Additive Effects of 3,4-Methylenedioxymethamphetamine (MDMA) and Compassionate Imagery on Self-Compassion in Recreational Users of Ecstasy
Additive Effects of 3,4-Methylenedioxymethamphetamine (MDMA) and Compassionate Imagery on Self-Compassion in Recreational Users of Ecstasy
Sunjeev K. Kamboj 0 1 2
Ylva S. E. Walldén 0 1 2
Caroline J. Falconer 0 1 2
Majdah Raji Alotaibi 0 1 2
Ian S. Blagbrough 0 1 2
Stephen M. Husbands 0 1 2
Tom P. Freeman 0 1 2
Sunjeev K. Kamboj 0 1 2
0 Present address: National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London , 4 Windsor Walk, London SE5 8BB , UK
1 Medicinal Chemistry, Department of Pharmacy and Pharmacology, University of Bath , Bath BA2 7AY , UK
2 Clinical Psychopharmacology Unit, Research Department of Clinical , Educational and Health Psychology , University College London, Gower St. , London WC1E 6BT , UK
A b s t r a c t 3 , 4 - M e t h y l e n e d i o x y m e t h y l a m p h e t a m i n e (MDMA;'ecstasy') produces prosocial subjective effects that may extend to affiliative feelings towards the self. Behavioural techniques can produce similar self-directed affiliation. For example, compassionate imagery (CI) and ecstasy reduce self-criticism and increase self-compassion to a similar extent, with the effects of CI enhanced in the presence of ecstasy. Here, we examine self-compassion and self-criticism in recreational users who consumed chemically verified MDMA in a within-subjects crossover study. In a naturalistic setting, polydrug-using participants performed a self-focused CI exercise on two occasions separated by ≥6 days: once having consumed self-sourced MDMA and once not. Effects on state self-criticism, self-compassion and emotional empathy were assessed before and after MDMA use (or over an extended baseline period on the occasion that MDMA was not consumed) and reassessed after CI. In participants (n = 20; 8 women) whose ecstasy contained MDMA and no other drug, CI and MDMA appeared to separately increase emotional empathy (to critical facial expressions) and self-compassion. The effects of CI and MDMA on self-compassion also appeared to be additive. Establishing the observed effects in controlled studies will be critical for determining the combined utility of these approaches in fostering adaptive selfattitudes in a therapeutic context.
MDMA; Prosocial; Compassion; Self-compassion; Self-criticism; Compassionate imagery; Empathy
Introduction
Ecstasy is a popular recreational drug
(European Monitoring
Centre for Drugs and Drug Addiction 2015)
. Its subjective
interpersonal effects are well documented in recreational users
(Sumnall et al. 2006)
, with reports of heightened interpersonal
understanding and compassion for others. Similar subjective
effects are seen in controlled laboratory experiments with
3,4methylenedioxymethamphetamine
(MDMA; Kamilar-Britt
and Bedi 2015)
, the primary constituent of most street ecstasy
(Brunt et al. 2012).
MDMA may have unique potential as an adjunct to
psychotherapy for disorders characterised by heightened
(interpersonal) threat, concerns about social evaluation and
deficits in understanding of interpersonal communication
(Danforth et al. 2016; Mithoefer et al. 2016)
. A number of
biological and neuropsychological mechanisms have been
proposed to account for these potential therapeutic effects.
Behavioural studies, for example, indicate that MDMA
increases emotional empathy and reduces aspects of cognitive
empathy
(Kamilar-Britt and Bedi 2015)
. In addition, evidence
from multiple experimental paradigms
(e.g. Bershad et al.
2016)
supports the idea that MDMA’s subjective effects are
mediated by supranormal central oxytocin levels (Francis
et al. 2016). Since oxytocin is implicated in attachment
behaviour, altruism and cooperation
(Campbell 2010)
, its enhanced
release could result in a strengthening of the therapeutic
relationship and increase the willingness of patients to disclose
private and painful memories during MDMA-assisted
psychotherapy. In addition, MDMA might promote changes in
dysfunctional self-referential attitudes, especially when used in
conjunction with behavioural procedures that aim to modify
these attitudes
(Kamboj et al. 2015)
.
The goal of changing dysfunctional self-attitudes and
beliefs (e.g. ‘I am worthless/unloveable’) reflects a general
challenge in psychotherapy, namely, to create conditions that
enable patients to respond to their perceived personal
shortcomings in a less harsh and self-critical manner. In cognitive
therapy, for example, this involves encouraging patients to
generate compassionate responses to self-attacking thoughts
(Kelly
et al. 2009)
. These strategies have been refined into a system
of psychological treatment—‘compassion focused therapy’—
which integrates insights from Buddhist psychology with
cognitive therapy
(Gilbert 2010)
.
The inwardly directed affiliation promoted by techniques
used in compassion-focused therapy, such as compassionate
imagery, may also be generated or augmented by oxytocin
release. In fact, intranasal oxytocin admin (...truncated)