Effects of post-session administration of methylene blue on fear extinction and contextual memory in adults with…
This drug seems to strengthen whatever the exposure session taught — including a bad session. If I am doing exposure therapy, is that a risk worth taking?
Well-supported by good-quality research. how we score evidence
Caveat on this rating: Blinding was almost certainly compromised: 95.6% of methylene blue participants reported blue-green urine discoloration versus 21.1% on placebo. The subgroup finding that drives the headline result was predicted in advance but comes from splitting 42 people by post-training fear level, so it needs replication before it means much.
Methylene blue is an FDA-approved drug, but only for one thing: ProvayBlue (methylene blue injection, NDA 204630, Provepharm) is indicated for the treatment of pediatric and adult patients with acquired methemoglobinemia.
42 adults with marked claustrophobic fear were randomised to 260 mg of methylene blue or placebo immediately after six exposure trials. The drug did not simply improve outcomes: participants whose fear was low by the end of the session had less fear at one-month follow-up on methylene blue, while those still moderately or highly fearful tended to do worse on it than on placebo. Methylene blue appears to consolidate whatever was learned in the session, good or bad.
Worth asking
This drug seems to strengthen whatever the exposure session taught — including a bad session. If I am doing exposure therapy, is that a risk worth taking?
Source
Effects of post-session administration of methylene blue on fear extinction and contextual memory in adults with claustrophobia. — Telch MJ, Bruchey AK, Rosenfield D, et al. (2014)
Top-tier peer-reviewed journal
Read the source: https://doi.org/10.1176/appi.ajp.2014.13101407
DOI: 10.1176/appi.ajp.2014.13101407
How this was scored
- Study design
- Randomised controlled trial
- Funding
- Independently funded
- Published in
- Top-tier peer-reviewed journal
- Sample size
- 42
- Preregistered
- No
- Conflicts disclosed
- Yes
- Independent of proponent
- Yes
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published August 19, 2026.
Questions
How strong is the evidence behind this?
Resolv rates this source "strong evidence". Well-supported by good-quality research. It scores 81 out of 100 on our published rubric. One caveat travels with that badge: Blinding was almost certainly compromised: 95.6% of methylene blue participants reported blue-green urine discoloration versus 21.1% on placebo. The subgroup finding that drives the headline result was predicted in advance but comes from splitting 42 people by post-training fear level, so it needs replication before it means much. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Effects of post-session administration of methylene blue on fear extinction and contextual memory in adults with claustrophobia. — Telch MJ, Bruchey AK, Rosenfield D, et al. (2014). Published in: Top-tier peer-reviewed journal. DOI: 10.1176/appi.ajp.2014.13101407. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Randomised controlled trial. Funding: Independently funded. The researchers were independent of whoever benefits from the result. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is methylene-blue, provayblue, methylthioninium chloride, methylene blue usp, mb FDA approved for this use?
No. Its current status is: Not FDA-evaluated for this use. Methylene blue is an FDA-approved drug, but only for one thing: ProvayBlue (methylene blue injection, NDA 204630, Provepharm) is indicated for the treatment of pediatric and adult patients with acquired methemoglobinemia.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.