I'm curious for people's view on whether 1) complex trauma, including non-secure attachment, explains most of the risk of MDMA-therapy-induced destabilization (assuming the therapist/guide is competent, ethical, and well-matched), and 2) how easy that risk factor is to assess.

I finally have a mostly complete first draft of my MDMA therapy book/manual! It's built on predictive-processing/memory-reconsolidation, complex systems dynamics, and the defense cascade model of autonomic threat responses. I'd love any feedback anyone would like to offer.

Does anyone know why there is so much caution around mixing MDMA with a history of psychosis or mania, when there aren't that many case reports of MDMA inducing psychosis (and none that I could find of mania), and a large majority of those involve confounding factors not present in therapy?

Huh. The MAPP1&2 long term follow-up found that those who got MDMA were much more likely to have gotten (Or were currently getting during the trial? It's unclear.) vaccinated or use psychiatric medications than those who got placebo. Page 88.
www.fda.gov/media/179062...

This article makes a good case that there is little evidence for a physiological placebo effect. I'm sure, if correct, that there is still a place for placebos changing beliefs, including mental illness (in the predictive processing model).

The push for psychedelic therapy trials to address unblinding is good. But my impression is that the large majority of all mental health interventions rely on trials with poor blinding. Should we not recommend psychotherapy, exercise, all psychiatric drugs with noticeable effects, etc?

Does anyone know of instances of mdma therapy reconsolidating healthy avoidance-of-danger priors (e.g. not touching hot stoves, walking into solid objects, etc)?

Has anyone heard of anyone successfully or unsuccessfully using naltrexone during MDMA therapy to reduce dissociation?

I think LaTeX’s biggest downsides, its complexity and confusing compile errors, are not a major problem any more. LLM’s like Claude can now solve most of your errors or tell you how to do what you want. I feel so much better writing in LaTeX than Word now.

Does anyone know of a “following” feed where politics/activism posts from people i already follow are filtered out? Is that possible? I sympathize but it’s exhausting and useless for me to get outraged about things I largely cant do anything more than I’m already doing to change.

MDMA sometimes seems to act as a universal source of prediction error for any maladaptive prior. Sometimes this is because MDMA is facilitating non-dual awareness, which can contradict most or all maladaptive priors. Is this how it always works though? Is everyone getting glimpses of non-dualness?

I don’t think capacity for memory reconsolidation is straightforwardly improvable. I’ve done 2 hours of MR every day —up to my exhaustion limit— for the past 14 months and haven’t seen any increase in the amount of time I can do it before exhaustion sets in.

www.lesswrong.com/posts/i9xyZB... convinced me that 1) Most mental illness is caused by maladaptive emotional learnings or beliefs (often unconscious) 2) Prediction Error/Memory reconsolidation is the fundamental mechanism of permanently updating those beliefs.

My consistent experience with MDMA therapy was that the medicine provides a universal mismatch that reconsolidates/unlearns seemingly any possible maladaptive schema/pattern. It skipped straight to the fundamental neural mechanism (MR) of therapy; no need for a framework like CBT, IFS, etc.

1) My coauthor Thomas and I are writing a short book (it started as a paper!) called "Open MDMA: A Broad Narrative Review and Practical Guide for the Therapeutic use of MDMA." We want to democratize knowledge of safer and more effective MDMA-therapy, solo or assisted.
osf.io/preprints/ps...