Chris* has never been comfortable in large social settings, he'd rather hang out in small groups of close friends. But as a young man living in the heart of London, he kept finding himself at big parties and outings, and drinking heavily to cope.
That is, until he tried MDMA. When he took the psychedelic for the first time at 18, "it felt like an answer to something," said Chris, who is now 37. "Everything suddenly felt very different. Quickly, it became the only way that I felt comfortable."
The anxiety that Chris experienced is very common. About 15 million Americans have been diagnosed with social anxiety—which is characterized by the fear of what others think about you, worrying they're judging you, that you'll mess up and say something stupid or wrong. It’s the second most-diagnosed anxiety disorder in the country.
While it's not unusual for people to turn to alcohol for liquid courage, a subset reach for harder drugs like MDMA, and other psychedelics, like magic mushrooms, ketamine, and LSD, for social lubrication. They say the drugs help them interact with people in a new, elevated way, whether it be at a party, concert, or work event.
The therapeutic effects of these drugs work best in tandem with therapy and guidance from an expert, and MDMA actually has a history of being paired with psychotherapy to achieve greater mental well-being. Today, since it and other psychedelics are illegal, people have been seeking out these benefits on their own, despite the risks of doing so.
But we are in the midst of what some are calling a psychedelic renaissance. The illegal drugs relegated to rave and hippie culture have been popping up in clinical trials at top universities all over the world. Psychedelics have garnered preliminary evidence that they could be effective in treating conditions like depression, PTSD, or anxiety. So what about social anxiety?
The increasing research on these compounds is leading to an understanding of what they do in the brain to create those warm fuzzy feelings, to explain what people like Chris have been noticing. “It shaped all my relationships, most of my friends," Chris said. "It’s hard to imagine what my life would have been like without it.”
The pharmaceutical company Merck first synthesized MDMA in 1912, but no one tried it until the 1970s. A chemist from California named Alexander Shulgin used himself as a guinea pig, writing of the experience, "I feel absolutely clean inside, and there is nothing but pure euphoria. I have never felt so great or believed this to be possible…I am overcome by the profundity of the experience.”
Shulgin shared the drug with a California psychotherapist, Leo Zeff, who had been using other psychedelics in his practice. Zeff subsequently gave MDMA to around 4,000 patients and trained more than 150 other therapists to use it in between 1977 and 1985. At a conference called MDMA in Psychotherapy, held right before MDMA became illegal in 1985, therapists discussed how MDMA had the ability to open a person up, make their emotions more intense, and give them access to closed-off memories and insights.
In the 1960s, psychiatrist Claudio Naranjo found that it helped people get along in group therapy settings, to trust and empathize with each other. Around the same time, the drug even began to be used in couples therapy for this reason. A psychiatrist named Rick Ingrasci treated 100 patients with MDMA, about a third of them couples. He wrote that “what [MDMA] does is actually remove the fear of being real, of being authentic with yourself and with other people.”
“You basically couldn’t design a molecule that is better for therapy than MDMA," psychiatrist Julie Holland told The Guardian this past April. And yet, in 1985, the drug was labeled as a Schedule 1 drug, despite protestation from many clinicians—essentially halting research on its therapeutic applications.
The first time Greg Ferenstein, a data scientist in San Francisco, took MDMA, he thought it would be like an exaggerated experience of alcohol or Adderall. Then he started to gush about his emotions, “talking about the most intimate things about my life, and expressing gratitude and appreciation for my friends in ways that I didn't completely understand,” Ferenstein said. “I felt this wave of happiness and warmth, and I wanted to show my friends how much I appreciated them, and talk about very deep things about myself.”
Though MDMA is still illegal, these recreational and euphoric effects are well-known. Ferenstein said he takes different psychedelics in all settings, like conferences for work, where there can be an anxiety around impressing people. He didn't consider himself an extremely socially anxious person before drugs, but they made him a better listener, more gracious, appreciative and less selfish. “One of the ways I know a psychedelic is working is when it’s harder to talk about myself,” he said.
“I felt this wave of happiness, and I wanted to show my friends how much I appreciated them, and talk about very deep things about myself.”
The use of psychedelics for social anxiety “has been going on for a long time,” said Guy Jones, a chemist who helps run The Loop, a drug safety testing lab at festivals and events in the U.K. "MDMA is perhaps the most obvious and well-known for its pro-social effects, but I’ve also spoken to people who have found that psychedelics have left them with longer-lasting improvements while sober as a result of introspections they had while intoxicated."
There has been only one recent study specifically on social anxiety and the effects of MDMA, led by Alicia Danforth, a clinical psychologist who has researched MDMA and psilocybin-assisted therapy. At Harbor-UCLA Medical Center, she and her colleagues gave MDMA to a group of autistic adults in a randomized, double-blind, placebo-controlled experiment from 2018.
Moderate to severe social anxiety is common in people with autism, Danforth said, and so they wanted to explore how MDMA could help with the social anxiety in a population with an increased need for treatment.
In her participants, she found that the ones who got MDMA in their therapy sessions had a fast and long-lasting decrease in their social anxiety symptoms. “We continue to hear from some participants who check in to tell us, years after treatment, that they are still experiencing less social anxiety at college, at work, in romantic relationships, and in everyday life,” she said.
