Getting Started with Ketamine-Assisted Psychotherapy (KAP)

Getting Started with Ketamine-Assisted Psychotherapy (KAP)

by | Jun 12, 2023 | Ketamine-Assisted Psychotherapy

Ketamine-Assisted Psychotherapy (KAP) is a holistic modality in which ketamine is used as a complement to psychotherapy to help eligible patients experience more frequent breakthroughs and sustained improvement in symptoms. Sustainable Wellness takes on the psychotherapy portion of the experience, while Journey Clinical’s medical team supports you on all medical aspects of the process. This includes determining eligibility, developing a custom treatment plan, prescribing the medicine and monitoring outcomes. Below is more information about KAP to help you explore whether it may be a good fit for you.

What is Ketamine?

Ketamine is a legal, safe and effective medicine used to treat a variety of mental health conditions, including depression, anxiety and post-traumatic stress disorder (PTSD). Ketamine has rapid-acting antidepressant and mood-enhancing effects, which can begin to take effect within 1-2 hours after treatment and last for up to two weeks. Ketamine works by blocking the brain’s NMDA receptors and stimulating AMPA receptors, which are thought to help form new synaptic connections and boost neural circuits that regulate stress and mood. Ketamine has also been shown to enhance overall neuroplasticity for lasting improvement of symptoms.

Ketamine can be administered in a variety of ways, including IV infusion, intramuscular injection, nasal spray and sublingual lozenges. Our team at Sustainable Wellness only uses the sublingual lozenge form at this time.

What is Journey Clinical?

Journey Clinical is a platform for licensed psychotherapists to incorporate science-based psychedelic therapies in their practice safely and effectively. Journey Clinical’s in-house medical team takes on patient eligibility, prescriptions and outcome monitoring, allowing KAP-trained clinicians the opportunity to provide the psychotherapy components of KAP treatment. Journey Clinical’s collaborative care model is designed to deliver personalized treatment plans to meet your individual needs and improve long-term outcomes.

What does Ketamine feel like?

The effects of ketamine, which most patients find pleasant, last for approximately 45 minutes. These effects can make you feel “far from” your body and facilitate shifts in perception that can often feel expansive in nature. Patients lie down in a comfortable position during the dosing experience, as verbal abilities are reduced.

Once the effects of ketamine subside, your KAP-trained therapist spends the remainder of the appointment giving you space to process and discuss your experience. While it may feel hard to articulate the experience, patients often find clarity in their gained insights. Studies have shown that the benefits to mood and neurological growth can last up to two weeks after the ketamine dosing experience.

What to expect from the KAP process.

1. Initial consultation with Journey Clinical

  • Your first step is to schedule an initial evaluation with a clinician from the Journey Clinical medical team. These consultation appointments are conducted via Zoom. A member of Journey Clinical’s medical team will review your medical and psychiatric history, provide education on the treatment, and determine your eligibility for KAP.
  • If the medical team determines that you are eligible for KAP, they will develop a personalized ketamine prescription and outcome monitoring plan for you.
  • A medical staff member will write a ketamine prescription for you, which will then be sent to your home or local pharmacy for pick up. Your first prescription will include enough medicine two KAP dosing sessions.
  • You will receive instructions by the medical team on how to take your vitals and self-administer the ketamine lozenges during your KAP dosing sessions.

2. Preparation sessions

  • Once you receive your ketamine lozenges, you will schedule time to meet with your therapist for KAP preparation, dosing and integration sessions. Preparation session(s) will be scheduled just like regular therapy sessions prior to the KAP dosing session. The goal of a preparation session(s) is to align on the process and set intentions for your KAP experience.

3. KAP dosing sessions

  • A typical ketamine dosing session lasts for about three hours and can take place either in-person at our office, or remotely via telehealth. You will be in charge of self-administering your ketamine lozenge.
  • You will be in a comfortable, reclining position wearing an eye mask and listening to calming music.
  • Although a KAP dosing session may be largely an internal experience, your therapist will be present with you the entire time to hold space and provide support as needed.

