It's not, actually. I'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't.
Never underestimate the power of placebos or of the human mind.
https://pubmed.ncbi.nlm.nih.gov/17484949/
His blood pressure crashed (80/40 initally, 100/62 after several hours of IV fluids) and his heart rate was over 100 bpm. When he found out the pills he had taken were inert, he bounced back almost immediately.
- Blood pressure tends to shoot up, rather than down, during a panic attack.
- Four hours would be incredibly long; they're usually more like 20 minutes
But if you've ever done MDMA you'd certainly know it was a placebo, so it feels like these are people who never had, but imagined what they thought it ought to be like.
I'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'm not quite sure people have as definite an idea of MDMA?
What's the dose used in the experiment? Similar to a recreational dose, or much smaller? If it was much smaller, i could imagine people not really being able to tell.
EDIT: The paper [1] says there are two MDMA 'sessions', about three weeks apart, and:
> Each partner was given 75 mg MDMA in the first MDMA session, and 100 mg in the second MDMA session, with an optional supplemental half-dose 1.5 hours later in both sessions (participants were informed that the supplemental half-doses could prolong the therapeutic window of MDMA effects).
I am told that a typical recreational dose of MDMA is 100 mg. More concretely, an Orange Tesla is ~250 mg, so make of that what you will.
[1] https://www.tandfonline.com/doi/full/10.1080/20008198.2020.1...
Not sure how based in reality that is, but seems to imply a similar effect for other drugs might be real.
I don't know about this couples therapy thing, but remember that in most of this trials researchers are dealing with somehow of an "unstable" 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.
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's effects are very well understood and not similar to the usual "that person is on coke" stereotype.
There have been times when the effect of coffee or marijauna hits me after a few sips/a bite of an edible, which feels placebo-y. But then I'm aware that it seems to be too fast, even as I start to feel it so fast, so could that still be a placebo effect?
I don't know, but it confuses me.
My only guess is that some of the THC is absorbed orally, but in a small quantity. That might explain the high feeling. Can't say I would know what the mechanism for this is, just a guess.
Experiencing an unusual taste in the mouth is common. I've heard of some people feeling a need to vacate their bowels when they are anticipating taking a drug.
So it's not at all surprising that when you actually take a drug you experience something right away, even before the drug has had time to work.
The mind is a powerful thing.
This is a completely untested hypothesis, but I wonder if these kinds of effects are somehow related to hallucinogen persisting perception disorder (HPPD). People experience some really powerful effects under the influence, and maybe the mind somehow learns to reproduce some of these effects on its own.
I think it's like hypnosis - they say that just allows people to do what they want to do anyways. It's just permission to act differently and that be OK.
I strongly suggest with little evidence that if you took 10 people who had previously taken MDMA and gave them placebos at least 9 would know it if not all 10. A single digit percentage of the control who don't know they got a placebo probably renders it pretty useless.
The BBC did a doco [1] on MDMA as a symptom mitigator for parkinson's disease with a stuntman who had it bad but liked to party at music festivals and saw it completely alleivated the symptoms. They did the two trials thing with him, take a pill (once mdma, another time placebo) and try to perform specific tasks in a gym and grade how well he could do it. The cameras got him saying something like this to the boffins in white coats: "I know this is the real thing because I can do it all easily and THE MUSIC ISN'T LOUD ENOUGH!!!"
[1]https://www.bbc.co.uk/science/horizon/2000/ecstasyagony.shtm...
The same happens when you take a paracetamol, you always feel better as soon as you've taken it, but it's because previously it did really work.
A similar thing happens with cursing - you can put up with more pain while shouting swear words than normal words, it is believed that is because you associate all those swear words with previously painful/traumatic times in your life and you're kind of drawing on those for extra strength.
The brain is strange and marvellous.
The problem then becomes the "nocebo" effect, wherein the patients who know they haven't been dosed with a powerful psychoactive substance assume that their treatment will be ineffective, and therefore stop giving it the required effort.
With therapy, it's important that the patient be onboard with and believe in the therapy. Giving people obvious placebos is a reliable way to lower expectations and instill doubt.
My best guess is that it was at a video of a talk or interview given on the Aware Project[1], or on an episode of the Psychedelic Salon[2]
[1] - https://www.youtube.com/channel/UC0oErWkP157InE47YAuhzPg