Ketamine, Psychedelics, and Psychotherapy: Reframing, Redefining, Renaming Treatment Models

Summary & key facts

Researchers looked at the growing use of ketamine and other psychedelic drugs for mental health care and found the field is confusing. Studies and clinics call the psychological side of treatment many different things. The researchers say this makes it hard to tell what part of treatment actually helps people. They propose three clear ways to name treatments so doctors, regulators, and patients can better understand whether the drug itself, the drug experience, or a talking therapy is doing the work.

Key facts:

• Many clinics now offer ketamine-based treatments, but the science behind how those treatments are described and tested is mixed and unclear.
• Studies often do not clearly say whether a talking therapy was a full, manualized therapy, only basic education and support, or special help that tries to make sense of the drug experience.
• Because of these mixed methods, it is hard to know whether the drug alone helps, whether the drug’s psychological effects are necessary, or whether the talking therapy is the main active part.
• To fix this, the authors propose three clear definitions: one where the drug is used just for its chemical effects, one where the drug’s acute psychological effects help psychotherapy, and one where the drug is paired with a structured ther
• The authors say better, clearer definitions and more rigorous clinical trials are needed so patients and regulators can judge which treatments work and why.

Abstract

There has been a renewed interest in the use of various psychedelic agents as potential therapies for multiple psychiatric conditions, including post-traumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), to name a few. This follows the recent accumulation of evidence for ketamine pharmacotherapy and a rapid proliferation of clinics/programs offering a variety of ketamine based treatments. A quick glance at the existing evidence, however, reveals a confusing scenario for patients, healthcare providers, and regulators. Overall, there are no standard definitions of what constitutes a psychotherapeutic intervention within a psychedelic-based or a ketamine-based treatment. More specifically, studies have not always distinguished between using a well-known, manualized psychotherapy, providing psychoeducation and psychological support, or providing a therapy specifically to integrate the drug experience in psychedelic trials. Also, it is difficult to determine the role of the psychedelic agent as a stand-alone treatment, and the relative importance (if any) of the psychedelic experience for the desired therapeutic effect. In this perspective, we discuss the evolving landscape of psychedelic-based and ketamine-based treatments, highlighting different therapeutic models, their methodologies, and the need for clearer definitions and rigorous clinical trials. The document proposes three new definitions to improve clarity in evaluating the effects of these agents and the role of psychotherapies. We suggest language that will distinguish: (1) when the drug is used for its pharmacologic effects as a stand-alone treatment, without requiring the psychedelic experience or combined psychotherapy; (2) when the treatment requires the acute psychological effects of the drug to assist psychotherapy and (3) When ketamine or a psychedelic agent is used in combination with a structured, manualized psychotherapy that could be implemented even in the absence of these agents. We hope that this new terminology and definitions will help distinguish the various therapeutic roles of these agents (as stand-alone treatments or in combination with psychotherapies), and facilitate study designs, regulatory pathways, and more informed patient care.Plain Language Summary TitleKetamine, Psychedelics, and Psychotherapy: Understanding treatment models to better inform practice.

Topics

Diverse academic research themes Forensic Toxicology and Drug Analysis Psychedelics and Drug Studies

Categories

Clinical Psychology Psychology Social Sciences

Tags

Anxiety CLARITY Clinical psychology Drug Intervention (counseling) Ketamine Major depressive disorder Medicine MEDLINE Mental health Mindfulness Pharmacotherapy Psychiatry Psychoeducation Psychology Psychopathology Psychotherapist Variety (cybernetics)

Substances

Ketamine Other

Conditions & symptoms

Anxiety Depression PTSD Anxiety or worry Feeling disconnected from others Sadness or low mood