<instructions>Your goal is to analyze the following comment and estimate how highly it will be upvoted by the Hacker News community.</instructions><comment><author>pvarangot</author><text>The first MDMA experience is usually very surprising, yes, but not for everyone. Depending on how you usually regulate your serotonin release, getting a very similar feeling to that of a run of the mill &amp;quot;roll&amp;quot; may happen if you are just very happy or melancholic or introspective. A very deep conversation about something that you have been wanting to let go for a while or a therapy breakthrough can elicit that feeling.&lt;p&gt;I don&amp;#x27;t know about this couples therapy thing, but remember that in most of this trials researchers are dealing with somehow of an &amp;quot;unstable&amp;quot; brain chemistry. Individuals with PTSD or ASD tend to dissociate even when sober and to be very sensitive to mindset and setting and believing they took a pill that is going to make their struggles go away while talking with a therapist can be a very warm and welcoming setting.&lt;p&gt;That being said, I also would like to point out that how people act on cocaine is usually heavily misunderstood and most of the stereotype of someone under the influence of cocaine is usually how people act on cocaine+some other strong stimulant like pseudo-efedrine. Cocaine was used medically for a long while and it&amp;#x27;s effects are very well understood and not similar to the usual &amp;quot;that person is on coke&amp;quot; stereotype.</text><parent_chain><item><author>crazygringo</author><text>Wow, that is bizarre. At first I&amp;#x27;d say it seems unbelievable, but then when you think of people in churches speaking in tongues, etc. -- I guess I could see it.&lt;p&gt;But if you&amp;#x27;ve ever &lt;i&gt;done&lt;/i&gt; MDMA you&amp;#x27;d certainly know it was a placebo, so it feels like these are people who never had, but &lt;i&gt;imagined&lt;/i&gt; what they thought it &lt;i&gt;ought&lt;/i&gt; to be like.&lt;p&gt;I&amp;#x27;d actually be incredibly curious to hear their description of it? Especially since everyone knows what people act like when drunk or on cocaine... but I&amp;#x27;m not quite sure people have as definite an idea of MDMA?</text></item><item><author>pmoriarty</author><text>&lt;i&gt;&amp;quot;Note that the control group in this case doesn&amp;#x27;t have to be a placebo group, because it&amp;#x27;s too obvious if someone has taken a powerful drug.&amp;quot;&lt;/i&gt;&lt;p&gt;It&amp;#x27;s not, actually.  I&amp;#x27;ve heard interviews with researchers in other MDMA studies saying that there were subjects who were absolutely convinced they got MDMA, and acted like they were on it, but when the double-blind study was over it was revealed that they didn&amp;#x27;t.&lt;p&gt;Never underestimate the power of placebos or of the human mind.</text></item><item><author>PragmaticPulp</author><text>Good to see some progress in this area.&lt;p&gt;As usual, it&amp;#x27;s important to emphasize that this research is about therapy, with MDMA as an additional modulator on top of the therapy. In this case, 15 therapy sessions over a period of 7 weeks. MDMA was only involved in 2 of the 15 sessions. If I&amp;#x27;m reading the paper correctly, patients received 3 therapy sessions before MDMA was introduced and the bulk of reported improvements happened prior to MDMA being added. Looking at the graphs, there aren&amp;#x27;t any obvious score increases around the MDMA sessions. In fact, I couldn&amp;#x27;t tell when the MDMA was introduced without reading the methodology section.&lt;p&gt;The study was also limited to 6 couples, with no control group. Note that the control group in this case doesn&amp;#x27;t have to be a placebo group, because it&amp;#x27;s too obvious if someone has taken a powerful drug. Instead, the control group would simply receive therapy without MDMA and results would be compared. The difference would begin to show the benefit of therapy+MDMA over therapy alone, which is critically important in these trials. You can&amp;#x27;t just give people 15 therapy sessions and then attribute the benefits to 2 doses of MDMA.&lt;p&gt;People tend to see these headlines and assume that the drug is doing all the work, or that they can simply replicate the results by taking the drug and seeing what happens. This is usually backed up by a couple of random positive anecdotes in the comment section while anyone with negative experiences is downvoted or dismissed.&lt;p&gt;Please don&amp;#x27;t assume you can replicate these results with ad-hoc experimentation with street drugs. If you browse Reddit, it&amp;#x27;s not hard to find anecdotes from people who have mistaken the short-term effects of these drugs for long-term healing, which usually results in them reaching out for more drugs the next time they have problems. Once people convince themselves that the drug is the easy solution to their problems, they&amp;#x27;re on their way to low-level addiction.</text></item></parent_chain></comment><story><title>MDMA-assisted couples therapy investigated in pilot trial</title><url>https://newatlas.com/health-wellbeing/mdma-assisted-couples-therapy-ptsd-cbct-pilot-trial-maps/</url></story>