4. Integration sessions

  • After your KAP dosing session, you and your therapist will meet for multiple integration therapy sessions to review the memories, thoughts and insights that arose during your dosing session. You will also prepare for the next dosing session.
  • Your first integration session will be scheduled within 72 hours, preferably the next day, to maximize the ketamine’s impact on your therapy process. 

5. Follow-up consultations with Journey Clinical

  • After your first KAP session, Journey Clinical’s medical team schedules regular follow up medical consultations with you to monitor outcomes and prescribe ketamine lozenge refills, as appropriate. The frequency of these follow up appointments depends on your unique treatment plan, though they’re scheduled once quarterly at minimum.

What is the cost of treatment?

As you learned above, first-time patients require an initial medical consultation with Journey Clinical, and follow-up consultations are required at least once quarterly. Your first ketamine prescription will include enough medicine for at least 2 dosing sessions with your therapist. Your follow-up prescriptions often include enough medicine for 4-6 KAP dosing sessions. You can find the latest information about Journey Clinical’s medical consultation and prescription fees here. Although the medical intake and follow-up appointments through Journey Clinical are not covered by insurance, they are eligible for out-of-network reimbursement.

Fees surrounding the psychotherapy portion of your KAP treatment will depend on your treatment needs and goals, as well as the modalities used by your individual psychotherapist. Our most current psychotherapy KAP fees at Sustainable Wellness are listed on our Rates page here. While our dosing sessions are not covered by insurance, your preparation and integration sessions may be eligible for in- or out-of-network reimbursement, depending on your insurance provider and plan.

Contact us at 585-206-2631 or hello@sustainablewellnessny.com to inquire about our KAP services, or submit a message through our Contact Form and someone will follow up with you within 48 buisness hours.

Helpful resources.

Paradigms of Ketamine Treatment by Raquel Bennett, Psy.D. for MAPS

Ketamine Assisted Psychotherapy (KAP): Patient Demographics, Clinical Data and Outcomes in Three Large Practices Administering Ketamine with Psychotherapy, a research study by Jennifer Dore et al, 2018.

Ketamine for Depression and Mood Disorders by Erica Zelfand, ND for Townsend Letter

Ketamine-Facilitated Psychotherapy for Trauma, Anxiety, and Depression by goop

Ketamine-Assisted Psychotherapy with Jonathan Sabbagh of Journey Clinical, Psychology Talk Podcast

How to Activate the Vagus Nerve

How to Activate the Vagus Nerve

by | Apr 17, 2022 | Grounding Exercises, Trauma, Vagus Nerve

The Vagus Nerve is one of the cranial nerves that connects the brain to the body. It represents a main component of the parasympathetic nervous system, which oversees an array of crucial bodily functions, including our mood, immune response, digestion, and heart rate. A stimulated vagus nerve can produce powerful health benefits, making it an attractive target in treating psychiatric and gastrointestinal disorders.

How to Activate the Vagus Nerve

Belly breathing. One of the main ways to stimulate the vagus nerve is through deep, slow belly breathing. The moment we anticipate stress in any form, most of us stop breathing and hold our breath. This activates the fight-flight-freeze response; which often also increases pain, stiffness, anxiety, or fear. To practice deep breathing, inhale through your nose and exhale through your mouth. Breathe slowly (aim for six breaths per minute) and deeply, from the belly. The exhale triggers the relaxation response, so also aim to exhale longer than you inhale.

‘OM’ chanting. Effective ‘OM’ chanting is associated with the experience of a vibration sensation around the ears and throughout the body. It’s expected that this sensation is also transmitted through the auricular branch of the vagus nerve, which supplies sensory stimulation to the skin of the ear canal, tragus, and auricle. To chant, hold the vowel (O) part of the ‘OM’ for 5 seconds then continue into the consonant (M) part for the next 10 seconds. Continue chanting for 10 minutes. Conclude with some deep breathing and end with gratitude.

