Honoring Veterans and Addressing PTSD

As Veterans Day arrives, it's not just a time for gratitude but also a moment to shine a light on the mental health challenges faced by those who have served in the military. On a recent episode of KSL’s Dave & Dujanovic, hosts Debbie Dujanovic and Dave Noriega delved into the topic of Veteran mental health, particularly post-traumatic stress disorder (PTSD), with Numinus therapist John Ellis.

The discussion opens with personal stories, including Dave's revelation about his grandfather's World War II experience, emphasizing the often unspoken struggles that veterans carry. John Ellis, a therapist with a background in the United States Air Force Reserves, shares insights into the importance of storytelling for veterans and the therapeutic value of sharing experiences.

"A lot of veterans do keep things inside. But they have stories to tell. And when they start to tell them, it does help." John says.

Fostering an environment of connection, empathy, and emotional understanding, the need for vets to share their experiences is paramount. Our collective society's attentive listening becomes pivotal in acknowledging the importance of veterans' narratives. So, what first steps can we take? 

Let’s start with compassion. Creating a safe and supportive environment to empower veterans to openly express their feelings will help them navigate the path towards healing.

But it isn’t all that simple to create this safe space. Veterans face challenges when opening up about the past, particularly the painful memories. These experiences don’t always flow from the memory into a story - they are sometimes haunting, and dig up old wounds. "We need to help them start telling their stories a little bit. And when they do, we need to listen. It does help them, and it's hard to tell them. Even the good ones." John continues to say. Many people feel sensitive about asking questions, fearful of saying something wrong or triggering. However, there is a balance, and approaching the conversation with delicacy, kindness, and respect can make a veteran feel appreciated. Think about starting by saying something like this: “I understand that talking about your experiences in combat can be challenging, but I want you to know that if you ever feel the need to share or discuss anything, I am here to listen without judgment. Your feelings and experiences are important, and if you choose to open up, this is a supportive space. I appreciate what you've done, and I'm here whenever you're ready.”

For veterans, the emotional connection formed through shared narratives can also be built through engagements such as individual therapy, group sessions, or community resources. "There's that emotion and empathy that can be formed in connection. I think that's really where it starts, whether it's in a therapeutic relationship, just one-on-one with a family member, or amongst veterans - combat or otherwise."  John explains. 

When discussing signs of PTSD,  common indicators include flashbacks, hypervigilance, night terrors, existential dread, and fear that can linger, making it difficult for veterans to feel safe. To begin working through these unwanted feelings, starting with the Veterans Affairs (VA) system is always a solid first step. 

The door is wide open at Numinus, where we provide therapy and utilize treatments like ketamine-assisted therapy, known for its effectiveness in reducing symptoms of PTSD and suicidal thoughts. Many Numinus therapists and staff are veterans themselves, and we always do our best to pair vets-to-vets for an added layer of empathy.

At Numinus, we strongly believe in the power of psychedelic therapy. Ongoing research favors ketamine and other psychedelic medicines, such as psilocybin and MDMA, in treating mental health conditions. Numinus is helping carry the torch for this work, alongside and partnered with long-standing companies like MAPS (Multidisciplinary Association for Psychedelic Studies). The promising results from recent studies show psychedelics, when coupled with talk therapy, have a highly positive impact in relief from depression, anxiety, PTSD, and more.   

We really have learned, from the 70s to now. There really is a lot of research and some real expertise – and there are people that really know how to help navigate your experience," John says. "We’re [Numinus] really helping people rewire their brain from that trauma - that medicinal kind of regeneration of neurons that happens during a psychedelic experience.

As we reflect on Veterans Day, let's carry forward a renewed commitment. Acknowledging the struggles of veterans and the importance of mental health, we extend our gratitude and encouragement. Together, let us foster a compassionate environment, embracing the healing potential of both shared narratives and therapeutic interventions. 

If you or someone you know is a veteran facing mental health challenges, remember, seeking support is a courageous and vital step. Your well-being matters, and the journey towards healing is a shared endeavor.

 

Reflections on a Silent Retreat

By Sarah Roberts, Assistant Director of Numinus

Insight Meditation Society

Last week, I drove to Barre, Massachusetts with Numinus Clinic director Joe Flanders and Numinus Clinic teacher Julien Lacaille to attend a six-day silent meditation retreat at the Insight Meditation Society (IMS). Founded in the 1970s by American Buddhist teachers Sharon Salzberg, Jack Kornfield, and Joseph Goldstein, IMS is one of the oldest meditation retreat centres in the West. The centre is housed in a beautiful old mansion, and runs regular retreats dedicated to the cultivation of vipassana (insight) and metta (lovingkindness). Our retreat was run by Kittisaro and Thanissara, Buddhist teachers who live and teach primarily in the US and in South Africa.

Orientation

On Monday evening, we gathered with one hundred retreatants from all over the United States and Canada for our orientation session. We were given a tour of the centre, and each retreatant was assigned a small dorm room (single bed, sink and mirror, wardrobe and chair) and a daily job that would contribute to the functioning of the centre. I was assigned to a team of after-lunch pot-washers; fellow retreatants were assigned various gardening, housekeeping, and food preparation jobs.

Noble Silence

Following the orientation session, Thanissara and Kittisaro rang a bell and Noble Silence was officially in session. Noble Silence simply refers to a commitment to remain silent for a certain extended period; the silence is designed to still our mouths and therefore our minds; making it easier to sit calmly; observe the workings of our minds and bodies; and cultivate perception, clarity, and wisdom.

