A Systematic Review of MDMA’s Effects on Social Cognition in Placebo-Controlled Trials
Abstract
<p>Background3,4-Methylenedioxymethamphetamine (MDMA) is associated with distinctive prosocial and empathogenic effects, yet the consistency and scope of its impact on social cognition in humans remain unclear. Although numerous placebo-controlled studies have examined MDMA’s acute social effects, findings vary widely across subjective and behavioural domains.MethodsWe conducted a systematic review of placebo-controlled studies investigating the acute effects of MDMA on social cognition in adults. Outcomes included self-reported social and emotional experience, task-based measures of social cognition and behaviour, and relevant physiological and neurobiological indices. Studies administering MDMA as the sole intervention were included.ResultsAcross 75 studies, MDMA reliably enhanced subjective social experience, including feelings of sociability, emotional openness, closeness, and emotional empathy. In contrast, behavioural manifestations of prosociality, such as cooperation and trust in economic or performance-based tasks, were inconsistent and strongly context dependent. Behavioural and neuroimaging measures showed reduced accuracy in identifying negative social cues, including fear and anger, but no study used signal-detection metrics to discriminate genuine perceptual blunting from a shift in response criterion. Neuroimaging findings were from small, methodologically heterogeneous samples.ConclusionsMDMA consistently alters how social interactions are experienced, but subjective changes do not reliably translate into observable prosocial behaviour. MDMA reduces accuracy in identifying negative social cues, particularly fear and anger, but whether this reflects a specific blunting of threat processing or a shift in response bias and salience detection remains unresolved. Clarifying these mechanisms has implications for understanding MDMA’s therapeutic potential in conditions characterised by heightened social threat and avoidance.</p>
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