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Pursue What Matters

Episode 245: What is Ketamine-Assisted Psychotherapy?

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www  Dr. Melissa Smith 0:00
Have you heard about ketamine assisted psychotherapy? Have you wondered what it is and how it works? Maybe you wonder if it’s something that could benefit you, or someone you love? Well join me today as I answer these questions and more.

Dr. Melissa Smith 0:15
Hi, I’m Dr. Melissa Smith, welcome to the Pursue What Matters podcast where we focus on what it takes to thrive in love and work. So there’s been a lot of talk about ketamine therapy, in addition to the talk of psychedelic medicine, maybe you are curious, maybe you’ve read about it, or listen to some podcasts about it. We are really seeing a revolution in the field of psychiatry. And so the face of psychiatry is changing dramatically. And while ketamine is not a magic bullet, ketamine and psychedelic medications these therapies can really help individuals get traction, where they felt stuck before with depression with anxiety, trauma, that sort of thing.

Dr. Melissa Smith 1:20
And so today, I want to introduce you to ketamine assisted psychotherapy. So what is it? How does it work? We’ll talk about its effectiveness. And we’ll also discuss specific diagnoses, and then you know, why you might want to consider it or what, how it might be indicated for certain conditions. And then next week, for sure, join me because I’m going to jump into the process of ketamine assisted psychotherapy, also known as Cat. And we’ll talk next week about, you know, what does the therapy actually entail? What do you need to know, when choosing a provider? Not all treatments are created equally? And what is the experience like? So if we think about taking a medication that has dissociative or psychedelic properties? What is that like? What can you expect? So be sure to join me next week for all of the nuts and bolts of this breakthrough treatment.

Dr. Melissa Smith 2:20
And of course, every week with the podcast, my goal is to help you pursue what matters by strengthening your confidence to lead in one of three areas. So leading with clarity, leading with curiosity, and leading and building a community. And primarily today, our next week, we’re talking about leading with curiosity, which is all about self awareness and self leadership. So we want you to be in a good position to lead and I don’t know if, if you’ve seen others, or you’ve had this experience of of trying to be effective and moving forward on vision and goals. When you’re struggling with anxiety, or when you’re struggling with depression, it can be so difficult, like everything feels like a slog. And so we don’t want to make life harder than it already is.

Dr. Melissa Smith 3:12
We don’t want to make the world of work harder than it already is. And so being able to attend to your needs and develop some awareness about your needs, and also options can be really helpful. And so with that, let’s jump right in to the first question, which is what is ketamine therapy? And so ketamine assisted psychotherapy, which is what I’m talking about specifically today, has been identified as a breakthrough treatment by the FDA, with the potential to provide rapid and lasting relief for a range of mental health conditions. So just think about that for a moment. That’s really remarkable, a breakthrough treatment. So the results on the studies have been so compelling, that the FDA is like, Okay, we gotta pay attention to this. And so ketamine is a medication that has been widely used in medicine for anesthesia and pain purposes for decades, right. It’s used probably every single day in emergency departments and operating rooms. So it’s, it’s a well known medication, it’s a quite safe medication. But what we are recognizing is that its potential to facilitate significant symptom reduction in a host of mental health concerns, represents a more recent revolution in the field of psychiatry.

Dr. Melissa Smith 4:41
So there was some early research on ketamine for mental health, but a lot of that was kind of shut down decades ago, and it’s been in more recent years that that research has opened up and then of course, treatment options. And so, you know, generally speaking when we think about ketamine therapy, specifically ketamine assisted psychotherapy, it, it is the use of the medicine ketamine to facilitate improvements in mental health concerns, including symptom reduction. So if you have depression, we’re really targeting those depressive symptoms. We also are targeting less rigid thinking. So those cognitive distortions, and then of course, we’re targeting a greater sense of well being. I don’t know about you, but those sounds pretty good. And so now let’s go to the next question, which is, what’s the difference between ketamine treatments, like I said, not all ketamine treatments are equal, they’re not created equal. I think this is an area where there’s a lot of confusion. And so there are many medical and mental health clinics at this point, that offer ketamine treatment, there’s really has been an explosion in this in this therapy, but it’s really important to understand the differences among treatments and providers, and what this means for your well being. And so when addressing mental health concerns and personal growth, ketamine is best considered as a catalyst for a therapeutic process in which individuals are able to develop greater awareness and perspective about their lives and challenges. And so if the medication is provided as a standalone treatment, without focused integration, therapy and coping skills as part of a tailored mental health treatment plan, individuals are less likely to experience comprehensive and sustainable relief. And that is one of the ways that you see ketamine treatment happening is you know, medical clinics are providing ketamine treatment, and basically, they’re just doing infusions.

