MDMA Enhances Emotional Empathy and Prosocial Behavior

Cédric M. Hysek; Yasmin Schmid; Linda D. Simmler; Gregor Domes; Markus Heinrichs; Christoph Eisenegger; Katrin H. Preller; Boris B. Quednow; Matthias E. Liechti


Soc Cogn Affect Neurosci. 2014;9(11):1645-1652. 

In This Article

Abstract and Introduction


3,4-Methylenedioxymethamphetamine (MDMA, 'ecstasy') releases serotonin and norepinephrine. MDMA is reported to produce empathogenic and prosocial feelings. It is unknown whether MDMA in fact alters empathic concern and prosocial behavior. We investigated the acute effects of MDMA using the Multifaceted Empathy Test (MET), dynamic Face Emotion Recognition Task (FERT) and Social Value Orientation (SVO) test. We also assessed effects of MDMA on plasma levels of hormones involved in social behavior using a placebo-controlled, double-blind, random-order, cross-over design in 32 healthy volunteers (16 women). MDMA enhanced explicit and implicit emotional empathy in the MET and increased prosocial behavior in the SVO test in men. MDMA did not alter cognitive empathy in the MET but impaired the identification of negative emotions, including fearful, angry and sad faces, in the FERT, particularly in women. MDMA increased plasma levels of cortisol and prolactin, which are markers of serotonergic and noradrenergic activity, and of oxytocin, which has been associated with prosocial behavior. In summary, MDMA sex-specifically altered the recognition of emotions, emotional empathy and prosociality. These effects likely enhance sociability when MDMA is used recreationally and may be useful when MDMA is administered in conjunction with psychotherapy in patients with social dysfunction or post-traumatic stress disorder.


3,4-Methylenedioxymethamphetamine (MDMA, 'ecstasy') and similar phenethylamines release brain serotonin [5-hydroxytryptamine (5-HT)] and norepinephrine and are classified as 'entactogens' or 'empathogens'. MDMA produces subjective prosocial feelings (Dumont et al., 2009), and the enhancement of empathy and sociability is also considered a major reason for the recreational use of MDMA and its therapeutic effects in psychotherapy (Bedi et al., 2010; Hysek et al., 2012b; Mithoefer et al., 2013). However, it is unknown whether MDMA indeed increases empathic concern for others or prosocial behavior when measured objectively.

The empathy construct includes cognitive and emotional aspects (Blair, 2005; Dziobek et al., 2008). Cognitive empathy is defined as the ability to recognize emotional states in others, and emotional empathy refers to the emotional response to another person's emotional state (Blair, 2005). Two previous studies assessed the effects of MDMA on emotion recognition which relates to the cognitive aspects of empathy using a static Face Emotion Recognition Task (FERT) (Bedi et al., 2010) and the Reading the Mind in the Eyes Test (RMET) (Bedi et al., 2010; Hysek et al., 2012b). MDMA did not improve emotion recognition overall in any of these tests (Bedi et al., 2010; Hysek et al., 2012b). However, MDMA impaired the recognition of fearful faces (Bedi et al., 2010) and mind reading of negative emotions and enhanced the identification of positive emotions in the RMET (Hysek et al., 2012b). Thus, MDMA may differentially alter emotion recognition, depending on the emotional valence of the stimuli. Whether MDMA modulates the emotional aspects of empathy such as empathic concern and whether it changes social behavior has not yet been tested.

This study investigated the effects of MDMA using the Multifaceted Empathy Test (MET) (Dziobek et al., 2008), a test specifically designed to assess different aspects of empathy. As an additional assessment of the cognitive component of empathy, and to confirm previously documented effects of MDMA on emotion recognition, we used a novel FERT, which uses more naturalistic dynamic presentations of facial affect (Domes et al., 2008). Furthermore, we assessed the effects of MDMA on prosocial behavior using the Social Value Orientation (SVO) test (Murphy et al., 2011). Because several neuropeptides and steroid hormones are involved in the regulation of social cognition and behaviors (Kosfeld et al., 2005; Thompson et al., 2006; Domes et al., 2007; Guastella et al., 2010), we determined the plasma concentrations of oxytocin (Dumont et al., 2009; Hysek et al., 2012b), C-terminal provasopressin (copeptin) (Simmler et al., 2011), cortisol, prolactin (Harris et al., 2002) and testosterone in all of the subjects before and after MDMA or placebo administration.

We hypothesized that MDMA enhances both emotional empathy and prosocial behavior consistent with the self-rated social effects of the drug. The study included equal numbers of both sexes to test the modulatory effects of the MDMA response by sex, which has been observed for oxytocin (Hurlemann et al., 2010).