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.  

 

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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.

 

 

The Healing Potential of Psychedelic-Assisted Therapy for Eating Disorders

Eating disorders affect millions of people worldwide, presenting complex challenges that often require comprehensive and innovative approaches to treatment. In recent years, there has been growing interest in the potential of psychedelic-assisted therapy as a transformative tool in the realm of mental health. This blog post explores the emerging field of psychedelic-assisted therapy for eating disorders, shedding light on its promising benefits and the implications it may have for the future of treatment.

Introduction

Eating disorders affect at least 9% of the population, or 70 million people, worldwide[8], and this number is increasing. A review of worldwide data found that eating disorder diagnoses more than doubled from 2000-2018, with the trend was consistent across regions, age groups, and genders.[10]

These conditions are also serious, falling among the deadliest mental illnesses, second only to opioid overdose.[8] Every year, 10,200 deaths occur as the direct result of an eating disorder—that’s one death every 52 minutes.[9]

 

Understanding Eating Disorders

“Eating disorders are a window into the struggle of the soul.”

People don’t choose eating disorders. Nobody wakes up one day and says “I’d like to have anorexia”—If they do, they’re seriously misinformed. Eating disorders aren’t choices, but rather serious multi-faceted and biologically influenced illnesses. An individual may consciously decide to purge or over-exercise at first, but before long, this disordered relationship with food and one’s body can become a deeply-ingrained subconscious pattern that takes on a life of its own. When left untreated, eating disorders can lead to serious, and sometimes life-threatening, physical and psychological consequences, underscoring the urgent need for effective therapeutic interventions.

Thankfully, eating disorder behaviors are learned behaviors and can be unlearned—but it takes time. Everyone has the capacity for full recovery. Part of the work in recovery is to uncover the meaning or purpose behind the symptoms.

 

The Limitations of Traditional Treatments

Conventional treatment approaches, including cognitive-behavioral therapy and medication, have demonstrated some effectiveness in managing eating disorders. However, there are currently no FDA-approved treatment options for anorexia nervosa and only one for bulimia nervosa and binge-eating disorder respectively. While depression commonly occurs with most eating disorders, traditional antidepressants (i.e. SSRIs) often lack efficacy in patients with anorexia. Even when patients are able to take advantage of available treatments, many continue to struggle with symptoms, and relapse rates remain high.

Studies have found that over a third of all patients treated for anorexia or bulimia end up relapsing within the first few years of completing treatment. The highest risk for relapse from anorexia occurs in the first 18 months (about 1 and a half years) after treatment, with 35% falling back into eating disordered behaviors.[1]

While the onset of bulimia usually occurs during adolescence or early adulthood, it tends to persist for several years, either chronically or intermittently. Treatment does help most people with bulimia achieve long-lasting recovery, but relapse still is a significant concern, with rates of up to 41% of former patients resuming bulimic behaviors within 2 years.[2]

Recognizing these challenges, researchers and clinicians have continued to search for new and improved ways to help individuals with eating disorders find more long-lasting and complete healing, including the use of psychedelic-assisted therapy as a potential alternative or complementary treatment modality.

 

The Role of Psychedelics in Healing

Psychedelic substances like psilocybin, MDMA, and LSD have shown promise in facilitating profound psychological healing in individuals dealing with depression, PTSD, substance abuse, eating disorders, and other mental health conditions. Though theoretical mechanisms of action of psychedelic medicines are still being investigated, a growing body of research points suggest that psychedelics create desirable brain states that can accelerate therapeutic processes and make eating disorder interventions easier to receive. The desirable brain states in

 

Research Studies

Group Ketamine-Assisted Therapy for Eating Disorders [3]

This pilot study, led by Dr. Reid Robison, Chief Clinical Officer of Numinus, explored the use of group ketamine-assisted psychotherapy (KAP) in a residential eating disorder treatment facility. 5 individuals with eating disorder diagnoses and comorbid mood and anxiety disorders received weekly intramuscular ketamine injections in a group setting followed by non-drug psychotherapy over 4 weeks.

Regarding the outcomes, the study found promising results. Group KAP was feasible and well-tolerated, with high patient satisfaction and treatment adherence rates. Participants experienced reduced symptoms of depression, anxiety and showed significant improvements in eating eating symptoms and quality of life, with effects persisting at a 6-month follow-up.

Participant quote:

“Trying ketamine allowed me to see the possibility of a life I could have. While the effects did not last, my very first experience snapped me out of a state of life-long, deep disconnection that I didn't even know I had been experiencing. Suddenly, I was able to live in the world in the way people had always described it. Though I am still trying to figure out how to attain that level of connection after catching a glimpse, that one experience was so essential. I could finally feel hunger and fullness cues. I felt what it's like to live in a body, instead of living a short distance from it. I felt connected to others and genuinely cared about their well-being. I felt human for the first time in a long time.”

 

Psilocybin-Assisted Therapy for Anorexia [4]

This study being conducted by Compass Pathways in collaboration with University of California San Diego,  is exploring the safety, tolerability, and efficacy of psilocybin-assisted therapy for patients with anorexia. Preliminary results from 10 participants who received a single 25 mg dose of synthetic psilocybin (~3.5 grams of dried psilocybin) shows:

 

Psilocybin-Assisted Therapy for Binge-Eating Disorder [5]

This Phase II study is currently underway at the University of Florida in collaboration with Tryp Therapeutics and happens to be the first ever psilocybin-assisted therapy study addressing binge-eating disorder. Interim analysis of five early participants has found:

MDMA-Assisted Therapy for Eating Disorder Symptoms [6]

This study investigated the effects of MDMA-assisted therapy on adults with severe PTSD, specifically exploring its impact on eating disorder symptoms. A total of 90 participants with severe PTSD received treatment in a double-blind, placebo-controlled trial. At baseline, 13 participants had EAT-26 scores in the clinical range, and 28 had scores in the high-risk range, despite the absence of active purging or low weight. After finishing the study, there was a significant reduction in total EAT-26 scores in the entire PTSD group following MDMA-assisted therapy compared to placebo. Moreover, significant reductions in total EAT-26 scores were observed in women with high EAT-26 scores (≥11 and ≥20) following the study protocol.

