Couples therapy for those with PTSD is a growing area of research in psychedelic medicine. Anne Wagner, PhD, C.Psych, shares her insights as a PTSD researcher, a clinician trained in MDMA-assisted psychotherapy, and the principal investigator on several studies exploring the impact of MDMA-assisted therapeutic interventions with couples in which one member has a diagnosis of PTSD.
Getting to Know Dr. Anne Wagner
Dr. Anne Wagner is the founder of Remedy, a centre for mental health innovation committed to clinical practice, research, and community-building, based in Toronto, Ontario. Dr. Wagner uses her training in MDMA-assisted psychotherapy, cognitive-behavioural and mindfulness-based approaches in helping individuals, couples, and others in intimate relationships to process trauma, navigate their lives, and prepare for and integrate experiences in psychedelic and non-ordinary states of consciousness. She was one of the investigators of the MAPS-sponsored pilot trial of Cognitive-Behavioral Conjoint Therapy for PTSD + MDMA, studying the impact of treating couples where one member is diagnosed with PTSD. She is the Principal Investigator for the upcoming randomized trial of Cognitive Behavioral Couples Therapy (CBCT) + MDMA, as well as for a pilot trial of Cognitive Processing Therapy + MDMA for PTSD. She sits on the Board of Directors of Casey House, Toronto’s HIV/AIDS hospital, and is also an adjunct professor at Ryerson University.
Psychedelic.Support interviewed Dr. Anne Wagner as a part of our new series, The Quick Trip, where we hear expert answers to questions about psychedelic medicine and mental health.
Joining the Psychedelic Field
Dr. Wagner started her career as a PTSD treatment development researcher at Ryerson University, working as a post-doctoral fellow with Dr. Candice Monson. Dr. Monson, and her colleague, Dr. Steffany Fredman, had developed Cognitive Behavioral Couples Therapy (CBCT), which is a couples’ therapy for PTSD. Around 2013, the Multidisciplinary Association for Psychedelic Studies (MAPS) approached Dr. Monson about collaborating on a study combing CBCT with MDMA, and as a post-doc at the time, Dr. Wagner joined those meetings.
“It just really captured my attention. Before that, I had really never thought about using a psychedelic with treatment. I really didn’t know a lot about the background. So, I quickly read up on what was going on at the time.”
This was prior to Phase 3 trials with MDMA that have occurred in the years since, so Dr. Wagner began reading up on older studies with LSD as well as alternative techniques to induce altered states of consciousness, including Holotropic Breathwork.
To Trip or Not to Trip?
“It just all was really compelling. But at that point, I was still really agnostic in terms of the potential. I didn’t really know what it would mean or what it would look like. And then I got the opportunity to be a participant in a trial for therapists that MAPS had put together, to give therapists the opportunity to have the experience of being in an MDMA session in a therapeutic context. I feel very lucky that I got to participate in that study because it was the reason why I got so excited about doing this work. That experience for me was probably one of the most impactful, therapeutic experiences that I’ve ever had, and certainly changed the course of how I do my own personal work. And so from there, we dove headfirst into developing that treatment and ever since it’s been the focus of my clinical work, my research work, and now most of what I do, professionally. That was the starting point of it.”
One question deeply alive in the psychedelic field is if practitioners need to have their own firsthand experiences with psychedelics in order to be effective. Dr. Wagner recognized the impact a firsthand experience of a psychedelic in a therapeutic context had on her as a clinician and a researcher. Yet she is quick to highlight that there are many paths to accessing non-ordinary states of consciousness, such as through breathwork and through spontaneous experiences. Dr. Wagner is working to extend the opportunity she had to experience a psychedelic in a therapeutic context to other clinicians through her efforts at Remedy to create a similar study in Canada. The goal is:
“…that folks have more opportunity to have experiential training that is legal and they’re able to do it in a research context. So, we’re hopeful that that will be something that gets going in the next year or two, perhaps.”
Couples Therapy: MDMA + PTSD
Dr. Wagner is at the center of several exciting research projects in the world of MDMA-assisted therapy for PTSD. She is one of the investigators of the MAPS-sponsored pilot trial of Cognitive-Behavioral Conjoint Therapy for PTSD + MDMA, studying the impact of treating couples where one member is diagnosed with PTSD. She is also the Principal Investigator for the upcoming randomized trial of CBCT + MDMA. She appreciates the impact that healing can have not only for the individual, but for the couple, family system, and other intimate relationships they are intertwined.
