How Can Psychotherapy Be Combined with Ketamine? A Clinical Psychology Podcast Episode.
Continuing on from the mini-theme of last week, I want us to continue to look at great and fascinating new therapies for a wide range of mental health conditions. It turns out that ketamine and other similar drugs can actually be combined with psychotherapy to treat a wide range of mental conditions, so in this clinical psychology podcast episode, we’ll going to examine this in more depth so we understand how this works, and what the future could bring. If you’re into clinical and biological psychology then you will love today’s episode.
Today’s episode has been sponsored by Biological Psychology. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it.
How Can Psychotherapy Be Combined With Ketamine?
I just want to say upfront like last week, I am not for or against this new approach at this moment in time and of course I am far from recommending it. we are all just learning about it and I’ll share my thoughts, feelings and opinions on the approach throughout the episode.
Therefore, whilst the research isn’t conclusive on the effectiveness of ketamine combined with psychotherapy to treat mental health conditions, there is a growing body of literature showing that ketamine can be a good tool for treating a lot of psychological conditions (Borenstein, 2021). As well as esketamine, a derivate of ketamine, is what’s most commonly used and even the USA’s Food and Drug Administration has signed it off as a treatment for different conditions.
In addition, research shows that ketamine treatments are most effective when therapists combine them with courses of psychotherapy and draw on the psychological approaches. And personally, I already prefer this line of treatment compared to neuromodulation from last week, because this feels a lot more holistic as it effectively combined the biological and psychological approaches to treatment.
But it does raise the question of why is psychotherapy reported to be effective with ketamine?
In order to answer these questions, we need to look at the benefits of ketamine and what it does to the human body to fully understand how ketamine can optimise treatment outcomes for the client.
3 Benefits of Ketamine For Psychotherapy
Firstly, ketamine engages the neurotransmitters glutamate and GABA. Due to N-methyl-D-aspartate (NMDA) is a glutamate receptor and ketamine effectively blocks NMDA receptors from action so this allows more glutamate to be present in the synapses of a client (Furikawa et al., 2005). Therefore, with glutamate being an excitatory neurotransmitter and GABA being an inhibitory neurotransmitter, the client’s other neurotransmitters can reach an optimal homoeostasis. Then this leads to a reduction in depression and anxiety symptoms as it decreases hyperarousal as well as rumination.
As a result from a psychotherapist’s perspective, this allows them to focus on the underlying events that are causing the client’s affective and cognitive dysfunction with a client that is calmer and more able to focus constructively on finding better ways to effectively manage their condition.
Personally, I think this is a very interesting idea and concept because whilst this isn’t right for everyone, and to be honest I do sort of question the idea of giving clients drugs to make them calmer, but some people will need this. For example, I was in a lecture this week and the clinical psychologist said, sometimes there’s no point in giving someone therapy if they aren’t going to be able to focus. Therefore, yes if we need to give drugs to the client to help them focus on the psychotherapy then this is something we need to do.
Ketamine Causes An Ephemeral Dissociative State:
Secondly, we need to look at how ketamine causes an Ephemeral dissociative state and why this is potentially useful in psychotherapy. Since in many traumatic conditions, dissociation can be a deliberating chronic problem that prevents clients from being able to even acknowledge that they have a condition in the first place in some cases, and as we know if a person doesn’t acknowledge they have a condition first of all then they have next to no hope of resolving the associated difficulties.
Nonetheless, with ketamine, this causes the dissociative state that it induces to be temporary and ideally this should (or will) occur in a controlled setting with the psychotherapeutic staff actively engaged in the process. The reasoning behind this is that the dissociative state can give the client a brief break from the underlying emotional dysfunction and this allows the therapist with the client to address the originating difficulties. Overall, leading to potential long term relief.
Afterwards, when the dissociative state is over, the psychotherapist then helps the client to cognitively realign with a greater understanding of the formative difficulties that have led to the mental health condition.
In other words, the ketamine allows the client to take a break from their emotional and other difficulties and this allows them to really focus on the psychotherapy without having to deal with or be potentially overwhelmed with their difficulties at the same time. Then when the state is over the therapist helps the client with their new found knowledge to deal with the “returned” difficulties that they didn’t feel during their dissociative state.
