Pathways Magazine Article - Ketamine Assisted Psychotherapy: The “Journey” to Healing the Mind, Body and Spirit
Article originally published in Pathways Magazine Fall 2024
The human experience has been wrought with anxiety and depression since the beginning of time. The treatment of such mental health issues has evolved greatly for the past several centuries and has varied from bloodletting and purging to lobotomies and ECT. Fortunately, we have come a long way, but a large portion of the population continues to struggle with mental illness.
According to the National Alliance on Mental Illness, it is estimated that 1 in 5 adults in the US will experience a diagnosable mental health condition every year. That equates to approximately 46 million people. Thankfully, the stigma of mental health treatment has improved in the past several decades, and it is now acknowledged there are many factors involved in cultivating a healthy body and mind.
The treatment of mental health issues such as depression has historically been managed with medication, therapy, or a combination of the two. Traditional antidepressants have targeted Serotonin and Norepinephrine, with research showing that only about 40-60% of individuals show some reduction in symptoms. The most commonly researched and prescribed psychotherapeutic approach has mostly included Cognitive Behavioral Therapy (CBT), which has shown to have an estimated success rate of 50-70%. While research supports that a combination of medication and therapy is most effective, the success rate of this approach is also estimated to be between 50-70%.
Unfortunately, the poor success rate of antidepressants is also accompanied with a delayed onset of 4-6 weeks for these medications to reach their therapeutic potential. Furthermore, it often takes several attempts with different medicines or a combination of medicines to find the optimal treatment effects. The likelihood of side effects also contributes to the challenge of determining the best medication and dosage for each individual.
Another challenge to achieving positive outcomes is the possibility of “treatment resistance”, particularly with respect to medications. The definition of “treatment resistance” is described by the US Food and Drug Administration (FDA) as “inadequate response to a minimum of 2 antidepressants despite adherence to treatment.” According to the Journal of Clinical Psychiatry (2021) It is estimated that 30% of adults diagnosed with Major Depressive Disorder (MDD) are classified as treatment resistant. Treatment resistance also affects 30-50% of those diagnosed with Anxiety Disorders. With continued increase in the prevalence of depression, anxiety, and suicide in the US, and with such a large percentage of those individuals being treatment resistant, the mental health community is constantly seeking to improve the treatment outcomes of individuals suffering from anxiety and depression.
Ketamine Assisted Treatment
Ketamine is not new to the medical world. In particular, ketamine has been widely used since the 1970s as an anesthetic and pain blocker; but its usage for the treatment of depression and anxiety has only recently grown in popularity. The World Health Organization (WHO) has classified ketamine as an essential medicine due to its evidence of efficacy, safety, and cost effectiveness with respect to disease prevalence and the relevance to public health. Despite its popularity in the anesthetic and pain management field, it has been used off-label for about 20 years to treat depression and anxiety. It has taken several years for the general public to consider this medication as a safe and useful option for mental health due to some bad publicity it attracted in the 1990s for its abuse and misuse as a party drug.
So, how does ketamine work and what does it do to your brain? Ketamine works by blocking glutamate receptors in the brain. By doing so, it disrupts some of the communication to the nervous system which blocks the reception of pain. When ketamine is used in psychotherapy, it is used at a lower sub- anesthetic dose, which actually increases the production of glutamate. This process has been proven to increase neuroplasticity and neurogenerativity in the brain, thus allowing the client to make rapid psychological, emotional, and behavioral changes.
The purpose of psychotherapy is to change maladaptive thinking and behavioral patterns, which is very challenging for most people. Therefore, combining ketamine with psychotherapy makes it more likely that the client can make changes with less resistance. You can liken it to working with wet clay and being given an opportunity to mold yourself with more ease and less discomfort.
The majority of research on Ketamine Assisted Psychotherapy (KAP) indicates it is more effective than psychotherapy alone, and more effective than ketamine alone. Some benefits of ketamine are that it offers a high likelihood of rapid mood improvement in a matter of hours or days, has fewer side effects than traditional antidepressants, and is considered a very safe medicine. In the long term, many clients experience a remission of MDD and anxiety symptoms as well as improved introspection, resilience, and overall mood.
