Group Ketamine-Assisted Therapy: A Therapist's Musings

Group Ketamine-Assisted Therapy From The Perspective Of A Therapist


When I first started bringing up the idea of group ketamine therapy to my patients as a potential option, I did so somewhat timidly, often prefacing the conversation with “ok, now hear me out” or “I know it sounds strange…group therapy but with ketamine”. This was in part because the idea and execution of it was new to me, my hopes for positive outcomes were still a hypothesis and in part, because the patients I spoke with about it were immediately incredulous and skeptical, not only of group therapy work, but also of throwing a consciousness-altering medicine into the mix. After seeing firsthand the positive outcomes of group sessions that my co-facilitator and I have led, and working closely with facilitators of other groups with similarly outstanding results, I approach the group ketamine conversation differently: with confidence and earnest convictions of the benefits for those who bravely enter this space.

I will say here what I say to my patients who I think are a good fit but who are skeptical of this model: healing happens in groups. Yes, individual work is important, and for some people that individual work needs to happen first before entering a group space, but for generations across time, across cultures, and across the world, healing has happened in communities, when we witness and are witnessed in this process and we begin to embody the sense that we are all connected in more ways than we ever dreamed.  

During the medicine sessions, this is not group talk therapy, although we are together in the same room each person is having their own experience with the medicine. Typically, everyone is wearing eyeshades and music is playing while at least two facilitators carefully watch over the group, providing support when needed, but mostly leaving participants to explore their own innate ability to heal themselves, with support from others. All are welcome in this room, laughing, crying, and complete silence, it is all ok and requires no explanation.  

When we have shared experiences of transcendence, of entering the depths of sorrow, of embodying joy and playfulness, of connecting deeply with those around us, we find that we are better able to do those things in our everyday lives: with our families, our friends, and our community. We are able to bring these learnings back to those we love, facilitating a deeper connection with others, and ourselves.  And for those who feel they lack those relationships in their lives currently, practicing this kind of vulnerability opens the door of possibility that community is not only possible but accessible. Connection often doesn’t just happen in the culture we currently live in, it's not a given - it must be sought out and practiced. Coming together in a group with a shared purpose gives each of us the opportunity to practice vulnerability and connection with others in ways we are not often afforded in our everyday lives.  

I know I keep referring to “we” and “us”.  I have done this because we come into this group together. The group is not a service we as therapists and medical providers are giving to you. We are in this place together, learning and growing along with you, and for that we thank you for taking this leap.  




If you're interested in learning more about our Group Ketamine-Assisted Therapy sessions, visit our webpage. 

If you're in the Utah area, we are leading Group Ketamine-Assisted Therapy sessions focused on chronic and serious illness at our Murray Clinic starting October 9th. One-on-one intake visits are currently open until October 4th. To learn more or to book your spot email INFO-UTAH@NUMINUS.COM or call 1 (801) 369-8989.



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 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 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 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 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 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 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.

How Ketamine Facilitates Healing

by Dr. Reid Robison, MD MBA

If you haven’t checked it out yet, I highly recommend Michael Pollan’s 2018 book How to Change Your Mind. It’s a deep dive into the history, research, and resurgence of psychedelics as a valid modality of psychiatric treatment.

In chapter 5, Pollan explores what brain imaging has been teaching us about the effect of psychedelics on the brain. One of the most notable findings is that psychedelics lessen the activity of a series of neurological pathways in the brain known as the Default Mode Network (DMN).

The DMN serves a multitude of functions in navigating our daily lives and plays a major role in how we define the self (our definition of who we are), very similar to what is often referred to as the “ego.”

The DMN is also often referred to by psychologists as “The great orchestrator of the brain.” Let’s explore how psychedelics, like ketamine, affect these DMN functions and discuss why these effects can facilitate healing.

Where does the mind go when it is not occupied by an immediate task?

Individuals suffering from depression may default to ruminations or feelings of worthlessness. People suffering from substance abuse may default to thoughts of guilt or the urge to use. Those battling eating disorders may default to obsessions with control and relentless thoughts about body image. People suffering from anxiety may default to an unrelenting need to get things done and have everything perfect.

This list could go on and on. For individuals whose minds tend to wander to such places, psychedelic medicine may help. Ketamine and other psychedelic medications reduce the activity of the DMN, allowing the mind to daydream in a different way and form new pathways for the brain to use.

