MEDICINE
Ketamine-Assisted Psychotherapy (KAP)
Frequently Asked Questions
We offer a program for both individual and group experiences. Learn about the benefits of a group experience. The following FAQs aim to address many common questions about KAP.
Is Ketamine safe?
Ketamine is safe. Due to its excellent safety profile, Its common use in surgical settings, including pediatric surgery. Its properties of dissociative anesthesia have made ketamine a widely used drug. In 1970, the FDA approved ketamine, and since then, it has been used in hospitals, emergency departments and clinics because of its rapid onset, proven safety and short duration of action. If used in a controlled medical practice, ketamine is safe and is administered at a dosage that is below the anesthesia dose. In uncontrolled recreational use, it can be potentially life-threatening, especially if taken with certain conditions or combined with alcohol.
What does dissociative anesthesia mean?
Dissociation means a sense of disconnection between the mind-body and one’s ordinary reality and usual sense of self. Ketamine, when used in a controlled, clinical setting for psychedelic-assisted therapy, can be safe and effective for treating certain mental health conditions, such as treatment-resistant depression, anxiety, PTSD, and some other mood disorders. However, the safety and efficacy depend on several important factors: 1. Medical Supervision: Proper Dosing: Ketamine is generally safe when administered at appropriate doses under medical supervision. The dosage in therapeutic settings is much lower than what might be used recreationally or in anesthesia. Qualified Professionals: The administration should be done by trained professionals who can monitor vital signs and respond to any adverse effects. 2. Individual Health Conditions: Physical Health: Pre-existing conditions like heart disease, hypertension, or liver problems may increase risks. Mental Health History: People with certain conditions like schizophrenia, bipolar disorder, or a history of substance abuse may have a higher risk of adverse psychological effects. Appropriateness for treatment is individually assessed. 3. Side Effects: Short-Term: Ketamine can cause dissociative effects, altered perceptions, nausea, dizziness, and confusion. These are typically short-lived and mild when monitored in a therapeutic setting. Long-Term: Prolonged or repeated use can potentially lead to issues like bladder problems, cognitive impairments, or dependency, though this is more common with recreational misuse. 4. Emerging Research: While ketamine-assisted therapy has shown promising results, it is still a developing field with ongoing research. Long-term safety data, particularly with repeated use, is being studied. In summary, ketamine can be safe and effective when used in a controlled therapeutic context, but it must be carefully managed and tailored to individual needs.
Is Ketamine legal?
Ketamine is a schedule III non-narcotic substance. It is used legally and approved by FDA as a general anesthetic to induce loss of consciousness. It is also used off-label at lower doses by doctors to treat conditions such as depression, anxiety, and pain.
Is Ketamine addictive?
Yes, ketamine can be addictive, particularly when used recreationally or in higher doses over prolonged periods. However, the risk of addiction is generally lower when it is used in a controlled, clinical setting for therapeutic purposes, where doses are carefully managed and administered under medical supervision. Understanding Ketamine Addiction: Psychological Dependence: People can develop a psychological dependence on ketamine, especially if they frequently use it recreationally to escape reality or experience its dissociative effects. Over time, they may feel a compulsion to keep using the drug for its pleasurable or mind-altering effects. Tolerance: With repeated use, individuals can develop a tolerance to ketamine, meaning they need higher doses to achieve the same effects. This increases the risk of addiction. Physical Dependence and Withdrawal: While ketamine does not typically cause the same physical withdrawal symptoms as drugs like opioids or alcohol, some users report feeling irritable, anxious, or depressed when they stop using it, indicating a psychological withdrawal effect. Risk of Addiction in Therapeutic Settings: In a clinical setting, ketamine is administered at low, carefully controlled doses by medical professionals, significantly reducing the risk of addiction. The therapeutic focus is on improving mental health conditions, not on the euphoric or dissociative effects that recreational users may seek. Sessions are often spaced out, and patients are monitored closely, limiting the potential for dependency to develop. Recreational Use and Addiction Risk: When used recreationally, often at much higher doses and more frequently, ketamine can lead to both psychological addiction and physical health issues, such as bladder and kidney damage (known as ketamine bladder syndrome). To summarize, while ketamine has addiction potential, especially in uncontrolled, recreational contexts, the risk is much lower when used properly in therapeutic settings.
Are there exclusions for participation?
We carefully interview potential participants to determine if you are a good candidate for ketamine treatment. This will include discussing your medical and psychiatric history, review your medical and psychiatric records if necessary. You are required to be under the care of a primary care provider to evaluate your overall health. If you have a medical history of heart or breathing issues, or a history of cystitis, we will discuss first obtaining clearance from specialty providers. If you have a history of hypertension, you must show you are treated with a blood pressure at or below 140/90, and not have symptoms of elevated blood pressure. For those with a primary psychotic or dissociative disorder or for individuals who are currently in a hypomanic or manic episode, ketamine is not indicated. Not all interactions with other medications are known. Any possible interactions will be assessed to help determine eligibility for ketamine treatment, Pregnant women and nursing mothers are not eligible because of the undetermined potential effects on a fetus and nursing infant.
