Réduction de l'anxiété sociale après une psychothérapie assistée par MDMA chez des adultes autistes : une étude pilote randomisée, en double aveugle, contrôlée par placebo

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

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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

Date de publication: 08/09/2018 Ajout dans AutiHub: 07/07/2026 Type: Article Langue de l’article: Anglais
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Auteurs

Auteur·ices des publications
8
Auteur·ices de la publication identifié·es comme autistes
1 / 8 (12,5 %)
  1. Alicia Danforth
  2. Charles S. Grob
  3. Christopher M. Struble
  4. Allison A. Feduccia
  1. Nick Walker *
  2. Lisa Jerome
  3. Berra Yazar‐Klosinski
  4. Amy Emerson

Résumé

JUSTIFICATION : Les approches thérapeutiques standard visant à réduire l'anxiété sociale chez les adultes autistes ont une efficacité limitée. Étant donné que la psychothérapie assistée par 3,4-méthylènedioxyméthamphétamine (MDMA) est prometteuse comme traitement d'autres troubles anxieux, une étude pilote en aveugle, contrôlée par placebo, a été menée. OBJECTIFS : Explorer la faisabilité et la sécurité de la psychothérapie assistée par MDMA pour réduire la peur sociale et l'évitement, fréquents dans la population autiste. MÉTHODES : Des adultes autistes présentant une anxiété sociale marquée à très sévère ont été randomisés pour recevoir de la MDMA (75 à 125 mg, n = 8) ou un placebo inactif (0 mg, n = 4) lors de deux séances de psychothérapie de 8 h (séances expérimentales) dans un cadre clinique contrôlé. Les séances expérimentales en double aveugle étaient espacées d'environ 1 mois, avec 3 séances de psychothérapie sans médicament après chacune d'elles. Le critère de jugement principal était la variation des scores totaux de la Leibowitz Social Anxiety Scale (LSAS) entre l'inclusion et un mois après la deuxième séance expérimentale. Les résultats ont été mesurés de nouveau six mois après la dernière séance expérimentale. RÉSULTATS : L'amélioration des scores LSAS entre l'inclusion et le critère principal était significativement plus importante dans le groupe MDMA que dans le groupe placebo (P = 0.037), et la taille d'effet d de Cohen corrigée du placebo était très grande (d = 1.4, IC - 0.074, 2.874). La variation des scores LSAS entre l'inclusion et le suivi à 6 mois a montré des résultats positifs similaires (P = 0.036), avec une taille d'effet d de Cohen de 1.1 (IC - 0.307, 2.527). L'anxiété sociale est restée la même ou a continué à s'améliorer légèrement chez la plupart des participants du groupe MDMA après l'achèvement de la phase de traitement actif. CONCLUSIONS : Cet essai pilote a démontré une amélioration rapide et durable des symptômes d'anxiété sociale chez des adultes autistes après une psychothérapie assistée par MDMA. Les résultats initiaux relatifs à la sécurité et à l'efficacité soutiennent l'élargissement de la recherche à des échantillons plus importants afin d'étudier davantage ce nouveau traitement de l'anxiété sociale. ENREGISTREMENT DE L'ESSAI : identifiant clinicaltrials.gov, NCT02008396.

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.

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Références citées
59
Nombre total de références citées intégrées pour cette publication.
Références citées avec un·e auteur·ice identifié·e comme autiste
0 / 59 (0,0 %)
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Parmi les occurrences rattachées à des auteurices intégré·es à la base de données AutiHub : 0 / 19 (0,0 %). Auteurices cité·es distinct·es identifié·es comme autistes : 0 / 243 (0,0 %).
Occurrences citées rattachées à la base AutiHub
19 / 284 (6,7 %)
Auteurices cité·es distinct·es rattaché·es : 14 / 243 (5,8 %)
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19 / 19 (100,0 %)
Parmi les seules occurrences rattachées. Sur l’ensemble des occurrences d’auteurices cité·es : 19 / 284 (6,7 %). Auteurices cité·es distinct·es rattaché·es, non identifié·es comme autistes : 14 / 14 (100,0 %).
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