Dr. Julie Holland on MDMA-Assisted Therapy: What the Sessions Actually Look Like
The MDMA session itself runs the length of a full day. Figure eight hours at a minimum. In the South Carolina study, some participants would stay overnight and get picked up the following morning, so the whole thing stretched into a very long stretch of therapy with no leaving until the next day.
Around that core session there's a lot of contact. Every day or so, the therapist calls to check in: how are you holding up, has anything come up that's giving you trouble. Then the person comes back into the office for a series of sessions to work through whatever surfaced and got talked about during the dosing day.
Add it all up and you get something like sixteen therapy sessions total. Only one or two of those involve actual MDMA. The remaining ones are preparation beforehand and integration afterward. It is not a quick intervention.
One thing that shows up in the data: even people on placebo tend to improve, simply because of all that therapist contact. They just don't improve nearly as much as the people who went through the high-dose MDMA sessions.
Erik asked about the felt difference between a low dose and a high dose, and whether both have a use. There are studies that treat a low dose as what's called an active placebo. For some people that low dose isn't pleasant at all. It doesn't bring on the calm or the sense of satiety you might expect, and it can even feel a little uncomfortable.
Other people use low-dose MDMA the way someone might reach for Adderall or Dexedrine as an ADD medication, to sharpen focus and concentration. I've heard of people taking very small amounts to help them write, or to stay parked in front of a computer for hours.
The dose generally accepted as therapeutic is 125 milligrams. Sometimes, after an hour and a half or two hours, a booster is added, often about half of that, roughly 65 milligrams, to stretch the experience out. For a lot of people MDMA only runs about three or four hours. It is nothing like LSD, where you can be in an altered state for twelve or fifteen hours. The window is far shorter than that.