Shannon Dames, BsN, MPH, EdD, is Nursing Professor, Resilience Educator, and Researcher at Vancouver Island University. Her doctoral studies focussed on core factors that mitigate stress and promote human flourishing. She is also a steering committee member of the 2020 Psychedelic Psychotherapy Forum.

Shannon will be moderating a panel on Ketamine-assisted Psychotherapy at the Forum this year — featuring Raquel Bennett, PsyD; Susan McBride, RN, MTS, RSW; and Mark Cornfield, MD, FRCPC; and Pamela Kryskow, MD. PPF2020 is featuring 2+ continuing education hours of presentations and discussions on the topic of Ketamine-assisted Psychotherapy on Day 2/Oct 15 of the forum.

Ketamine-assisted Psychotherapy (KAP): Mechanisms and Merits

Shannon Dames BsN, MPH, EdD

Professor and Resilience Researcher

Can we engage with ketamine to help us build capacity and education avenues to support the emergence of other psychedelics in the system? Yes!

Once we absorb other psychedelic medicines (as they become legal) into the mental health toolbox, will ketamine go away? No!

The Mental Health Crisis: Nearly half of all Canadians have or have had a mental health diagnosis by the age of 40 (CMHA, 2020). Current treatment modalities only work for a minority of those suffering from chronic mental distress.

Much of the work we have in front of us relates to our individual capacity to remember our humanity. We do this by expanding our consciousness of who we are and working with the barriers that keep us stuck (asleep). Currently, ketamine is one of the most effective and safe psychelytic and psychedelic tools we have legal access to. Plus, it does indeed help us build capacity and educational pathways to support the emergence of other psychedelic-assisted therapies as they become more widely accessible.

Like many, I came to psychedelic therapies through the personal healing door, which naturally made its way through the professional door. I now focus most of my time researching and working with like minded others to expand access to ketamine for the treatment mood disorders. With more knowledge and experience, my perspective changed, no longer see it as the ‘second best’ or black sheep of the psychedelics. Quite the opposite, it’s an evidence-based shining star and its having a significantly positive impact for countless people who’ve spent a lifetime suffering with mental health conditions, which the status quo treatment options failed to alleviate. In fact, while the mechanism of action is not entirely clear, there is a general consensus that is well supported by the research, that ketamine is one of the greatest, most effective treatments for depression we’ve seen in the last 50 years.

Medication. Data is limited, stats show that 17% of Americans between the ages of 40-59 years and 19% of people over 60 use anti-depressants to treat symptoms stemming from anxiety and depression (Pratt, Brody, & Gu, 2017), These medications, including herbs and the supplements are providing the building blocks that enable them to produce and activate important chemicals such as dopamine, serotonin, and amino acids, all necessary to manage biology and to govern our emotions.

The Psychedelic Process. Research is paving the way as we continue forging new pathways to interweave psychedelics with psychotherapy in western medicine. While still controversial, with research advancing so quickly, healthcare providers will be (or already are) integrating these medicines as powerful tools that can promote neuroplasticity and which are showing great promise to address treatment resistant depression (Ly, et al., 2018) and a variety of other mental health conditions. These psychedelic-assisted therapies are helping to compassionately uncover and address unresolved trauma. Because of the mechanisms of action that promote non-attachment and self-compassion, these mental health tools have great potential to quickly cultivate both congruence and sense of coherence. Just as important, some are also showing great promise as neuroprotective and regenerative agents, not only by tending to old wounds that cause current day stress, but by repairing the parts of the brain that promote connection, deep insights, the ability to sustain mindful states, and cognitive performance in general.

When used with healing intention, these psychedelics can promote a benevolent connection to one’s inner world, where people can practice providing unconditional positive regard inwardly. For many who have never felt wholly accepted and loved, this new felt sense can empower people to embrace previously forbidden parts of themselves, resulting in greater self-compassion and congruence.

Viewing past trauma, pain, regrets, and fractured relationships through a more loving lens helps us to accept and transform regret and shame with grace and forgiveness. This happens as the defensive self (the ego) moves into the background and we attain non-attachment. With this non-attachment, we can navigate past events and thought patterns more objectively, enabling us to see that harm from others is often a result of their own hurt and suffering. Transgressions can become less personal, shaking us free from feeling out of control, and inspiring a greater sense of agency and choice in how we show up in the world. When used with a therapeutic intention, psychedelics enable us to see we ARE whole and to embrace and live from that state of wholeness.

When we realize we are inherently whole and worthy, we begin to live out of that remembrance. In this way, psychedelics can lift the veil of the ego, enabling us to see ourselves and others in a more positive, loving, and gracious way. Breeding unconditional positive regard and objectivity enables us to accept and digest those parts of ourselves that felt unacceptable and unpalatable. The spirit comes to the forefront while the ego and the labels of this world fall into the background. This objectivity can fuel shifts (ah ha moments) that are otherwise unreachable. Shifting to see things as they are, with our spirit at the forefront, enables us to develop trust in a bigger picture. We experience what it feels like to be held in this more secure spiritual world, providing a sense of immunity to the external events and pressures that swirl around us.