What are the differences between group and individual KAP?
Both have a structure of intention setting, preparation, and integration that frames and guides the experience. By definition, individual sessions are individualized and usually involve the participant and one therapist. Group KAP has a number of people who may have similar or complementary issues who are journeying at the same time with several staff to attend them. Though not individualized 1:1 during the medicine session, it is still quite attuned to each participant’s intention, needs and care and staff is there to insure each participant and the group gets the care needed. There is a benefit of groups that have their own magic, as hearing what others are discovering through the experience can deepen and expand the participant’s discovery. Where individual KAP has the wisdoms of the therapist, the client, the medicine, the music and whatever other supports are offered, groups additionally have the collective wisdom and growth of the group. There is an additional power in this element that can inform the therapeutic effect. Generally, group KAP is also less expensive, so it is more accessible than individual KAP.
What is a bad trip, and how do you handle that?
A "bad trip" in the context of psychedelic experiences refers to a distressing or overwhelming experience during the use of substances like LSD, psilocybin, or other psychedelics. These experiences can include intense fear, anxiety, paranoia, confusion, or disturbing thoughts and visions. The reasons for a bad trip can vary, but common factors include an unsafe setting, unprepared mindset, unresolved psychological issues, or unexpected emotional or sensory overload. In psychedelic-assisted psychotherapy (PAP), the aim is to create a controlled and supportive environment to minimize the risk of a bad trip. However, even in this context, challenging experiences can arise as part of the therapeutic process. These experiences, although uncomfortable, can often lead to significant psychological insights and healing if managed properly. In therapeutic use, we don’t label challenging journeys as “bad trips” since anything that arises often is of importance and warrants care as the person’s system confronts and often unwinds long-held blocks. Sometimes, like a “bad dream,” scary things can emerge temporarily, and the therapist accompanies and assists the journeyer through music, breathing, talking, movement, to move through it so that the learnings can be harvested. Ketamine is relatively short acting so the challenge usually resolves as soon as the medicine wanes. In the subsequent integration, the participant has a chance to make meaning from the experience which usually results in a higher level of integration and functioning. How to Handle a Bad Trip Set and Setting: Prevention is key. Ensuring a safe and comfortable environment (setting) and a positive, prepared mindset (set) can significantly reduce the risk of a bad trip. Stay Calm and Grounded: Remind yourself or the person experiencing the bad trip that the effects are temporary and will pass. Deep breathing, grounding techniques, or focusing on a calming object can help. Supportive Presence: Having a trusted person present who can offer reassurance and a calming presence is crucial. This person should remain calm, avoid judgment, and help the individual feel safe. Acceptance and Surrender: Encourage acceptance of the experience rather than fighting it. Resistance can often intensify the fear. Surrendering to the process can lead to deeper understanding and integration of the experience. Change the Environment: If possible, moving to a different location, adjusting the lighting, or playing calming music can help shift the mood and reduce anxiety. Verbal Reassurance: Remind the individual that they are in a safe space and that the experience is a product of the substance. Simple affirmations like “You are safe” or “This will pass” can be comforting. Professional Guidance: In the context of PAP, a trained therapist can guide the person through the experience, helping them process difficult emotions and memories that may arise. Aftercare: After the experience, it’s important to debrief and integrate the experience with a therapist or guide. This helps make sense of the insights gained and address any lingering discomfort. While bad trips can be challenging, they can also provide opportunities for profound personal growth when handled with care and support.
What is a K-hole?
A "K-hole" is a term used to describe a dissociative state that can occur when someone takes a high dose of ketamine, typically recreationally. It refers to an intense, out-of-body experience where the person feels disconnected from their body, reality, and surroundings. Characteristics of a K-hole: Extreme dissociation: The person may feel detached from their body or experience a sense of floating as if they are outside of themselves. Loss of motor control: People often lose the ability to move or speak, which can make the experience overwhelming or frightening. Altered perception of time and space: The person may feel like they are in a different dimension, with time slowing down or speeding up in unusual ways. Visual and auditory hallucinations: Some may experience vivid, dream-like imagery or distortions in what they see and hear. Ego dissolution: A sense of losing one's identity or connection to reality, which can feel profound or terrifying. While some people seek this state for its psychedelic effects, it can be disorienting, and in a recreational setting, it may involve risks like injury, confusion, or panic. In clinical or therapeutic settings, doses of ketamine are carefully managed to avoid this kind of extreme dissociative effect.
Does ketamine also help relieve physical pain?
In addition to dissociative anesthetic properties, Ketamine also has analgesic properties. Many people find that these properties provide relief from their pain during the medicine session and also another vantage point from which to experience sometimes long-term pain. With this buffer, in the KAP process, just as ketamine gives perspective to psychological issues, allowing the resolution of stuck patterns, many people find they can renegotiate their relationship with pain in a way that is long-lasting. Even having a window of relief in this way with expanded awareness provides new sensations and opportunities to try on different responses that bring greater hope.
