Utilizing In Vivo and Imaginal Exposure in the Context of MDMA-Assisted Therapy for Social Anxiety Disorder: A Case Report
Jason B Luoma, M. Kati Lear, Kyong Yi, Brian Pilecki
preprint DOI: 10.31234/osf.io/wft35_v1
Summary
AI-generated from the abstractA man in his late 30s with generalized social anxiety disorder (SAD) received MDMA-assisted therapy that included imaginal exposure to shame-related memories and in vivo social exposures during drug sessions, plus imagery rescripting and social activation homework. His symptoms and functional impairment, measured by the Leibowitz Social Anxiety Scale and Sheehan Disability Scale, showed significant reduction. He reported increased social engagement, less anxiety in social situations, and more self-compassion. The participant found exposures during MDMA sessions particularly impactful, allowing access to intrinsic desires for social connection. The authors suggest MDMA-assisted therapy with exposure techniques may be a promising treatment for SAD, warranting further research.
Study at a glance
| Characteristics | Case report Randomized |
|---|---|
| Sample size | 1 |
| Population | Man in his late 30s with generalized social anxiety disorder |
| Interventions | MDMA-assisted therapy imaginal exposure in vivo exposure imagery rescripting social activation homework |
| Duration | Three non-drug preparation sessions, two drug sessions, and six non-drug integration sessions |
| Key finding | MDMA-assisted therapy incorporating imaginal and in vivo exposure techniques led to significant reduction in social anxiety symptoms and functional impairment in a participant with generalized SAD. |
Abstract
This case report describes the application of in vivo and imaginal exposure techniqueswithin MDMA-assisted therapy (MDMA-AT) for social anxiety disorder (SAD). The treatment,conducted as part of a randomized controlled trial, consisted of three non-drug preparationsessions, two drug sessions, and six non-drug integration sessions. Exposure interventionsincluded imaginal exposure to shame-related memories during MDMA sessions, in vivo socialexposures during MDMA sessions, imagery rescripting exercises during integration sessions, andsocial activation homework between sessions. The participant, a man in his late 30s withgeneralized SAD, showed significant reduction in symptoms and functional impairment asmeasured by the Leibowitz Social Anxiety Scale and Sheehan Disability Scale. Qualitativereports indicated increased social engagement, reduced anxiety in social situations, and a shifttowards more self-compassion. The participant found both imaginal and in vivo exposuresduring MDMA sessions particularly impactful, reporting they allowed him to access intrinsicdesires for social connection and performance that were previously masked by anxiety. This casesuggests MDMA-AT incorporating exposure techniques may be a promising treatment for SAD,warranting further research.