MDMA therapy Guide

This guide is designed to help you conduct therapeutic MDMA sessions safely and effectively. By covering the essential fundamentals, we aim to provide a practical resource for anyone interested in using MDMA as a tool for healing.

We, the creators of this site, have personally experienced profound trauma healing through MDMA and have also supported others in their own journeys by serving as trip sitters. Our firsthand experiences demonstrated the remarkable impact MDMA can have in a therapeutic setting, and we want to share this knowledge to help others find healing as well.

Heal your emotions that are stuck in the past.
That will heal your body and calm your thoughts.
With the silence that then remains,
you can experience what you really are.

Disclaimer

The information provided on this website is for educational purposes only and does not constitute medical or legal advice. MDMA is a controlled substance in many areas and may pose health risks, especially for individuals with certain conditions (e.g., former psychosis) or those taking medications like SSRIs.

Always consult a qualified healthcare professional before making any decisions about your health or medication use. The authors and website owners assume no responsibility for any harm, loss, or damage resulting from use of this information. Use it at your own risk and, when in doubt, seek medical advice.

The pages are translated by an AI from the source text in english.

Effects of MDMA therapy

MDMA therapy has been demonstrated to be highly effective in treating various forms of emotional trauma, including PTSD, CPTSD, anxiety disorders, and milder traumatic experiences. Ongoing research also suggests potential benefits for conditions such as depression, addiction, eating disorders, and relational challenges.

The therapeutic impact of MDMA stems largely from its ability to increase levels of key neurotransmitters such as serotonin, dopamine, and oxytocin. This rise in neurotransmitters promotes emotional openness, compassion, and a sense of connection, making it easier for individuals to confront and process difficult experiences. These neurochemical changes foster empathy and trust—both internally and toward others—which are critical for trauma recovery.

Studies indicate that MDMA therapy may require only a few sessions to achieve long-term benefits, offering a distinct advantage over some traditional treatments that can take years. Participants frequently report lasting relief from trauma-related symptoms and a deeper sense of emotional stability even long after their final session.

It is important to note that memories or specific details can resurface during or after MDMA therapy. While some individuals hope for this to happen, it does not always occur and can lead to disappointment if expectations are not met. In cases of (C)PTSD, people may repeatedly re-experience events, or they may re-experience only the emotions tied to those events. The brain does not store events and emotions in a one-to-one, linear way. While recalling the exact details of a trauma can aid in understanding, it is not necessary for healing; the core of the therapeutic process unfolds on an emotional level.

How to do a session

Setting

Successful MDMA therapy depends largely on dosage, environment and intention. While MDMA is commonly used recreationally (it’s the active substance in ecstasy), such settings typically do not facilitate emotional healing. By contrast, therapeutic benefits arise when individuals direct their attention inward—often with eyes closed and supported by carefully chosen music in a safe, trusted environment.

A typical MDMA therapy session lasts about six to eight hours, during which participants usually lie on a bed or mattress. An eye mask is often employed to encourage deeper introspection, and the music selection plays a key role in guiding and shaping the therapeutic experience.

Before the session

Avoid eating for at least four hours before your session. In rare cases, ingesting MDMA can cause nausea, and having an empty stomach can help minimize this risk.

Do not consume coffee the day before or on the day of your session. MDMA can already increase your heart rate slightly, and combining it with caffeine can exacerbate this effect.

Consider taking a magnesium supplement to help reduce jaw tension. MDMA often causes jaw clenching and muscle stiffness during and after the session.

While MDMA can make some people feel thirsty, it’s important to avoid overhydration. Limiting yourself to a pre-measured flask of water can help you monitor your intake and prevent drinking too much.

Depending on the climate, have a blanket handy in case you feel cold during the session.

If you anticipate strong emotions like anger, a teeth protector can be useful. Clenching your jaw combined with MDMA-induced muscle tension may lead to tooth damage without proper protection.

Before beginning, take a moment to set a positive intention. It can be as simple as “I want to be more open” or “I want to take better care of myself.” This helps guide your experience in a constructive direction.

MDMA usually takes about one hour to take effect after swallowing it.
If you’re using crystal MDMA rather than a pill, you can dissolve it under your tongue for faster absorption—but be very careful with measurements. Small amounts, such as 100 mg, can be tricky to weigh accurately.

The first noticeable signs often include a slight increase in heart rate and a change in body temperature. You may feel cooler or warmer than usual. As the effects begin, you’ll likely want to lie down and settle into a comfortable position.

During the session

Let go of expectations, every session is different and will bring something new, be open for what presents itself.
Lay down, eye mask on, relax and let your body come with what you are ready to heal or process. There is enormous wisdom in your body, it knows how to heal.