Why three sessions?
Though studies have demonstrated an antidepressant response to low doses that are minimally psychoactive, or sub-psychedelic, repeated sessions tend to be cumulative. We find that three sessions give the space and familiarity with the group and medicine to allow for introduction ( the first session, which is like a handshake with the medicine and the group experience), deepening (second session), and broadening (all sessions, but especially the third session). Since the purpose of KAP is to be able to apply this expanded awareness to life, and there is a golden window that opens following the medicine session where old habits may fall away and new behaviors can be entertained, three sessions give room for this to happen and to grow both individually and as a group.
How is Ketamine administered?
Routes of administration vary, including intravenous, intramuscular injection, subcutaneous, intranasally, and oral dissolving tablet or solution. Oral ketamine is a lower dose strategy that may allow for psychotherapy, a more gradual experience. This route may allow for developing a relationship with and learning to work with the experience. The intramuscular route by injection is given in the shoulder or hip. Compared to oral administration IM delivers a more bioavailable amount with more rapid onset. The choice route of ketamine administration depends on personal preference, goals of therapy, experience with therapeutic uses of ketamine and other psychedelics, body height, weight, and sensitivity.
Can I drive following a KAP treatment?
Since Ketamine is anesthesia and creates numbing and sedation, including an altered sense of limbs and focus, driving is not safe following a ketamine session. We require that you arrange for a responsible person to drive you home from the sessions.
What determines the cost of KAP?
Ketamine-assisted psychotherapy can be costly due to several factors, many of which are related to the complexity of the treatment and the high level of care required. Here’s a breakdown of the main reasons: 1. Medical Supervision and Safety Requirements: - Highly Trained Staff: Ketamine therapy must be administered by licensed medical professionals such as psychiatrists, anesthesiologists, or specially trained therapists. This includes supervision by both medical and mental health experts, which raises the cost. - Monitoring Equipment: During ketamine administration, patients often need to be closely monitored for heart rate, blood pressure, oxygen levels, and other vital signs to ensure safety. 2. The Cost of Ketamine Itself: While ketamine as a drug is relatively inexpensive, the costs in therapy reflect the additional resources and care involved in its administration, not just the medication. 3. Length and Complexity of Therapy: - Multiple Sessions: Ketamine-assisted therapy usually involves several sessions over weeks or months. In many cases, it includes both the ketamine administration and therapy sessions before, during, and after the drug's effects. - Integration Therapy: After each ketamine session, patients often have integration sessions with a therapist to process and make sense of the experience, which adds to the overall cost. 4. Personalization of Treatment: - Individualized Dosing: Treatment protocols are tailored to the individual, meaning doses are personalized, and each session is adapted to the patient’s unique mental health needs. This customization adds to the time and expertise required. 5. Facility Costs: - Private Clinics: Most ketamine-assisted psychotherapy is offered in private clinics that specialize in this treatment. These clinics often have high overhead costs, such as maintaining specialized medical equipment, therapy spaces, and experienced staff. 6. Lack of Insurance Coverage: - Out-of-Pocket Expenses: Many insurance companies do not fully cover ketamine-assisted psychotherapy, considering it an experimental or alternative treatment. This means patients often pay out-of-pocket, which can drive up the perceived cost. 7. Legal and Regulatory Costs: Because ketamine is a controlled substance, clinics must follow strict legal guidelines and medical protocols. This compliance can increase operational costs, which are often passed on to patients. In summary, the cost of ketamine-assisted psychotherapy is driven by the need for specialized, highly trained professionals, personalized treatment plans, multiple sessions, and strict medical supervision. These elements combine to ensure safety, efficacy, and a therapeutic approach that addresses the complex mental health needs of patients.
Can I eat before a medicine session?
The day of treatment we advise you to take your prescribed medications as usual. We ask that you not eat for four hours before a session, and if something is necessary to be eaten, that it be light and toward the beginning of that time period. This is to prevent nausea or vomiting. This is the same precaution that is used before surgeries, which is where ketamine has traditionally been used.
What diagnoses are best suited for KAP?
Ketamine is effective for depression and suicidal ideation. The FDA approval of esketamine is in the form of a patented nasal spray. An FDA study in 2019 showed esketamine’s superior response in treating depression compared to placebo. In addition, it is being studied for its efficacy in OCD, eating disorders, and substance use disorders. Ketamine works differently than traditional antidepressants. It primarily affects the glutamate system, enhancing neuroplasticity (the brain's ability to reorganize and form new neural connections), which may explain why it is effective in conditions where other treatments fail. The rapid-acting nature of ketamine also makes it uniquely suited for mental health crises, particularly in reducing severe symptoms like suicidality. Summary of Best-Suited Diagnoses: - Treatment-Resistant Depression - Major Depressive Disorder - Bipolar Depression - Post-Traumatic Stress Disorder (PTSD) - Suicidal Ideation - Anxiety Disorders - Obsessive-Compulsive Disorder (OCD) - Substance Use Disorders - Chronic Pain with Mental Health Components Because ketamine is still being studied in various contexts, not all uses are FDA-approved, and the treatment is generally considered for cases where conventional therapies have not worked.
