 Our last days of summer are here in the Colorado mountains! The aspen trees at higher elevations are beginning to tinge yellow, and the mornings have that whiff of the ending of growth. Even though it has been years since I went to school, I still get excited for the atmosphere of learning that September brings. Memories of cool days and busy coffee shops with intellectual conversations come to mind. I think about my younger self, in the first years of college, searching for the meaning of life, wanting to make a difference in the world, and longing for love and acceptance. I wanted my parents to be proud and supportive, even though I was pursuing a degree in English that I might not use in the future. There is definitely a piece of that younger self with me in late summer -- the one with big dreams, the one that keeps me in check and reminds me to find moments of joy when I get too focused on solving all the problems in my world. One Piece of Advice for Your Younger Self On one recent summer evening filled with conversation about kids and memories, a friend asked me, “Given the opportunity, what one piece of advice would you give your younger self?” Boy, lots to think about there! And what a great question to reflect on knowing what I know now. Today, I ask that question to you. What’s your answer? Given the crystal ball you now have into your past, what have you learned that could guide you? Would you have believed it at the time? I don’t ask you in order to trigger regret but rather to reinforce that what you’ve realized now is so important to you. One thing I would definitely say to myself is to spend more time in nature and to make sure that I use that space to reboot my energy levels. Watch my latest video for a little glimpse of a lovely place where I spent time recharging in southern Colorado. Therapy Exercise As a way to deepen the exploration of what’s important to you, there’s a therapy exercise I like to use with Life Compass Cards, developed by Joanne Steinwachs. You sort 108 word cards that represent values that may or may not resonate with you, using guidance from the exercise instructions and some coaching from the facilitator on how to narrow it down to your top 7 values. I find the exercise useful and also difficult at times. It requires you to let go of those things you may find important but not necessarily the most important to you. It’s a lovely endeavour to do with your therapist or a trusted friend. So whether you are on your own recovery journey or supporting someone on their’s, I encourage you to enjoy the end of this summer and the beginning of the introspective opportunity that fall gives us. Make a plan to spend more time with who and what is important to you, perhaps inspired by that question from my dear friend. And, if your younger self has some advice for you, listen carefully to what that voice says! Check out my website or reach out to me via my contact page. I offer free, 30-minute consultations to new clients.  Of the many things I value about being a clinician who helps persons with eating disorders and their families, the one I perhaps hold most dear is that the clients themselves have been some of my best teachers. I believe in keeping an open mind and being ready to change. A shift that has been happening recently is the use of psychedelic medicines to help with a variety of mental health challenges. Many of these medicines are not legal yet, but the Food and Drug Administration (FDA) has approved trials for them with specific disorders, including a Multi-Site Study for MDMA Assisted Psychotherapy with Eating Disorders.
The Use of Ketamine for Mental Health Challenges One medicine that is linked to psychedelics that is legal is ketamine, a schedule III medication that is not technically a psychedelic but a dissociative anesthetic known for its psychedelic effects at low doses and when emerging from anesthesia.(1) It is used off-label for the treatment of several mental health challenges, including depression, anxiety, substance use, post-traumatic stress disorder, obsessive compulsive disorder, and suicidality. My clients and families began asking about ketamine. When I was working at a world-class eating disorders treatment program, my psychiatric colleagues also began using ketamine for eating disorder cases with treatment-resistant depression. At first, I was skeptical, as ketamine is also known as a club drug with potential for abuse. But from listening to my clients and my observation of their recovery journeys, I could see it was helping them. There is now emerging data and interest in research for the use of ketamine for the treatment of eating disorders.(2) I began to wonder about how to do psychotherapy with the medicine and discovered there was a whole world of ketamine-assisted psychotherapy as well as a very lovely practice of intentional preparation, setting, guided experience, and integration of the medicine experience. Leading the way in this space are Dr. Phil Wolfson, co-author of The Ketamine Papers: Science, Therapy, and Transformation, and his team with Julane Andries at The Center for Transformational Psychotherapy in San Anselmo, CA, where I went to add to my own experiential learning. They describe how ketamine works using the language below: “Ketamine, when taken in a psychotherapy session, can be beneficial. The medication can stabilize patients with severe depression swiftly. Scientists from the University of Texas (UT) have identified the key protein that helps activate the rapid antidepressant effects of ketamine in the brain. Their study, published in the journal Nature, revealed that ketamine inhibits a protein responsible for an array of normal brain functions. The medication blocks the N-methyl-D-aspartate (NMDA) receptor, an ion channel protein and glutamate receptor found in nerve cells. Inhibiting NMDA produces an initial antidepressant reaction. A metabolite found in ketamine is responsible for prolonging the effect’s duration. Stabilization is not the only effect of ketamine depression therapy. The blocking of the NMDA receptor also induces the hallucinogenic responses of ketamine. When taken with proper care, however, the drug may help severely suicidal or depressed patients get effective and fast treatment.” KRIYA Ketamine Research Institute also has a nice reading list here for more learning. Ketamine in Eating Disorder Treatment Because so many of my clients with eating disorders also struggle with co-occurring conditions and the data on ketamine therapy is very compelling, I decided to get training through Polaris Insight Center and offer ketamine-assisted psychotherapy to my treatment of eating disorders. Also