Ketamine Starts Neural Pathway Formation
Finally, this rather new finding about ketamine is very exciting for psychologists, because it differentiates ketamine from a lot of other monoamine-based psychotropic medications. For example, ketamine is different from SSRIs with these showing disappointing results (Rush & These, 2018). Also with Ketamine blocking NMDA receptors, glutamate presence is increased which mediates synaptic plasticity (Furukawa et al., 2005). And that basically just means the adaptability of the synapses in the nervous system.
Therefore, by taking advantage of the new neural pathways created by this synaptic plasticity, psychologists can work with clients to create positive thought processes as well as memories to mitigate the effects of the previous negative feedback loops and rumination. Meaning this can literally give the clients a new opportunity to find relief and a more positive overlook on the whole, and as future or current psychologists that is exactly what we want.
Also, it is very much worth noting that if a psychologist isn’t used or at least present to help the client create a more positive overlook during this increased synaptic plasticity process, this does lead to even worst outcomes for the client. It is the positivity that is absolutely key here.
Clinical Psychology Conclusion
At the end of today’s episode, we can conclude that there is good research that by taking advantage of the benefits provided to us by ketamine, psychologists can work with clients to achieve three main benefits as we’ve learnt about today. Resulting, in the client being helped to deal with their psychological distress and trauma through short-lived and removed (also known as dissociated) states.
Additionally, we know that depression and anxiety can be calmed and its symptoms decreased by ketamine’s effects on both GABA and glutamate, enabling a more logical examination of the causes of the mental health condition without the client’s difficulties overshadowing and making it difficult to constructively engage with the therapy. As well as ketamine helps for new neural pathways to be formed and hopefully break the previous negative cycles as well as rumination.
Furthermore, these three benefits of ketamine all thankfully reduce the client’s sympathetic stress response mechanisms, including the presence of cytokine and the inflammation it causes, which further improves their physiological and psychological wellbeing (Comer, 2022).
However, we have to take note that this is a relatively new treatment and we seriously need more longitudinal studies before we can even begin to understand the long-term effects of ketamine and psychological treatment. Since like any medication, ketamine does have side effects, which we aren’t going to look at in today’s post but it still has some.
Yet the current research and even the practitioner reports do provide a promising glimpse of hope for the use of ketamine and psychotherapy in the future and how they can potentially benefit the treatment of people with treatment-resistant forms of depression, suicidal ideation, anxiety, alcohol abuse and Post-Traumatic Stress Disorder.
Personally, I am very interested in this new approach to treatment, because it is great that we are still finding ways to combine biological and psychological aspects in treating mental health conditions. Because a condition never has a single cause so neither can its treatment. Of course, a lot of clients will not need ketamine in the slightest but I can understand why ketamine will definitely be useful for clients that are resistant to treatment and have severe symptoms that can make psychotherapy difficult to engage in.
This is an area I will certainly be interested in in the future, but until then we will have to keep researching, learning and enjoying all the amazing possibilities possibly heading our way.
I really hope you enjoyed today’s clinical psychology podcast episode.
If you want to learn more, please check out:
Biological Psychology. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it.
Have a great day.
Clinical Psychology References
Furukawa, H., Singh, S., Mancusso, R., and Gouaux, E. (2005). "Subunit arrangement and function in NMDA receptors". Nature, 438 (7065), 185–192. doi:10.1038/nature04089.
Borenstein, F. (2021). "Ketamine and chronic PTSD symptoms: Repeated ketamine infusions reduces symptoms." Psychology Today. https://www.psychologytoday.com/us/blog/brain-and-behavior/202101/ketam…
Psychology Today. (2022). "Ketamine basics." https://www.psychologytoday.com/us/basics/ketamine
Rush, A. and Thase, M. (2018). "Improving depression outcome by patient-centered medical management." American Journal of Psychiatry, 175, 118-1198.
Comer, J. (2022). "Beyond stress and burnout: What Is psychoneuroimmunology? Taking the stress out of stress." Psychology Today. https://www.psychologytoday.com/us/node/1171851/preview
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