What does the research say about the efficacy of Ketamine?
Research into the use of ketamine for treating mental health conditions, particularly depression, has shown promising results, especially for treatment-resistant cases. Here's a summary of what the research says: 1. Rapid Antidepressant Effects - Treatment-Resistant Depression (TRD): Ketamine has been found to be highly effective in rapidly reducing symptoms of depression, especially in patients who have not responded to traditional antidepressants. Studies show that ketamine can produce significant antidepressant effects within hours, compared to the weeks required by conventional medications. - Mechanism of Action: Unlike typical antidepressants that affect serotonin, norepinephrine, or dopamine, ketamine works primarily on the glutamatergic system. It is an NMDA receptor antagonist, which leads to an increase in glutamate and, subsequently, synaptic plasticity. This is believed to contribute to its rapid effects on mood. 2. Suicidal Ideation - Reduction of Suicidal Thoughts: Several studies have demonstrated that ketamine can reduce suicidal ideation within a short time frame. This has made it a valuable tool in emergency settings for patients at high risk of suicide. 3. Anxiety and PTSD - Anxiety Disorders: Preliminary studies suggest that ketamine may also be effective in reducing symptoms of anxiety disorders, including generalized anxiety disorder (GAD) and social anxiety disorder. - Post-Traumatic Stress Disorder (PTSD): Some studies have shown that ketamine can help reduce the symptoms of PTSD, particularly in terms of alleviating depressive symptoms associated with the disorder. However, more research is needed in this area to fully understand its efficacy. 4. Obsessive-Compulsive Disorder (OCD) - OCD Symptoms: Research on ketamine for OCD is still in its early stages, but there is some evidence that it may reduce OCD symptoms, potentially by disrupting obsessive thought patterns. 5. Chronic Pain and Depression - Chronic Pain Syndromes: Ketamine has also been used to treat chronic pain conditions, and it may help alleviate depression associated with chronic pain, likely due to its analgesic properties combined with its mood-enhancing effects. 6. Administration and Duration of Effects - Routes of Administration: Ketamine can be administered intravenously, intramuscularly, orally, or intranasally. The most common and studied route is intravenous, often administered in controlled clinical settings. - Duration of Effects: While ketamine’s antidepressant effects are rapid, they are often short-lived, with effects lasting from days to weeks. Repeated dosing or maintenance infusions have been explored to sustain the benefits. 7. Safety and Side Effects - Short-Term Side Effects: Ketamine is generally well-tolerated in the short term. Common side effects include dissociation, dizziness, nausea, and increased blood pressure. These effects are usually transient. - Long-Term Safety: Long-term safety data is still limited, and there are concerns about potential neurotoxicity, cognitive impairments, and the risk of addiction with prolonged use. Careful monitoring and controlled administration are recommended. 8. Ketamine vs. Esketamine - Esketamine (Spravato): Esketamine, a derivative of ketamine, has been approved by the FDA for treatment-resistant depression and is administered as a nasal spray. It has shown similar efficacy to ketamine but with some differences in side effects and administration. Conclusion Overall, ketamine represents a significant advancement in the treatment of mental health concerns, particularly for those with treatment-resistant conditions. However, while the results are encouraging, ketamine is not a first-line treatment, and its use should be carefully monitored by medical professionals due to potential risks and the need for further research on long-term outcomes.
What else is Ketamine used for?