Retreat Schedule

Starting Tuesday morning, the format of the retreat was as follows: at 5am, a bell-ringer walked through the halls of the dorms, ringing a bell to wake us and call us to gather in the meditation hall at 5:10 for chanting and sitting meditation. I usually took the opportunity to sit outside and enjoy the lightening sky instead, joining the group for the next meditation period at 6am. At 6:30, we ate breakfast. At 8:15am, we reconvened in the meditation hall for alternating periods of sitting meditation and walking meditation until lunch at noon. The afternoon schedule was very similar: alternating periods of sitting and walking meditation, until a light dinner (soup with crackers or bread) at 5:30pm. All meals were vegetarian, and each period of sitting, walking, or eating was indicated by bell-ringing.  At any time, retreatants could choose to meditate in the meditation hall, in the dorm rooms, in alternate designated meditation areas, or outside; we were also free at any time to nap, take a walk, have a cup of tea, or otherwise rest or rejuvenate.

Dharma Talks

Every evening, Thanissara or Kittisaro gave a “dharma talk.” The word dharma refers to the underlying order of nature and human life, and to behaviour considered to be in accord with that order. The word is also often used to refer to the entirety of the teachings of the Buddha, and a “dharma talk” simply means a talk on Buddhism by a Buddhist teacher. Kittisaro and Thanissara’s dharma talks were excellent. Some referred to Buddhist teachings that were not familiar to me, but the underlying themes of compassion, acceptance, and non-striving were very familiar from my experience as an MBSR participant and teacher. The teachers were warm, engaging, and funny. In particular, Kittisaro’s description of his early life as an incorrigible striver (Rhodes’ Scholar, wrestling champion, medical student) made us laugh.

Buddhism and MBSR

For me, one of the pleasures of the retreat was hearing Thanissara and Kittisaro teach many of the concepts we teach in our mindfulness-based stress reduction (MBSR) program, but from their unique perspective. Mindfulness is a Buddhist concept only quite recently popularized and secularized in the West as a tool for physical and emotional health and well-being. Although Western mindfulness teachers are educated in Buddhist principles and cognizant of the roots of mindfulness, the MBSR curriculum is specifically designed to be secular, and does not explicitly refer to Buddhist teachings.  Although the retreat teachers only used the word mindfulness a handful of times during the week, the themes of awareness via body sensations, allowing experience to be as it is, turning toward rather than away from pain, and cultivating compassion for personal and others’ suffering were unmistakable. Furthermore, many of the dharma talks touched upon the seven foundational attitudes to mindfulness practice (acceptance, non-judgment, non-striving, beginner’s mind, patience, trust, and letting go) identified by MBSR founder Jon Kabat-Zinn, and explicitly taught in MBSR.

Retreat Life

Being on retreat is in some ways demanding (waking up at 5am, meditating for extending periods) and in some ways relaxing (no phones, internet, email, shopping, cooking, or demands on your time), but it’s above all interesting. Noticing what your mind does when the usual demands are absent is like sitting behind the window of a laboratory. I became extremely sensitive to the operations of my mind, immediately noticing each time a stray thought caused a twinge of anxiety or stab of fear; and acutely aware of the precise moment I became itchy, hungry, or otherwise physically uncomfortable. I had the space and time to observe my mental habits, noticing each time my mind latched onto one of its usual topics of rumination, or reacted to some nonverbal behaviour from a fellow retreatant. In some instances, the heightened awareness allowed me to behave more skillfully; in other instances, I observed myself repeating unhelpful patterns.

Post-Retreat Life

Now the retreat is over. I’m back in Montreal, back at work, and meeting with the usual demands and pleasures of my regular life. What’s different? First, I have retreat jet lag, which means that I’m going to bed and waking up about two hours earlier than usual. Second, I regularly stop and ask myself “How is it now?” This is a phrase Kittisaro and Thanissara encouraged us to use to check in with ourselves. Third, I’ve been speaking more slowly and less often, and listening more, realizing that everything that crosses my mind doesn’t need to be spoken out loud. Fourth, I’ve noticed that I’m more sensitive than usual to my own and others’ emotions, to the sounds in my environment and to the loveliness of nature.

I hope all of these changes last, but I’m prepared for them to fade or fluctuate. After all, if there’s any one lesson to take from Buddhist teachings, it’s the impermanence of all things.

Reflections on Difficult Times and How Mindfulness Can Help

The last 6 months have been difficult for my family and me. In fact, I can’t recall another period in my life in which I felt so overwhelmed, depleted, and discouraged. Thankfully, the worst of it has past. I’ve since had time to reflect on this period and, in particular, how my mindfulness practice helped me cope. While much of what follows is an account of my personal experience, I believe the value of the practice as it is applied here is universal.

I’ll try to get you up to speed on what happened without boring you to death with the minutiae of my “first-world” problems: My wife and I live with our 2 little kids (M, 4 years old & G, 1.5 years old) in a condo in Montreal. Last spring, we discovered a significant mould infestation in our basement. The problem was so bad that it was compromising the structural integrity of our kitchen and bathroom floors (we were lucky the floor didn’t caved in while M & G were in the bath) and poisoning the air quality in our home. Imagine: G had been breathing this toxic air since she came home from the hospital at 2 days old! The upshot was that we had to: move out; hire specialists to decontaminate the crawlspace; rip out the floors; dig up our yard to fix the water infiltration problem; and then rebuild and refinish everything. To make matters worse, we had to pursue 3 separate lawsuits if we wanted to recoup the 6-figure costs of the job.

In the middle of all of this, I got some devastating news from my mother: her cancer relapsed. It had been under control for 3 years thanks to an amazing new drug, but sadly, the disease had progressed and the drug was no longer effective. We didn’t know how much longer she had to live.

