Psychedelic Psychotherapy and Neurodivergence: Exploring New Pathways for Social Anxiety in Autistic Adults

by Mary Rawson Foreman, PhD — Psychologist & Art Therapist, Kirkland WA

Our understanding of healing continues to evolve, and with it comes new curiosity about how emerging therapies might support neurodivergent adults. One promising area of study explores MDMA-assisted psychotherapy for social anxiety in autistic adults.

Social anxiety is common among adults on the autism spectrum and can make connection and communication exhausting. Traditional therapies help many people, yet for some, progress remains limited. Early research suggests that MDMA, when used carefully within a therapeutic setting, may help reduce fear and open new possibilities for social engagement.

Early Findings from the 2018 Pilot Study

In 2018, the journal Psychopharmacology published the first controlled clinical trial of MDMA-assisted psychotherapy for adults on the autism spectrum. The study was led by Dr. Alicia Danforth and Dr. Charles Grob, with contributions from Dr. Allison Feduccia, Christopher Struble, Nick Walker, Lisa Jerome, Berra Yazar-Klosinski, and

Amy Emerson. The research examined whether MDMA combined with psychotherapy could ease the severe social anxiety that often limits quality of life for autistic adults.

Twelve adults participated. Eight received MDMA and four received placebo during two day-long therapy sessions, each surrounded by preparatory and integration meetings. The goal was not to treat autism itself but to explore whether MDMA could reduce the anxiety that so often accompanies social interaction.

Results were encouraging. Participants who received MDMA showed greater improvement on the Liebowitz Social Anxiety Scale than those given placebo, and these gains persisted at six-month follow-up. The therapy sessions were safe and well tolerated within the clinical environment.

In interviews and follow-up reports, participants described feeling more comfortable in conversation and more connected to others. Some noticed improved confidence in relationships and a gentler attitude toward themselves.

Why This Research Matters

Before this study, most knowledge about MDMA and autism came from personal accounts shared online. Autistic adults had described temporary experiences of openness and emotional warmth when using MDMA in non-medical settings. The 2018 trial was the first to test those observations scientifically, with medical supervision and structured psychotherapy.

Researchers worked closely with autistic consultants to create a calm, sensory-aware environment. They also integrated mindfulness-based approaches to support emotion regulation. These design choices helped participants feel safe and able to reflect on their experiences.

The findings suggested that MDMA-assisted psychotherapy might help unlock social capacities that were already present but often overshadowed by anxiety. As one of the study researchers observed, MDMA did not create new traits—it helped participants access strengths that had always been there.

Continuing the Conversation: New Research in 2023

In 2023, investigators at the Portland Psychotherapy Clinic, Research and Training Center and Oregon Health and Science University published a new protocol describing an open-label pilot study of MDMA-assisted therapy for social anxiety disorder. This trial includes both neurodivergent and neurotypical adults and focuses on emotional factors such as shame, belonging, and self-compassion.

Participants will complete preparation meetings, two MDMA sessions, and integration sessions over sixteen weeks. The aim is to explore feasibility, safety, and the psychological processes that may contribute to healing. Results have not yet been published, but the work represents another careful step toward understanding how MDMA-assisted therapy might support people living with intense social fear.

Moving Forward with Care and Hope

The early data are promising, yet much remains to be learned. MDMA remains a controlled substance in the United States, and the only safe and legal way to access this therapy is through approved clinical trials. Researchers such as Dr. Danforth and Dr. Feduccia emphasize the importance of waiting for larger studies and regulatory approval before seeking MDMA-assisted treatment outside these settings.

In the meantime, established approaches—such as mindfulness, self-compassion practice, and neurodiversity-affirming psychotherapy—continue to offer meaningful ways to reduce social anxiety and strengthen self-understanding.

For many neurodivergent adults, the idea of psychedelic-assisted therapy represents hope for deeper connection and less fear. This developing field invites both clinicians and clients to imagine gentler ways of healing, grounded in safety, respect, and curiosity.

References

• Danforth, A. L., Grob, C. S., Struble, C. M., Feduccia, A. A., Walker, N., Jerome, L., Yazar-Klosinski, B., & Emerson, A. (2018). Reduction in social anxiety after MDMA-assisted psychotherapy with autistic adults: A randomized, double-blind, placebo-controlled pilot study. Psychopharmacology, 235(11), 3137–3148.

• Lear, M. K., Smith, S. M., Pilecki, B., Stauffer, C. S., & Luoma, J. B. (2023). Social anxiety and MDMA-assisted therapy investigation: A novel clinical trial protocol. Frontiers in Psychiatry, 14, 1083354.