Ketamine is being studied for chronic pain, in palliative settings for end-of-life care as well as for depression. Ketamine is a versatile drug with several medical and therapeutic uses beyond its emerging role in mental health treatment. Here are the main areas where ketamine is commonly used: 1. Anesthesia - General Anesthesia: Ketamine is widely used as an anesthetic agent, particularly in situations where other anesthetics might not be suitable. It's favored for its ability to provide both anesthesia and analgesia (pain relief) while maintaining cardiovascular stability. - Procedural Sedation: Ketamine is often used for sedation during minor surgical procedures, especially in emergency settings or for patients who cannot tolerate more traditional anesthetics. Its dissociative properties allow patients to remain conscious but unaware of the procedure. - Pediatric Anesthesia: Due to its safety profile, ketamine is frequently used in pediatric anesthesia, particularly in settings where resources are limited or in the field of emergency medicine. 2. Pain Management - Chronic Pain: Ketamine is used to manage various types of chronic pain, including complex regional pain syndrome (CRPS), neuropathic pain, and fibromyalgia. Its NMDA receptor antagonism helps in modulating pain pathways that are not responsive to conventional painkillers. - Acute Pain: In emergency departments, ketamine is used as an analgesic for acute pain management, especially in cases of severe trauma or burns. It's particularly useful in situations where opioids are not effective or advisable. 3. Emergency Medicine - Rapid Sequence Intubation (RSI): Ketamine is sometimes used in the process of RSI, where quick sedation is required for intubation, especially in critically ill patients. Its ability to maintain airway reflexes and cardiovascular function makes it a preferred choice in emergency settings. - Field Medicine and Combat Situations: Due to its stability at room temperature and ease of use without the need for specialized equipment, ketamine is frequently used in field medicine, including military combat zones. 4. Veterinary Medicine - Anesthesia for Animals: Ketamine is commonly used as an anesthetic and analgesic in veterinary medicine for a variety of animals, including cats, dogs, horses, and other domestic and wild animals. It is often used in combination with other drugs for surgical procedures. 5. Recreational Use (Illicit) - Club Drug: In the recreational drug scene, ketamine is sometimes used as a club drug, often referred to as "Special K." Its dissociative effects can induce hallucinations, a sense of detachment from reality, and an altered perception of time and space. However, this use is illegal and can be dangerous, leading to potential for abuse, dependence, and harmful health effects. 6. Research and Experimental Uses - Neuropsychiatric Disorders: Beyond depression and anxiety, ketamine is being explored in research settings for its potential benefits in treating conditions such as bipolar disorder, eating disorders, and certain forms of addiction. - Brain Injury: Ketamine is being studied for its potential neuroprotective effects in cases of traumatic brain injury (TBI) due to its ability to reduce excitotoxicity, a process that can damage brain cells following injury. Conclusion Ketamine's versatility stems from its unique pharmacological profile, which allows it to be used in a wide range of medical contexts—from anesthesia and pain management to psychiatric treatment and beyond. However, its use should always be carefully managed by healthcare professionals to mitigate risks and ensure patient safety.
What else is an expanded state?
An "expanded state" typically refers to a state of consciousness that goes beyond ordinary waking awareness. It is often characterized by a heightened sense of connection, perception, or understanding. This concept is frequently discussed in contexts such as meditation, mindfulness, psychedelic experiences, and spiritual practices. Here are some aspects of what an expanded state might involve: 1. Altered Perception - Sensory Awareness: In an expanded state, individuals might experience heightened or altered sensory perceptions. Colors may appear more vivid, sounds more resonant, or sensations more intense. - Time Perception: The experience of time may change, with moments feeling elongated, compressed, or existing outside of linear progression. 2. Heightened Emotional and Mental Clarity - Emotional Insight: People in an expanded state often report deep emotional insights or the resolution of inner conflicts. There might be a sense of clarity about personal issues or relationships. - Creative and Intellectual Inspiration: Expanded states can lead to bursts of creativity, new ideas, and the ability to see connections that were previously unnoticed. 3. Spiritual or Transcendent Experiences - Unity and Oneness: A common feature of expanded states is the feeling of unity with the universe, nature, or other people. This can manifest as a deep sense of interconnectedness and a reduction in the boundaries between self and others. - Transcendence of Ego: In some expanded states, individuals may experience a temporary dissolution of the ego, where the sense of a separate self diminishes or disappears, leading to profound spiritual or mystical experiences. 4. Altered States of Consciousness - Psychedelic Experiences: Psychedelic substances like ketamine, psilocybin, LSD, and ayahuasca are known to induce expanded states of consciousness. These experiences can include visual and auditory hallucinations, as well as deep psychological and spiritual insights. - Meditative States: Deep meditation can lead to expanded states where one experiences profound peace, heightened awareness, or a sense of merging with the present moment. 5. Mindfulness and Flow States - Mindfulness: Practicing mindfulness, or being fully present in the moment, can lead to expanded states of awareness where one's experience of reality becomes more vivid and rich. - Flow States: A flow state, often experienced during activities requiring deep focus and skill, is a form of expanded state where time seems to disappear, and actions feel effortless and fully aligned with one's abilities. 6. Therapeutic and Healing Contexts - Psychedelic-Assisted Therapy: In therapeutic settings, expanded states induced by psychedelics or other means are used to help individuals access and process deep psychological material, leading to healing and personal growth. - Energy Healing and Bodywork: Certain forms of bodywork or energy healing practices aim to induce expanded states to facilitate physical, emotional, or spiritual healing. 7. Collective Consciousness - Group Experiences: Expanded states can also occur in group settings, such as during collective meditation, drumming circles, or rituals. These experiences can create a shared sense of consciousness or group energy that feels greater than the sum of its parts. Conclusion An expanded state is a broad term that can refer to various experiences of heightened or altered consciousness. These states can be profound and transformative, providing insights, healing, and a deeper understanding of oneself and the world. The specifics of the experience can vary widely depending on the method of induction, the individual’s mindset, and the context in which it occurs.
Why are expanded states helpful in PAP?