I have learned over the years that when I’m processing emotion or feeling overwhelmed, the primary symptom is irritability. I am easily frustrated by minor setbacks and impatient with people around me. What I lived over the summer was the perfect storm of triggers for me in my vulnerable state: we moved in and out of 6 different homes, supported our children through the change, managed the financial burden of all the work on our home, had countless meetings with contractors and lawyers, all while having to process this troubling news about my mother’s health.

Because we moved around a lot over the summer, it was tough to keep track of our stuff. I’d go to the bathroom to shave before work, only to realize I’d left my shaving stuff in another bag at home; my daughter wanted to sleep with her 2nd favorite stuffed animal, but that one was in storage; my wife wants to charge her iPhone, but I forgot to pack it at the other apartment. On and on like this for 3 months. And each each of these little frustrations would infuriate me. I would tighten up, growl inside, and think (over and over again) “This is so irritating! I can’t deal with all this frustration! I can’t believe I have to buy yet another iPhone charger!” As you can imagine, my head was not a fun place to be.

In one of my more acute moments of discouragement, it occurred to me that the magnitude of these challenges superseded my capacity to practice and cope with them. So I looked for inspiration from Pema Chodron, whose books had helped me through difficult times in the past. I picked up Living Comfortably with Uncertainty and Change and was reminded of one of her most compelling theses: that moments of difficulty offer the best opportunities to deepen insight and wisdom.

According to Pema, when things don’t go according to plan – when things fall apart to use her phrase – we typically react with some form of resistance such as frustration, disappointment, sadness, or indignation. We are attached to having things the way we want them and all of these reactions involve emotionally doubling-down on the plans that have not worked out.

When things don’t go according to plan, we typically react with some form of resistance such as frustration, disappointment, sadness, or indignation

Rather than tightening our grip on what has already slipped away, Pema invites us to let go and relax into the “fundamental groundlessness of being.” That phrase is fancy spiritual jargon referring to the impermanent and unsatisfying nature of reality. The fact is that my desire to have my “stuff” in order is bound to be unsatisfied because “stuff” invariably falls out of order again. iPhone chargers get lost and found; the soothing presence of stuffed animals comes and goes; apartments floors rot and get rebuilt; relationships fall apart and come together; even human life itself arises and passes. So as long as we are attached to having things a certain way, we will inevitably experience that dissatisfaction. In Buddhism, this is called dukkha.

Most of us, myself included, can’t really help it. Our brains evolved to make us feel more at ease in familiar environments that are predictable and under control. It requires more effort and energy to adapt to novel, unpredictable circumstances – and who knows what unknown threats lurk in the disorder? So adaptation to change is often accompanied by stress, anxiety, and depletion. Stretching beyond our evolutionary heritage and working skillfully with dukkha requires significant practice.

According to Pema, we can open up and ease into moments of frustration and stress. This practice begins with mindfulness. The idea is to drop into the moment-by-moment unfolding of an awareness that is not hooked or shaped by our preferences or judgements. The resistance itself can be used as an invitation to shift into openness and curiosity. In my case, that refers to the tightness in neck and shoulders, accelerating frustrated feeling, and racing thoughts about how my circumstances. Any of these elements could serve as a cue to stop and say “wow, resistance is here; let’s see what this is like.” At one level, this attitude disrupts the automatic habitual reactions of irritation and rumination and makes it possible to relate to the moment differently, such as with kindness and self-compassion. At a deeper level, it also opens the door to the experiential insight of impermanence, a deep and clear understanding that conditions change and sustainable well-being arises from a willingness to accept and work with what shows up.

We can open up and ease into moments of frustration and stress. This practice begins with mindfulness.

Of course, a lot of repetition and deliberate practice is required to move from a momentary insight to new way of being. And I have to admit I did fail to make this shift more often than I succeeded. But I do have one interesting experience to share.

One morning in the middle of the summer, I took my daughters out for a walk so my wife could catch up on sleep. The weather was lousy, but it hadn’t started raining yet and the kids needed to get out. So we went and had a reasonably good time. On the way back, the whining started: “I’m huuunnngry. I’m tiiiiirred. I don’t want to walk anymore, etc.” Shorty after that, it started pouring rain (obviously) and the whining escalated to crying.  Somehow, despite headache, fatigue, and own wet clothes, I managed to not react. I didn’t say or do anything except observe the moment unfolding. To be clear, this wasn’t an act of suppression or self-deception; there were simply no other “strategies” available to me aside from letting go of my preferences and working with what was present. After a minute or 2, the kids calmed down and walked along quietly. Then, the rain actually let up. And as we approached our home, I noticed a feeling of peaceful gratitude set in as the beauty of my surroundings registered, as well as a sense that everything was going to be ok.

For a brief moment I was attuned to the “fundamental groundlessness of being.” And as hard and complicated as that sounds, it actually involved little effort or technique – just slowing down and tuning in. So here is your invitation to try relaxing into those moments (big or small) when you’re feeling stuck in reactivity. It may help bring back intentionality and a deeper appreciation of impermanence.

Photo by Michael Dam on Unsplash

 

Feeling Clearly: How Ketamine-Assisted Psychotherapy Helped a Father Overcome Severe Social Anxiety and Childhood PTSD

By Greg Ferenstein

An Unrelenting Specter of Judgment

Tom* couldn’t shake his constant fear of being perceived as awkward and unworthy of friendship.

“I always felt like the outcast,” he recalls. The crippling self-doubt kept all of his relationships at a cold distance, even his wife.

In everyday social situations, even light-hearted water-cooler conversations at work, Tom was haunted by thoughts about why people right in front of him—freely engaging with him in conversation—silently judged him as unpleasant.

Tom had done the work to figure out the source of his dread. After years of therapy, he knew it came from an abusive childhood growing up in a religious culture that used shame and bullying to enforce conformity. As a result, he ran away as a teenager.

One notable symptom of trauma is “hyper-vigiliance”, or an over-sensitivity to threats in everyday situations.

