Ketamine-Assisted Psychotherapy (KAP)

I offer a therapeutic modality called Ketamine-Assisted Psychotherapy (KAP) in

partnership with an organization called Journey Clinical in California.

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. I take on the

psychotherapy portion of the experience while Journey Clinical’s medical team

supports you on all medical aspects. This includes determining eligibility, developing a

custom treatment plan, prescribing the medicine, and monitoring outcomes. Below is

more information about KAP to help you navigate and decide whether it may be a good fit for you.

kAP

Ketamine-Assisted Psychotherapy:

Janice partners with the medical team at Journal Clinical to jointly provide KAP to our clients. The medical portion of KAP appointments is billed separately through Journey Clinical.

KAP FEES FOR IN-OFFICE, IN-HOME, AND VIRTUAL SESSIONS

Intake session | 45 Mins $249

in-office or virtual

KAP Preparation sessions:

1-3 sessions | 53 mins $249

depending on the individual situation

90-min session | $349

KAP initial dosing session | 2.5-3 hours

with integrated EMDR, Brainspotting, and/or IFS as appropriate):

per session | $900

in-home in San Francisco Bay Area; travel fee will be added for other areas in California

per session | $750

in-office in San Francisco

per session | $700

virtual in California

KAP DOSING SESSIONS FOLLOWING YOUR INITIAL SERIES (ALSO REFERRED TO AS "MAINTENANCE SESSIONS | 2 Hr

with integrated EMDR, Brainspotting, and/or IFS as appropriate):

Per session | $600

in-home in San Francisco Bay Area; travel fee will be added for other areas in California

per session| $498

in-office in San Francisco

per session | $448

virtual in California

KAP Integration sessions (golden hours to make long-lasting positive outcomes from KAP dosing session is 24-72 hours post-dosing):

53 min session | $249

90 min session | $349

in-office or virtual

Does insurance cover?

* Insurance might cover 53-minute preparation and integration sessions, but dosing sessions are fully out of pocket.

* Sliding scale slots are available.

* KAP groups help save money and are offered periodically. If interested, please email Janice directly to be added to the list: JHuang@PresentMomentWellness.org

KAP Treatment Series

The recommended treatment series:

2 Prep sessions | 90 mins
6 - 8 KAP dosing sessions
and 6 - 8 Integration sessions | 90 mins

Janice provides 20% off if paying in full upfront for the treatment series (~$1,500 - $2,000 off)

FAQ

RECENT research on KAP for depression, anxiety, and trauma.

What makes ketamine-assisted psychotherapy effective for depression, anxiety, and trauma?

Biological Mechanisms:

NMDA Receptor Antagonism:Ketamine is an NMDA receptor antagonist, promoting synaptic plasticity and rapidly enhancing connectivity in brain areas critically involved in mood regulation.

BDNF Increase:Ketamine triggers an increase in brain-derived neurotrophic factor (BDNF), fostering neurogenesis and synaptic connections, aiding in the alleviation of depressive and traumatic symptoms.

Psychotherapy Component:

Integration and Contextual Understanding:Psychotherapy helps individuals process and integrate the dissociative experiences or insights gained during ketamine sessions. This contextual understanding fosters sustained therapeutic growth.

Emotional Release and Reprocessing:Psychotherapy can guide patients through emotional release, enabling the reconsolidation of traumatic memories in a safer, more controlled environment.

Neuroplasticity and Cognitive Flexibility:

Enhanced Neuroplasticity Post-Ketamine: Studies like Dore et al. (2019) and Rodrigues et al. (2021) emphasize ketamine's role in augmenting neuroplasticity, which psychotherapy leverages to inculcate healthier cognitive and emotional patterns.

Set and Setting:

Treatment Environment:The therapeutic environment, emphasizing safety and support, helps maximize ketamine's positive psychological effects.

Therapeutic Alliance:A strong, empathetic therapeutic relationship can make a significant difference in how patients assimilate and apply their ketamine-experience insights into their daily lives.

1. Is KAP effective in treating depression, anxiety, and trauma?

Study 1: Wilkinson, S. T., et al. (2018).

This study explored the effects of ketamine on depression. They found that ketamine showed a rapid antidepressant effect within hours or days, as opposed to the weeks required for traditional antidepressants. This rapid response is pivotal for patients with severe depression.

Study 2: Feder, A., et al. (2014).

In a randomized controlled trial, patients with PTSD showed a significant reduction in symptoms after ketamine treatment compared to a placebo. This study augmented the burgeoning evidence that ketamine could be an effective intervention for trauma-related disorders like PTSD.

Study 3: Grunebaum, M. F., et al. (2018).

A double-blind, randomized, placebo-controlled trial found that ketamine significantly reduced suicidal ideation in patients with major depressive disorder (MDD). Since suicidal ideation is closely related to both depression and anxiety, this finding is crucial in understanding ketamine's broad impact.

