Why prepare?
The way ketamine works on the brain offers a wonderful opportunity to choose new ways of responding to negative thoughts and feelings, and to make choices in line with what you most value in life.
At Klearwell, we take the view that ketamine is much more than simply a drug which can foster helpful changes in the brain – we believe the altered state of consciousness induced by this medicine and the way you and your therapist put them to use, are crucial to your progress. This altered state comes with a huge variety of experiences – scary, challenging, fun, exciting, weird, revealing, calm, and soothing – all of which can be potentially beneficial in the long run.
This is why it’s important that you prepare in advance and make some adjustments to your life while under our care, to help you make the most of the treatment. Most human societies which have used psychedelics intentionally value the idea of preparation, with good reason. These are powerful medicines – but in contrast to compounds such as SSRI’s, we know that fostering an active relationship with the ketamine and the experience it induces can help promote a sense of agency rather than simply passively receiving the drug and hoping for the best.
It’s also helpful to prepare to let go and trust what happens, before the dose itself. This can be hard for those of us used to trying to control our internal and external lives, but it can help us relate to whatever shows up with curiosity rather than aversion.
You can discuss more with your therapist during your preparation sessions, but we include some ideas here to give a flavour of what can help:
The weeks before the dose:
Schedule for Reflection and Practice
Try to make room in your schedule for reflection, rest and practice of techniques. Our treatment is quite brief – around 6-8 weeks – so choose a period in your life when you can prioritise working on yourself.
Setting Your Intention
Consider your intention for the dosing session – there’s more information on intention setting here.
Seek Support from Friends and Family
Talk with understanding friends or family to help you clarify your intention. There’s no need to obsess about it, though – there’s no right or wrong.
Mindfulness Preparation
Mindfulness can help you prepare. A simple breath focus can help quiet the mind – but if it doesn’t, that’s OK too – just be open to the feelings, experiences, emotions, and insights which arise – pleasant, unpleasant or neutral.
If you have never done formal mindfulness or meditation, that’s fine – simply taking a few minutes each day to notice your thoughts and feelings without other distractions is enough. This 3-minute practice can help you with this: Mindfulness Practice – Three Step Breathing Space.
Limit Substance Use
Limit the use of alcohol or other drugs. But don’t make changes to any prescribed medication unless agreed with our psychiatrist first.
Digital Content Consumption
Try to minimise viewing digital content that is negative, argumentative or violent.
Avoid Stressful Situations
Avoid stressful situations or conversations on the day before and of your dose. It will help to approach difficult situations during treatment, but they’re best avoided just before or after a dosing if possible.
Exercise and Healthy Diet
Exercise and a relatively healthy diet have been shown to increase mental wellness. No need for dramatic new exercise routines or diets, just make good choices as best you can.
Spend Time in Nature
Spend time in nature if possible – a mindful walk in a park can be helpful. Pay gentle attention to your five senses, and notice and allow all thoughts and feelings that show up.
Prioritise Good Sleep
Prioritise a good sleep routine – see whether you can be rested by dosing day. (And if sleep is elusive, no problem!)
Dosing day – before and during the dosing:
What to eat & drink
Eat a light breakfast (eg, a bowl of cereal) and do not eat anything for two hours prior to your appointment.
Limit your caffeine intake (eg, one cup of tea/coffee with breakfast if this is usual for you) and then drink water/caffeine-free drinks.
No alcohol or recreational drugs at all on the dosing day.
What to wear
Wear comfortable clothing. A T-shirt or vest can be helpful, as the nurse can easily access your arm to administer the ketamine injection.
What to expect
You may be asked to give a urine sample when you arrive at the clinic. This is to test for the presence of other drugs and to confirm females are not pregnant.
Your blood pressure will be taken before and after the ketamine administration.
Throughout the session, you will wear a pulse oximeter on your finger. This monitors your heart rate and the level of oxygen in your body.
Dosing day: after the session:
Allow plenty of time after the session to rest and reflect. Clients have had success with the following activities:
Pay attention to your intuition or “gut feelings” after a profound ketamine experience. You may feel like you see or “know” more. That’s your intuition or subconscious communicating with your conscious mind.
Contemplate old routines, habits, and unhealthy behaviours that you want to change.
Express what you experienced through writing or art.
Talk with supportive, trustworthy friends and family. Be careful that their opinions don’t overpower your own interpretation of the experience.
Start a new routine – hiking, exercise, adding more nutrients into your diet, or eliminating something unhealthy from your diet. Take advantage of your more flexible mindset.
Meditate – you might notice new abilities and tools to enhance your meditation practice after your dosing. After facing inner conflict or experiencing deep connections with ketamine, you might notice how meditation can give you a similar experience on demand!
Your integration with your therapist the day after will help you process whatever may have come up.
What to Avoid After Your Dosing
Avoid overstimulation, work, chores, and stressful situations immediately after the dosing. It takes a while to regain normal consciousness and would also waste a golden opportunity for reflection and growth.
Don’t drive or operate machinery on the day of the dosing
Don’t take what you saw and experienced literally – the experience during dosings is often abstract and symbolic like a dream.
Don’t make dramatic life changes immediately. Inspiration and the urge to take immediate action is common after treatments. Concentrate on reasonable and incremental changes. Dramatic changes will often result in stress that is counter-productive to healing so it’s always worth talking through any changes with your therapist.
Find a balance between being patient with yourself, and remembering you are responsible for lasting change.
You will not always have an insightful ketamine-induced altered state, or remember it clearly. Other times in the days after the treatment you might lose the motivation to make the changes you wanted. That is okay. Be patient with yourself, it is a healing journey not a race. As the days go by after your dosing, you may gradually gain greater clarity on the experience that wasn’t immediately available. Your integration session will allow you to plan for changes which are both realistic and meaningful to you.
It is important to also remember that Ketamine allows you to have powerful psychological change, but the change comes from within you. The experience during the ketamine treatment only showed you the power of unlocking your own subconscious and wisdom. The desire and motivation to make the change is the strongest immediately after your infusion and weakens over time. Integration is crucial to extending the benefits beyond the physical effects of Ketamine.
by Dominic Riches, Cognitive Behavioural Therapist at Klearwell.