Cold water face immersion. Cold water face immersion can be a simple and efficient means of immediately accelerating the parasympathetic reactivation via the vagus nerve. In other words, it helps to reduce the heart rate, motility of the intestines, and turns on the immune system. Remained seated and bend your head forward into a basin of
cold water. Immerse your face so that the forehead, eyes, and at least two-thirds of both cheeks are submerged. Hold your breath for as long as you can, then come up, exhale, inhale and dunk again. Repeat as many times as you need to until you calmer. The most the average person should need to dunk their head is 4 times in one session. *NOTE: Do NOT try this technique if you have a heart condition.

Increased salivation. To stimulate salivation, try relaxing and reclining in a chair and imagine a juicy lemon. As your mouth fills with saliva, just rest your tongue in this bath. Relax and notice your hands, feet, hips, neck and head all relaxing. Breathe deeply into this feeling and stay there as long as you can. If you are having trouble producing saliva, you can also fill your mouth with a small amount of warm water and rest your tongue in this bath. The simple practice of relaxing will actually stimulate the secretion of saliva.

Sing, hum, or gargle loudly. The vagus nerve is connected to our vocal cords and the muscles in the back of our throats. Singing, humming, chanting and gargling can activate these muscles and stimulate the vagus nerve.

Foot massage. When gentle or firm massage is applied to the feet, it can stimulate the vagus nerve and, in turn, stimulate all the organs of the body promoting a sense of wellbeing.

Laugh. A good laugh can lift your mood, boost your immune system and – you guessed it! – stimulate the vagus nerve.

We can help!

Our bodies have a natural ability to heal. Our entire team at Sustainable Wellness is trained in trauma-focused modalities, including techniques that assist with supporting the vagus nerve. We are passionate about helping our clients build insights and heal from the root.  Contact us at hello@sustainablewellnessny.com or 585-206-2631 to begin your healing journey.

The Nervous System’s Role in Trauma

The Nervous System’s Role in Trauma

by | Feb 25, 2022 | Grounding Exercises, Trauma, Vagus Nerve

The nervous system controls every function in our bodies and is the direct pathway to one of our most important organs: the brain. Nerves that branch off the spinal cord relay information between the brain and body, allowing us to self-regulate and function in our daily lives.

The nervous system is made up of three major parts:

  • Central Nervous System. Consists of the brain and spinal cord.
  • Peripheral Nervous System. Includes the head and spinal nerves.
  • Autonomic Nervous System. Includes both the sympathetic and parasympathetic nervous systems, which control proper function of organs and involuntary movement (ie. heartbeat, breathing, reflexes, digestion and healing.

The Regulated Nervous System

On any given day, our nervous systems experience a combination of both stress and calming responses. Perhaps you recently rushed to get somewhere (stress) and then relaxed when you arrived on time (calm). Or, maybe you slammed on the brakes to protect yourself while driving (stress) only to return to a calmer state after avoiding a crash.

When we can regulate ourselves by shifting between these states of stress and calm, we’re within what Dr. Dan Seigel calls our “window of tolerance.” When people are within their window of tolerance, they’re within a zone that allows them to receive, process, and integrate information and otherwise respond to the demands of everyday life without much difficulty.

The Impact of Trauma on the Nervous System

Trauma pushes the nervous system beyond its ability to self-regulate, making it incredibly difficult for someone to stay within the window of tolerance. For many, this activate nervous system gets stuck “on.” When a system is overstimulated like this, it stays in fight-flight mode, often leading to experiences of anxiety, panic, anger, hyperactivity, and restlessness. This fight-flight response is the body doing what it knows how to do: get ready to move and protect from threat.

Some nervous systems will stay activated in this state of hyperarousal, while others will dip below the window of tolerance and become stuck “off” – or freeze mode. In this state, we see symptoms of depression, fatigue, dissociation, disconnection, “zoning out,” and lethargy. 

Our nervous systems can get stuck in states of hyperarousal and hypoarousal for prolonged periods of time, or they can vacillate between the two.

How to Self-Regulate the Nervous System

When we learn to work with our nervous systems, we build our ability to self-regulate and even build a wider window of tolerance, which allows us to move through the world feeling more grounded and connected to others.

