Getting in Touch with Touch: The Importance of Studying Touch in MDMA-Assisted Therapy and the Development of a New Self-Report Measure

Luoma and colleagues situate their paper within the rapid clinical development of MDMA-assisted therapy (MDMA-AT), noting that Phase II and Phase III trials have demonstrated safety, tolerability, and preliminary efficacy for post-traumatic stress disorder and have explored other indications. The Multidisciplinary Association for Psychedelic Studies (MAPS) treatment manual frames therapeutic touch as a central element of MDMA-AT, prescribing careful use, informed consent, and explicit prohibitions on sexualised or therapist-driven touch. At the same time, commentators have raised ethical concerns that touch in the context of MDMA's empathogenic effects could exacerbate power imbalances or enable boundary violations. The paper aims to address a clear gap: there is very little empirical research on touch in psychotherapy generally and none specific to MDMA-AT. To begin filling that gap, the authors review theories and prior literature about therapeutic touch and describe the development of a new self-report instrument, the Touch Outcomes Measurement Inventory (TOMI), intended to capture client perceptions of touch during MDMA-AT sessions. They present the TOMI as a tool to inform protocol development, training, and ethical oversight as MDMA-AT moves towards broader implementation.

The authors developed the TOMI following COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) guidance for content validity. Development began with a comprehensive literature review covering touch in psychotherapy, allied fields that use touch (for example nursing and physical therapy), theoretical taxonomies of touch, and published guidelines about when touch may be appropriate or harmful. Following the literature review, the study team conducted semi-structured interviews with three MDMA-AT experts, two of whom had direct experience using touch in therapy. Interview topics included typical client reactions to touch in MDMA-AT, negative reactions observed or reported, the perceived importance of touch in MDMA-AT, consequences of restricting touch, and what should differ about touch in MDMA-AT versus other psychotherapies. Expert input informed construct definition, intended use, and target population. Item generation used a multistep process: the authors extracted common positive and negative themes about touch from the literature, drafted multiple items per theme, and iteratively reduced redundancy to produce an initial 18-item questionnaire. Experts then rated items for relevance, comprehensiveness, and comprehensibility as recommended by COSMIN and provided feedback on response options and instructions. The measure was revised accordingly, yielding a final instrument comprising 16 items assessing positive and negative perceptions of touch, plus one multiple-answer item about types/locations of touch during the session and one item about amount of touch. A free-text qualitative item invites additional participant comments. The TOMI is atheoretical, intended to be completed by clients after MDMA dosing sessions, and is being deployed in an ongoing clinical trial of MDMA-AT for social anxiety disorder (clinicaltrials.gov NCT05138068). Primary measurement properties of interest are predictive and convergent validity; formal psychometric results are not reported in the extracted text.

The principal outcome reported is the creation of the Touch Outcomes Measurement Inventory (TOMI). The final instrument contains 18 total items: one multiple-answer item listing types and locations of touch; one item assessing perceived amount of touch; 16 items addressing positive and negative client experiences of touch; and an open-ended qualitative item for experiences not captured by fixed-response items. Items were selected to represent themes identified in the literature and refined through expert ratings of relevance, comprehensiveness, and comprehensibility. The literature review conducted as part of measure development reinforced major gaps and conveyed the theoretical landscape. Empirical studies on therapist–client touch are scarce, with most existing data coming from provider surveys and older analogue studies rather than contemporary client-centred measurements. Several theoretical frameworks suggest mechanisms by which touch might be therapeutic: attachment and developmental theories (touch as foundational to healthy development), psychophysiological mechanisms (e.g., increases in oxytocin, decreases in cortisol), enhancement of the therapeutic bond, affect regulation, and modelling of healthy touch. Conversely, theory and limited evidence also indicate risks, including retraumatisation, boundary violations, reinforcement of power imbalances, and culturally contingent negative meanings of touch. The authors summarised common positive client-reported functions from prior work, such as providing a sense of containment or safety, communicating that a client is not alone, enhancing self-esteem, modelling new relational patterns, facilitating contact with bodily sensations, and enabling therapeutic breakthroughs. They also compiled common negative reactions, including feelings of intrusiveness, sexualisation of touch, distraction from therapeutic processes, unexpected or non-consensual contact, and potential exacerbation of social or cultural vulnerabilities. The TOMI items were therefore designed to capture both beneficial and harmful experiences of touch as reported by clients.

Luoma and colleagues interpret the TOMI as a necessary first step toward empirically characterising how clients experience touch in MDMA-AT. They argue the measure's main strengths are its development process, which followed COSMIN standards and combined literature review with expert feedback, and its potential utility: researchers can use TOMI to associate touch experiences with process variables and outcomes, and programmes could employ it as a quality-assurance tool to detect distressing or iatrogenic applications of touch. The authors acknowledge important limitations. TOMI does not assess contextual antecedents of touch such as how consent was negotiated before or after a session; it captures only clients' immediate post-session perceptions. Single-timepoint measurement is limited because meanings of touch may evolve across therapy and perceptions recorded soon after a dosing session could later be reinterpreted. The extracted text does not report psychometric validation results; planned work in the ongoing trial will address convergent and predictive validity. Several future research directions are proposed. The authors encourage studies to develop methods for assessing therapist comfort with touch, to standardise negotiation and renegotiation protocols for touch in preparation and during MDMA sessions, and to explore stepwise or alternative strategies (for instance participant self-touch, breathwork, weighted blankets, or indirect touch through objects). They also call for qualitative research to explore subtleties that a self-report scale may miss. Finally, the authors suggest TOMI could be adapted for other forms of psychedelic-assisted therapy or ordinary talk therapy and used as part of clinician training and monitoring systems to promote safe, ethical practice.