Expanded states are considered helpful in psychedelic-assisted psychotherapy (PAP) for several reasons. These states, often induced by psychedelic substances like ketamine, psilocybin, LSD, or MDMA, can facilitate deep psychological exploration and healing. Here’s why expanded states are beneficial in this therapeutic context: 1. Access to the Unconscious Mind - Repressed Memories and Emotions: Expanded states can allow individuals to access memories, emotions, and traumas that are typically buried in the unconscious mind. This can lead to the processing and integration of these experiences, which is often difficult to achieve through traditional talk therapy. - Insight into Personal Issues: In an expanded state, clients might gain profound insights into their behaviors, beliefs, and patterns. This heightened awareness can help them understand the root causes of their psychological struggles. 2. Enhanced Emotional Processing - Intensified Emotions: Psychedelics can amplify emotions, allowing clients to fully experience and process feelings that they might typically avoid or suppress. This can be crucial for healing deep emotional wounds. - Catharsis: The intense emotional release that can occur in an expanded state may lead to catharsis, helping individuals release pent-up emotions and find relief from long-standing emotional burdens. 3. Ego Dissolution and Perspective Shifts - Ego Dissolution: In many expanded states, the ego—the sense of a separate, individualized self—may temporarily dissolve. This can help clients break free from rigid, self-limiting beliefs and see their lives from a new, broader perspective. - Shift in Worldview: The expanded perspective gained in these states can lead to a re-evaluation of life priorities, values, and relationships. This shift can support lasting psychological and behavioral change. 4. Increased Neuroplasticity - Brain Connectivity: Psychedelics are thought to enhance neuroplasticity, or the brain's ability to form new neural connections. This increased connectivity can help individuals develop new ways of thinking and behaving, which can be especially beneficial in overcoming entrenched patterns of depression, anxiety, or PTSD. - Flexibility in Thought Patterns: Expanded states may facilitate cognitive flexibility, allowing clients to approach problems or traumas from new angles, which can lead to breakthroughs in therapy. 5. Spiritual and Mystical Experiences - Spiritual Insight: Many individuals report having spiritual or mystical experiences during expanded states, which can provide a sense of meaning, purpose, and connectedness. These experiences can be profoundly healing, especially for those grappling with existential concerns or a loss of meaning in life. - Connection to a Larger Whole: Feeling connected to something greater than oneself, whether it be the universe, nature, or a spiritual entity, can reduce feelings of isolation and foster a sense of peace and acceptance. 6. Reduction of Psychological Defenses - Lowered Defenses: Psychedelics can reduce psychological defenses, such as denial or repression, that normally protect the conscious mind from distressing thoughts and emotions. This allows clients to confront and work through difficult material that they might otherwise avoid. - Openness to Therapy: The reduction in defenses can also make clients more open and receptive to the therapeutic process, enhancing the effectiveness of interventions and insights gained during sessions. 7. Facilitation of Healing Narratives - Constructing Meaningful Narratives: During expanded states, clients often create new narratives about their lives, reframing past experiences in a way that is more constructive and less traumatizing. This narrative reconstruction is a key aspect of healing in psychotherapy. - Integration of Experiences: The insights and experiences gained in expanded states can be integrated into everyday life with the help of a therapist, leading to long-term positive changes in behavior, mood, and overall well-being. 8. Breakthroughs in Treatment-Resistant Conditions - Challenging Cases: Expanded states have been particularly effective in treating individuals with conditions that have not responded well to conventional therapies, such as treatment-resistant depression, PTSD, and certain anxiety disorders. The profound shifts in consciousness can provide new pathways to healing for these difficult-to-treat conditions. Conclusion Expanded states are powerful tools in psychedelic-assisted psychotherapy because they open up new avenues for emotional processing, cognitive flexibility, and spiritual insight. These states allow clients to access parts of their psyche that are normally hidden or defended against, facilitating deep healing and personal transformation. When guided by a skilled therapist, the experiences gained in these states can lead to significant and lasting improvements in mental health.
What happens if scary material presents during a session?
Challenging experiences may arise. Adequate preparation and understanding of where these journeys might lead help to mitigate intense, overwhelming, and disorienting experiences. We ensure a safe ratio of clinician to participant. In the case of challenging emotions arising, if you chose, you will be offered support and guidance. If scary or difficult material presents itself during a ketamine-assisted psychotherapy (KAP) session, it’s important to remember that this is a common part of the process, and it can actually be a valuable opportunity for healing. Here’s what typically happens and how it’s managed: 1. Trained Facilitators Are There to Support You: The facilitators in your KAP session are trained to guide you through challenging experiences. They will remain present, offer reassurance, and help you feel safe. Their role is to help you navigate difficult emotions or imagery in a constructive way. 2. You Are in a Controlled and Safe Environment: The setting for KAP is carefully designed to be calm, comfortable, and supportive, which can reduce the intensity of fear. Knowing that you are in a safe, monitored space helps mitigate overwhelming feelings. 3. Breathing and Grounding Techniques: Facilitators may guide you through breathing exercises or other grounding techniques if scary or uncomfortable material comes up. These techniques can help you stay present and reduce anxiety during the session. 4. Facing the Material with Curiosity: In therapy, difficult material is often seen as a gateway to deeper insight. You’ll be encouraged to approach whatever comes up with curiosity rather than fear. The dissociative effect of ketamine often provides a sense of emotional distance, which can make it easier to confront scary material without feeling overwhelmed. 5. It’s Temporary: The effects of ketamine are temporary, and any distressing material will pass. The facilitators will help you through the experience, reassuring you that these feelings or visions are part of the therapeutic process and won’t last. 6. Post-Session Integration: After the session, during integration therapy, you’ll have the chance to discuss and process any challenging or scary material that came up. This reflection can help you make sense of the experience and extract meaning or healing from it. 7. Reframing the Experience: What may initially feel frightening could, through the lens of therapy, transform into an opportunity for growth or understanding. The ketamine state often allows people to reframe difficult memories or emotions in a way that promotes healing. By working with experienced facilitators and having a safe environment, encountering scary material can be transformed into a meaningful part of your healing journey.