Dr. Melissa Smith 6:55
And they might say, hey, go to your therapist for the therapy part and integration part. And I’m here to tell you, it’s not as effective. And so, you know, it’s really important to understand the differences in these treatments, you will still get the benefits of the medication. But the real power and effectiveness of ketamine assisted psychotherapy comes when the medication is used as a catalyst of psychotherapy. Because that’s where you’re really able to get in and target specific symptoms and create lasting and effective behavioral change. And so, you know, at our clinic balance, health and healing, we only provide ketamine assisted psychotherapy. We will you know, we do IV we do is we do oral, we’ll talk a little bit more about that. But you really want you want ketamine assisted psychotherapy, it is the most comprehensive ketamine treatment available for mental health concerns and personal growth. And so, you know, if you think about just getting, you know, ketamine infusion without integrated therapy as part of the administration of ketamine, you’re just, you know, you’re you’re not getting, you’re not getting the best bang for your buck, right? Like it, you’re, you’re undermining your potential for, for lasting benefits. And so, it’s really important to understand that difference. So ketamine assisted psychotherapy presents a promising approach to healing. So this innovative therapy combines the use of ketamine, the medication, with integration, focused talk therapy, and robust coping skills to create a safe and supportive environment for individuals seeking lasting healing. And so what does that mean? So this comprehensive treatment protocol is really tailored to your specific needs. And ketamine assisted psychotherapy facilitates the brain’s ability to learn.

Dr. Melissa Smith 9:03
So that’s pretty cool. That is known as neuroplasticity. And so this facilitates positive mental health changes that are sustainable over time. And so when I think about neuroplasticity, right, we all have, you know, some cognitive distortions or some unhelpful thoughts that we kind of get stuck in like ruts on a road and some of our negative thoughts, we we turn to our negative thoughts so often, that they are like super highways, and yet, you know, the paths of positive, positive focus, optimism, hope, that sort of thing. They can be less often used and so they turn into just little cow trails, where it’s hard to find where the path is. And so when we think about neuroplasticity, it’s really helping us to get out of those ruts or those superhighways of negative thinking gain, and really be able to break new ground and strengthen the paths along positivity and optimism and perspective and hope.

Dr. Melissa Smith 10:14
And so it’s no Pollyanna view, but it’s really being able to carry perspective about life. And so you know, ketamine assisted psychotherapy can provide symptom relief very quickly. That’s one of the things that is so remarkable about this treatment. And so it can lift those negative thoughts, while broadening your perspective about life and your challenges. So it’s, of course, it’s not that your challenges go away, but you have more perspective about the challenges, you are able to have a broader view. And that is more effective for problem solving. You’re not you don’t get incapacitated by fear, or dread. And so these benefits are leveraged during integration psychotherapy session. So we think about traditional talk therapy in which individuals are able to make significant gains and insight in behavior change. Now, one of the ways that ketamine assisted psychotherapy can be so effective is when you do therapy as part of the dosing experience. This is what we do at balance, health, inhaling, I don’t know many clinics that do this or do it really effectively. And it really opens up that window of opportunity for people where you have the medication on board, and you’re able to help people with those thoughts and, and those neural pathways and really help them to strengthen More Effective Pathways. And so, when it comes to ketamine has effect on the brain. It is multifaceted. And the truth is, it’s not totally understood. Although research has discovered many positive effects, including like I mentioned, a rapid and significant antidepressant effect. So ketamine targets NMDA receptors in the brain. And these, this seems to increase the amount of glutamate which is a neurotransmitter in the spaces between neurons. And so glutamate then activates another receptor known as a MPa. And together, this leads to the release of other molecules that help neurons communicate in new neural pathways. So we’re strengthening these new neural networks or pathways. And so this process is known as cipta synaptogenesis. And it jumpstart effective thought patterns, cognition and mood. So it makes it a little bit easier to develop new thoughts, and let go of some of those old ones. Another way that ketamine works in the brain is that it may also decrease signals related to inflammation, which is also tied to mood disorder.