“I was on high alert all the time," he remembers.

His relationships were shallow because he avoided social activities. Even surrounded by those who loved him, he was still alone and fearful.

Addictive Attempts

Determined to be more social, Tom looked for solutions. While they did improve his anxiety, they also came with troubling trade-offs.

One was a popular and controversial legal drug, Phenibut, a synthetic anti-anxiety supplement originally synthesized in the USSR for cosmonauts.

Phenibut acts on the central nervous system by inhibiting the neurotransmitter, GABA. Essentially, it can dull reactions to perceived dangers. Because Tom was not in any true danger, it was a workable solution that gave him the confidence to be more social.

Unfortunately, Phenibut is highly addictive and there are reports of painful withdrawal. Tom remembers one occasion when he forgot to take one of his various anti-anxiety supplements on the way to a movie with his wife and they had to immediately turn back, making them late for the show.

Being tethered to addictive, unapproved medical treatments was clearly not helping him or his relationships.

Ketamine and a Feeling of Unconditional Love

Tom came across a Facebook ad for a new therapy at Novamind’s Cedar Psychiatry in Utah using ketamine, a surgical-grade general anesthesia that was being used to treat mental illness, including social anxiety disorder.

“I didn't quite know what to expect," he recalls of his general aversion to psychedelic-assisted therapy. “This was kind of my last hope."

Desperate for better options, Tom scheduled an appointment and brought his wife with him for support.

Tom remembers the luxury gravity chair that he sat in while the IV ketamine infusion was placed in his arm. He began drifting off into a dream-like state and felt as if he was tipping over backward in the chair, but the fear subsided.

“It’s ok, just let go," he recalls telling himself. For Tom, the psychedelic aspect of ketamine was not about wild hallucinations, but a feeling of ease. “I fell into this black space."

Tom’s thoughts drifted to his wife and he felt unconditional love. Prior to the appointment, he had worried about bringing her, since he felt silently judged for turning to psychedelics for treatment, even though she had never expressed skepticism about the approach.

But that feeling was replaced with one of acceptance. With ketamine, “You get to see yourself in third person," Tom explains. He experienced, at a visceral level, how others saw him and he knew they didn't judge him as he feared they did.

Instead, he could simply be beside his wife. “She held my hand; I felt so loved."

Feeling Less Judged

"Our marriage has skyrocketed," Tom says proudly. He also has more energy to enjoy swimming and going to the gym with his wife.

"I feel like going outside because I don't feel like there are eyes everywhere judging me."

Tom still has more ketamine treatments to go but feels he’s on a better path.

He seems to take challenging social experiences less personally. If someone disagrees with him, there is “zero emotion attached" to the argument.

Without constant rumination about what he’s doing wrong, he’s able to put challenges into perspective.

What Seemed to Work

Tom says that two things, in particular, stand out in his mind about what helped, aside from his wife being at his first treatment.

The first was listening to unfamiliar music. Music can have a calming, meditative effect during psychedelic episodes, allowing people to more deeply drop into a dream-like state. However, listening to familiar music can dredge up unpleasant memories that could distract from seeing oneself in a new light.

The second was Tom’s experience with mindfulness therapies prior to ketamine, including meditation and another called Eye Movement Desensitization and Reprocessing (EMDR).

The basis of both strategies is to embrace difficult thoughts and memories as they come up. Tom doesn’t know whether having these psychological tools in his toolbelt made the difference between successful and unsuccessful ketamine treatment, but he did have the honed skills to address challenging thoughts during the treatment.

So, it is worth noting that people who have come from therapy might be able to use the tools they’ve learned from previous counselors with ketamine. This is why Cedar Psychiatry is careful to prepare patients with the mindfulness tools they’ll need to navigate the psychedelic experience and integrate insights afterward.

It certainly seemed to work for Tom. "It changed my entire life," he concludes.

*Tom is a pseudonym. Some quotes edited for clarity

About the author

Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.

His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.

Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.

Friends With Myself: How Ketamine Helped a Frontline Therapist Overcome Panic Attacks

By Greg Ferenstein

On the surface, Emily* had a blessed life: a supportive husband, a loving son, and a solid career as a frontline therapist. She had all the professional training and social support to manage her mental health, yet she was plagued by debilitating panic attacks.

Even when nothing was wrong, she couldn’t escape intrusive, catastrophic daydreaming of how she was likely to wreck her family and community. She knew the thoughts were purely imaginary, yet the uncontrollable episodes of sobbing that accompanied these ruminations took a toll on both her family and office administrators.

As an example, Emily recalls being mildly afraid that she might cheat on her husband. That same day, she went through a grocery checkout line with a male cashier and was bombarded with thoughts of cheating on her husband.

“I immediately just lost it,” she says. “I cheated on my husband because I went through this line that had a male cashier.”

She burst into her home, began crying, and apologized to a very confused partner. She remembers thinking that “I just can't, I can't live like this.”

As a working mental health professional and current master’s degree student, Emily was surrounded by treatments and strategies to help her deal with her panic attacks.

And she did on occasion find them helpful.

Yoga, for example, helped give her space to contemplate quietly. “I was able to lay there and relieve some of my self-loathing and self-hatred and difficulty in accepting myself as a human.”

Unfortunately, nothing seemed to stick, partly because Emily was terrified to let her mind wander. “I get a little skittish around trying to create images in my mind because I don't trust my brain; any moment, this self-compassion exercise could be totally taken over by myself.”

As bad as the attacks were, Emily could still function as a loving mother and run a therapy practice while going to grad school.

But COVID tipped the scale; intrusive fears became too intense. Shopping at Target was a panic-inducing experience. “What if the girl that is spraying the carts right now doesn't believe in COVID? And so she actually just put water in the spray bottle …. And now I'm going to take it home, and we're all going to die?”