Do psychedelic medicines negatively impact my brain and cognitive functioning?
The impact of psychedelic medicines on cognition and brain functioning is a topic of ongoing research. While psychedelics can temporarily alter perception, cognition, and consciousness, the long-term effects on cognition and brain function are generally considered minimal when used responsibly in controlled settings. Here's a more detailed breakdown: 1. Short-Term Cognitive Effects - Acute Alterations: During the acute phase of a psychedelic experience, users often experience significant alterations in cognition, including changes in perception, thought processes, and attention. These effects are temporary and typically resolve within hours after the substance is metabolized. - Impaired Judgment: While under the influence of psychedelics, individuals may experience impaired judgment, confusion, and difficulty performing complex tasks. This is why it is advised to use these substances in a safe and controlled environment. 2. Long-Term Cognitive Effects - Minimal Long-Term Impact: Research indicates that there is little to no evidence of long-term cognitive deficits in individuals who use psychedelics occasionally and responsibly. Studies have found that psychedelics like psilocybin and LSD do not cause significant harm to brain function or cognition in healthy users. - Neuroplasticity and Cognitive Flexibility: Some studies suggest that psychedelics may actually enhance neuroplasticity and cognitive flexibility, potentially leading to positive cognitive changes, such as improved problem-solving abilities, creativity, and emotional resilience. 3. Risks Associated with Heavy or Unsupervised Use Frequent and High Doses: Heavy or frequent use of psychedelics, especially outside of a controlled therapeutic context, could pose risks. For example, repetitive use might lead to psychological distress, persistent alterations in perception (such as visual disturbances), or exacerbation of underlying mental health conditions. - Hallucinogen Persisting Perception Disorder (HPPD): A rare condition known as HPPD can occur in some users, where they experience ongoing visual disturbances long after the effects of the drug have worn off. The exact cause and prevalence of HPPD are not well understood, but it is considered rare. 4. Impact on Mental Health Psychological Risks: Psychedelics can trigger or exacerbate mental health issues in vulnerable individuals, particularly those with a personal or family history of psychosis, schizophrenia, or severe anxiety disorders. In such cases, the use of psychedelics could lead to acute psychological distress or long-term mental health challenges. - Therapeutic Benefits: Conversely, when used in a therapeutic setting with proper support, psychedelics have shown significant benefits for mental health, including the treatment of depression, PTSD, anxiety, and addiction. These benefits suggest that, for many individuals, psychedelics can have a positive impact on mental health without detrimental effects on cognition. 5. Research on Brain Structure and Function - Neuroimaging Studies: Neuroimaging research has shown that psychedelics temporarily alter brain connectivity, particularly between regions of the brain involved in sensory perception, emotion, and self-referential thinking. These changes are typically reversible and do not appear to cause lasting damage to brain structures. - Default Mode Network (DMN): Psychedelics often decrease activity in the brain's default mode network, which is associated with the ego and self-referential thoughts. This temporary alteration is thought to underlie many of the therapeutic benefits of psychedelics, such as the reduction of negative thought patterns in depression. Conclusion Overall, current research suggests that psychedelics, when used responsibly and under appropriate conditions, do not cause significant long-term cognitive deficits or damage to brain function. In fact, they may even have positive effects on brain plasticity and cognitive flexibility. However, it is important to approach their use with caution, especially for individuals with certain mental health conditions or those who might misuse these substances. The safest and most beneficial use of psychedelics is typically within a structured, therapeutic context.
Why are most psychedelic medicines schedule I?