Dr. Melissa Smith 12:53
So we think about depression specifically, this also seems to facilitate communication within specific areas of the brain, thereby increasing cognitive flexibility, and learning. And when we think about some of the features of well-being cognitive flexibility is right up there at the top of the list. So it’s not being too rigid, not being too tied to your own thoughts, being able to be open to new perspectives, being able to be flexible in relationships, it’s really very powerful. Another way that ketamine works in the brain is that it stimulates BDNF in the brain, leading to neurogenesis and new connections. And so in this way, ketamine stimulates new neuron growth. This allows the, again, that new learning to happen, while making it easier to overcome rigid thought patterns. So lots of great benefits. But we’re not done right, ketamine also seems to turn off the burst mode in the lateral habenula. I’m sure I’m pronouncing that wrong. But this is the anti reward center of the brain. And so sometimes when you are stuck in a chronic stress mode, that that lateral habenula is stuck on a burst mode.

Dr. Melissa Smith 14:13
So this leads to a break from a chronic stress mode, thus facilitating emotional processing, while reducing avoidance of negative emotions. And so in this way, ketamine acts to turn off the chronic stress button of the brain. And when I think about one of the main benefits of ketamine, it really seems to hit the reset button on our nervous system. And that, you know, this is probably one of the mechanisms by which it does that. And so what’s really powerful about that is it allows people to approach their negative emotions, the things that they’re afraid of the things that they’re dragging, with, without as much intense without as much fear, and they’re actually approaching it rather than avoiding it. And when we think about mental illness, one of the biggest challenges is the strength of avoidance. It just keeps us from understanding ourselves and helping ourselves. So we’re not done yet though ketamine also seems to interrupt the connection between the cortex and the limbic system of the brain. So the limbic system is known as the emotional brain.

Dr. Melissa Smith 15:28
So if you have a history of trauma, the limbic system is quite activated. Whereas we think about the cortex, we think about the frontal cortex, specifically is where we have executive functioning where we have reason perspective, all those good things. And so what happens is, when this connection is interrupted this through ketamine, this puts a pause on our typical thinking, and can decrease our anxious rumination. So our Worry, worry worry when you get caught in an anxious rumination of worry. Ketamine can help to interrupt that connection. And so it kind of settles down that limbic brain which is all about the fear and trauma, and helps you to bring in reason and perspective. This process also down regulates the default mode network, which results in an increase of cognitive flexibility, which again, is a hallmark of well being. So lots of really cool ways that ketamine works. And that’s one thing that’s unique about ketamine is seems to work in several different ways. And we’ve got some very good research and thoughts on that, but it’s still like we don’t understand it entirely, but we know it works. We know it’s effective.

Dr. Melissa Smith 16:46
So that brings us to our next question, how effective is ketamine-assisted psychotherapy? So it is very effective in addressing a variety of presenting mental health concerns. And so several studies indicate that ketamine assisted psychotherapy specifically right, so this is different from just getting a ketamine infusion that the ketamine assisted psychotherapy leads to a statistically significant reduction of depressive symptoms in between 60 to 70% of individuals. That’s a very remarkable result. It’s not it’s not a result we typically find in the world of Psychiatry in the world of mental health treatment. So again, this is one of the reasons it’s has been identified as a breakthrough treatment. So ketamine assisted psychotherapy can lead to a significant decrease in depressive symptoms, including pessimistic thoughts, that inability to feel a sense of latitude, sadness, social withdrawal, fatigue and changes in eating. So other effects of ketamine assisted psychotherapy include the disruption of those ruminative thinking patterns. We talked about that, a reduction in negativity, a narcissistic focus and self obsession. And maybe you’ve noticed that when you get anxious or depressed, we become self focused and we lose perspective about ourselves and the world. And so ketamine can ketamine assisted psychotherapy can really help to reduce that. It also can lead to an increase in cognitive and emotional flexibility. It can help with the development of discernment to be able to look at options and make a choice based on your values, rather than feeling reactive or feeling like you’re at the mercy of life.

