Last month marked a milestone for research into a new treatment to combat depression. The FDA in an 14-2 decision approved a new nasal spray called Esketamine, marking a shift in how researchers understand the use of off-label Ketamine and its derivatives. While the science behind why Ketamine works in lifting depression is still being fleshed out, results from recent research is showing extraordinary outcomes in the use of Ketamine in conjunction with psychotherapy.
Over the last 10-15 years, the off-label and legal use of Ketamine has grown to over 300 clinics in the United States. Most offer Ketamine through intravenous infusion (IV) treatments for patients to come in for weekly or monthly visits. While this method of administration is highly effective, patients have found a need to regularly return to the clinics for booster dosages. Current findings have started to explore pairing Ketamine with deep psychological and therapeutic work, showing a cumulative effect over time when paired with therapy.
A recently published study in the Journal of Psychoactive Drugs demonstrates the positive outcomes of pairing Ketamine with psychotherapy. With over 235 KAP patients in the study, over a 6 year period, results showed clinically significant reductions in multiple psychological disorders including depression, trauma, PTSD and ADHD. As mentioned in the paper "The psychedelic, or dissociative, effects are an integral part of KAP, not to be feared or avoided, but instead that offer benefit to our patients when supported and integrated in a psychotherapeutic context." Pairing Ketamine with psychotherapy explores a very different approach to bringing together two paradigms that are often at odds with one other, psychiatry and psychology. This integration is bringing new hope to many who are no longer finding relief from SSRI`s or traditional talk therapy alone.
While there are many different protocols available, Ketamine assisted psychotherapy sessions often begin with patients taking a low dosage ketamine lozenge or rapid dissolving tablet. Before that, there is an opportunity for clients to set session intentions, creating a safe container and establishing a good connection with their therapist. The sessions are also an opportunity to see how the patient will respond to the medication, while also exploring any psychological, biographical and/or other material that wants to emerge. Insights from these sessions can allow for patients to have an expanded window into their inner-self, allowing for a wider more expansive perspective to take hold. While the biochemical effects are taking place, there seems to be a window that opens for enhanced mental plasticity in these states, allowing for a person to better understand themselves and their place in the world.
If there are good results in the low dose sessions, patients can then move on to do a high dose inter-muscular (IM) session. These high dose sessions often thrust clients into what is called a deep psychedelic experience, sometimes entering into an egoless states. These states can engender powerful insights about one's Self, the cosmos and a person's connection to something greater then their suffering.
In both low and high dose sessions, clients enter into what researcher Stanislav Grof calls Non-Ordinary States of Consciousness. According to Grof's experience, when our normal intellectual minds are allowed to rest, take a break and move into the background, material is allowed to float up from our unconscious minds, emerging experiences, memories, feelings and other psychic material. In these states, as described by KAP pioneer Phil Wolfson, therapists “serve as refuge makers, guides, interlocutors, who support new mind and the contextualizing of new ways of being; the therapist’s presence supports the here-and-now freedom to refresh, renew, release, and start again, and in the best of conditions and circumstances, a kind of rebooting of the mind, heart, and spirit.”
Having a safe environment and caring individuals to support whatever arises can help complete unfinished business in the mind, allowing for a grounding and integration into everyday life. With more time and future studies we will better understand the mechanisms of action within Ketamine`s rapid resolution of depression. Until then we must trust the accounts of those finding relief and transformation from this novel approach while also being aware of its limitations.
For more information about KAP or to schedule an intake session feel free to reach out at firstname.lastname@example.org
Wired Article On Ketamine
Journal of Psychoactive Drugs. (n.d.). Retrieved from https://www.tandfonline.com/doi/citedby/10.1080/02791072.2019.1587556?scroll=top&needAccess=true
Maybe you’ve heard the word trauma be used before but are not sure what people mean when they say it. Are they referring to ER room trauma units who help people stay alive after a serious accident? Or perhaps you’ve heard it used in the context of war veterans and their stories, many experiencing things no one could ever fathom. In the world of psychology the term trauma has been adopted to include exposure to accidents, violence, abuse or even a lack of care and support growing up. Only within the last 50 years have psychologists begun to understand the emotional imprint these events leave on our bodies and minds. As if stuck in a perpetual loop, our nervous system can be in constant alert, ready for another moment similar to the awful experiences we encountered. This can force us to live in the past, never fully being free to experience the goodness of the world around us.
There are two main categories psychologists use today when referring to trauma. Big T-trauma speaks to physical events such as car accidents, physical violence or sexual assault that cause people harm. The other category is referred to as developmental trauma, associated with an abusive relationship or deprivation of care and love. If a combination of these two are experienced, the term is referred to as complex trauma as both relational and physical elements were involved.
In situations where childhood developmental trauma is involved, we can often shut ourselves down in the face of overwhelming circumstances. In this process we can loose touch with our own authentic needs in order stay alive. Developmental trauma can take the form of abusive parents who belittle us, creating a world of shame and guilt without any understandable reason. Children often develop in response to these circumstances in order to survive unusually difficult circumstances. Coming into the world vulnerable and dependent on others for their survival, kids often suppress parts of themselves in order to make it through the turbulence of childhood. These adaptive responses are crucial for staying alive when young, yet may no longer be supportive in adulthood. Many don’t realize they carry these old ways of relating to others with them today, hindering an ability to bring their full selves to adult relationships.
As a therapist I find myself helping clients bring these old and often out dated patterns formed by trauma to light. I help them explore and discover the places in their adult lives that are actually keeping them in the past. I follow what story my clients` bodies are telling them, bringing awareness to protective patterns from childhood. From observing how startle responses show up, to becoming aware of how they hold and tighten their muscles, it is impressive to me just how much the body reveals. Through becoming aware of these body and breath constrictions, my clients can eventually find ways of feeling safe again in the present, relaxing defensive patterns that have protected them for years.
Learning to feel safe within our bodies can be challenging as it requires patience, support and a loving relationship. When the conditions are right, the natural healing mechanism within us can kick into gear, bringing about a reprograming and repatterining in our nervous system. While talk therapy can aid this process, it is important to work with a somatic or body oriented therapist. Somatic therapeutic approaches have been shown to be much more effective for healing from trauma. While it may feel overwhelming at times, healing is possible in today's world, given the enormous amount of research and insight psychology has gained in the last few decades.
For more information and resources feel free to explore some of the links below. You can also reach me at email@example.com
Peter Levine - Waking the Tiger - Insights on Trauma
Bessel Vander Kolk - The Body Keeps the Score - Trauma and the body
Gabor Mate M.D. - Authenticity - Children and Trauma