r/mdmatherapy

Hi folks,

See it at https://osf.io/preprints/psyarxiv/aps5g

There's now an ebook version at https://github.com/groeneveld/mdma-guide/blob/main/Open%20MDMA.epub and an html (webpage) version at https://groeneveld.github.io/mdma-guide/.

I substantively edited almost everything for clarity, flow, and rigor. This meant rewriting about a third of total content. It’s much more readable now!

I also double checked that the large majority of claims I make in the book are backed up by their citations. I fixed a handful of errors, but there wasn’t anything major. This process just checked that my claim matched the citation; it didn’t double check that the cited paper is actually correct, since that is much harder to determine.

I also made a few structural changes: Added the Feeling Like You are Going Crazy troubleshooting subsection. Added Alternatives to MDMA. Removed Our Pitch because it didn't fit in well and was redundant. Removed Psychoeducation and Self Determination Theory because they were also redundant. Removed Making Sense of the Experience and distributed its content to Precautions and Uncertain Memory. Reorganized Between Sessions. Shuffled a few other sections around. Condensed Making Positive Life Changes to a small subsection at the end of Life Changes.

Moved T.H. from an author to an acknowledged contributor since they're no longer a part of the project.

As always, I’d love feedback and am happy to answer any questions!

Mark

I am considering a solo MDMA trip to try and address a recent and ongoing experience that carries lot of pain. I don't have a therapist and as I am in the U.K., finding one that supports and understands MDMA therapy would take time. From prior trips, I know I may have a very strong need to talk to someone at some point and do not want it to be family or friends. I do feel it need not be a therapist, as I believe I have the answers, but may need to talk things through to find them. I would like it to be someone who has experienced MDMA and knows how to listen and support at the level I will be speaking from, without being expected to advise.

Any ideas? Is there a support line that is not just for people in crisis? Or a group like this where members will arrange to be available for a phone call? If so it would also be something I'd volunteer for.

Or is it just an inadvisable idea? I guess I could call the Samaritans, but I'd feel the need to constantly apologise for talking a mile a minute and from a heightened state.

So I did MDMA solo (my first time was with a therapist and it went to a preverbal and loving state). I thought I could handle it and really needed to work on my codependency and boundary issues, and disorganized attachment style. I tend to swallow all my emotions and have an extreme people-pleasing response- it feels like I will die if I put up boundaries with a person I’m attached to. I am currently trying to get out of a manipulative/abusive relationship. I know that going solo was reckless, but please spare me the judgment - I was in an extremely desperate state.

During the trip I was shown several abuse situations from my childhood and talked to protectors and exiles. I experienced some body shaking related to different traumas, along with some insights and compassion towards my inner child.

Here’s the thing- it’s been a week since my solo session but the process is not stopping. I am not able to work or do pretty much anything. Traumatic stuff just keeps surfacing through my body and I am repeating the process with many memories to which I was previously numb. I gag a lot when I touch the feelings related to abuse. There is so much shame related to that that I carry. The good thing is that I am gradually letting myself feel anger towards my abusers- both in childhood and adulthood.

But it is scary and I’m afraid I broke something. Has anyone experienced this? I do have a phenomenal IFS therapist once a week, but she is not experienced in psychedelics. I talked to one integration therapist and she commented that I opened pandora’s box of suffering when I needed more of a Self energy. It left me kind of scared.

Hi everyone,

I’m a 40-year-old looking for perspectives on transitioning past recreational experiences into structured, therapeutic MDMA work—specifically looking at lower, counseling-style doses.

My Baseline & History:

The Problem: I have a constant, exhausting background loop of worry, pessimism, and the feeling that "something is fundamentally wrong with me." I've built a nice, balanced life (good job, family, a few close friends), but my default mode is to self-isolate in a safe bubble to avoid getting hurt.

The Roots: I’ve done a massive amount of self-reflection and cognitive work. I know my trauma stems from childhood, but it was heavily cemented by daily, heavy weed use in my teens in a very paranoid environment. That conditioned my nervous system to see the world as dark and dangerous, creating a permanent, hyper-vigilant baseline.

My Experience: I’ve taken MDMA about 10 times total in my life, usually at long intervals in dance/social settings.

The Breakthrough vs. The Crash:

When I take MDMA, the physical come-up is terrifying (intense anxiety, dry mouth). But once I break through that wall, it completely snaps me out of my autopilot mind-world. It silences the threat detector, handles my social anxiety, and makes me genuinely happy, confident, open, and functional. Crucially, the "afterglow" shifts my baseline for several weeks.

