5 - (SYM 51) A Case Study of the First Mdma-augmented Couple-based PTSD Treatment Within the Veterans Health Administration

Abstract Body
PTSD is known to impact romantic relationship functioning, and poor relationship and social functioning can worsen PTSD symptoms. Couple-based PTSD interventions, including standard and brief Cognitive-Behavioral Conjoint Therapy for PTSD (CBCT and bCBCT), tend to have large effects on PTSD symptoms and smaller effects on relationship functioning. MDMA (3,4-methylenedioxymethamphetamine)-assisted therapy is emerging as a breakthrough treatment for PTSD, and the entactogenic effects of MDMA may make it an excellent candidate to augment CBCT. This case study highlights a female military veteran diagnosed with PTSD and her intimate partner who participated in an open-label MDMA+bCBCT trial at a Veterans Affairs (VA) medical center. The case study was completed with approval from VASDHS IRB and the participant couple. The veteran was a 29-year-old Latina Navy veteran with a history of military sexual trauma, comorbid depression, and suicidality that had previously been managed with SSRI medication. Following a medication taper, the veteran and her partner both participated in massed bCBCT, preparation, and integration, while only the veteran received MDMA due to VA policy. Quantitative and qualitative results, along with illustrative procedural data, emphasize the unique considerations of implementing MDMA+bCBCT within a VA setting. Results showed substantial PTSD symptom reduction for the veteran (CAPS-5 severity: pre-treatment = 51, post-treatment = 22, 3-months follow-up = 28, 6-months follow-up = 21), maintenance of high relationship satisfaction for the veteran (CSI-32: pre-treatment = 136, post-treatment = 140, 3-months follow-up = 137, 6-months follow-up = 129), and improvement in relationship satisfaction for the partner (CSI-32: pre-treatment = 92, post-treatment = 149, 3-months follow-up = 151, 6-months follow-up = 131). Qualitatively, the couple described the treatment as “life changing” and reported having a “permanent sense of empowerment” following the study. Qualitative feedback emphasized the role of self-compassion and forgiveness in healing, as well as the importance of feeling cared for by the treatment team. Although the partner did not receive MDMA, he reported improvements in his own depression, relationship functioning, and overall wellbeing, as well as reducing PTSD symptom accommodation. This case illustrates a novel delivery of MDMA-assisted bCBCT using an outpatient model within the VA system of care and highlights the importance of including loved ones in MDMA treatment and integration.