Below are some healthy ways to help our nervous systems stay in – or more easily return to – the window of tolerance:

 

  • Seek safe relationships. Being with someone who feels safe and soothing helps us feel more settled and connected. Humans are social creatures, and we heal through relationships. While you don’t need to be around people all the time, if you find yourself isolating or pulling away, seek out people who feel supportive.
  • Find a trained trauma therapist. Finding a therapist who you trust and is also skilled in understanding the relationship between trauma and the body can help you better understand and connect with your nervous system.
  • Recognize your own window of tolerance. If you are someone who identifies with any of the above-mentioned symptoms of hyperarousal or hypoarousal, you are probably living outside your window of tolerance. Start building awareness to how you feel at different times of the day, around certain people, and while doing certain activities. Notice whether you’re more anxious, more shut down, or more calm. All of this can help you build awareness to your body’s shifts.
  • Activate your Vagus Nerve. The vagus nerve represents the main component of the parasympathetic nervous system, which oversees a vast array of crucial bodily functions, including control of mood, immune response, digestion, and heart rate. Use these strategies to help support your vagus nerve.
  • Learn what calm looks like for you. It’s important to recognize whether your system needs to be soothed or stimulated – and if these needs occur at different times. For some, calm may look like being alone and staying still, while others may find peace in light movement like walking or yoga. Explore what works best for you.
  • Get in tune with your body. When you’re feeling stressed, take a moment to notice how you feel physically. Where do you feel the stress in your body? What does it feel like? Let yourself fully experience this for as long as you can. If you start to feel overwhelmed by focusing on the distress directly, focus on a small part of the stress instead.  
  • Practice mindful breathing. Simply put, breathing has the capacity to calm the brain and regulate the nervous system. Trauma responses are connected to the brain stem (which helps us with physiological regulation) and the limbic (emotional) brain. Mindful breathing helps connect a basic physiological process (breathing) with your prefrontal cortex (thinking brain), which helps to integrate and shift our neurological state. 

We Can Help!

Our bodies have a natural ability to heal. Our entire team at Sustainable Wellness is trained in trauma-focused modalities, including techniques to help calm the nervous system. We are passionate about helping our clients build insights and heal from the root.. Contact us at hello@sustainablewellnessny.com or 585-206-2631 to begin your healing journey.

Comparing EMDR Therapy and Brainspotting

Comparing EMDR Therapy and Brainspotting

by | Feb 13, 2022 | Brainspotting, EMDR therapy

Our team at Sustainable Wellness has a special passion for getting to the root of our clients’ symptoms and struggles. Two of our favorite treatment approaches, EMDR therapy and Brainspotting Psychotherapy have both similaries and differences. Read more about them below.

Similarities between EMDR and Brainspotting

Both utilize Bilateral Stimulation (BLS).

Bilateral Stimulation is any type of stimulation that occurs on both sides of the body. Bilateral stimulation is used to activate and integrate information from the brain’s two hemispheres. In both EMDR and Brainspotting, the stimulation occurs in an alternating rhythm. BLS serves to create balance between the right and left hemispheres of the brain, which enhances a feeling of calm in the body. This helps to lessen the activation of distressing memories and change the brain’s wiring related to that memory.

Examples of bilateral stimulation include using alternating right to left stimulation such as tapping on the knees, legs or shoulders, tapping toes or feet on the floor, or eye movements. 

Both focus on the eyes and eye movements. 

Research has consistently found that eye movements lower the vividness and emotionality of memories, and intrusive thoughts of negative memories. While EMDR and Brainspotting have different ways of focusing on the eyes, both use the eyes to help clients effectively process distressing trauma memories and ongoing pain.

Both use specific evidence-based research protocols. 

In EMDR, the process that the therapist follows is called a protocol. In Brainspotting, it’s referred to as a set up. Both of these treatment approaches make note of physical and emotional activation in the body using the Subjective Unit of Disturbance (SUD) scale.

Both use resourcing and grounding.

EMDR and Brainspotting both have methods for helping to ensure that clients are grounded and resourced. It’s not uncommon for resources to naturally show up in an EMDR or Brainspotting session. 