 

Other studies:

 

GROUP PHASE INDICATION STATUS
MAPS Phase II MDMA for anorexia and BED Anticipated start date in 2023
Johns Hopkins Phase I Psilocybin for anorexia Enrollment complete
Imperial College Phase I/II Psilocybin for anorexia Enrollment complete
TRYP Phase II Psilocybin for BED Enrolling
XPIRA Phase II Psilocybin for Anorexia Anticipated start date in 2023
COMPASS Phase II Psilocybin for Anorexia Enrolling

 

 

Integrating Psychedelics with Conventional Models

Integration of psychedelic-assisted therapy with conventional eating disorder treatment requires careful consideration of medical and safety factors, as well as the crucial involvement of specialized eating disorder clinicians. These clinicians have the expertise to navigate the unique challenges and triggers associated with eating disorders, helping patients access and integrate psychedelics in a safe and therapeutic manner. Their involvement ensures a comprehensive treatment approach that combines the benefits of psychedelic therapy with the tailored support required for individuals with eating disorders, leading to more effective and sustainable outcomes. We view the role of psychedelics as an adjunctive to traditional treatments, not a “replacement.”

 

Conclusion

Psychedelic-assisted therapy represents a promising frontier in the treatment of eating disorders, offering new possibilities for deep healing and transformation. While further research is needed to fully understand its effectiveness and establish appropriate guidelines, preliminary studies and anecdotal evidence suggest that this approach holds tremendous potential. As the field progresses, it is essential to strike a balance between innovation and responsible practice, ultimately providing individuals with hope and a path toward recovery from their eating disorders.

 

References

  1. Arcelus, Jon et al. “Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies.” Archives of general psychiatry 68,7 (2011): 724-31. https://doi.org/10.1001/archgenpsychiatry.2011.74
  2. BMC Psychiatry. 2019; 19: 134. Published online 2019 May 6. doi: 10.1186/s12888-019-2112-9
  3. https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-022-00588-9
  4. https://compasspathways.com/comp360-psilocybin-therapy-shows-potential-in-exploratory-open-label-studies-for-anorexia-nervosa-and-severe-treatment-resistant-depression/
  5. https://tryptherapeutics.com/updates/tryp-therapeutics-announces-interim-results-for-its-phase-ii-clinical-trial-for-the-treatment-of-binge-eating-disorder-with-psilocybin-assisted-psychotherapy
  6. https://www.sciencedirect.com/science/article/pii/S0022395622001303
  7. https://pubmed.ncbi.nlm.nih.gov/9797933/
  8. (Ghaderi et al., 2018, Ward et al., 2019)
  9. Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020. Available at: https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.
  10. Galmiche M, Déchelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. Am J Clin Nutr. 2019;109(5):1402-1413. doi:10.1093/ajcn/nqy342

Physician Information — Ketamine-Assisted Psychotherapy

What is ketamine-assisted psychotherapy?

As you will likely know, ketamine is an anesthetic and analgesic used widely internationally. Ketamine also has antidepressant and psychedelic effects at certain doses, and international research has increasingly demonstrated that the combination of ketamine with structured psychotherapy can have benefits for a range of mental disorders. The ketamine assisted psychotherapy protocol at Numinus is distributed over approximately 4-6 weeks, depending on the patient’s schedule and how the visits are scheduled. Generally, the therapeutic protocol is expected to include two 50 minute introductory psychotherapy sessions without the use of ketamine, three ketamine dosing sessions of 2.5 hours in duration each followed within 24 hours by 90-minute psychotherapeutic sessions where insights from the ketamine experience are integrated, and a closing 50-minute psychotherapy (non-ketamine) session. Throughout this process, the psychotherapy delivered is focused on support, integrating insights, and identifying and reinforcing change as part of the therapeutic process.

Who is eligible for ketamine assisted psychotherapy?

Though research indicates that ketamine assisted psychotherapy may be effective for a number of mental health indications, Numinus is currently focused on addressing treatment-resistant depression. If you have a patient suffering from treatment-resistant depression that is interested in ketamine assisted psychotherapy, our team will work directly with them to determine whether the patient is a good candidate for treatment by taking a full medical and psychological history. To be eligible for ketamine assisted psychotherapy at Numinus, the patient must be referred by their primary care providers, such as a family physician or nurse practitioner.

What are the contraindications of ketamine assisted psychotherapy?

Those conditions that may make ketamine assisted psychotherapy contraindicated (i.e., potentially unsafe) include, but are not limited to, a history of psychosis (e.g. hallucinations), mania, cerebrovascular or cardiovascular disease, seizure, and severe liver disease. At present, youth, pregnant women and nursing mothers are not eligible for ketamine assisted psychotherapy since the effects of ketamine on pregnancy, nursing children, and youth are unknown. Additionally, the ketamine product monograph lists other risks which will be reviewed with all patients as part of an informed consent process at Numinus.