The goal of KAP is not only to process emotional material that has felt “stuck” or too painful to process with therapy alone, but also to access the client’s “inner healing intelligence.” By decreasing defenses and resistance, clients can often access the part of themselves that holds the power to heal themselves. As therapists, we believe each person carries the knowledge and power to heal themself if we can just get our defenses and unprocessed trauma out of the way.
Ketamine’s Holistic Journey
There are three main ways to administer ketamine. For chronic, severe, and treatment resistant depression, the first line of treatment involves 6-9 infusions over the course of 2-3 weeks. This is often recommended for highly depressed and suicidal clients for it’s fast-acting relief. It is not normally accompanied with therapy and is mostly administered in an infusion clinic. The other two modes of low back and pelvic areas. In an effort to reduce pain, she had altered her biomechanics, which in the end created more pain. And by avoiding weight bearing for a longer than necessary time waiting for the pain to subside, her leg and foot continued to hurt when she did start to bear weight due to loss of strength and endurance.
Suffering
“Suffering” is all about being in a state of resistance or aversion to what is; and suffering, of course, is what leads you to get help. Our suffering comes from being scared, anxious, depressed, or even sad about being in pain. It is the beliefs about the pain that drives the emotions, which leads to suffering. Seeing the pain as something foreign, or as a punishment from God or a harbinger of future pain, only leads to more suffering. People suffer with pain when: they perceive a threat to their existence and integrity; it evokes fear involving the future; and when it is associated with social isolation and distrust of one’s own perceptions of one’s body, especially if a physician or relative fails to affirm the experience as being transitory — or worse yet — fails to provide the individual with a reason for the pain.
Sometimes the pain is more than just what is going on physically in the body — it can be the pain of a change in the experience of self. To illustrate, I consulted on an elderly woman who had sustained a below-knee amputation as part of an integrative approach to her pain management. Her physical therapist wanted assistance as the woman’s reaction to the pain was interfering with what they wanted to accomplish. During my evaluation I learned part of the suffering she was experiencing was due to a loss of femininity. Years earlier she had also undergone bilateral mastectomies for breast cancer. However, her sexual identity was not affected by the loss of her breasts, but rather to that of her leg; when she was a young woman, she stated the men all admired her legs. Without asking about what it means to have a particular illness or injury (or amputation), we cannot know what is driving a person’s suffering.
Emotions and Beliefs
We first learn about pain as infants during the birth process. Later on as children and growing into adulthood, we experience only acute pain from injury or illness that dissipates over time. However, from our experience with that, we conclude we were leaking somewhere (bleeding), or broke something, or had an unseen bacteria or virus eating away at our body. We learn early on to interpret pain as an alarm that something is wrong. With chronic pain, for the most part everything has healed over, scarred over, but the alarm continues to ring away, even though there is no acute threat. With chronic pain, we sound the alarm of an immediate threat to our existence, when really it is much more of a hellacious nuisance. Yes, it is possible to be hurting without being harmed. Hurt and harm are not the same thing.
The problem of chronic pain compounds further when we try avoiding activity or movement for fear of experiencing or aggravating the pain. Developing kinesiophobia, the fear of movement, leads to deconditioning, which leads to an intensification of pain as endurance, stamina and flexibility are lost, leading to further deconditioning and avoidance of activity. Simultaneously, the pain may trigger anger, anxiety, fear or distress that can lead to depression and hopelessness, which leads to increased awareness and perception of pain.
Thanks to Pathways Magazine for allowing us to share our knowledge about Ketamine Assisted Psychotherapy and our transformative offerings!
We feel honored and privileged to have been able to guide individuals through powerful healing journeys over this past year. Psychedelic assisted therapy assists clients with tapping into their own internal healing resources, to gain perspective, and to make lasting changes in their lives. We also integrate trauma therapy and somatic based techniques. Read more to find out and feel free to reach out for a complimentary consultation about our individual and group services for Ketamine Assisted Ketamine Assisted Psychotherapy. ❤️