MDMA-assisted therapy in Somaliland East Africa: Beginning Experience

Acceptance and Change for Health (ACFH) began to provide mental health support to the self-declared independent nation of Somaliland in 2018. Mental health services are virtually nonexistent in this war-torn region of the world, and most Somalis suffer from trauma related to war. Our goal was to create a strategy for teaching native Somali therapists effective treatments for post-traumatic stress disorder (PTSD) and other causes of mental suffering. One of the methods we wanted to explore was MDMA-assisted therapy. We first wanted to test the effectiveness of MDMA-assisted therapy in a culture very different from the U.S. MAPS helped provide training in MDMA-assisted therapy for our Somali mental health trainees. Five trainees were given at least one dose of MDMA, and all had the opportunity to be guides in the therapy. We followed the MAPS protocol for providing therapists with their own MDMA experiences as closely as possible. They were screened with the MINI, giving the PANAS, AAQ-2, and Self Compassion Scale pre- and post-MDMA use. In July and August 2024, 4 therapists were given an initial 80 mg dose of MDMA with a 40 mg booster given two hours later. Two months later, three therapists were given a second dose of 120 mg of MDMA followed by a 60 mg booster. A fifth trainee received her first 80ng dose. She and another trainee will take the second dose eventually. All trainees will be given the option of taking a third dose. We have received feedback from all participants that they feel MDMA assisted therapy would be a useful tool for treating PTSD in Somaliland. A key finding is that each participant needs adequate time to develop a secure relationship with the therapist before taking the MDMA. Likewise we need to provide participants with a toolbox of coping skills to navigate the intense emotions that may accompany the journey. More work with the therapist may be needed after the medication sessions than we anticipated. We will need to make sure we have the resources available to help each participant with integration for as long as it takes. We are currently developing a protocol for using MDMA for a select group of patients in the larger community.