<instructions>Your goal is to analyze the following comment and estimate how highly it will be upvoted by the Hacker News community.</instructions><comment><author>sushisource</author><text>Indeed. It&amp;#x27;s something I rarely hear mentioned, but I have found valuable about recreational drugs - they teach you a &lt;i&gt;lot&lt;/i&gt; about how your body works and what certain things feel like. A lot like tasting a spice in isolation allows you to pick it out in a complete dish.</text><parent_chain><item><author>crazygringo</author><text>Wow, that is bizarre. At first I&amp;#x27;d say it seems unbelievable, but then when you think of people in churches speaking in tongues, etc. -- I guess I could see it.&lt;p&gt;But if you&amp;#x27;ve ever &lt;i&gt;done&lt;/i&gt; MDMA you&amp;#x27;d certainly know it was a placebo, so it feels like these are people who never had, but &lt;i&gt;imagined&lt;/i&gt; what they thought it &lt;i&gt;ought&lt;/i&gt; to be like.&lt;p&gt;I&amp;#x27;d actually be incredibly curious to hear their description of it? Especially since everyone knows what people act like when drunk or on cocaine... but I&amp;#x27;m not quite sure people have as definite an idea of MDMA?</text></item><item><author>pmoriarty</author><text>&lt;i&gt;&amp;quot;Note that the control group in this case doesn&amp;#x27;t have to be a placebo group, because it&amp;#x27;s too obvious if someone has taken a powerful drug.&amp;quot;&lt;/i&gt;&lt;p&gt;It&amp;#x27;s not, actually.  I&amp;#x27;ve heard interviews with researchers in other MDMA studies saying that there were subjects who were absolutely convinced they got MDMA, and acted like they were on it, but when the double-blind study was over it was revealed that they didn&amp;#x27;t.&lt;p&gt;Never underestimate the power of placebos or of the human mind.</text></item><item><author>PragmaticPulp</author><text>Good to see some progress in this area.&lt;p&gt;As usual, it&amp;#x27;s important to emphasize that this research is about therapy, with MDMA as an additional modulator on top of the therapy. In this case, 15 therapy sessions over a period of 7 weeks. MDMA was only involved in 2 of the 15 sessions. If I&amp;#x27;m reading the paper correctly, patients received 3 therapy sessions before MDMA was introduced and the bulk of reported improvements happened prior to MDMA being added. Looking at the graphs, there aren&amp;#x27;t any obvious score increases around the MDMA sessions. In fact, I couldn&amp;#x27;t tell when the MDMA was introduced without reading the methodology section.&lt;p&gt;The study was also limited to 6 couples, with no control group. Note that the control group in this case doesn&amp;#x27;t have to be a placebo group, because it&amp;#x27;s too obvious if someone has taken a powerful drug. Instead, the control group would simply receive therapy without MDMA and results would be compared. The difference would begin to show the benefit of therapy+MDMA over therapy alone, which is critically important in these trials. You can&amp;#x27;t just give people 15 therapy sessions and then attribute the benefits to 2 doses of MDMA.&lt;p&gt;People tend to see these headlines and assume that the drug is doing all the work, or that they can simply replicate the results by taking the drug and seeing what happens. This is usually backed up by a couple of random positive anecdotes in the comment section while anyone with negative experiences is downvoted or dismissed.&lt;p&gt;Please don&amp;#x27;t assume you can replicate these results with ad-hoc experimentation with street drugs. If you browse Reddit, it&amp;#x27;s not hard to find anecdotes from people who have mistaken the short-term effects of these drugs for long-term healing, which usually results in them reaching out for more drugs the next time they have problems. Once people convince themselves that the drug is the easy solution to their problems, they&amp;#x27;re on their way to low-level addiction.</text></item></parent_chain></comment><story><title>MDMA-assisted couples therapy investigated in pilot trial</title><url>https://newatlas.com/health-wellbeing/mdma-assisted-couples-therapy-ptsd-cbct-pilot-trial-maps/</url></story>