology, 17(03), 371-381. Oxford University Press (OUP).
    Crossref OpenAlex OpenCitations
  31. Philip A. Mackowiak (1992). A Critical Appraisal of 98.6°F, the Upper Limit of the Normal Body Temperature, and Other Legacies of Carl Reinhold August Wunderlich . JAMA: The Journal of the American Medical Association, 268(12), 1578. American Medical Association (AMA).
    Crossref OpenAlex OpenCitations
  32. Rafael de la Torre , Magí Farré , Pere N. Roset , Neus Pizarro , Sergio Abanades , Mireia Segura et al. (2004). Human Pharmacology of MDMA . Therapeutic Drug Monitoring, 26(2), 137-144. Ovid Technologies (Wolters Kluwer Health).
    Crossref OpenAlex OpenCitations
  33. Danforth A (2013) Courage, connection, clarity: a mixed-model, collective-case study of MDMA (ecstasy) experiences of autistic adults (doctoral dissertation). Retrieved from ProQuest Dissertations & Theses (PQDT) database. (UMI No. 3596826)
    Type: Other
    Crossref
  34. Skye McDonald , Cristina Bornhofen , David Shum , Esther Long , Clare Saunders , Kerryn Neulinger (2006). Reliability and validity of The Awareness of Social Inference Test (TASIT): A clinical test of social perception . Disability and Rehabilitation, 28(24), 1529-1542. Informa UK Limited.
    Crossref OpenAlex OpenCitations
  35. Alicia Danforth , Christopher M. Struble , Berra Yazar‐Klosinski , Charles S. Grob (2016). MDMA-assisted therapy: A new treatment model for social anxiety in autistic adults . Progress in Neuro-Psychopharmacology and Biological Psychiatry, 64, 237-249. Elsevier BV.
    Crossref OpenAlex OpenCitations
  36. G. J. H. Dumont , F. C. G. J. Sweep , R. van der Steen , R. Hermsen , A. R. T. Donders , D. J. Touw et al. (2009). Increased oxytocin concentrations and prosocial feelings in humans after ecstasy (3,4-methylenedioxymethamphetamine) administration . Social Neuroscience, 4(4), 359-366. Informa UK Limited.
    Crossref OpenAlex OpenCitations
  37. M Davis (1980). Davis M (1980) A multidimensional approach to individual differences in empathy. Cat Sel Doc Psychol 10:85 Cat Sel Doc Psychol, 10, 85.
    Type: Other
    Crossref
  38. Peter Oehen , Rafael Traber , Verena Widmer , Ulrich Schnyder (2013). A randomized, controlled pilot study of MDMA (±3,4-Methylenedioxymethamphetamine)-assisted psychotherapy for treatment of resistant, chronic Post-Traumatic Stress Disorder (PTSD) . Journal of Psychopharmacology, 27(1), 40-52. SAGE Publications.
    Crossref OpenAlex OpenCitations
  39. P A Mackowiak , S S Wasserman , M M Levine (1992). A critical appraisal of 98.6 degrees F, the upper limit of the normal body temperature, and other legacies of Carl Reinhold August Wunderlich. PubMed, 268(12), 1578-80.
    Type: Article OpenAlex: https://openalex.org/W2024156863
    OpenAlex
  40. Genoveva Uzunova , Stefano Pallanti , Eric Hollander (2016). Excitatory/inhibitory imbalance in autism spectrum disorders: Implications for interventions and therapeutics . The World Journal of Biological Psychiatry, 17(3), 174-186. Informa UK Limited.
    Crossref OpenAlex OpenCitations
  41. Naomi M. Simon , John J. Worthington , Alicia Doyle , Elizabeth A. Hoge , Gustavo Kinrys , Diana Fischmann et al. (2004). An Open-Label Study of Levetiracetam for the Treatment of Social Anxiety Disorder . The Journal of Clinical Psychiatry, 65(9), 1219-1222. Physicians Postgraduate Press, Inc.
    Crossref OpenAlex OpenCitations
  42. Martha S. McCallie , Claire M. Blum , Charlaine J. Hood (2006). Progressive Muscle Relaxation . Journal of Human Behavior in the Social Environment, 13(3), 51-66. Informa UK Limited.
    Crossref OpenAlex OpenCitations
  43. MB First (2002). Structured clinical interview for DSM-IV-TR axis I disorders, research version, Patient edition . Structured clinical interview for DSM-IV-TR axis I disorders, research version, Patient edition.
