Ketamine Therapy for Complex Trauma and Dissociation

by Lauren Going, LCSW-C, trauma specialist and KAP clinician

Unlocking Healing: Understanding Ketamine Assisted Therapy for Complex Trauma and Dissociation

When we hear the word "psychedelic," images of mind-altering substances often come to mind—LSD, psilocybin mushrooms, and others that induce a journey into altered states of consciousness. But what if I told you psychedelics are more than just substances? At its core, "psychedelic" derives from the Greek words "psyche" (mind) and "delos" (to manifest). Essentially, psychedelics reveal aspects of our unconscious, those hidden realms of our psyche that are normally inaccessible during our waking state.

Unlike traditional psychedelics that may last for hours, a ketamine session typically spans about 90 minutes. This shorter duration not only enhances accessibility but also makes it more affordable compared to longer psychedelic experiences.

What is Ketamine?

First synthesized in 1962, ketamine initially gained FDA approval as an anesthetic and analgesic due to its unique safety profile—unlike many anesthetics, it doesn't depress respiratory or cardiac functions. This safety has earned it a place on the World Health Organization's list of essential medicines.

Ketamine's application in mental health began gaining traction in the early 2000s, with significant progress in the last decade, especially in treating conditions like treatment-resistant depression and PTSD. What sets ketamine apart is its ability to rapidly alleviate symptoms within hours to days, a stark contrast to the weeks it can take for traditional antidepressants to show effects.

As I often discuss in my practice at Inner Path Wellness, ketamine offers a pathway to immediate relief for those experiencing severe depression or suicidal thoughts. In some cases, it can dramatically reduce suicidal ideation almost immediately, providing crucial support where traditional treatments fall short.

Mechanisms of Action: How Ketamine Works

To understand how ketamine aids in trauma therapy, it's essential to grasp its mechanisms of action. Ketamine acts on the brain's glutamate and opioid receptors. By doing so, it not only induces neuroplasticity—essentially rewiring the brain's neural pathways—but also reduces hyperactivity in areas like the amygdala, our brain's threat center.

In trauma, the amygdala can become overactive, keeping individuals in a perpetual state of fight-or-flight. Ketamine helps calm this hyperarousal, allowing individuals to remain within their "window of tolerance." The window of tolerance is the optimal zone where emotional processing and regulation can occur effectively. 

Complex Trauma and Ketamine's Role

Complex trauma, often stemming from prolonged childhood exposure to traumatic events, can lead to profound developmental impacts. Individuals may struggle with negative self-concepts, difficulties in relationships, and heightened emotional dysregulation—challenges that make conventional therapies less effective.

Ketamine's dissociative properties are particularly intriguing here. Unlike dissociation in trauma, where individuals disconnect from overwhelming emotions or memories, ketamine-induced dissociation can facilitate a deeper connection with the body and emotions by first removing one from their bodies and then reintegration on the ‘tail’ end of the journey. This effect can be likened to a pendulum that swings far in one direction only to use the same momentum to swing back in the other direction- moving from dissociation/ disconnection to increase somatic awareness/ embodiment. This paradoxical effect helps individuals reclaim a sense of safety and control over their internal experiences. This is crucial for healing from complex trauma.

The Future of Ketamine Assisted Therapy

Looking ahead, the integration of ketamine into therapeutic practice represents a promising frontier in mental health care. Its ability to rapidly alleviate symptoms, combined with its compatibility with existing medications like SSRIs, makes it a versatile tool in the therapist's toolkit.

As we continue to explore and refine our understanding of how ketamine works, its potential to transform treatment outcomes for trauma survivors is undeniable. From reducing suicidal ideation to enhancing neuroplasticity and emotional regulation, ketamine offers hope where most current interventions are failing.

Ketamine Assisted Therapy for Trauma: A Deep Dive

Trauma can manifest in many ways, often leaving individuals feeling disconnected from themselves, their surroundings, and others. This disconnection, known as dissociation, is a common survival mechanism that helps us cope during overwhelming experiences. However, when dissociation becomes chronic, it can severely impact our ability to engage with life, leading to issues like chronic numbness, depression, anxiety, and suicidality.

Understanding Dissociation

Disconnection from one's own direct subjective experience is a hallmark of dissociation. This can include detachment from emotions, thoughts, and sensations, making it feel as though these experiences don't belong to oneself. Additionally, dissociation can extend to feeling distant or unreal in one's surroundings or even in relationships with others.

Connecting to oneself, their experiences, and others is vital to feeling connected to life itself. This connection forms the foundation of our emotional well-being and sense of purpose in life.

Ketamine's Role in Dissociation and Trauma Healing

In the context of ketamine-assisted psychotherapy (KAP), ketamine-induced dissociation takes on a therapeutic role that contrasts with its usual defensive function in trauma. Unlike traumatic dissociation, where dissociation occurs involuntarily to protect from overwhelming experiences, ketamine-induced dissociation is deliberately induced and controlled. This ‘therapeutic’ dissociation allows individuals to approach and process traumatic memories and sensations without becoming overwhelmed.

Ketamine can help us stay within our 'window of tolerance,' where we can process traumatic material without being flooded by it. This process is crucial for trauma healing as it enables the brain's neuroplasticity, facilitating the growth of new nerve cells and connections that were impaired by trauma.

Ketamine-induced dissociation can be likened to traveling to a foreign land. Just as travelers gain new perspectives on returning home, dissociation through ketamine offers a fresh view of one's traumatic experiences. This expansive perspective allows individuals to re-enter their bodies with heightened awareness and a deeper connection to bodily sensations—a critical aspect often dulled by trauma.

Memory Reconsolidation and Trauma Healing

Central to trauma recovery is memory reconsolidation, where traumatic memories shift from implicit (unconscious) to explicit (conscious) memory. Every time we recall a memory, it's imprinted with new associations. Ketamine Assisted Psychotherapy, by facilitating a relaxed and supported state in a safe and supportive environment, helps individuals reprocess traumatic memories in the context of attunement and safety, thereby lessening the emotional charge associated with the memory and integrating the experience with more adaptive and reparative associations.

Integrating Ketamine-Assisted Therapy with Other Modalities

Combining KAT with other evidence-based therapies, like Internal Family Systems (IFS), somatic therapy, and Eye Movement Desensitization and Reprocessing (EMDR) complements ketamine's effects of downregulating the default mode network and amygdala, creating new neural connection. The combination also provides additional tools for trauma processing and integration.

Choosing the Right Therapist for Ketamine-Assisted Therapy

Selecting a qualified therapist for KAP, especially for trauma survivors, is essential. Ensure your therapist is trained in psychedelic assisted therapy, trauma-informed care, and prioritizes your safety and empowerment throughout the KAP process. This holistic approach not only enhances safety but also empowers individuals in their healing journey which is critical in trauma recovery.

Conclusion

In conclusion, ketamine-assisted therapy offers a promising avenue for trauma healing by leveraging dissociation as a therapeutic tool. By carefully managing dissociative states, individuals can confront and integrate their traumatic experiences, fostering resilience and reclaiming a sense of connection and control in their lives.

While the field of ketamine assisted psychotherapy is still evolving, its impact on trauma and dissociation treatment is profound. By leveraging ketamine’s unique mechanisms of action, therapists at Inner Path Wellness and similar practices are pioneering new avenues for healing that transcend the traditional modalities that are in many cases failing the clients we serve. We can do better. 

As always, the journey to healing is deeply personal, but with innovations like ketamine assisted therapy, individuals are finding new hope and pathways to recovery.

If you have any questions or would like to delve deeper into this topic, feel free to reach out. Your curiosity and engagement are encouraged!