Limit your speaking and thinking, allow yourself to go inside and feel into your body, every emotion can be felt inside your body. Embrace every emotion or resistance that you encounter.

Events that happened in your past can not be changed by thinking. Events happened and had an effect. Honor the effects the event had on you and accept the emotions that they triggered in you.
Embrace the part of you that is stuck in the past with a blanket of love in the now. That helps the stuck part to come to the now and then its energy dissipates.

Judging yourself on your emotion can block you from accepting and releasing the emotion. For example: if you feel stupid for feeling fear, look into where the judgement came from, is it from yourself or did you take it over from someone else?

There is information in emotion, this can help you gain insight:
- Fear is about physical threat or future loss, threat from what? Feel into it.
- Sadness is about loosing connection. Connection with what? Feel into it.
- Anger is about protecting autonomy. Protecting from what? Feel into it.

When feelings are overwhelming:
1. it is just a feeling
2. no feeling survives being really experienced longer than 90 seconds.

When you are not feeling anything or nothing happens: feel into your body, what happens there? Scan your body, go inside.

For the trip sitter: keep an eye on the body temperature. For some people this can get too high. Monitor and cool the body if this happens. For other tasks for the trip sitter see the part: trip sitter.

After the session

Just after the trip drink a glass of water with electrolytes. This helps restore the minerals in your body and eases the comedown. Eating something light like fruit can be a real treat after a session.

You will not be fit to drive after the session. Do not drive any vehicle or use public transport without guidance on the day of the trip. Arrange somebody who can transport you if you can not stay overnight at the place of the session.

MDMA will make your eyes wide open, this is normal and will be restored the day after.
Some people encounter difficulty to sleep after a session, MDMA will still be active in your body.
Your jaw muscles can feel stiff up to 4 days after the session, if so it will fade away slowly. Taking magnesium helps reduce the time and intensity.

If you can, it is helpful to keep the day off after a session. Time is needed to integrate all that was experienced. And MDMA has a relative long comedown, the effect of the trip will still be noticeable the day after.

Listening to the music that was played during the session can help integrate and deepen the effect of the session. Many insights and extra processing of emotions happen not only during but also after the trip.

A known effect is the Tuesday dip, referring to the dip some people experience on Tuesday after a trip/party with MDMA on Saturday. This is caused by serotonin depletion in the body. During the trip serotonin is released by the body, leading to depletion later on. Some people take 5-HTP after the trip to compensate this, as it is a precursor for serotonin. Make sure to do this 24 hours after the session ends otherwise it will increase serotonin by the MDMA that is still active.

Location

Use a safe and undisturbed location. An accessible toilet on the same floor is needed, walking under influence of psychedelics like MDMA is not as easy, so avoid having to use stairs during the trip.
You might want to express yourself during the session so a place where sound can be made without disturbing others is preferred.
Dimming the light and blocking outside sunlight is what most people prefer during their session and helps to turn inside.

Music

Music plays an integral role in shaping the therapeutic atmosphere for MDMA-assisted sessions. Playlists tailored to MDMA therapy are available on Spotify, ranging from soothing and slow-paced to more upbeat, rhythmic selections, preferences vary.
Instrumental tracks are recommended because lyrics can shift focus toward cognitive processing rather than emotional exploration. As a starting point, the following playlist has been carefully curated with MDMA therapy in mind:

Dosage

A typical therapeutic dose of MDMA or 5-MAPB during a session ranges from 100 to 180 mg, although some practitioners use the guideline of 0.7–1.2 mg per kilogram of body weight.

- United States: A split-dose approach is often used. Typically, 120 mg is given initially, followed by 60 mg about one hour later.
- Netherlands: A standard single dose of about 100 mg is commonly observed.

However, dosages can vary considerably depending on individual sensitivity—some people respond to as little as 25 mg, while others might tolerate up to 250 mg. Although 250 mg is generally considered a practical maximum, there has been a reported fatality at 300 mg.

Exceeding the Therapeutic Range

MDMA has a specific dosage range in which it is most effective for therapeutic work. If too much is taken, the body is flooded with serotonin, creating a highly euphoric state described as “love, rainbows, and unicorns” that can overwhelm the therapeutic process. Once the intense effects subside, individuals naturally drop back into a more optimal therapeutic range. Aside from a prolonged experience of MDMA’s effects, there are usually no additional side effects associated with higher doses; however, exceeding one’s personal tolerance can reduce the therapy’s effectiveness and increase risks.

Important Note: These guidelines are provided for informational purposes only and do not replace professional medical advice.

MDMA Analog

Next to MDMA there exist MDMA analogs that work similar to MDMA. An analog is a modification of a substance, mostly consisting of just one atom difference with the original.
The analogs have a slightly different effect in the body, some of these even being more suitable than MDMA for MDMA therapy.