notable is that the founder who trained me in Emotion Focused Family Therapy (EFFT), Dr. Adele Lafrance, has developed Emotion Focused Ketamine Assisted Psychotherapy (EFKAP) with Reid Robison, MD. Of course, I was in the first training cohort! Some of the things I find advantageous about ketamine for eating disorder treatment is that, while other psychedelics may last 6 to 8 hours, ketamine effects range from roughly 45 minutes to 2 hours. I also find it to be a gentle, loving medicine that allows for some respite from deeply-entrenched eating disorder thoughts and access to emotions and the heart space that is often difficult for someone with an eating disorder to reach. Combined with psychotherapy, there is a huge opportunity to get into contact with who and what is important to you and set some goals on how to move in those directions. And, thanks to the EFKAP model, there is inclusion of support persons to learn about the process and assist in at-home dosing. So that is a long introduction into announcing that Eating Disorder Intervention will now be offering ketamine-assisted psychotherapy in-person in Golden. If you are interested in this therapy for yourself or a loved one, the first step is to reach out to me and discuss the process. Ketamine has some medical and psychiatric contraindications and is not for everyone. We will need to work with a prescribing provider to do an assessment to determine if the medicine would be an option for your situation. If ketamine is a possibility for you, we will take it slow and get to know each other so that you can build a sense of trust and safety to prepare you for what may be a wonderfully transformative experience. Check out my website or reach out to me via my contact page. I offer free, 30-minute consultations to new clients. 1 Andrew T. Bowdle, Allen D. Radant, Deborah S. Cowley, Evan D. Kharasch, Rick J. Strassman, Peter P. Roy-Byrne; Psychedelic Effects of Ketamine in Healthy Volunteers : Relationship to Steady-state Plasma Concentrations. Anesthesiology 1998; 88:82–88 doi: https://doi.org/10.1097/00000542-199801000-00015 David S. Mathai, MD , Sanjay J. Mathew, MD , Eric A. Storch, PhD , Thomas R. Kosten, MD. Revisiting the Hallucinogenic Potential of Ketamine. June 25, 2018. Psychiatric Times, Vol 35, Issue 6, Volume 35, Issue 6 2 Daniel F. Hermens, Gabrielle Simcock, Megan Dutton, Ana P. Bouças, Adem T. Can, Chris Lilley, Jim Lagopoulos. Anorexia nervosa, zinc deficiency and the glutamate system: The ketamine option. Progress in Neuro-Psychopharmacology and Biological Psychiatry. Volume 101, 2020; 109921, ISSN 0278-5846. https://doi.org/10.1016/j.pnpbp.2020.109921.Esther Dechant, Brian Boyle, Rachel A Ross. Ketamine in a Patient with Comorbid Anorexia and MDD. Journal of Women’s Health and Development 3 (2020): 373-375 Schwartz T, Trunko ME, Feifel D, et al. A longitudinal case series of IM ketamine for patients with severe and enduring eating disorders and comorbid treatment-resistant depression. Clin Case Rep. 2021;9:e03869. https://doi. org/10.1002/ccr3.3869  As we spend the next few weeks in Mental Health Awareness Month, I invite you to consider how you can change your relationship with the thoughts inside your mind. While many of us would like to delete some of our thought content from time to time, it turns out that trying to not think about something or trying to suppress it may have the paradoxical effect of increasing the thought.(1)
That Song in Your Head I like to think of this idea as having a song in your head that you don’t want in your head. I bet you’ve had one, annoyingly looping around your thoughts. Maybe it’s a jingle from a commercial, the echoes of your kids’ favorite program, or just a song from a random space in time that plays in the background of your mind much longer than you want. How do you get rid of it? Can you just tell your mind, “Stop thinking about that song”? Can you grit your teeth, plug your ears, and force it out? Or maybe you try to give it away and tell your buddy, “Hey, remember that annoying song?” Now you’ve just doubled the pain. You might try to listen to another song...and then, it dubs its way into the original song! So how do you get rid of that song in your head? The more we pay attention to the song, the louder, stronger, faster it may present itself and the more likely we are to experience the urgency of wanting to do something about it. The answer is that you change your relationship to it and stop attending to it or trying to force yourself not to have it. You accept that it is there and that it is annoying, and you go about your day. Once it’s gone, you may realize you got rid of it — and there it is again! Acceptance and Commitment Therapy Now, I’d like you to think about the song in your head as similar to the thoughts you may have about yourself that are hurtful or painful. Maybe you have a thought that you are “too much” or “not enough.” Or that you will never succeed or that things are hopeless. Acceptance and Commitment Therapy (ACT) teaches us to just notice those thoughts or stories about ourselves, to make some space for them to just be thoughts without necessarily being the definition of who we are and what is important to us. Debating with yourself and others about whether they are true or not may paradoxically increase the feeling that they are. The more airplay you give to the thought, the more you will be spending time with it, and the louder and stronger it may seem. There is also no need to shame yourself for having a thought you don’t want. We don’t blame ourselves about a song being there, right? Judging ourselves for having thoughts we don’t want is adding pain on top of pain — what ACT calls “dirty pain.” So for a mental reset in this month of mental health awareness, I encourage you to notice a thought that cycles around like a song in your head and just let it be that: a song that will fade away as you attend to other things. Change your relationship from trying to fight with it to giving it some space to be there and drift away without judging yourself for having it. As Steven Hayes, the founder of ACT, shares in his TEDx talk, this approach will allow you to make space to focus in the direction of who and what is important to you and how you can bring what you love and joy into the world and share it with others. Check out my website or reach out to me via my contact page. I offer free, 30-minute consultations to new clients. 1 Wegner, Daniel M.,Schneider, David J.,Carter, Samuel R.,White, Teri L. Paradoxical effects of thought suppression.Journal of Personality and Social Psychology, Vol 53(1), Jul 1987, 5-13 |
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