“The experience of recovering from trauma…doesn’t impact just the person who experienced it. It will have reverberations throughout that person’s social network, their close relationships, their intimate relationships….being able to do healing work with someone who is close with you can not only help the relationship, it can help both people, and it can potentially have longer lasting effects and broader impacts as well. And the fact is that it’s really hard to heal in isolation. When we’re healing with a therapist, that can feel less isolating, but then the idea of actually having it take place in the relationships that exist in your life, outside of that, can be very impactful as well. So that’s the idea behind doing a dyadic or couples work with PTSD, and when we’re combining it with MDMA, the idea is we’re trying to help catalyze that process.”
Communication & Openness in Couples Therapy
A vital component of the CBCT + MDMA studies involve increasing communication, specifically helping couples understand “what’s going on with PTSD, understanding how it’s impacting them both, and their relationship, and how they interact together.” MDMA is then strategically added in at two points in the treatment. The first is at the beginning, after folks have learned communication skills, “so they’ve got a language…and a template to work with together to be able to go into deep experiences.” This experience can allow some important material to surface, which they can then use those skills to work on.
The second point is the MDMA is administered “right in the heart of the trauma processing. And so the idea is to give that piece a boost of being able to go really deeply and explore what’s there. So that’s in essence what we’re doing to combine those things together. And MDMA, as an entactogen – this idea of ‘to touch within’ – it’s really well suited to interacting with couples and helping with that creation of safety and the container, but also the feeling of empathy that comes along with it and an openness to sharing.” The focus is on having the difficult conversations, so the couple can move through trauma towards an even stronger relationship.
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The Results of Couples Therapy
“That’s what we did with the pilot study. We ran six couples through that study. We saw really compelling results. Five of the six folks no longer had PTSD at the end of the treatment and we saw gains in terms of relationship satisfaction as well, which is very exciting for us, especially because folks didn’t have to be distressed in their relationships at the beginning of treatment. And so, to see gains in relationship satisfaction, even when you’re not starting in a distressed range, is a really nice signal and nice demonstration that it can help with growth and with satisfaction and well-being as well. And then the outcomes with the partner were compelling too, in terms of their own well-being and growth. And that was exciting for us because we’re giving a dose of MDMA to the partner, who does not have necessarily have a diagnosis of anything, and they definitely don’t have PTSD, because that was a rule-out. So, we’re planning on taking that model, doing a few tweaks methodologically to it, and putting it into a larger randomized controlled trial that we’re getting ready right now.”
Dr. Wagner and the team at Remedy have lots of great ideas ready to go. The nearest term one is the:
“launch our study of cognitive processing therapy, which is an individual treatment for PTSD. That is one of the ones that’s the most widely disseminated in terms of healthcare systems. It’s a short-term treatment for PTSD, and combining that with MDMA. And that’s a pilot trial to demonstrate that we can combine MDMA with different modalities of psychotherapy, which I think is an important and interesting questions so that when we get to the point where MDMA is able to be prescribed as a medicine, there may be a wider array of therapists who would be able to do that given if they have training in CPT, which many do, and also just showing what could happen with that combination. So that’s been a study that’s been in the works for a long time and we’re really excited to launch it, and just waiting for some of the COVID restrictions here in Toronto to reduce…And then ideally that will lead hopefully almost directly into the larger couple study.”
“I [also] really hope to focus on clinician experiences and training…not only for people who are going to be participating in doing MDMA therapy themselves, but also as a tool for growth and experience for the clinicians. One of the biggest gifts we can give to ourselves, but really to our clients as well, is to do our own work and to understand what is coming up for us and be able to feel those depth experiences. So that makes me really excited.”
A Message for the Field
Dr. Wagner has a broad view of some of the growth happening across the psychedelic field, both as a researcher and as a clinician. When asked what ideas she thinks are most needed in the field right now, she first highlighted the need to pause. There is so much energy from new entities and companies that are rushing to join the field, yet
“…what the psychedelic work and the non-ordinary state work asks us to do is to go inwards, to get quiet and to sit. And I think we could all benefit from a moment of pause whenever we’re about to launch into something or go full steam ahead. So, that’s a thing I hope for. And, I try to do myself and I really encourage everyone to think about.”
“And then I think the other piece is this idea of trying to lead with love. There’s a oneness experience, that we don’t need to be grabbing at pieces of the pie that because of this idea of scarcity or fear or needing to be best or biggest or first. Because this is not new, this information, this knowledge, we’re not inventing it. It’s knowledge that has been known for a long time and through lots of different cultures and experiences. Some of the medicines may be a little bit newer, but not all of them. And so, I think those are two things that come to mind.
Dr. Wagner is an inspiring clinician and works to bring her values alive in the field. We are grateful she is part of the Psychedelic Support community. Learn more about Remedy at https://remedycentra.ca