Ketamine assisted psychotherapy (KAP) is an innovative treatment approach that combines the use of ketamine with psychotherapy to address various mental health conditions. This emerging field offers hope for individuals who have not found relief through traditional treatments. We sat down with Dr. Allan Gold and Dr. Theresa Robertson, Co-Directors of the Ketamine Assisted Psychotherapy (KAP) Program at Gladstone Psychiatry and Wellness to learn more about this promising new avenue of treatment.
What is Ketamine and How Does It Work to Treat Mental Illnesses?
Ketamine is an anesthetic drug that has been used safely in medical settings for decades.
“The drug itself is not a classic psychedelic. It has a long history of safety being used as an anesthetic,” says Theresa Robertson, PhD, LCPC, Co-Director of the KAP Program at Gladstone Psychiatry and Wellness. “And more recently, it began to be used off label for pain relief as well as for psychiatric and psychological conditions.”
Dr. Robertson also points out that there is a difference between simple Ketamine therapy and KAP. “There are clinics, IV clinics, where folks will go in and have an IV drip of Ketamine, periodically, sometimes as much as three times a week, for several months. And they’re simply getting the medicine in most of those clinics. They’re not getting the assisted psychotherapy.”
While not a classic psychedelic, ketamine can produce psychedelic-like effects when used in sub-anesthetic doses. In recent years, ketamine has shown promise in treating conditions like depression, anxiety, and PTSD, especially when previous attempts at treatment have failed.
Ketamine works differently than traditional antidepressants. It appears to rapidly increase neuroplasticity – the brain’s ability to form new neural connections. This “miracle grow” effect on the brain facilitates learning and can help break negative thought patterns. Ketamine also seems to reduce inflammation in the brain and affect glutamate, a neurotransmitter involved in mood regulation.
“What the therapy does is really use that boost in mood state and access to what’s going on inside emotionally or traumatically so that you can do therapy around it,” says Allan Gold, MD, Psychiatrist and Co-Director of Gladstone’s KAP program. “With ketamine, therapy can be life changing and life transformative. The work for change continues past the ketamine series as the patient continues to explore what the ketamine opened up. The positive mood effects of the drug last one to two days, more with repeated dosings. But when combined with psychotherapy during the two day window of increased neuroplasticity, new thoughts, new more positive beliefs about oneself and others, and a richer emotional life can be extended beyond the immediate effects of the ketamine.”
How Do People Prepare to Receive Ketamine Assisted Psychotherapy?
Drs. Gold and Robertson say that proper preparation is crucial for KAP. The process typically involves:
- Medical screening: A thorough evaluation to ensure ketamine is safe for the individual.
- Psychological assessment: To determine if KAP is appropriate and to identify treatment goals.
- Preparation sessions: Usually 3 sessions focused on building trust with the therapist, addressing concerns, and setting intentions for treatment.
- Familiarization with the treatment space: Patients visit the room where they’ll receive ketamine to increase comfort.
- Discussion of expectations: Therapists explain what patients might experience and how to navigate challenging moments.
- Personalization: Patients may bring meaningful objects or engage in rituals to enhance their sense of safety and connection.
This preparation phase aims to create a safe, supportive environment for the ketamine experience.
What Happens in Ketamine Assisted Psychotherapy?
Dr. Robertson and Dr. Gold described a typical KAP session. It usually looks like this:
- Pre-ketamine check-in: The patient meets with their therapist to discuss their current state and revisit intentions.
- Comfort and safety measures: A medical professional monitors blood pressure and other vital signs, and is on site for any adverse effects, which are generally mild and readily addressed during the dosing session.
- Ketamine administration: Patients bring their ketamine prescription with them and self-administer it sublingually (under the tongue) in the form of lozenges called troches.
- The ketamine journey: Patients lie down wearing an eye mask and headphones playing carefully selected music. The journey typically lasts 40-60 minutes.
- Therapeutic support: A trained therapist remains present throughout the ketamine journey, offering support and guidance as needed.
- Integration: As the effects subside, patients have time to process their experience through discussion, journaling, or art.
- Follow-up: An integration session occurs within 24-48 hours to help patients make meaning of their experience and identify practices to reinforce insights gained.
During the ketamine journey, patients may experience a range of phenomena. “The sky is the limit when it comes to experiences on your journey,” says Dr. Robertson. “You might have visual imagery, emotional release, dreamlike experiences, connection to memories or insights into personal issues.” It’s important to note that experiences vary widely between individuals and even between sessions for the same person.
“What ketamine does and what all psychedelics do to some extent is to reduce some of our personality filters so that we can experience the world and feel things more richly,” says Dr. Gold. “And people often experience a new sense of unity and a sense of well-being that expands the richness of their experience in their lives. And once someone has that experience of well-being, which they may not have felt for some time if ever, they see this is possible and commit to working toward that to having this experience more often. Psychedelics expand our consciousness of beauty, awe, and a more positive view of life.”
Is Ketamine Assisted Psychotherapy Effective?
KAP is an evidenced based treatment, and early research has shown promising results. Additional research is ongoing for this emerging treatment. Ketamine alone has shown rapid and significant effects in treating depression, particularly in cases resistant to other treatments. When combined with psychotherapy, these benefits may be extended and deepened.
KAP appears to work through several mechanisms:
- Neuroplasticity: Ketamine’s ability to increase brain plasticity may help patients break free from rigid thought patterns and behaviors.
- Emotional processing: The ketamine experience can allow patients to access and process difficult emotions in a supported environment.
- Insight generation: Many patients report gaining new perspectives on their lives and challenges during KAP.
- Behavioral activation: The mood-lifting effects of ketamine can motivate patients to engage in positive behaviors, which can then be reinforced through therapy.
- Enhanced therapeutic alliance: The shared experience of KAP may strengthen the bond between patient and therapist.
While more research is needed, many clinicians and patients report significant improvements in mood, anxiety, and overall well-being following KAP.
Gladstone’s Ketamine Assisted Psychotherapy Program
Gladstone Psychiatry & Wellness is developing a ketamine assisted psychotherapy program aimed at making this innovative treatment more accessible. Key features of our program include:
- Insurance coverage: Gladstone is working to make KAP available through insurance, potentially broadening access to this treatment.
- Comprehensive approach: The program involves thorough preparation, supported ketamine sessions, and integration therapy.
- Tailored treatment: The frequency and number of sessions can be adjusted based on individual patient needs.
- Experienced team: Gladstone has assembled a group of therapists trained specifically in KAP.
- Focus on integration: The program emphasizes the importance of integrating insights from ketamine experiences into daily life through specific practices.
Gladstone’s KAP program is currently in a pilot phase, with plans to expand availability in the future. This initiative represents an important step in bringing ketamine assisted psychotherapy into mainstream mental health care.
Ketamine assisted psychotherapy offers a novel approach to treating mental health conditions by combining the neuroplasticity-enhancing effects of ketamine with the guided support of psychotherapy. While not a magic bullet, KAP shows promise in helping individuals who haven’t found relief through traditional treatments. As programs like Gladstone’s continue to develop, KAP may become an increasingly accessible option for people seeking transformative healing experiences in mental health care.