If you're a physician, there's a good chance that you may think that psychedelic therapy benefits sound too good to be true. Physicians and other healthcare professionals are asked by patients about their clinical opinion about psychedelic therapies for healing, including legal options such as ketamine and non-legal options like psilocybin, ayahuasca, and MDMA.
It's understandable that clinicians are cautious, if not even suspicious about the speed that psychedelic medicines are emerging in the media and in our culture. But at the same time, the studies are also emerging at rapid pace and with results that we can't ignore.
I felt the same way. But when the literature kept getting published, I started paying attention. I recognized that our current psychiatric treatment options - even in integrative psychiatry - had their limitations. Having tools that improved emotional and spiritual health in new and different mechanisms of actions was more important than listening to my own biases I previously held about psychedelic medicine.
I knew I needed to have an open mind because the need for new therapies was so great and the potential for therapeutic benefit was becoming known.
How does psychedelic therapy fit into physician burnout?
Healthcare providers are becoming increasingly burned out. If you are a physician or other healthcare provider, you know the reasons. You don't need me to write them out for you, because you deeply know.
Physician mental health is a public health issue. We know that if healthcare professionals are unable to adequately care for themselves at home or at work due to their work environments (time, energy, soul, pressures from administration, short staffing), it is very hard for them to continue to do the sacred work of caring for their patients. Many healthcare providers are considering leaving medicine.
Above all, we need solutions that are not focused on the individual healthcare provider but are at the systems and policy level. But it's also important that physicians can heal, feel empowered, and reduce their level of suffering as well.
So where does small group ketamine assisted therapy fit in?
I'll be referencing a case report that was published in 2022 by our Canadian colleagues (Dames, Kryskow, and Watler) to substantiate this post. But from a deep intuitive sense, small group work (whether or not you call it therapy or something else is up to you) for physicians seems to be a potentially profound modality because of the community aspect. You are not alone and there are others - your peers - who understand how you feel, and vice versa.
Being vulnerable with and in the company of our peers is very challenging for us as healthcare professionals but that very thing that is challenging may be what we need most.
Psychedelic therapies have been showing positive outcomes for conditions such as depression, anxiety, PTSD, and end of life distress. Ketamine is the only legal psychedelic medicine in the country and has been used for over 60 years as an anesthetic agent at much higher doses than what we use for mental health reasons. When used in a therapeutic context, ketamine can help individuals experience new insights about themselves (core beliefs, thought patterns, behaviors) and make positive changes in their lives.
The study referenced developed an innovative treatment plan to serve healthcare professionals using group ketamine assisted therapy (KAP) who were experiencing PTSD, chronic anxiety, OCD, suicidality, treatment resistant depression, or substance use disorder AND had a history of previous treatment failure.
The core concepts integrated into the program included:
connection to self and others through the experience of secure attachment,
addressing trauma within an environment of unconditional positive regard
regulating the nervous system
co-regulating through relationship
alignment with one's desires and calling
Over the 12 weeks, group participants joined for 12 sessions, which included preparation sessions, integration sessions, and three group intramuscular ketamine dosing sessions.
Researchers Dames, Kryskow, and Watler shared their remarkable results:
Of those who screened positive for generalized anxiety disorder symptoms (GAD), such as feeling on edge, not being able to stop worrying, trouble relaxing, unable to sit still, irritability, a sense of impending doom, 91% had reduced scores, dropping into a milder category or had significant clinical improvements.
Of those who screened positive for symptoms of depression, such as feeling hopeless, little interest in doing things, sleeping too much or too little, loss of appetite and energy, trouble concentrating, feeling like a failure, and thoughts of being better off dead, 79% had reduced scores that dropped them into a milder category or had significant clinical improvements.
Of those who screened positive for PTSD, such as re-experiencing past, emotional numbness, avoidance of people and activities that remind them of past trauma, difficulty sleeping, jumpy, easily irritated and angered, 86% left the program screening negative for PTSD.
Of those who screened positive for Life/Work Impairments in romantic relationships, family relationships, work, friendships and socializing, parenting, education, and self-care, 92% had significant clinical improvements.
And from a visual perspective:
S, Kryskow P and Watler C (2022) A Cohort-Based Case Report: The Impact of Ketamine-Assisted Therapy Embedded in a Community of Practice Framework for Healthcare Providers With PTSD and Depression. Front. Psychiatry 12:803279. doi: 10.3389/fpsyt.2021.803279
While we can acknowledge that these results are not double blinded, placebo controlled, nor randomized, they are important nonetheless.
We need more solutions and not more lip service for helping physicians experiencing existential distress, workplace moral injury and burnout, depression, anxiety, trauma, and substance use dependency.
Join our 5 week Small Group KAP program for healthcare professionals, personal ketamine retreats, and professional training for mental health clinicians.
Read more about how we utilize ketamine at our clinic at Driftless Integrative Psychiatry, serving individuals living in Wisconsin, Minnesota, and Iowa - as well as those living in any of the fifty states for our personal ketamine retreats.