Dr. Melissa Smith 18:37
Some of the other effects of ketamine assisted psychotherapy include the reworking of trauma, and placing those traumatic experiences in the emotional and historical past. Now, that’s really big, because if you have a history of trauma, one of the most troubling symptoms is that the past doesn’t stay in the past are our memories and especially our emotionally laden memories? No difference between the past and the present. And so they become intrusive. And you know, we can be going through our lives and things can be going well, and then we can be triggered a specific memory that can be triggered at the slightest, the slightest hint of something, and it can really throw an individual into a very strong stress response. And so ketamine assisted psychotherapy really helps to integrate that and put trauma history in the past, so that you still have the memories but you’re not as troubled. You have some separation from that. It can also be effective for relaxing the habit of vigilance, where you can relax and trust. There is an enhanced capacity for mindfulness.

Dr. Melissa Smith 19:53
So this is one of the reasons that our clinic we have every single one of our clients who’s doing ketamine assisted psychotherapy. Here we have part of their programming is a online mindfulness course evidence based, empirically validated. And people are really able to get traction on a mindfulness and meditation practice, where maybe they really struggled to get traction before. And of course, we know there are so many benefits of mindfulness. And so it’s such a lovely combination. There’s also an enhanced create to enhance creativity and problem solving, which is really great. There’s an increased self regard and self compassion. So people who have been very self critical, learn to develop some compassion for themselves. And of course, we know that this is key to healing individuals have are able to cultivate greater trust in themselves and others and so relationships can be strengthened relationships can be repaired, and then individuals are able to accept reality and lower their existential distress and anxiety. So those big questions about life, the meaning and purpose, can some of the angst or the anxiety around that can really settle down quite nicely. So those are some of the ways that ketamine is effective. And you know, I just talked about several specific symptoms that it can make a big difference for.

Dr. Melissa Smith 21:25
So now, let’s take a look at what what is ketamine therapy good for. So what kind of presenting concerns are helpful? So first of all, it can be very helpful for depression, for anxiety for eating disorders, treatment, resistant depression, even if someone is actively suicidal. Ketamine assisted psychotherapy can be very, very helpful. We think about it being very effective for PTSD and trauma. Also obsessive compulsive disorder or OCD. It can be very helpful for postpartum depression, substance use disorders, chronic pain and other mood disorders. So we think about bipolar disorder. As long as you’re not in a manic phase, it can be very helpful. And so next question, who is a good candidate for ketamine assisted psychotherapy? And so, you know, if you’re considering ketamine assisted psychotherapy, you should have a medical and a clinical intake assessment. We do both of those here at our clinic, indicating that KAP could be beneficial. So it’s very helpful but it’s not a magic bullet. It’s really important that you have a very thorough assessment, both by a medical provider and by a mental health professional so therapists and really determine if you are good candidate for it.

Dr. Melissa Smith 22:52
Generally speaking, teenagers and adults can qualify for ketamine therapy. Now ketamine, the medication is used in pediatric clients for sedation all the time. But there’s less research out there on the use of ketamine assisted psychotherapy for children. So generally speaking, we think about teenagers and adults really being able to benefit from this. Criteria supportive of ketamine assisted psychotherapy include, like I mentioned before, depressive disorders, eating disorders, anxiety disorders, suicidal ideation. Some of the criteria excluding ketamine assisted psychotherapy include psychosis, schizophrenia, and manic episodes of bipolar disorder. I mentioned that significant cardiac concerns are a poorly managed high blood pressure. And so there certainly are some medical concerns and mental health concerns that that would rule out ketamine assisted psychotherapy, with some of the medical concerns, sometimes we would just use another route of administration where we can have heightened medical monitoring. And that can be that can be a useful tool so that people can still benefit from the ketamine assisted psychotherapy. So that’s why one of the reasons you have a very thorough medical and clinical assessment just to make sure that that you’re a good candidate.

Dr. Melissa Smith 24:21
So how can ketamine assisted psychotherapy help with mental health issues? So it can it has the potential to rapidly alleviate the burden of mental health conditions and pave the way for personal transformation? It’s really remarkable to see the changes happening for people with its capacity to provide swift relief and enhance traditional therapy and promote lasting well being. This innovative approach of ketamine assisted psychotherapy really does offer hope, resilience and a path toward a more fulfilling life. This has the potential to help individuals break free from the constraints have mental health challenges and step into a brighter, more helpful future. And so, you know, I am an eating disorder specialist. And these illnesses are very intractable. It often takes decades for people to make progress. And ketamine assisted psychotherapy has been very helpful with this population, even the toughest populations really do seem to benefit. And so it’s important to keep in mind that ketamine assisted psychotherapy builds upon the therapeutic work, you’ve already done to this point. And, you know, you’re encouraged to continue working with your existing providers, while working with your KAP team. And so, you know, when you do ketamine assisted psychotherapy, you have a KAP therapist, and then you might have your regular therapist, and that’s great, continue working with them. We don’t have individuals do integration with their therapist, because most of these therapists have not had KAP specific training. And it’s a very comprehensive program. And so if you’re thinking about ketamine treatment, you’re like, I’ll just go to my therapist for integration, it’s like, it just won’t be as effective. And so it’s really important that you look at a comprehensive program that includes a KAP therapist, that’s absolutely focused on your ketamine assisted psychotherapy integration. And of course, continue working with your providers. We love working with other providers and collaborating with them.