Study 4: Dore, J., et al. (2019).

This qualitative study included a cohort undergoing KAP for major depressive disorder and generalized anxiety disorder. Patients reported substantial improvement in mood and anxiety levels, with many highlighting the psychotherapy component as essential for sustaining these benefits.

Study 5: Rodrigues, G., et al. (2021).

This meta-analysis of multiple studies on ketamine's impact on depression and anxiety disorders confirmed the substance's effectiveness. Notably, the analysis called for further research to delineate the psychotherapy component's role in these outcomes.

Frequently Asked Questions

Please reach us at jhuang@presentmomentwellness.org if you cannot find an answer to your question.

What is Ketamine?

Ketamine is a legal, safe and effective medicine used to treat a variety of mental

health conditions, including depression, anxiety and PTSD. Ketamine has

rapidly-acting antidepressant and mood-enhancing effects, which can begin to

take effect within 1-2 hrs. after treatment and last for up to 2 weeks. It works by

blocking the brain’s NMDA receptors as well as by 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 symptom improvement. Ketamine can be administered in a variety of ways, including IV infusion,

intramuscular injection, via nasal spray and using sublingual lozenges. In my

work with Journey Clinical we only use the sublingual lozenge form.

How Does Ketamine Feel?

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. Your motor and verbal

abilities will be reduced, so you’ll be lying down in a comfortable position during

the experience. Once these effects subsided, we’ll spend the remainder of our

appointment giving you space to process and discuss your experience. While it

may feel hard to articulate what happened during the experience, patients feel

like the insights gained are none-the-less clear. Studies have shown that the

benefits to mood and neurological growth can last up to two weeks after the

Ketamine experience.

How Does Ketamine-Assisted Psychotherapy Work?

Initial consultation with Journey Clinical

1. You schedule an initial evaluation with a clinician from the Journey Clinical

medical team via zoom. They will go over your medical and psychiatric

history with you, provide education on the treatment and determine if you

are eligible for KAP.

2. If Journey Clinical’s medical team determines that you are eligible for KAP,

they will develop a personalized Ketamine prescription and outcome

monitoring plan for you.

3. Journey Clinical’s medical staff will write a ketamine prescription for you, and a small amount of oral ketamine will be sent to your home, enough for

the first 2 KAP sessions. You will be taught to take your vitals and self-administer the ketamine lozenges by Journey Clinical’s medical team in advance of our KAP sessions.

What are Preparation Sessions like?

Once you receive your ketamine lozenges, we will schedule time together

for our 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 our KAP sessions together.

What can I Expect During and after the KAP Dosing Session?

A typical ketamine dosing session lasts between 2-3 hours and can take

place either in-person at my office, in your home or remotely via telehealth.

During a dosing session, you will self-administer your ketamine lozenge

either in my office or in your home. 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, I will be

present with you the entire time to hold space and provide support as

needed.

I might incorporate Internal Family Systems (IFS), Eye Moment Disensazation and Reprocessing (EMDR), Brainspotting, or Acceptance and Commitment Therapy (ACT) after you complete your internal journey to support your processing based on your goals and experience.

Integration Sessions:

After our KAP dosing session, we will meet for multiple integration therapy

sessions to review the memories, thoughts & insights that arose during

your dosing session, and to prepare for the next dosing session.

Follow-up consultations with Journey Clinical:

After our first KAP session, Journey Clinical’s medical team schedules

regular follow ups with you to monitor outcomes and prescribe ketamine

lozenge refills, as appropriate. The frequency of follow ups depends on

your unique treatment plan, at a minimum of once per quarter.

Common Side effects?

Ketamine has an extensive record of safety and has been used at much higher doses for surgical anesthesia, without respiratory depression. As with any medication, there are also some potential side effects and risks to consider. Our setting and medical monitoring are intended to minimize ketamine’s side effects as much as possible.

● Effects of ketamine may include nausea, brief, transient increase in blood pressure, changes in perception and visual, tactile, and auditory processing, feeling suspended in space or floating, and falling sensations. Synesthesia (a mingling of the senses) may occur. Perception of time may also be altered.

● Other possible adverse effects may include dizziness/lightheadedness, sedation, slurred speech, mental confusion, excitability, diminished ability to see things that are actually present, diminished ability to feel objects accurately (including one’s own body), diminished awareness of physical functions such as respiration, headache, anxiety, and vomiting (although rare).

● Due to the risk of nausea and vomiting, patients will be advised to refrain from eating for at least 4 hours before a session.

● Due to possible blurred and altered vision, as well as impaired balance and coordination, you will be advised to remain lying down and keep your eyes closed (as long as you are comfortable doing so) or use the eye mask provided until the main effects have worn off.