MDMA Analogs that are used in MDMA therapy are:

5-MAPB is used in the Netherlands for MDMA therapy as it is (still) a legal alternative. Less endorphin is released compared to MDMA, giving less of an aroused effect, making it a very suitable for therapeutic sessions.

6-APB shares empathogenic and stimulant effects with MDMA but has a longer duration and slightly different psychoactive profile.

Trip sitter

A trip sitter plays a vital role in ensuring the participant's safety, comfort, and overall well-being.
This can be a therapist or a trusted person. During the session many will want to share the experiences they have.

The trip sitter listens without judgment or pity to anything the participant expresses during the session. This includes emotions, thoughts, memories, or insights that arise under the influence of MDMA.
The trip sitter serves as a calming and stabilizing influence, helping the participant feel safe to explore their inner experience.
If the participant encounters difficult emotions or traumatic memories, the trip sitter provides calmness, support and helps the person navigate the experience without suppressing it.

A trip sitter also checks the amount of fluid that is being consumed and the temperature of the participant.

Time in between sessions

There is a consensus that significant time between MDMA (or MDMA analogon) consumption is needed. Taking too much, too often, can lead to serotonin poisoning of the body.

Also clear is that the exact time that is needed in between sessions is an educated guess.
The MAPS organisation’s guideline is 6 weeks in between sessions.
Others keep 2 months or even longer as a safe interval.
Some keep this guideline: maximum 3 trips per half year.
All of these guidelines have been proven to work, anything shorter than the above is not advised.

When not to do MDMA therapy

MDMA therapy can be a powerful tool for personal growth and healing. However, it is not suitable or safe for everyone.

If you’re on any medication, whether prescription, over-the-counter, or herbal supplement: verify its safety with a healthcare professional before exploring MDMA therapy.
If any of the following apply to you, do not proceed with MDMA therapy without consulting a qualified healthcare professional:

Younger Than 18 Years
Adolescents under 18 are vulnerable to MDMA’s neurotoxic effects due to brain development still being in progress.

History of Psychosis or Bipolar Disorder
Individuals with a history of psychotic episodes, schizophrenia, schizo-affective disorders, or certain mood disorders may be at higher risk of adverse reactions.

Combined Usage with Other drugs
Combining with other drugs that effect serotonin levels can increase the risk of serotonin syndrome. Psilocybin (magic mushroom) and LSD are considered safe combinations.

Serious Heart, Liver, or Kidney Conditions
MDMA can elevate heart rate and blood pressure, putting extra strain on these organs. People with preexisting cardiac, hepatic, or renal issues should avoid MDMA therapy.

Pregnancy or Breastfeeding
The effects of MDMA on fetal development or nursing infants are not well studied. It is generally advised to avoid any nonessential medications or substances during these times.

Antidepressants (SSRIs, SNRIs, TCAs)
Examples: Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), Venlafaxine (Effexor), Amitriptyline (Elavil)
Many antidepressants affect serotonin levels in the brain. Combining them with MDMA’s strong serotonergic effect can increase the risk of serotonin syndrome.

MAO Inhibitors (MAOIs)
Examples: Phenelzine (Nardil), Tranylcypromine (Parnate)
MAOIs also regulate the breakdown of neurotransmitters. Mixing MAOIs with MDMA can dangerously intensify or prolong MDMA’s effects, leading to severe cardiovascular and neurological risks.

Certain Anxiety Medications (Benzodiazepines)
Examples: Alprazolam (Xanax), Diazepam (Valium), Lorazepam (Ativan)
While not typically linked to serotonin levels, taking MDMA with benzodiazepines can complicate the body’s response, potentially masking or altering effects and presenting unknown risks.

Stimulant Medications (ADHD Medications)
Examples: Methylphenidate (Ritalin, Concerta), Amphetamine salts (Adderall)
Adding MDMA (another stimulant) on top of existing stimulant therapy can overload the cardiovascular system, raising blood pressure and heart rate to unsafe levels.

Over-the-Counter Medications and Supplements
Examples: Certain cold and cough medicines (especially those with dextromethorphan), weight-loss supplements containing stimulants, or high doses of 5-HTP/tryptophan
Even readily available products can contain compounds that interact with serotonin pathways or increase stimulant load, thus elevating risks when combined with MDMA.

Blood Pressure or Heart Medications
Examples: Beta-blockers (propranolol), ACE inhibitors (lisinopril), Calcium channel blockers (amlodipine)
MDMA can raise blood pressure and heart rate. If you have a cardiovascular condition or are on related medications, the additional strain may lead to dangerous complications.