However, I stopped for a while because taking standard recreational amounts sometimes got me way too high, and the subsequent comedown was incredibly unhealthy for my baseline depression. I suspect this is purely a dosing issue.

What I’m Looking For:

I am currently tapering off emotional-numbing antidepressants and want to use MDMA intentionally as a therapeutic tool to bridge that open, confident state into my sober, everyday life.

Has anyone with a similar chronic "worry wiring" had success using lower, more manageable "counseling doses" (rather than full floods) combined with therapy to safely shift their baseline without the harsh comedowns? How did you navigate the dosing and integration?

Couple in our early 50s in Europe that a enjoys the occasional recreational use. Any input about couples therapy potential?

Tl;dr: curious about experiences with lowering dose to reduce comedown and how that impacts people, and how/when to transition to psilocybin and/or consider combining both :)

Hi everyone, I am continuing to work on integrating my recent medicine journey. This integration has focused primarily on working with deep grief. I've been doing a lot of journalling about how I speak to myself/my inner child when I am experiencing grief and hurt, and this feels fruitful.

These are my questions/areas where I am hoping for some input:

1. The comedown I experience from these sessions is absolutely brutal - usually I am physically knocked flat with fogginess, exhaustion, and short term memory loss for about a week, then depressed and anhedonic for another 2 weeks or so, and now I am slowly starting to recover from that, though I still don't feel totally myself and am sad and exhausted no matter how much I sleep.

While I do feel like I have the skills to weather this through, I do worry that it's a sign that this is maybe not ideal for my brain, as I don't often hear of people having this rough of a time with the comedown. I do think some of it is related to unmet needs and not having enough human contact and support during integration, but I worry that some of it is that the medicine is just really rough on my brain and body.

I feel like I am doing everything to help myself - good preparation and integration, as much nutrition, sleep, and gentle exercise as I can do, taking a reasonable dose (120 mg with a 40-60 mg booster), spacing out sessions (3-6 month breaks in between, the last time had been a 4 month break, with a 6 month break before that, and I have waited until I really felt like I had done a lot of integration and felt like I really needed to go ahead again), supplements (ALCAR, ALA, ginger, vitamin C, and CoQ10 during the session, 5HTP afterwards, and NAC in between sessions stopping about 1 month prior to the next session), and I am off all other psychiatric medications. I don't drink alcohol or use any other substances at all aside from occasionally microdosing mushrooms. The medicine I use is tested/decent quality.

Is there anything else that might help with this? If I do another session in the future (planning to wait at least 6 months and see how I feel), I am thinking of asking about lowering the dose a little bit, but I am a bit worried that it won't be as effective. Does anyone use lower doses and if so, what does that look like?

I've also considered trying a short term SSRI for just a few weeks after the session, but I don't want to mess with my brain/body more than necessary when things are already out of whack.

2. Increasingly, I have been wondering about trying psilocybin assisted therapy. Part of why I'm interested in it is the idea that it might go deeper or be more helpful with depression and existential dread, but the major reason is that it might not be as hard on my body afterwards, and I've had the idea of either trying it by itself or mixing it with a lower dose of MDMA to see if this is easier on my system afterwards while not losing the power of the sessions. My fear is that it might get too dark or overwhelming for me, or that it might be much more destabilizing in a way that I wouldn't be able to handle (hence the appeal of potentially mixing to cushion it).

I have microdosed very small amounts (25 mg) before and found that it made me feel calm and ruminate much less on the day, but this didn't really last. I've also tried larger microdoses (50-200 mg) and found that the higher microdoses made me more spacey and sometimes more anxious (especially when it wore off I seemed to get a bit of a crash afterwards).

I've done some reading and it seems like there is disagreement about the best way to work with psilocybin for complex trauma. Some people say that you can inch up the dose and experiment with mid range doses (1-2g) as a first step to get to know the medicine and figure out what dose is helpful for you and others say that's a bad idea because there is more anxiety with mid range doses and you should just go straight for a 3-5g dose. Some people say if you're worried about it being too dark/difficult, to combine it with MDMA, other people say that you shouldn't take it with MDMA unless you've experienced it alone.

So I am curious/interested to know if anyone who has primarily worked with MDMA has then gone on to work with mushrooms, and if so, what their approach was to making that transition, how they knew they were ready, and how it went.

This is not something I'd be doing any time soon as I still have a lot of integration work to do from my most recent session, and obviously I'd need to talk to my guide about it, but it's something I'm curious about for the future and wondering about others' experiences with.

Thanks!