    Type: Other
    Crossref
  44. Patrick Vizeli , Matthias E Liechti (2017). Safety pharmacology of acute MDMA administration in healthy subjects . Journal of Psychopharmacology, 31(5), 576-588. SAGE Publications.
    Crossref OpenAlex OpenCitations
  45. Charles S. Grob , Russell E. Poland , Linda Chang , Thomas Ernst (1995). Psychobiologic effects of 3,4-methylenedioxymethamphetamine in humans: methodological considerations and preliminary observations . Behavioural Brain Research, 73(1-2), 103-107. Elsevier BV.
    Crossref OpenAlex OpenCitations
  46. Michael R. Liebowitz (1985). Social Phobia . Archives of General Psychiatry, 42(7), 729. American Medical Association (AMA).
    Crossref OpenAlex OpenCitations
  47. Cédric M. Hysek , Matthias E. Liechti (2012). Effects of MDMA alone and after pretreatment with reboxetine, duloxetine, clonidine, carvedilol, and doxazosin on pupillary light reflex . Psychopharmacology, 224(3), 363-376. Springer Science and Business Media LLC.
    Crossref OpenAlex OpenCitations
  48. James J. Gross , Oliver P. John (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85(2), 348-362. American Psychological Association (APA).
    Crossref OpenAlex OpenCitations
  49. Patrick Vizeli , Matthias E. Liechti (2018). Oxytocin receptor gene variations and socio-emotional effects of MDMA: A pooled analysis of controlled studies in healthy subjects . PLOS ONE, 13(6), e0199384. Public Library of Science (PLoS).
    Crossref OpenAlex OpenCitations
  50. Kadel R, Kip KA (2012) SAS macro to compute effect size (Cohen’s d) and its confidence interval from raw survey data. In: Proceedings of the Annual Southeast SAS Users Group Conference
    Type: Other
    Crossref
  51. Bryan H. King , Eric Hollander , Linmarie Sikich , James T. McCracken , Lawrence Scahill , Joel D. Bregman et al. (2009). Lack of Efficacy of Citalopram in Children With Autism Spectrum Disorders and High Levels of Repetitive Behavior . Archives of General Psychiatry, 66(6), 583. American Medical Association (AMA).
    Crossref OpenAlex OpenCitations
  52. Kim PC Kuypers , Patrick C Dolder , Johannes G Ramaekers , Matthias E Liechti (2017). Multifaceted empathy of healthy volunteers after single doses of MDMA: A pooled sample of placebo-controlled studies . Journal of Psychopharmacology, 31(5), 589-598. SAGE Publications.
    Crossref OpenAlex OpenCitations
  53. Michael C Mithoefer , Mark T Wagner , Ann T Mithoefer , Lisa Jerome , Scott F Martin , Berra Yazar‐Klosinski et al. (2013). Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study . Journal of Psychopharmacology, 27(1), 28-39. SAGE Publications.
    Crossref OpenAlex OpenCitations
  54. MM Linehan (1993). Linehan MM (1993) Dialectical behavior therapy for treatment of borderline personality disorder: implications for the treatment of substance abuse. NIDA Res Monogr 137:201–201 NIDA Res Monogr, 137, 201.
    Type: Other
    Crossref
  55. Morris Rosenberg (1965). Society and the Adolescent Self-Image . Princeton University Press.
    Crossref OpenAlex OpenCitations
  56. Kelly Posner , Maria A. Oquendo , Madelyn Gould , Barbara Stanley , Mark Davies (2007). Columbia Classification Algorithm of Suicide Assessment (C-CASA): Classification of Suicidal Events in the FDA’s Pediatric Suicidal Risk Analysis of Antidepressants . American Journal of Psychiatry, 164(7), 1035-1043. American Psychiatric Association Publishing.
    OpenAlex
  57. C Spielberger (1983). Manual for the state-trait anxiety inventory . Manual for the state-trait anxiety inventory.
    Type: Other
    Crossref
  58. Jose Carlos Bouso , Genís Ona , Rafael G. Dos Santos , Jaime E. C. Hallak (2021). Psychedelic Medicines in Major Depression: Progress and Future Challenges . Advances in Experimental Medicine and Biology, 1305, 515-533. Springer Singapore.
    OpenCitations
  59. Philip A. Mackowiak (1992). A Critical Appraisal of 98.6°F, the Upper Limit of the Normal Body Temperature, and Other Legacies of Carl Reinhold August Wunderlich . JAMA: The Journal of the American Medical Association, 268(12), 1578. American Medical Association (AMA).
    OpenAlex