Inducing Non-ordinary States of Consciousness in Psychiatry: Ketamine-assisted Psychotherapy  Jennifer Montjoy (Resilience Behavioral Health Solutions; PhD Candidate University of Arizona, Col, TUCSON, Arizona )   C5

There are currently few efficacious treatment options for complex developmental trauma and post-traumatic stress disorder (PTSD) and sequelae associated with these conditions (e.g. anxiety and depression). This shortfall in mental healthcare is exemplified by the more than 6,000 veteran suicides that have occurred each year for the last twelve consecutive years. Suicide is currently the second leading cause of death among 18- to 34-year-olds in the United States. Of those who seek treatment for depressive symptoms, approximately 30% do not experience symptom remission and current estimates of treatment resistant depression (TRD) are approximately 67%. Consequently, those with no or minimal treatment response experience daily functional impairment and poor quality of life with an estimated societal economic burden of $200 billion per year. The recent resurgence of psychedelic research and published findings offer new hope for potential treatments of numerous mental health conditions, including trauma-related symptoms and treatment-resistant conditions, often related to traumatic stress. The purpose of this presentation is to discuss how ketamine, currently the only legal psychedelic available for clinical use, can be utilized at sub-anesthetic doses with concurrent psychotherapy; a modality termed ketamine-assisted psychotherapy (KAP). Practitioners of KAP consider the dissociative effects of ketamine as beneficial, not undesirable side effects. Tenets of the KAP modality are to promote contemplation, integration, and to facilitate subsequent transformation. Most clinics offering ketamine for the treatment of psychiatric conditions are not incorporating concurrent therapy, consequently, missing an invaluable opportunity to facilitate transformative healing experiences. KAP utilizes principles from psychedelic-assisted psychotherapy (PAP) to work with clients during non-ordinary states of consciousness. PAP emphasizes intention, mindset, and setting to optimize the likelihood of transformative experiences, also termed journey, during the psychoactive post-administration phase of the molecule. This psychotherapeutic approach uses a complex, non-linear modality for treating mental health conditions, which is a deviation from the reductionist symptom-management practices currently employed in mental healthcare. The ketamine-induced non-ordinary state of consciousness allows the defensive parts of participants' psyches to temporarily go off-line, facilitating varied subjective experiences. Clients describe reunions with their authentic [non or pre-traumatized] selves, others recount a psychospiritual journey including near-death experiences and/or the presence of spiritual deities (e.g. Christ, Buddha). For many, these powerful ketamine-induced experiences catalyze psychological and psychospiritual healing. Additional research is needed in determining the longitudinal efficacy of KAP. There are data supporting psychiatric symptom remission for 6 months or more post-KAP treatment; however, some clients have been found to benefit from periodic maintenance KAP sessions. As discussed, mindset and setting are critical components of KAP; replicating this in a sterile research setting with non-therapeutically trained facilitators will yield unreliable findings. Thus, longitudinal and protocol-guided research in therapeutic settings is merited.