Intellectual humility: an old problem in a new psychological perspective

The conceptual framework for the therapeutic approach used in phase 3 trials of MDMA-assisted therapy for PTSD

Results from multiple recent studies support further evaluation of 3,4-methylenedioxymethamphetamine (MDMA) in conjunction with psychotherapy (i.e., MDMA-Assisted Therapy) in the treatment of post-traumatic stress disorder (PTSD). In two Phase 3 trials, MDMA-Assisted Therapy comprised a short-term, intensive psychotherapy that included three sessions directly facilitated by MDMA (referred to as "experimental sessions"), as well as a number of non-drug psychotherapy sessions. This treatment model aimed to harness the potential of MDMA to facilitate recall and processing of traumatic memories, and to increase learning in a social context, integrating "top-down" and "bottom-up" approaches to trauma-focused care. To date, the conceptual framework for this treatment has not been described in the scientific literature. This omission has contributed to misunderstandings about both the theoretical underpinnings of this modality and the therapeutic approach that emerges from it. This paper delineates the psychotherapeutic concepts, theories, and historical antecedents underlying the inner-directed approach to MDMA-Assisted Therapy for PTSD. Broadly speaking, this therapeutic framework centered the concept of the participant's inner healing intelligence as the primary agent of change, with the therapeutic relationship being the core facilitative condition fostering the participant's self-directed movement toward recovery and growth. Corollaries to this holistic, self-directed, relational, and trauma-informed framework include a non-pathologizing approach to the participant's embodied experience (including the possibility of intense emotional and somatic expression, experiences of multiplicity, suicidal ideation, and multigenerational and transpersonal experiences), as well as the therapists' own psychodynamic, somatic, and transpersonal awareness, empathic attunement, relational skillfulness, and cultural humility. The use of MDMA in conjunction with this psychotherapy platform outperformed the use of placebo with psychotherapy in Phase 2 and 3 trials, as measured by symptom reduction in participants with PTSD. However, within-group comparisons also identified significant symptom reduction in participants who did not receive MDMA, lending empirical support to the psychotherapy model itself. In addition to comparative efficacy trials, future research should investigate which elements of the conceptual framework and therapeutic approach underlie the clinical benefit in individuals with PTSD.

Mental Health Experts as Objects of Epistemic Injustice-The Case of Autism Spectrum Condition

This theoretical paper addresses the issue of epistemic injustice with particular reference to autism. Injustice is epistemic when harm is performed without adequate reason and is caused by or related to access to knowledge production and processing, e.g., concerning racial or ethnic minorities or patients. The paper argues that both mental health service users and providers can be subject to epistemic injustice. Cognitive diagnostic errors often appear when complex decisions are made in a limited timeframe. In those situations, the socially dominant ways of thinking about mental disorders and half-automated and operationalized diagnostic paradigms imprint on experts' decision-making processes. Recently, analyses have focused on how power operates in the service user-provider relationship. It was observed that cognitive injustice inflicts on patients through the lack of consideration of their first-person perspectives, denial of epistemic authority, and even epistemic subject status, among others. This paper shifts focus toward health professionals as rarely considered objects of epistemic injustice. Epistemic injustice affects mental health providers by harming their access to and use of knowledge in their professional activities, thus affecting the reliability of their diagnostic assessments.