The constant fear became too much. She needed new solutions.

The ketamine experience

At this point, Emily was open to anything that could help. She heard about a clinical pilot for frontline healthcare workers offered by Novamind, a mental health startup specializing in ketamine-assisted psychotherapy.

Ketamine, a dissociative anesthesia, was showing promise for a range of mental health issues, including suicidal ideation and depression.

Novamind’s clinic pioneered a method of pairing ketamine sessions with intensive psychotherapy.

Growing up in a religious community, Emily felt uncomfortable with psychedelics. But she was desperate for solutions and decided to sign up.

Emily was placed in a trial with other frontline healthcare workers exploring how ketamine-assisted therapy could help them overcome their mental health challenges.

In preparation for the treatment, they were given worksheets and instructions on how to mentally navigate the psychedelic experience. In between treatments, the group would come together for discussions and integration.

Emily recalls one particularly powerful psychedelic episode that rooted out the source of her panic attacks.

As she began to feel the effects of the ketamine, she remembers seeing a visualization of a black hole and asking the overseeing physician how she should interact with the bizarre object.

“The doctor encouraged me to go toward it and that he would be there if I needed. I asked to hold his hand.”

Images morphed, and she recalled herself a young religious missionary in South America. As an adult, she was no longer a member of her same church, and since leaving, maintained intense shame around trying to force religious beliefs on the local residents.

During the psychedelic experience, Emily felt the people of the town forgive her. They told her that her missionary work did not harm the community and that they were grateful to have known her.

Then, with that same compassion, Emily turned to speak to her childhood self, “I told her these thoughts that you have are called ‘obsessive compulsive disorder’, and you don't have to repent for them.”

Emily and her younger self openly discussed all the complex feelings around moral purity and guilt they would experience in their life. She forgave herself. And, in that moment, Emily acknowledged it as a significant source of panic attacks.

“It was a closure I didn't even know I needed.”

Better at managing attacks

Emily still experiences episodes of shame, but now, they don’t spiral out of control.

She recalls one recent example of an incident that would have triggered a panic attack prior to her ketamine treatment.

One day, she had thrown away a bunch of plastic. Normally this slight moral transgression would trigger intense feelings of guilt about how she was wrecking the planet.

“Yes, I will have the thought of like, ‘Oh my gosh, what am I doing to the earth’, but within moments, I'm able to go to a place of ‘Emily’, this is so hard for you, I'm so sorry that you struggle with this—everything's going to be okay.”

Emily estimates that before, she would have a debilitating episode about once every three weeks, and then more minor attacks in between.

Since her treatment, she has experienced just one triggering episode, but it was not as severe, and she was able to adopt new coping mechanisms.

In addition to a more stable family life, Emily believes she’s become a more empathetic and present therapist. “I'm able to be fully present in their story, instead of letting my mind wander off into my own story.”

Emily is a therapist in a community with a lot of mental health distress around religion. Her clients have become curious about her personal transformation and the role of psychedelic-assisted therapy. Emily says that she would recommend Novamind.

“Dr. Reid Robison and Dr. Stephen Thayer were really great at setting us up for success,” she exclaims. “I can't imagine doing this with any other people.”

*Emily is a pseudonym. Some quotes edited for clarity.

About the author

Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.

His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.

Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.

Interested in sharing your story? We'd love to talk.

Fully Present: How Ketamine-Assisted Therapy Helped One Woman Out of Depression

By Greg Ferenstein

Michelle* lived with constant anxiety that she would explode during an argument and enter into a months-long depressive episode. She’d tried so many strategies to manage her mental health, from group discussions to cognitive behavioral therapy, but nothing seemed to work well.

“Most of the therapy I’ve done just kind of muted my symptoms mostly, but I am still walking around with heavy, heavy depression and really terrible anxiety.”

Depressive episodes would socially paralyze her.

“I wouldn’t feel like I had any energy to do anything. I’d isolate myself,” she says. “I'm not social. I don't function besides what I absolutely have to function for.”

She could work but that was about it.

Unfortunately, the most effective solutions for her had intolerable side effects. The generic version of Zoloft, Sertraline, managed her major mood swings but came with “horrible” sweats that left her “drenched” in the middle of the night. Perhaps worse, it severed her emotions.

“It made me not care at all,” Michelle recalls. “I just kind of didn't feel anything.”

After her doctors recommended trying a higher dose, she went looking for something else. Her friends said good things about ketamine, a dissociative psychedelic that is known to help people confront painful topics and manage a range of mental health conditions, including depression.

Michelle was nervous. She had some not-so-positive experiences with psychedelics when she was younger. Even though it was years ago, she didn’t like the idea of losing control of her mind.

The therapists at Numinus made her feel more at ease with their Emotion-Focused Ketamine-Assisted Psychotherapy, which pairs intensive emotional management and trained mental health professionals with multiple rounds of in-person ketamine sessions.

The Ketamine Experience

The psychedelic portions of ketamine treatment typically last an hour and many people report hazy dreams representing unprocessed challenges.

After years of therapy, Michelle believed she knew the source of what she might encounter: being abandoned by her mother as an adolescent and subsequent years in-and-out of near homelessness.

Instead, her most healing psychedelic experiences were simple and pleasant experiences.

She remembers telling her husband, “Maybe this is what it feels like to feel normal.”

The simple absence of anxiety was profound. After one session, she burst into tears.

“I just started crying and crying and crying,” she recalls. “I really felt like it helped me release those emotions, and relieve some of that pain and all of the struggle that I had when I was a child with my family.”