The resurgence in research on MDMA, psilocybin, and LSD in healthy volunteers is revealing the mechanisms of how they could be achieving this: The drugs boost positive emotions while also lowering how much we perceive negative social cues, like angry and scared facial expressions, and they dull the pain of social rejection.
A study from 2013 found that ketamine and psilocybin change the electrical response of the brain to neutral and fearful faces. If people were shown a picture of a person with an angry or upset face, subjects on drugs didn’t recognize the negative emotions as easily. "This could be a factor for why if they were in a group or social setting, the social anxiety would be lessened,” said José Carlos Bouso, a psychologist and pharmacologist at the International Center for Ethnobotanical Education, Research and Service (ICEERS) in Spain.
"Psychedelics have left people with longer-lasting improvements while sober as a result of introspections they had while intoxicated."
Similarly, MDMA doesn’t just make people feel good, it may blunt their ability to notice the bad. In 2010, researchers found that MDMA lowered people's ability to detect threatening facial expressions. If people aren’t able to detect negative emotions, it might make social interactions more appealing.
Meanwhile, people with mood disorders like depression and anxiety tend to pay more attention to negative expressions and have heightened brain responses to threats. This may explain one of the ways other psychedelics, like magic mushrooms, have been helping in clinical trials of people with depression.
Psychedelics may also change the way we feel about being excluded socially. Scientists studied this through an activity called Cyberball, in which participants play a virtual game of toss and catch, but over the course of the game, get left out by other avatars in the group. Those with various mental health issues, including depression and anxiety, are more sensitive to this social exclusion.
On MDMA, people said that their mood and self-esteem wasn’t as affected by being skipped over in Cyberball. And since social pain, or the pain of being rejected or excluded, is associated with increased brain activity in certain regions, scientists found that taking mushrooms, reduced activation in several of them.
Many psychedelics lead to a reduction of activity in the amygdala, a region of the brain that processes emotions, including fear, Bouso said, and psychedelics interact with serotonin in the brain, a brain chemical associated with mood. MDMA also promotes the release of oxytocin, a hormone that affiliated with social behaviors, to create feelings of social affiliation while lowering negative responses to social rejection.
Not noticing negative social cues, not feeling excluded, a decrease in fear—the combination of all these effects could lead to more enjoyable, empathetic, and profound interactions with others. Translating them to a treatment for social anxiety requires an additional step, though: Not just taking psychedelics but getting talk therapy while you trip.
We still have a lot to learn about psychedelics, and teasing apart which drug—MDMA, mushrooms, ketamine, or LSD—works best for specific kinds of anxiety, and when, Jones said. The burgeoning state of the research means that these drugs can often get rolled up altogether, when their mechanisms of treatment and risks could be quite different.
Along with the impacts on the brain, MDMA might be an opportunity to practice social skills, Danforth said, like training wheels for interpersonal interactions. Then, when people remember what they were able to do while on MDMA, they can approach daily life with more confidence.
She wants to try a similar approach in adults without autism soon, the kind who regularly use alcohol to make it through social situations, like Chris before he tried MDMA. Danforth thinks that as far as substances go, psychedelics as a group could be more therapeutically productive than alcohol. Alcohol can temporarily reduce social fears and serve as a means of avoidance, she said, and it reduces the activity of the frontal lobe, where our brain makes decisions, plans, and performs reasoning. MDMA increases activity in the frontal lobe, while decreasing activity in the amygdala. While alcohol reduces our awareness, Buoso said, it can also increase violence and other non-social behaviors. “On the contrary, MDMA is a very peaceful substance,” he said.
As far as substances go, psychedelics as a group could be more therapeutically productive than alcohol.
“I don't see where people learn a whole lot about themselves or improve their capacity to function when they're intoxicated with alcohol,” said Charles Grob, a professor of psychiatry at UCLA and co-author on Danforth's paper. “On the other hand with MDMA within a therapeutic context, it's a learning experience and it's a guided learning experience and the individuals learn something about themselves."
Ferenstein still regularly takes psychedelics, and said he sees them as a tool for personal growth. “I’ve done them for conferences, I've done them for conference calls, birthdays, weddings," he said. "I like to do them in almost any situation I can get my hands on. I like to send emails on them, Tweet on them. I like to see how I am different in lots of different ways.”
While taking illegal drugs without the guidance of a professional can be dangerous, especially for those with a history of mental health issues, it makes sense that people are seeking them out, said Ben Sessa, a psychiatrist who studies and practices MDMA-assisted psychotherapy.
“People are desperate for help,” Sessa said. “They are increasingly finding that traditional psychopharmacological options are letting them down, so they are turning to alternative options—even ones that are illegal and unlicensed.”
A crucial part of taking full advantage of these therapeutic properties is to combine these drugs with a psychotherapy habit in which many or most of the sessions don’t include drugs. “A great deal of support and integration is required to make sense of such experiences,” Sessa said. “When done in a facilitative environment, with adequate support, psychedelics can be very useful."
Jones said without a trained therapist, and in the kinds of settings that people often take these drugs, it can be impossible to push the experience in a healing direction. "A dance floor is often not the right place to mentally relive traumatic childhood memories," he said.
Chris doesn't take drugs anymore, it's been about five or six years since he's touched anything. But his experiences stayed with him. "There’s definitely a very clear sense of unlocking a different way of thinking, a different sense of consciousness,” he said. “Even when the drug wears off, there is a lingering perspective on things that you can’t and don’t come back from.”
*Because of the sensitive information shared, first name only has been used.
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