A psychedelic experience can act as welcome reprieve from the unrelenting negative thoughts that many battle every day. It allows for a chance to cognitively and emotionally interact with life in a new way, and see ourselves with a fresh perspective.

The Self
The way each of us defines ourselves is wildly complex. In our brains is the wiring for thousands and thousands of rules and definitions that make up our unique experience of self (who we are).

Embedded in our sense of self are the rules and defense mechanisms for how we deal with things like guilt, shame, grief, and trauma. Many of our defense mechanisms were written in our minds when we were very young and entirely without our awareness.

Defense mechanisms that may have protected us as children may now only serve to drive our negative self-image. In a psychedelic experience, as the DMN is dialed down, the overpowering definitions of self are softened. This allows us to see and possibly even define ourselves in a new way. The ruts and trenches of how we think about ourselves are filled in and new definitions of who we are materialize and are given a chance to flourish.

The Great Orchestrator
Our brains receive and process enormous amounts of information. As a child, this information is not filtered. Over time, however, our brains learn to create short cuts and filter out extraneous information through a process called specialization.

This process is seen in language acquisition and motor skill development, as well as an assortment of other skills essential to daily life. As a part of specialization, the DMN comes online and orchestrates the cognitive short cuts or filters that are essential to daily life.

The downside to this is that the cognitive short cuts and filters imposed by the DMN make it more difficult to see the forest from the trees, so to speak. If we are perpetually seeing ourselves or the world in a negative way, then turning down the DMN through the use of psychedelics may facilitate new insights into life and a reframing of a negative self-image into a more honest and kinder one.

Mental health problems steal peace away from us in a myriad of ways. One of the most powerful tools for combatting this is found in our perception. Many people with mental illness wish they could change their reality.

To one degree or another, we all have a list of “I could-be-if…” statements. The problem with these statements is that they often give our power away. The world is never going to be perfect, but there is more than enough joy in it to have a rich and fulfilling life regardless of circumstances.

I once heard a man in a Narcotics Anonymous meeting share that he felt addiction could be defined as the inability to accept life on life’s terms. I think this profound statement can be expanded beyond the world of addiction to the struggles of life faced by many.

Ketamine may be a viable tool that enables us to come to terms with the world as it is. By quieting the DMN and its rigid response to the world, ketamine facilitates seeing our world and the suffering in it in a new way.

Reid Robison

About the author

Reid Robison, MDA MBA is the Chief Medical Officer at Novamind. He is a board-certified psychiatrist who was named Best Psychiatrist in Utah by Salt Lake City Weekly’s Best of Utah Body & Mind 2020.

Dr. Robison is the co-founder of Cedar Psychiatry and serves as the Medical Director for the Center for Change, a leading Eating Disorder center. He was previously a coordinating investigator for the MAPS-sponsored MDMA-assisted psychotherapy study of eating disorders.

Mallory Talks Ketamine on the Latest Episode of Diagnosis Explained

Did you know that anti-depressant medications only help 3-5/10 people?

And did you know that our very own Psychiatric Provider, Mallory Danielson, PA-C, has a popular and super informative podcast called Diagnosis Explained? 🙂 On the latest episode, we get to learn about ketamine and esketamine (Spravato) and how it can start helping your depression within only a few hours!

New Research Behind Ketamine’s Molecular Process

At Numinus, we’ve watched ketamine help our patients, and we’re witnessing it change the landscape of psychiatry for good. Compared to traditional medications, ketamine has rapid antidepressant effects, often evident within an hour. For people with treatment-resistant depression, ketamine has shown 50-70% response rates. And we know that here at Cedar. We’ve seen it.

Scientists are rushing to understand the molecular process that makes ketamine so fast-acting and effective. This new research from Sweden focuses on serotonin, which has long been implicated in depression. Researchers studied a specific serotonin binding site and found that after ketamine treatment, patients had an increase in serotonin 1b receptors. While this illuminates a particular aspect of the molecular mechanisms behind ketamine’s efficacy, the total process is still evolving. Concluding the study, the scientists called for more research to help us understand this powerfully therapeutic drug.

We know intimately the low clinical response rates and delayed onset of action of traditional antidepressants, and while they help for some, others need alternatives. That’s why new treatment options are vital. It’s why we stay up to date on current studies and host research of emerging neuropsychiatric treatments—it’s why our Principal Investigator and founder Reid Robison MD MBA has led over 100 clinical trials.

Call us anytime at 1-833-NUMINUS (686-4687), we’re here to help.