Trauma Under Psychedelics: How Psychoactive Substances Impact Trauma Processing

Abstract

Traumatic events play a causal role in the etiology of stress-related psychopathologies such as depression and posttraumatic stress disorder (PTSD). Recent research highlighted the therapeutic potential of psychoactive substances in alleviating trauma symptoms among chronic stress-related patients. This study is the first to investigate the impact of psychoactive substances consumed during actual trauma exposure. Our cohort includes 772 adult survivors (487 males, Mean{+/-}SD Age: 26.96{+/-}6.55) of the high-casualty attack that occurred at the Supernova festival in Israel on October 7th, 2023. Survivors completed the study during the peritraumatic period of one to four months following the attack. Primary outcomes include the PTSD Checklist for DSM-5 (PCL-5), the Kessler Psychological Distress Scale (K6), and a self-reported rating of feeling overwhelmed. Secondary outcomes include subjective experiences during the attack and reports on social interactions and sleep quality. All survivors reported being in direct danger of death during the attack. Approximately two-thirds of the sampled survivors were under the influence of psychoactive substances at the time of the attack, including LSD, MDMA, Ketamine, Cannabis, and Alcohol, creating a tragic and unique natural experiment to study the impact of psychoactive compounds on trauma processing. Analysis revealed that participants that were under the influence of MDMA during the attack (n=99) reported feeling less overwhelmed, having more social interactions, improved sleep quality, and reduced psychological distress compared to those not under the influence of any substance during the attack (n=216). In contrast, those consuming Cannabis and/or Alcohol during the attack (n=68) showed higher psychological distress, more PTSD symptoms, and worse sleep quality compared to those not under the influence of any substance during the attack. Together, these novel findings suggest that trauma exposure under the influence of MDMA is associated with reduced psychological distress and higher sociality, possibly mediated through MDMAs known effects of reducing negative emotions and elevating prosociality, while Cannabis and/or Alcohol consumption produces deleterious effects. Further research is needed to explore the cognitive and physiological mechanisms linking psychoactive substances to trauma recovery and establish the putative protective role of MDMA.