Psychedelic-Assisted Therapy and EMDR: Where Does the New Wave Stand?

Few areas of mental health have attracted more attention in recent years than psychedelic-assisted therapy. The most advanced of these is MDMA-assisted therapy for PTSD, and its trial results looked genuinely impressive.A phase 3 randomised, placebo-controlled trial led by Jennifer Mitchell and colleagues, published in *Nature Medicine* (2023), treated 104 people with moderate to severe PTSD. Participants received either MDMA or a placebo, both alongside a course of therapy. By the end, around 71% of those in the MDMA group no longer met the criteria for PTSD, compared with roughly 48% in the placebo group.Figures like that generated enormous excitement. Then in August 2024 the US Food and Drug Administration declined to approve the treatment and asked for another phase 3 trial.The reasons are worth understanding, because they are not mainly about whether MDMA works. The regulator raised several problems at once. Participants could usually tell whether they had been given the drug, which undermines blinding. Most had used MDMA before, which may have shaped their expectations. There were reports of misconduct during the therapy sessions. And adverse event reporting was judged incomplete.There is a useful lesson in that for anyone reading about promising new treatments. A striking headline figure and a solid evidence base are not the same thing.It also exposes something that often gets lost in the coverage. These are drug-assisted *therapies*, and the psychotherapy half of the package has generally been far less carefully specified than the drug half. The misconduct concerns related to exactly that half. Which therapy, delivered how, by whom, and with what safeguards, turns out to matter a great deal.That is where EMDR's position is worth stating plainly. It is recommended in national and international guidelines for PTSD, has decades of randomised trials behind it, involves no controlled substance, and is available now rather than after another multi-year trial.None of this makes the new wave a dead end. The phase 3 findings were real, further trials are under way, psilocybin is being studied for depression, and researchers are now testing EMDR alongside non-invasive brain stimulation. In a decade the picture may look quite different.For now, the honest summary for UK readers is that MDMA-assisted therapy is not licensed here and is not available outside research settings, while EMDR is available and well evidenced. Interesting is not the same thing as ready.*Source: Mitchell, J. M., Ot'alora G., M., van der Kolk, B., et al. (2023). MDMA-assisted therapy for moderate to severe PTSD: a randomized, placebo-controlled phase 3 trial. Nature Medicine, 29(10), 2473 to 2480.*