Praxical.Psych
Unit 19 of 20

Altered states: psychedelic, MDMA- and ketamine-assisted therapies

Evaluate the field’s most-publicised development on its actual evidence.

Beyond the standard syllabus

What you should be able to do afterwards

  • 1Describe the three-phase protocol structure and why dosing is the smallest part
  • 2Explain functional unblinding and why it matters so much here
  • 3State the regulatory position accurately, including the FDA decision on MDMA
  • 4Describe the specific ethical safeguards this field requires and why

The reading

This unit is an exercise in holding two things at once. The phase 3 MDMA results were among the largest reported for any PTSD treatment; the FDA declined approval in 2024 after an advisory committee voted against, citing unblinding, adverse-event reporting and misconduct at a trial site. Learning to describe both accurately, without becoming either an advocate or a debunker, is the skill.

What belongs to this unit

Questions to take away

For a seminar, a supervisor, or an argument with yourself.

  1. 1How would you design a psychedelic trial that solved the unblinding problem? Can it be solved?
  2. 2If the psychotherapy is inseparable from the drug, what is being approved?
  3. 3Who should have access to these treatments first, and who decides?

Your notes

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Before you begin

What Praxical.Psych is, and is not

Praxical.Psych is an educational tool. It teaches the theory, evidence base and clinical method of psychotherapy at the level of an advanced survey course, and it lets you rehearse a complete session in a simulator.

It is not medical, clinical, psychological or legal advice. It cannot diagnose or treat anyone, and it does not state the law where you practise — requirements differ by jurisdiction and change. Nothing here creates a clinician–patient or solicitor–client relationship.

  • Every patient, transcript and case in this app is fictional — a composite written for teaching. None depicts a real person.
  • Praxical.Psych is not therapy, not a substitute for supervision, and not a credential. Competence to practise comes from training, supervised hours and licensure.
  • Scores from the instruments here are for learning how they behave. They are not a diagnosis and not a risk assessment, and must not inform a decision about a real person.
  • Do not enter real patient information. Everything you type stays in this browser, but that is not the same as a compliant clinical record system.
If you are in crisis

In the US and Canada, call or text 988. In the UK and Ireland, call 116 123 (Samaritans). Elsewhere, find a local line at findahelpline.com. In immediate danger, use your local emergency number.

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