A meta-analytic analysis of the acute effects of MDMA on empathy and emotion recognition in humans

3,4-methylenedioxymethamphetamine (MDMA) is an amphetamine derivative known as an "entactogen," influencing emotional and social processing. Phase III clinical trials of MDMA-assisted psychotherapy for post-traumatic stress disorder have reported promising results, and MDMA-assisted therapy is currently under regulatory review. However, the precise mechanisms underlying positive treatment outcomes remain largely unknown. This meta-analysis aims to systematically synthesize existing data on the effects of MDMA on empathy and emotion recognition. Specifically, we focus on two established tasks, the Multifaceted Empathy Test (MET) and the Facial Emotion Recognition Task (FERT), to comprehensively evaluate MDMA's role in social cognition. Separate meta-analyses for each emotion tested in the FERT will help discern potential variations in MDMA's impact on specific emotional responses. Following PRISMA guidelines, we conducted the meta-analysis. The MET assesses cognitive and emotional empathy, while the FERT measures accuracy in identifying basic emotional expressions. Separate meta-analyses were performed for each emotion tested in the FERT. MDMA administration enhances emotional empathy but diminishes recognition accuracy of negative facial expressions (sadness, fear, anger). No significant effects on cognitive empathy or recognition of happy expressions were found. Understanding these nuanced effects may inform the optimization of therapeutic applications and considerations for safety in clinical settings. Further studies are warranted to elucidate the underlying psychological and neural mechanisms, emphasizing the importance of continued investigation into the multifaceted influence of MDMA on social cognition.