Additive Effects of 3,4-Methylenedioxymethamphetamine (MDMA) and Compassionate Imagery on Self-Compassion in Recreational Users of Ecstasy

Abstract

3,4-Methylenedioxymethylamphetamine (MDMA;'ecstasy') produces prosocial subjective effects that may extend to affiliative feelings towards the self. Behavioural techniques can produce similar self-directed affiliation. For example, compassionate imagery (CI) and ecstasy reduce self-criticism and increase self-compassion to a similar extent, with the effects of CI enhanced in the presence of ecstasy. Here, we examine self-compassion and self-criticism in recreational users who consumed chemically verified MDMA in a within-subjects crossover study. In a naturalistic setting, polydrug-using participants performed a self-focused CI exercise on two occasions separated by ≥6 days: once having consumed self-sourced MDMA and once not. Effects on state self-criticism, self-compassion and emotional empathy were assessed before and after MDMA use (or over an extended baseline period on the occasion that MDMA was not consumed) and reassessed after CI. In participants (n = 20; 8 women) whose ecstasy contained MDMA and no other drug, CI and MDMA appeared to separately increase emotional empathy (to critical facial expressions) and self-compassion. The effects of CI and MDMA on self-compassion also appeared to be additive. Establishing the observed effects in controlled studies will be critical for determining the combined utility of these approaches in fostering adaptive self-attitudes in a therapeutic context.

Keywords: Compassion; Compassionate imagery; Empathy; MDMA; Prosocial; Self-compassion; Self-criticism.

Fig. 1

Protocol outline. All the participants completed both sessions. Subjective state measures (‘Subjective’ in the boxes under T1, T2 and T3) and heart rate (HR) were assessed at the three time points (T1, T2, T3) and emotional empathy (EAT-SAM empathy assessment task using the Self-Assessment Manikin) at T2 and T3. T1 corresponds to baseline, before MDMA use (on the MDMA + CI session). T2 was post-MDMA (on the MDMA + CI session) or served as a second, extended baseline measure (on the CI-only session). T3 was post-CI (both sessions). Procedure and assessment time points were the same on both sessions with the exception that no MDMA was self-administered and additional trait and drug-use history measures were completed (from T1 to T2) on the CI-only session

Fig. 2

a Mean (± SEM) SCCS self-criticism scores at three time points: T1 (baseline), T2 (the extended baseline/post-MDMA time point) and T3 (post-CI on both sessions). b Mean (± SEM) SCCS self-compassion scores recorded at the same time points (T1–T3). The dashed line represents results from the CI-only session, and the solid line, the MDMA + CI session. One asterisk indicates p < 0.05; two asterisks indicate p < 0.01 in post-hoc tests

Fig. 3

Mean (± SEM) arousal ratings (indexing emotional empathy) in response to critical and compassionate faces on the empathy assessment task using the Self-Assessment Manikin (EAT-SAM). Two asterisks indicate p < 0.01 for MDMA versus drug-free performance on critical faces at T2; one asterisk indicates p < 0.05 for the T2 versus T3 effect of CI only on critical faces