Anxiety disorders are the most common type of mental disorders in the United States. An estimated 31% of American adults suffer from some kind of anxiety disorder in their lifetime – that’s over 80 million people. Anxiety disorders are more common in women and in people aged 18-60. About 57% of people with anxiety experience moderate to severe impairment to their life.

There are different “flavors” of anxiety: panic disorder, generalized anxiety, social anxiety, phobias, separation anxiety disorder, and selective mutism. All of them involve feeling some kind of worry or dread or fear in situations where such emotions are not rationally warranted.

Even obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) used to be considered anxiety disorders because anxiety is such a huge part of their presentation, but they have since been reclassified into their own categories.

To be diagnosed with generalized anxiety, the person has to have the following symptoms:

Excessive anxiety and worry about a variety of topics and situations that is very difficult to control and accompanied by at least three of the following symptoms:

Edginess or restlessness
Fatigue
Poor concentration or feeling as though the mind goes blank
Irritability
Increased muscle aches or soreness
Difficulty sleeping

What Is Treatment-Resistant Anxiety?

There is no official, agreed-upon definition of treatment-resistant or “refractory” anxiety. It is sometimes defined as having tried at least two different medications typically used to treat anxiety for an adequate amount of time without success. A better definition would also include trying therapy for anxiety without success.

Some studies suggest that about 30% of people with anxiety disorders have the treatment-resistant kind. Others say that only about half of people with anxiety respond to any kind of treatment. Clearly the rates of refractory anxiety are high.

People with treatment-resistant anxiety have usually tried at least one antidepressant and possible benzodiazepines as well as therapy such as cognitive behavioral or exposure therapy without experiencing significant relief from symptoms.

Up until recently, people with treatment-resistant anxiety had basically no options other than to keep trying different medications and talk therapies. However, now there is light at the end of the tunnel: ketamine-assisted therapy.

What Is Ketamine-Assisted Psychotherapy (KAP)?

Ketamine-assisted therapy or KAP is a modality where the person uses ketamine in a therapist’s office while being supervised by the therapist. The treatment involves a thorough assessment by both the therapist and the medical team as well as preparation and integration sessions led by the therapist.

During medicine sessions, the person takes the ketamine orally (under the tongue) and goes on a “journey” that may have psychedelic qualities.

Note that this approach is drastically different to doing ketamine on your own or in a party setting. The difference lies in intentionality, supervision, and integration of the experience with a trained mental health professional.

How Can Ketamine-Assisted Therapy Help Treatment-Resistant Anxiety?

A study of ketamine-assisted psychotherapy found that anxiety symptoms improved for almost 90% of the participants, with 30% reporting having no symptoms after four sessions. The response rates were better than antidepressants, traditional talk therapy, or IV ketamine.

A review of 18 studies involving using ketamine for treatment-resistant anxiety all showed great response and remission rates after just a few ketamine sessions. It is important to note that anxiety symptoms do return for many people who try ketamine; however, all of these studies only administered ketamine without any therapy.

Currently, there are no randomized controlled studies combining ketamine with EMDR therapy, but both are considered highly effective for anxiety on their own. Case studies seem to show that bringing the two together provides a much more lasting relief. This is possible at Courage to Heal Therapy.

How Does Ketamine-Assisted Therapy Work?

It’s important to know that KAP is a form of therapy where you may feel more vulnerable than in other settings. So, it is crucial to find a therapist who is a good fit and with whom you feel completely comfortable. After all, the quality of your relationship with your therapist is 7 times more important to your outcomes than the type of approach they use.

As such, the process should begin with you interviewing your prospective therapist! At Courage to Heal Therapy, we schedule free online video consultations for 15 minutes so you can chat with your therapist and determine fit (can be longer if needed).

If it’s a good fit – and if you pass some basic screening questions – you get to meet the medical team at Skylight Psychedelics virtually. They handle all the medical stuff, including prescribing the ketamine and advising you on buying a blood pressure monitor, which you will need for ketamine sessions.

Then, you have an assessment session where you will get to know your therapist, go over the consent forms, and answer questions about your background and reasons you want the treatment. You will set goals that can be reviewed after treatment is completed. After this, the treatment can be separated into preparation, ketamine sessions, and integration.

Preparation

Your treatment will involve at least one preparation session – more if the therapist deems that necessary. Most people need 1-3 preparation sessions. During these sessions, the therapist assesses your ability to “focus inwards” and access calm states of mind and body – then teaches you any skills you need to do that.

Mindfulness is a big part of preparation, and you will have homework to practice mindfulness at home. It is important to take this homework seriously as it will ensure a smooth ketamine experience. You also set your intentions during preparation. Intentions refer to your “set” or mindset and are an integral part of ketamine-assisted therapy.

Ketamine Sessions

Ketamine sessions are usually two hours long and held in late afternoon since you won’t be able to drive or operate machinery afterwards. You must ensure you have a ride to and from the ketamine sessions for this reason. THE AFTER-SESSION RIDE CANNOT BE A RIDESHARE OR TAXI.

During the session, your therapist will make sure you are comfortable, at ease, and in a positive state of mind before self-administering ketamine. You will set an intention specific to the session, choose a mantra to repeat if needed, and prepare yourself in accordance with mindfulness skills you learned during preparation. You will also take your own blood pressure as ketamine cannot be used in cases where hypertension is present.

If you feel ready to proceed, you will take the ketamine by placing it under your tongue and waiting for absorption (10-15 minutes). You will be resting on a couch or a mattress with a weighted blanket and an eye mask for the duration of your journey (usually 45 minutes to an hour). Your therapist will have a playlist for each session that will enhance your experience.

When you come out of your journey, you will remain with the therapist until you have a steady gait and can orient yourself to time and space. Your therapist will once again ensure your comfort and ease as you transition out of your psychedelic experience.

At Courage to Heal, we partner with Skylight Psychedelics and use their protocol of six ketamine sessions with an option to add four maintenance doses.

Integration

Some people choose to have their integration sessions immediately after the medicine sessions, others prefer to wait up to two days afterwards. While it’s possible to go for longer, you don’t want to wait too long to best take advantage of neuroplasticity afforded by ketamine.

During integration sessions, the therapist is there to assist you in making sense of your ketamine experience and the effect it had on your inner world and your view of the outside world. If you are choosing to combine ketamine-assisted therapy with EMDR therapy, this is when EMDR would be done.

Typically, you will need one integration session for each ketamine session although some people may choose more integration (this is especially true for EMDR therapy).

In Conclusion…

Ketamine-assisted therapy is an excellent new way to address treatment-resistant anxiety in just six ketamine sessions (with appropriate assessment, preparation and integration sessions). While results can never be guaranteed, current research tells us that ketamine-assisted therapy is effective against treatment-resistant anxiety for most people who try it.

How Do I Get Help Now?

If you are ready, schedule a free 15-minute consultation now. You can also contact us or call (720) 340-2327.

Ketamine-Assisted Therapy for Treatment-Resistant Anxiety