Dr. Melissa Smith 26:38
So I mentioned that ketamine assisted psychotherapy can be very helpful for eating disorders. It’s also helpful for things besides mental health concerns. And so it has the potential to unlock deeper levels of consciousness, making it a powerful tool for self exploration, perspective shifting and healing. And so, you know, if you are just kind of wanting to look at personal transformation, you don’t necessarily have a specific diagnosis. Definitely talk to us and we can assess and see, see what might be effective for you. And so, just a couple more questions. And then I will let you go and join me next week for a deep dive into the specifics of the treatment.

Dr. Melissa Smith 27:29
So why should you potentially consider ketamine assisted psychotherapy, so it can be very helpful for several mental health concerns if you’ve had difficulty making progress and traditional talk therapy, or if you struggle to consistently engage coping skills, or feel overwhelmed by intrusive symptoms on a regular basis, ketamine assisted psychotherapy can be an excellent treatment option to consider.

Unknown Speaker 27:55
So ketamine assisted psychotherapy is a time focused, but comprehensive treatment designed to alleviate symptoms improve functioning, and facilitate your consistent efforts in therapy and daily living. And so the KAP treatment really opens a window of opportunity, where you can get more traction in making meaningful changes, such as challenging problematic thinking, overcoming undermining behaviors, strengthening a mindfulness practice and developing habits that facilitate emotional regulation and a greater sense of well being. And so it can be really helpful in that way.

Dr. Melissa Smith 28:34
So the last question is, what should you look for when starting ketamine assisted psychotherapy, and I’ve talked about that throughout. But again, it’s a combination of thorough medical and psychological assessments. By KAPtrained providers, it’s really important to ask about the training of providers. Ketamine assisted psychotherapy is fairly new, and I can tell you for sure in in our area, many individuals, many providers are doing ketamine therapy without much if any training in ketamine assisted psychotherapy, and so you do want to ask about that. You want your treatment done by KAP trained providers. And then of course, they include the ketamine dosing sessions, a specialized integration, psychotherapy sessions, and focus mindfulness training and skill building. I know very few programs have the focus mindfulness training and skill building. But it is this type of comprehensive treatment approach that leverages the specific neuroplastic and antidepressant effects of the medication, resulting in significant symptom improvement that proves sustainable over time when the full treatment protocol is followed. So this is not something you decide to do casually. It’s really something that you need to commit to. It’s pretty short term in a matter of weeks. But it requires a lot of investment during that time.

Dr. Melissa Smith 30:10
And so when looking for ketamine assisted psychotherapy look for a multidisciplinary team that includes both medical providers and therapists trained and ketamine assisted psychotherapy, you want treatment that prioritizes, the highest medical safety standards, comprehensive psychotherapy services, and robust skill building, in order to get the best results. And so, if you want to learn more, of course, you’re welcome to give us a call, or we’re happy, you know, I’m part of a network and I’m happy to get you connected with providers in other areas. If you’re in Utah, we’re happy to help you and and if you’re not, in this area, we have an extensive network that we can I’m sure we can help get you connected with a ketamine assisted psychotherapy trained team.

Dr. Melissa Smith 31:03
And so you can learn more about all of this on my website. So check out the shownotes with the resources for this episode at www.drmelissasmith.com/245-whatisketaminetherapy Again, that’s www.drmelissasmith.com/245-whatisketaminetherapy. I’ll also link to our clinic website which is www.balancehealthandhealing.com and then also www.utahkap.com, where you can get more focused information about ketamine assisted psychotherapy. In the meantime, I’m Dr. Melissa Smith. Remember love and work, work and love. That’s all there is. Until next time, take good care

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