During another psychedelic experience, Michelle set an intention and drifted into a meditative state, daydreaming of swimming. Usually, when water was involved in Michelle’s dreams, it was a nightmare drowning sensation. This watery dream, though, was superbly healing.

“I have been a hyper-vigilant person, always looking for the next thing to crumble in my life,” she says. “But with ketamine, just to even have that feeling that I'm okay—and that I'm happy—was huge for me.”

Introspection, fewer explosions, less depression

In the three months since Michelle had her first ketamine treatment with Numinus, she has learned to better manage her emotional triggers.

One example stands out. Because of their shared traumatizing past, her family has had a tendency to set her off. But the last time they had a fight, Michelle recalls being able to remove herself from the argument, sensing that she was about to explode, and embrace her feelings without becoming overwhelmed by them.

“It's getting easier for me to recognize, even in conversation.”

She feels more in touch with her emotions, and if things start feeling really bad, she can discuss her emotions openly in a way that defuses the situation.

Her relationship with her husband has improved and she is no longer burdened with extended bouts of depression. She’s made incredible progress, but Michelle still struggles with explosive episodes and depression. So, she continues to go in for occasional ketamine treatments.

But she no longer needs antidepressants.

“It has really, really, honestly been the only thing that has helped me feel normal without taking a pill every single day.”

*Michelle is a pseudonym. Some quotes edited for clarity

About the author

Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.

His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.

Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.

Healing My Worth: How Ketamine-Assisted Therapy Helped One Woman Out of Depression

By Greg Ferenstein

 

Sarah* couldn’t understand why she felt such debilitating depression. On paper, she seemed to be doing everything right. She practiced yoga, ate well, and was raising two well-adjusted children. Her supportive family and healthy lifestyle helped her overcome a difficult cancer treatment, yet she was consumed by dark ruminating.

“I find myself constantly apologizing to everyone,” she recalls, of the crippling self-doubt that led to serious suicidal ideation.

Intuitively, she knew people loved her, but couldn’t stop her reaction to apologize as never being good enough for her family. Sometimes, the mere gentle embrace of her husband would send her into a sobbing fit.

“My kids were scared when I got really suicidal,” she admits.

Traditional therapy and medications had been somewhat helpful. One of the anti-depressants that she tried, specifically, Zoloft, took the edge off of otherwise brutal, constant rumination.

“I was more stable—I was much more approachable.” With Zoloft and talk therapy, Sarah’s relationships were more manageable. She could work, raise her kids, and not break down crying around her husband.

But, eventually, the trade-offs from Zoloft, and anti-depressants generally became too much. First, Sarah’s cancer medications interacted poorly with Zoloft.

Second, it strained relations with her husband in unexpected places like the bedroom. “There’s kind of a sexual dampening effect.”

Her husband wanted to be desired physically, but as an emotional ‘zombie’, Sarah just couldn’t feel it.

“I wasn’t filling that need for him because I wasn’t feeling it within myself,” she recalls. “I wanted to feel well, but I also wanted to feel everything.”

Eventually, Sarah’s therapist proposed a relatively new psychedelic pharmaceutical treatment, ketamine, a widely used surgical general anesthesia known to have potent antidepressant effects. In the dreamlike state of this powerful analgesic, patients can often process memories that are too painful to deal with normally.

Sarah’s initial ketamine treatments were positive, but they did not seem to alleviate her issue, nor did they help her understand the source of the depression.

So, she decided to try a new ketamine provider, Novamind, a growing mental healthcare company specializing in psychedelic-assisted therapy. Having treated thousands of patients using various ketamine therapies, Novamind was uniquely equipped to address Sarah’s challenging situation. In her case, Novamind providers used Emotion-Focused Ketamine-Assisted Psychotherapy or “EF-KAP”. EF-KAP is a special type of ketamine-assisted psychotherapy that focuses on helping patients learn to identify, cope with, and transform emotions related to their mental health condition. It is based on principles found in Emotion-Focused Therapy, an approach to psychotherapy that clinical research has shown is very effective.

A transformational visualization

Initially, Sarah remembers feeling “terrified” of psychedelics. Her fears ran the whole gamut of disaster scenarios, from suffering a hypothetical permanent psychosis to simply not ‘returning’ to her normal psychological state of being able to care for her family.

“I’m kind of a control freak,” she says.

But, she was desperate and willing to trust in the confidence of her mental health team.

Under Novamind’s care, Sarah recalls the trip that transformed her mental health. Sitting in a comfortable chair and dimly lit room, a ketamine IV was placed in her arm and she drifted off into a state that felt like the semi-conscious awareness of waking up from a long sleep.

In her dream, a building stood out in the middle of a big, cosmopolitan city. She peered in and could empathize with the hundreds of families seen through the windows. Soon, she witnessed the glow of different family members dissolving from what looked like divorce. But, it wasn’t a sad occasion, as each person floated into another room with a new, loving family unit.

To Sarah, this was a revelation: as the child of a difficult divorce, she realized how the scars of feeling unloved during her parents’ separation never fully healed. But, in her psychedelic vision, she understood separation as a natural part of life.

“My energy can now leave and go flow elsewhere.” Sarah did not have to take the scars of being unloved from her childhood into her role as a mother. “I equated trying to be perfect with getting love.”

She says that she could choose to accept the unconditional love of her husband and children, even if she is imperfect.

No more apologizing or suicidal thoughts

Sarah recalls feeling unusually pleasant in the days after the experience. Her first assignment was to ditch her knee-jerk reaction to apologize—and it worked.

She was determined to be “more mindful every time I wanted to say ‘sorry’.” Instead, she knew, “I could just show up and be enough.”

Soon, relations at home improved. Before the therapy, Sarah had become physically estranged from her husband, who had stopped being affectionate for fear of triggering a depressive episode. But, now, he could embrace her with a loving hug. It was the little things like this that gave her more confidence and began the road to repairing intimacy in her marriage.