Most psychedelic medicines are classified as Schedule I substances in the United States and similarly restrictive categories in other countries primarily due to historical, legal, and political reasons, rather than based on contemporary scientific evidence regarding their safety and medical potential. Here's a breakdown of why these substances are in Schedule I: 1. Historical Context - 1960s Counterculture Movement: Psychedelics, particularly LSD, became widely associated with the counterculture movement of the 1960s. During this period, psychedelics were used recreationally and became symbols of social and political rebellion. This alarmed authorities and led to a backlash against these substances. - War on Drugs: In response to the growing use of psychedelics and other drugs, the U.S. government, under President Richard Nixon, launched the "War on Drugs" in the early 1970s. Psychedelics were targeted as part of this broader campaign, leading to the passage of the Controlled Substances Act (CSA) in 1970, which categorized LSD, psilocybin, and other psychedelics as Schedule I substances. 2. Schedule I Criteria - No Accepted Medical Use: Schedule I substances are defined as drugs with no currently accepted medical use in the United States, a high potential for abuse, and a lack of accepted safety for use under medical supervision. At the time of their scheduling, the scientific understanding of psychedelics was limited, and their therapeutic potential was not widely recognized. - High Potential for Abuse: Psychedelics were perceived to have a high potential for abuse, partly due to their powerful effects on consciousness and the lack of control over their distribution and use in the 1960s. This perception contributed to their placement in the most restrictive category. 3. Lack of Research and Understanding - Suppression of Research: After being classified as Schedule I substances, research on psychedelics became extremely difficult due to legal and regulatory barriers. This suppression of research created a gap in scientific knowledge, reinforcing the idea that these substances were dangerous and lacked medical value. - Stigma and Misinformation: The Schedule I classification helped perpetuate stigma and misinformation about psychedelics, associating them with criminality, mental health risks, and social instability. This further discouraged research and exploration of their potential therapeutic benefits. 4. Emerging Evidence and Reevaluation - Recent Research: In recent years, there has been a resurgence of scientific interest in psychedelics, with numerous studies showing their potential benefits in treating conditions like depression, PTSD, anxiety, and addiction. This research challenges the Schedule I designation, as these substances have shown significant therapeutic potential with low potential for addiction or abuse. - Calls for Rescheduling: As evidence of their safety and efficacy grows, there is increasing advocacy for the rescheduling of psychedelics to allow for more widespread medical and therapeutic use. Some experts argue that these substances should be reclassified to Schedule II or lower, where they could be more easily studied and prescribed under medical supervision. 5. Legal and Regulatory Challenges - Complex Rescheduling Process: Changing the classification of a Schedule I substance is a complex and lengthy process involving multiple regulatory agencies, including the Drug Enforcement Administration (DEA) and the Food and Drug Administration (FDA). Despite emerging evidence, the rescheduling process faces significant bureaucratic and political hurdles. - Ongoing Legalization Efforts: In response to these challenges, some states and municipalities have moved to decriminalize or legalize certain psychedelics for medical or even recreational use. These efforts are part of a broader push to reevaluate and reform drug laws related to psychedelics. Conclusion Psychedelics are classified as Schedule I substances largely due to historical factors, cultural backlash, and limited early research. However, recent scientific studies have begun to challenge this classification by demonstrating the medical potential of these substances. While legal and regulatory barriers remain, there is a growing movement to reconsider and potentially reschedule psychedelics based on contemporary evidence of their safety and therapeutic benefits.
Are preparation and integration sessions necessary?
Each phase of KAP has its importance in setting the stage for the best outcome. Preparation is used to answer questions, educate on what to expect, hear what others’ concerns and hopes may be and set intentions for the work. Without adequate preparation, the safety of the individual and group is not a given. This is one of the ways KAP is different from spontaneous recreational use. It is very intention driven. Integration is vital to being able to understand, unpack and apply the experiences that arise during the medicine session. This is further deepened when hearing others’ meaning-makings and experiences which, even if different, inform and expand each participant’s experience. In these ways, preparation and integrations are not add-ons but are vitally important for digesting and bridging this to living life more fully.
How are group participants chosen?
The process of applying to the program involves several steps before participants are assigned to a group. It begins with a 20-minute consultation with one of the facilitators. This session allows participants to ask any questions that may not be addressed in the FAQ section of the website, while also giving the facilitator an introduction to the individual's needs and expectations for Ketamine-Assisted Psychotherapy (KAP). Next, a one- to 1.5-hour medical consultation is scheduled with a prescriber, who will address any medical concerns and assess possible limitations. Potential participants may be required to provide lab results and/or clearances from other healthcare providers. After medical clearance, participants complete a series of evaluations covering personality, clinical history, expectations, previous experiences with expanded states of consciousness, and more. Based on this data, we look for compatible themes to group participants, considering factors such as diagnoses, life stage, and shared personal goals. Finally, availability is taken into account when making the final group assignments.
What do I tell family/friends who are uncomfortable with my participation in KAP?
It is important that your participation in a KAP session is understood and supported by the closest people in your life. It is not uncommon to have participants report mixed feelings from their loved ones about their decision to pursue this route. As a result, the facilitators at Movement Mindfulness Medicine are more than happy to include concerned family/friends in the discussion. The FAQ section is also a nice component to share as a means to educate and dispute uninformed biases that might exist. With the recent high-profile loss of actor Matthew Perry, ketamine is being called into question by society at large. It is important for all people to have access to risks and benefits of pharmacological intervention. Another important component to consider while prepping friends/family for your KAP participation is to consider your needs following an expanded-state session. Your loved ones might be very supportive of your decision AND very curious about your experience. Sometimes returning from an expanded state takes time and personal self-reflection. It might be a good idea to let your curious family members (or friends) give you some time to process before you share. Again, we are here to help you with negotiating this process if needed.