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Therapeutic effect of increased openness: Investigating mechanism of action in MDMA-assisted psychotherapy
Open accessAbstract
A growing body of research suggests that traumatic events lead to persisting personality change characterized by increased neuroticism. Relevantly, enduring improvements in Post-Traumatic Stress Disorder (PTSD) symptoms have been found in response to 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. There is evidence that lasting changes in the personality feature of "openness" occur in response to hallucinogens, and that this may potentially act as a therapeutic mechanism of change. The present study investigated whether heightened Openness and decreased Neuroticism served as a mechanism of change within a randomized trial of MDMA-assisted psychotherapy for chronic, treatment-resistant PTSD. The Clinician-Administered PTSD Scale (CAPS) Global Scores and NEO PI-R Personality Inventory (NEO) Openness and Neuroticism Scales served as outcome measures. Results indicated that changes in Openness but not Neuroticism played a moderating role in the relationship between reduced PTSD symptoms and MDMA treatment. Following MDMA-assisted psychotherapy, increased Openness and decreased Neuroticism when comparing baseline personality traits with long-term follow-up traits also were found. These preliminary findings suggest that the effect of MDMA-assisted psychotherapy extends beyond specific PTSD symptomatology and fundamentally alters personality structure, resulting in long-term persisting personality change. Results are discussed in terms of possible mechanisms of psychotherapeutic change.
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“Previous studies using MDMA with individual psychotherapy have yielded significant improvements in PTSD symptoms, and other outcomes such as increased openness to experience, posttraumatic growth, and improvement in comorbid conditions (Gorman et al., 2020; Mithoefer et al., 2019, 2018; Wagner et al., 2017).”
From MDMA-facilitated cognitive-behavioural conjoint therapy for posttraumatic stress disorder: an uncontrolled trial (2020) · cites this paper as Wagner et al., 2017
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“MDMA has been shown to improve psychological flexibility, reduce fear of negative evaluation, and enhance self-reflection (89, 134–136).”
From Psychoanalytically informed MDMA-assisted therapy for pathological narcissism: a novel theoretical approach (2025) · cites this paper as [134]
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Metadata
- Authors
- Wagner, M. T., Mithoefer, M. C., Mithoefer, A. T., MacAulay, R. K., Jerome, L., Yazar-Klosinski, B., & Doblin, R.
- Affiliations
- Medical University of South Carolina (US)
- Private Practice, Mount Pleasant, USA
- University of Maine (US)
- MAPS Public Benefit Corp (MPBC), Santa Cruz, USA
- Multidisciplinary Association for Psychedelic Studies, Santa Cruz, USA
- Multidisciplinary Association for Psychedelic Studies (US)
- Corresponding author
- Wagner, Mark T
- Venue
- Journal of Psychopharmacology
- Publisher
- SAGE Publications
- Published
- 2017-06-21
- Volume
- 31
- Issue
- 8
- Pages
- 967-974
- ISSN
- 0269-8811 (ISSN-L)
- 1461-7285
- PMC
- PMC5544120
- OpenAlex
- W2716623847
- Cited by
- 160
- References
- 51
- Citations by year
- 2026: 9 · 2025: 14 · 2024: 21 · 2023: 14 · 2022: 18 · 2021: 11 · 2020: 49 · 2019: 10 · 2018: 10 · 2017: 4
- FWCI
- 24.76
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Psychopharmacology (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychedelics and Drug Studies
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- MDMA-assisted psychotherapy, MDMA, post-traumatic stress disorder, treatment-resistant PTSD, personality change, openness to experience, neuroticism, mechanisms of change, hallucinogens, personality traits
- MeSH terms
- Neuroticism, Adult, Combined Modality Therapy, Female, Hallucinogens, Humans, Male, Personality Inventory, Psychotherapy, Stress Disorders, Post-Traumatic, Treatment Outcome, N-Methyl-3,4-methylenedioxyamphetamine, Young Adult
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