Initiating intimacy ran both ways: now that she felt a fuller and more intense range of emotions, Sarah is comfortable in her body. She is less judgmental about her weight and image. In the bedroom, she enjoys connecting and is less likely to cover under the sheets.

“Years of eating disorders and body dysmorphia, and body shame had prevented me, for a long time, from really being present in my body.”

Sarah still has shaky days, but is staying vigilant in her practice of mindfulness. She finally believes, at her core, “I’m worth being here”.

Exploring the nuances of what worked

Sarah was no stranger to psychedelics; she’d experimented liberally years ago with LSD and psilocybin, both of which are known to have antidepressant properties in therapeutic settings. And, she had come to Novamind recently for ketamine treatments.

So, what was different about this particular transformation experience?

Novamind’s Dr. Stephen Thayer, who oversaw her care, credits two things in particular to the healing process.

First, Sarah was instructed how to ‘recall’ her psychedelic experience in her everyday life as a method of integrating the insights she learned while on ketamine. During challenging times, Sarah takes a moment to breathe and mindfully reflect on these insights, allowing her to emerge fortified and less self-critical. Dr. Thayer describes this process as following breadcrumbs back to insights first encountered during the ketamine experience.

Second, both Dr. Thayer and Sarah credit the unobtrusive talk therapy during the trip with a trusted counselor.

In many ketamine infusion clinics, clients go through the experience without supportive psychotherapy.

Sarah’s case is a fascinating example of why this kind of support may be crucial to the healing process. Ordinarily, she admits, anxiety would get the best of her and she would feel the need to do anything else but sit with her difficult emotions. That guidance involved open-ended questions, invitations to be curious, and reminders that she was safe. Being invited to describe the visualizations mid-trip helped uncover the meaning of the dream-like state and gave her the courage to dive deeper into the experience.

For Sarah, it made all the difference.

*’Sarah’ is a pseudonym. Some quotes edited for clarity.

About the author

Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.

His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.

Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.

Motivation To Heal: How Ketamine Has Helped One Woman Deal With an Eating Disorder

By Greg Ferenstein

Joan was desperate to overcome an eating disorder, which she had been struggling with since adolescence.

The disorder was unfortunately more than dangerously low weight; she didn’t have the energy to live her life and do what she loved most like hiking or traveling.

This spiralled into depression, anxiety and suicidal ideation.

Eating disorders are a major mental health challenge. According to the National Association of Anorexia Nervosa and Associated Disorders, a staggering 9% of the global population struggles with some form of eating disorder. Consistent with Joan’s experience, an estimated 26% with the condition attempt suicide.

The pandemic has been especially challenging for those suffering from mental health conditions and may have exacerbated the incidences of those struggling with eating disorders.

Joan tried many treatments, including a longer term residential program. But the coercive nature of being committed in a facility left her fearful to try more intensive, traditional medical services.

So, like many people, she turned to less traditional services in the psychedelics underground with facilitators who could help her cope with mental illness using unapproved drugs.

“I've done psilocybin to LSD,” she says.

Given that there is no regulation or oversight, the psychedelics underground can be a precarious place.

After an underground session with MDMA, a synthetic compound currently in final stages of FDA clinical trials, Joan said she developed some important sense of self-acceptance.

“It's the first time I was able to look at myself in a mirror,” she recalls. Previously she had so much self-loathing for her appearance.

The psychedelic experiences convinced her that she could focus on her health.

Eventually, Joan met someone from Cedar by Novamind and decided to go for a few sessions of their Emotion Focused Ketamine-Assisted Psychotherapy (EF-KAP).

Novamind recently published a case series of patients undergoing ketamine-assisted therapy for eating disorders and found promising results. “The seemingly rapid response in mood to ketamine treatments observed in some cases is congruent with previous studies of ketamine for depression,” concluded the report.

Joan’s experience seems consistent with the report’s results. In total, she had two sessions.

“Something shifted in me,” she says.

Sometimes people experience intense visualizations in a ketamine experience, but not always. After one of the sessions, Joan remembers calling her mother and being more open to new ideas.

“I was able to think about things more rationally and just hold ideas that I couldn't have held otherwise.”

Since those sessions, Joan says that she gets less “freaked out” about eating more calories per day. Previously that sort of idea frightened her, but less so after the ketamine sessions.

And she is currently becoming more comfortable with the idea of gaining weight.

“I don't have to gain a ton of weight. But I want to have a little bit more energy to do some of the things I used to do, like hiking and traveling.”

*Joan is a pseudonym. Some quotes edited for clarity

About the author

Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.

His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.

Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.

Rooted in Love: How Ketamine-Assisted Therapy Helped a Frontline Worker Overcome Anxiety and Burnout

By Greg Ferenstein

Christine* had finally managed to get her acute anxiety and depression under control and wean off a decade-long reliance on antidepressants. But when COVID-19 hit in 2020, she became increasingly overwhelmed. Though she had a huge stack of responsibilities—as a mother of three, a wife, and a frontline clinical therapist—Christine was debilitated by constant ruminating fears that she would fail her responsibilities.

“How do you help people when you also feel like you’re drowning?" she remembers thinking.

In her personal life, Christine struggled with a lack of self-worth, which impacted her husband and child.

“I just wouldn't show up as my best self, so I'd be more irritable with them—more easily frustrated with them—even though I was really frustrated with myself.”

The fear and tensions caused further distance from those she loved; she experienced serious physical intimacy issues with her husband, and in social situations, she found herself turning inward rather than being the energetic friend she wanted to be.

Christine began to isolate more and more, describing her collapse inward as a practice of self-care.

“I remember just taking multiple walks a day, just trying to get out of the house.”

