Preliminary Effectiveness of Individual and Group MDMA-assisted Therapy for Israeli Veterans With PTSD and Moral Injury.

Inclusion Criteria: Are veterans of special forces undercover units in the Israeli army. Are fluent in speaking and reading the predominantly used or recognized language of the study site (Hebrew). Are able to swallow pills. Agree to have study visits recorded, including Experimental Sessions, and non-drug psychotherapy sessions. Must provide a contact (relative, spouse, close friend, or other support person) who is willing and able to be reached by the investigators in the event of a participant becoming suicidal or unreachable. Must agree to inform the investigators within 48 hours of any medical conditions and procedures. Agree to the following lifestyle modifications : comply with requirements for fasting and refraining from certain medications prior to Experimental Sessions, not participate in any other interventional clinical trials during the duration of the study, remain overnight at the study site after each Experimental Session and be driven home after, and commit to medication dosing, therapy, and study procedures. At Screening, meet DSM-5 criteria for current PTSD with a symptom duration of 6 months or longer. At Screening, have at least moderate PTSD symptoms in the last month, based on PCL-5 total score of 36 or greater. May have well-controlled hypertension. May have asymptomatic Hepatitis C virus (HCV). May have alcohol or substance use disorder. May have a history of or current Diabetes Mellitus (Type 2). May have hypothyroidism if taking adequate and stable thyroid replacement medication. May have a history of, or current, glaucoma if approval for study participation is received from an ophthalmologist. Exclusion Criteria: Are not able to give adequate informed consent. Have used Ecstasy (material represented as containing MDMA) more than 10 times within the last 10 years or at least once within 6 months of the first Experimental Session; or have previously participated in a MAPS-sponsored MDMA clinical trial. Have any current problem which, in the opinion of the investigator or study physician, might interfere with participation. Sensitivity to any of the study interventions, or components thereof, or drug or other allergy that, in the opinion of the sponsor-investigator or study clinician, contraindicates participation in the study. Have received Electroconvulsive Therapy (ECT) within 12 weeks of enrollment. Have a history of or a current primary psychotic disorder. Have a current eating disorder with active purging assessed via MINI and clinical interview. Have current major depressive disorder with psychotic features assessed via MINI. Have a current alcohol or substance use disorder other than caffeine or nicotine that the investigators, therapy team, and/or study physician judge to be a safety concern for enrollment in the study. Have an active illicit (other than cannabis) or prescription drug substance use disorder at any severity within 12 months prior to enrollment. Have current Personality Disorders. .Any participant presenting current serious suicide risk, Require ongoing concomitant therapy with a psychiatric medication with exceptions described in protocol section on Concomitant Medications. Have a history of any medical condition that could make receiving a sympathomimetic drug harmful because of increases in blood pressure and heart rate. Have uncontrolled essential hypertension using the standard criteria of the American Heart Association (values of 140/90 milligrams of Mercury [mmHg] or higher assessed on three separate occasions). Have a history of ventricular arrhythmia at any time, other than premature ventricular contractions (PVCs) in the absence of ischemic heart disease. Have Wolff-Parkinson-White syndrome or any other accessory pathway that has not been successfully eliminated by ablation. Have a history of arrhythmia, other than premature atrial contractions (PACs) or occasional PVCs in the absence of ischemic heart disease, within 12 months of screening. Have a marked Baseline prolongation of QT/QTc interval . QTc interval > 450 milliseconds (ms) in males and >460 ms in females corrected using Fridericia's formula. Have a history of additional risk factors for Torsade de pointes (e.g., heart failure, hypokalemia, family history of Long QT Syndrome). Require use of concomitant medications that prolong the QT/QTc interval during Experimental Sessions. Have symptomatic liver disease or have significant liver enzyme elevations. Have history of hyponatremia or hyperthermia. Weigh less than 48 kilograms (kg). Have engaged in ketamine-assisted therapy or used ketamine within 12 weeks of enrollment.