These healing adjuncts have the potential to take us deeper than we could otherwise go. We have an immense opportunity to promote human flourishing by cultivating the re-connection necessary to resolve and release the shame and trauma that often lies at the root of our suffering. As modern medicine continues to gain access to these medicines, they provide hope amid a growing mental health crisis.

Ketamine has been widely used for over 50 years, typically as an anesthetic agent. However, it is also successfully used for a variety of off-label purposes (not yet approved by Health Canada for the specific purpose it is being used for). For instance, through used off-label, In the research to date, we are seeing the significant positive impacts that ketamine can have in the treatment of a variety of related mental health conditions such as depression, PTSD, substance use, pain, etc.

Ketamine is dissociative, which causes a profound sense of disconnection (mirroring non-attachment) between the mind and the body. Its mode of action happens as an NMDA antagonist, impacting the glutamate neurotransmitter system, which is different from other psychedelics. For those experiencing depression, it hampers communication between neurons and the amygdala and hippocampus, where mood is governed (Zanos & Gould, 2018). As a result, this stimulate rapid neural growth, which can have lasting (to varying degrees) positive effects after the medicine leave the body. KAP recipients often experience improvements in their emotional state, a greater connection between one’s BEing self and one’s DOing self, and as a result, a reduction in depression and anxiety. Neurologically speaking, there is evidence that there are positive impacts on the reward centre in the brain (Ionescu et al, 2018). However, these biological effects seem to be temporary, with varying levels of improvement for varying amounts of time.

Working with Ketamine to expand awareness, regulate, connect, and align:

  • Expanding awareness: When working with ketamine, recipients see themselves and their assumed reality in a new light, expanding their awareness of oneself, and how one relates to the inner and outer world.
  • Regulation: Ketamine promotes non-attachment to bodily sensations, the narratives one lives by, and impact these factors have on the nervous system (stress response). With this newfound space, one can work with the nervous system in a more conscious way. Without attachment to arising thoughts and sensations that would otherwise be too threatening to sit with (often resulting in a fight-flight or freeze response), there is an opportunity to compassionately sit with oneself in a way that would otherwise not be possible. From this compassionate and conscious place, you can see things as they are and re-orient yourself accordingly. As a result of this ability to regulate and re-orient, one can update belief systems that are no longer true or helpful, which are often at the root of a variety of projections that frequently activate the stress response. Finally, from this more regulated and spacious place, one can sit with, feel and ultimately, heal unhealed wounds from the past.
  • Heartful Connection: Because one can feel the body and associated emotions without feeling attached or threatened by them, there is a unique opportunity to orient oneself more compassionately (much like you would a dear friend), which enables a form of self-soothing that was not previously possible. In this way, you are practicing unconditional positive regard turned inwardly, which cultivates ongoing self-compassion and resiliency
  • Alignment: With the benefits of expanded awareness, regulation, and heartful connection, one can more accurately align with who they are, what matters to them, and what it would look like to live one’s calling in the world.

Integration:

While integration has become a buzz word in the world of psychedelic therapy, how we define it varies. In KAP, much like other psychedelic-assisted therapies, every participant will have a unique experience based on a variety of factors. It’s difficult to predict how one’s experience will unfold from session to session. For this work, integration refers to the process of embodying new insights, taking on a more empowered orientation to self and life.

In the process of integrating new insights (upgrading old belief systems), It’s important to be alert to common problems. For instance, shame and self-depreciating thoughts after being vulnerable with others, with the potential of exposing secrets and previously forbidden parts of oneself. It can be challenging to integrate positive changes in perspective and behaviours amid complex, and perhaps rigid, life and work environments. In these conditions, the work can happen more slowly, removing a layer at a time to establish sustainable shifts. However, many find more ease than effort in the integration process (MAPS, 2015), with minimal additional support needs beyond participating in a community of practice (formally or informally) that provides empathetic listening and compassionate witnessing.

Beyond the Mental Health Crises:

Jean Watson succinctly describes the realities of our own conditioning, which continues to hold us in a state of confusion.

Modern medicine and health in this new millennium seems to lie in the lack of a meaningful perspective on the very nature of our humanity. It seems that somewhere along the way modern medicine has forgotten that it is grounded and sustained by and through the very nature of our being and becoming more human (Watson, 2003, p. 7)

Self-actualisation, transcendence, re-villaging, and ultimately, our collective human resilience depends on connectedness, to our whole selves and to each other. To achieve this collective resilience, we must remember who we are and what it means to BE human. Ketamine and other psychotherapy adjuncts address the barriers that keep us disconnected, enabling us to securely attach to ourselves and to the common human ground we share. At a time in history when we as humans are more divided than ever, what an opportunity to remember who we are.