Therapists have to be specially trained to conduct both approaches. 

EMDR and Brainspotting therapists both go through extensive specialized training, which involves understanding the neurophysiology of trauma and the brain. As part of these (separate) trainings, therapists learn how to focus on a client’s thoughts, memories, physical sensations, and emotions as a core part of the healing process. 

Differences between EMDR and Brainspotting

Eye movements and eye positioning are different.

With EMDR, clients eyes are directed to move from side to side following a moving light or their therapist’s fingers. Bilateral stimulation may also occur using alternating sounds or tones, or through tappers, which are small vibrating paddles that buzz alternatively in the client’s hands (tactile stimulation).

In Brainspotting the eyes remain largely fixed on a particular spot (or spots). Brainspotting clients often use biolateral sounds, which are specifically designed to play alternatively in headphones. Many clients find these sounds to be relaxing. At times, the specific soundtrack can naturally evoke certain emotions or memories. Bilateral stimulation, however, is optional with Brainspotting as it’s not the component that makes Brainspotting work.

Each uses different devices to support therapy.

EMDR therapy and Brainspotting both use devices to support the therapeutic modalities. If you’re used to talk therapy and/or new to these approaches, these devices may look strange at first. EMDR’s devices might include a light bar, tappers or headphones to enhance bilateral stimulation. Brainspotting may include a wand, goggles or headphones. Either way, these help to enhance clients’ processing of information 

The protocols have some differences. 

While it’s not a client’s responsibility to understand the protocols or set up of these therapies, it may be helpful to know there are slight differences in each approach. As of the time this blog post was written, each of our therapists who are trained in Brainspotting are also trained in EMDR therapy. So, they’ll know how to navigate these protocols to best suit your personal needs.

Interested in trying either EMDR or Brainspotting?

Our bodies have a natural ability to heal, even through PTSD and complex trauma. You can read more about EMDR therapy and Brainspotting below, or check out our other specialized services here. 

There is no shame in seeking the treatment you need. Contact us at 585-206-2631, or at hello@sustainablewellnessny.com to begin your healing journey.

Five Senses Exercise

Five Senses Exercise

by | Dec 10, 2021 | Mindfulness, Sleep

This “Five Senses” exercise is a quick and relatively easy exercise to bring you to a mindful state quickly. It can be applied to almost any situation and conducted anywhere. The goal is to shift your attention to your body and away from your thoughts and environment.

Five Senses Exercise

Follow the below guidelines to practice the exercise:

Notice five things that you can see. Look around and bring your attention to five things that you can see. Pick something that you don’t normally notice, like a small crack in the wall or a fallen leaf in the yard. 

Notice four things that you can feel. Bring awareness to four things you are currently feeling, like the texture of your clothing, the feeling of the breeze on your skin, or the smooth surface of a table you are resting your hands on.

Notice three things you can hear. Take a moment to listen. Note three things that you hear in the background. Again, try to find things you don’t normally notice like the chirp of one specific bird, the faint sounds of nearby traffic, or the silent hum of an appliance in the next room.

Notice two things you can smell. Bring your awareness to smells that you usually filter out, whether they’re pleasant or unpleasant. This may be the smell of pine trees if you’re in nature, grease from a fast-food restaurant across the street, or body odor from a person sitting next to you on a train. 

Notice one thing you can taste. Focus on one thing that you can taste at this moment. Sip a drink sitting in front of you, chew a piece of gum, or observe the taste left in your mouth from your last meal. You might eve try opening your mouth to taste the air.

What is Mindfulness?

Mindfulness is our ability to focus on the present moment with curiosity and without judgement. Practicing mindfulness has several benefits, including increased empathy and compassion, improved immune functioning, improved sleep, greater focus and concentration, and reduced anxiety and stress.

Mindfulness resources

For additional resources, check out our:

  • library of books on Mindfulness, all hand picked by our Sustainable Wellness team and clients
  • library of Grounding Tools with a variety of grounding and relaxation videos, skills, and exercises
  • blog posts about Mindfulness