Ironically, these attempts took her away from her responsibilities and worsened her mental health challenges.

Feeling defeated, Christine decided to go back on her antidepressant medication to manage her depression. While the medication gave her more energy to be productive, it exacerbated other problems.

“It was really good at helping my depression, but it had the side effect of increasing my anxiety if my dose was too high. And so, there was a lot of playing around with dosages, and I never ever really found something that felt really good.”

The Ketamine Experience

Christine was desperate for a better solution. A few of her therapy clients had told her about their experience with psychedelic-assisted psychotherapy, in both the underground and with ketamine in clinics.

“I had literally never taken any sort of substance to change my state at all. I really had no idea what to expect.”

Christine was still nervous to try psychedelics by herself, but a colleague had told her about a positive experience at Novamind, a psychiatry clinic that specializes in ketamine-assisted psychotherapy. As a frontline worker affected by the stress and trauma of the COVID-19 pandemic, she qualified for their ongoing clinical pilot program for group therapy, where she and two others would undergo three sessions of oral and intramuscular ketamine, guided by a licensed psychotherapy team.

Ketamine, a dissociative anesthetic, can bring patients into a daydream-like state where their mental health challenges morph into insightful visualizations.

Going into her first psychedelic experience, Christine had set the intention of processing her issues of “enough-ness” and expected to find an answer detailing why she was an amazing caretaker. Yet, she got quite a different insight.

Christine began to see images of a large tree, which felt as though it represented a long lineage of caretakers, supporting both her and those she loved.

“What the ketamine kind of showed me was how I was actually connected. And I was a part of something much larger. And for me, that was my ancestry. So, I had these visualizations of seeing myself from above and having this family tree.”

Christine, for the first time, began to realize that she was not the only thing protecting her loved ones or her patients.

“I think it really comes down to this sense that I'm not alone and that these things are not just on my shoulders.”

Christine had placed unrealistic burdens on herself as a mom and as a therapist. She realized she could be imperfect and ask for help and this was enough.

Christine also notes that the group aspects of the therapy were essential to integrating these insights into her life.

“They also had some really powerful experiences, and they could understand maybe the weirdness.”

Psychedelic insights can be unusual. For Christine, it was vital to be surrounded by people like herself who understood the experience and why it was meaningful.

A More Confident Christine

Christine is happy to report that she is fully off her antidepressants and feeling much better.

She finds herself lashing out less in irritation at her family. As a therapist, she finds herself more present and grounded with her clients.

“I feel like my nervous system is a tool that I use with my clients and the more regulated I can be and the more I can feel myself in a grounded place, I can show up better for my clients. So, I do think that I'm giving better quality service.”

Perhaps just as important, she feels more vivacious and connected in her social life.

“In those social situations, I find myself sharing more and being more engaged, worrying less about saying the right thing or something that they wouldn't necessarily want to hear. And coming home or coming away from most situations and not being nearly as drained as I had been over the past few years.”

Christine credits new mindfulness skills with her continued mental stability. During one of her more intense psychedelic journeys, she experienced a so-called “ego death”, which she describes as an out-of-body feeling where she could independently observe different parts of her psyche.

During this daydream, Christine could hear the chatter of her negative, depressive, and judgmental self. "When are you going to post about this on Instagram?" she remembers hearing. But as a disembodied observer, she began to understand that these judgmental ruminations were a part of her psyche trying to care for her.

She could listen to the judgmental and worrisome voices without letting fear overcome her.

Now, when she begins to involuntarily ruminate, she’s better able to practice a form of mindfulness and experience a sense of objective awareness of the voices.

“Even significant family issues can be resolved and those feeling that come from that can be resolved in just a matter of hours, versus something that persists. And I ruminate on and it sticks with me for a very long time, and just kind of keeps me in that bogged down stuck place.”

Overall, Christine is feeling less anxious and depressed. She hasn’t resolved all the issues (she still sees a counselor with her husband) but is grateful for the progress made.

“I loved the entire structure of the experience.”

*Christine is a pseudonym. Some quotes edited for clarity

About the author

Greg Ferenstein is the founder of Frederick Research, a mental health innovation consulting firm. His research has been widely covered in leading publications, including the New York Times, The Brookings Institute and The Washington Post.

His field investigations in mental health have been supported by respected technology companies, from Google.org to Lyft and his public policy papers have influenced bills at the U.S. federal and state level.

Prior to founding Frederick Research, he taught statistics for journalists at the University of Texas and received a Masters in Mathematical Behavioral Sciences.

Julie Andrews: "Therapy Saved My Life"

Depression, more common than either cancer or heart disease, is the leading cause of ill health & disability worldwide, yet 50% of people with depression don't get treatment.

1 in 4 people will face mental illness at least once in their lifetime, but why do governments only invest 3% of their health budgets in mental health?

Going to a therapist or psychiatrist should be as normal as going to your family doc when you have the flu. Even though it's getting better, the stigma is still out there. So, you can imagine how pleased we were to hear about this conversation on The Late Show with Stephen Colbert:

"Colbert asked Andrews about the decision to discuss her history with therapy in Home Work. Andrews' first stint in therapy took place after her separation from her first husband, when "my head was so full of clutter and garbage." Mike Nichols, who she admired for being clear-headed, was going to therapy and so she gave it a try. As for why she shared this with readers, Andrews replied, "The truth is, why not, if it helps anybody else have the same idea? These days, there's no harm in sharing it, I think everybody knows the good work it can do."

We need to talk more about our mental health. We get this message from society that asking for help is weak, but maybe society needs some therapy. Therapy is cool, psychiatry is rad, and working on your mental health is a sign of strength, not weakness. It's showing up for ourselves so we can be there for the other people in our lives too.