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PERSPECTIVE article
Front. Psychiatry
Sec. Psychopharmacology
Volume 16 - 2025 |
doi: 10.3389/fpsyt.2025.1433999
This article is part of the Research Topic Women in Psychiatry 2024: Psychopharmacology View all 5 articles
Bringing MDMA-Assisted Therapy for PTSD to Traditional Healthcare Systems: Tending to Set and Setting
Provisionally accepted
Dimitri Perivoliotis 1,2*
Kayla Knopp 2*
Shannon Remick 3
Allie Kaigle 3,4
Chris Stauffer 5,6
Chandra Khalifian 1,2 Tamara Wachsman 1* Bettye Chargin 1*
Andrew W. Bismark 1,2 Al Alam 1,2* Leslie Morland 1,2,7*- 1 VA San Diego Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, San Diego, United States
- 2 School of Medicine, University of California San Diego, La Jolla, California, United States
- 3 VA Loma Linda Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Loma Linda, California, United States
- 4 VISN 23 Clinical Resource Hub, Eagan, United States
- 5 VA Portland Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, Portland, Oregon, United States
- 6 Oregon Health and Science University, Portland, Oregon, United States
- 7 Division of Women’s Health Science, National Center for Posttraumatic Stress Disorder (PTSD), Boston, Massachusetts, United States
Although effective evidence-based trauma-focused psychotherapies for posttraumatic stress disorder (PTSD) are available, a significant proportion of patients show a suboptimal response or do not complete them. MDMA-assisted therapy (MDMA-AT) for PTSD is a promising intervention currently being evaluated in numerous studies worldwide, including investigation for potential Food and Drug Administration (FDA) approval in the United States. The concepts of set and setting are foundational in psychedelic therapy and refer to the mindset a person brings to therapy and the environment in which it takes place, respectively. Both are believed to play a critical role in the individual's experience and efficacy of MDMA-AT. In this article, we describe the importance of set and setting in MDMA-AT for PTSD and outline the advantages and challenges of implementing this novel intervention in large healthcare settings such as the Veterans Health Administration (VHA). Mostly derived from our experience conducting clinical trials of MDMA-AT for PTSD in VHA, we present specific and practical suggestions for optimizing set and setting from both the participant's and clinician's perspective in a manner that both leverages the opportunities of such settings and adapts to their challenges. These recommendations are intended to inform future MDMA-AT for PTSD research and, potentially, eventual clinical implementation efforts in traditional healthcare systems.
Keywords: implementation, MDMA, MDMA-assisted therapy, psychedelics, Psychotherapy, PTSD, Veterans, Veterans Health Administration -VHA
Received: 16 May 2024; Accepted: 07 Jan 2025.
Copyright: © 2025 Perivoliotis, Knopp, Remick, Kaigle, Stauffer, Khalifian, Wachsman, Chargin, Bismark, Alam and Morland. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Dimitri Perivoliotis, VA San Diego Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, San Diego, United States
Kayla Knopp, School of Medicine, University of California San Diego, La Jolla, 92093, California, United States
Tamara Wachsman, VA San Diego Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, San Diego, United States
Bettye Chargin, VA San Diego Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, San Diego, United States
Al Alam, VA San Diego Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, San Diego, United States
Leslie Morland, VA San Diego Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, San Diego, United States
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