THE iKAP PROTOCOL
Integrative ketamine assisted psychotherapy or "iKAP" is an interdisciplinary, step-wise treatment protocol that combines repeated sessions of low-dose ketamine with psychotherapy, mind-body skills, ambient music, and textile art. The protocol, developed by clinical psychologist, Dr. Patricia Henrie-Barrus, consists of six repeated iKAP sessions that are designed to target underlying symptoms of neuropsychiatric disorders, accelerate the process of healing, and ultimately facilitate positive behavior change.
While Dr. Henrie-Barrus has used iKAP for several years in private practice, it is now being scientifically tested for the first time in two clinical trials: one for major depression and another for co-existing major depression and early cognitive decline. These studies are currently in the research and development process, awaiting IRB approval, and led by researchers at University of Utah, Harvard University, Yale School of Medicine, and Baylor College of Medicine.
INTEGRATIVE KETAMINE ASSISTED PSYCHOTHERAPY™ (iKAP)
Source: Riverwoods Behavioral Health Integrative Ketamine Assisted Psychotherapy (iKAP) Protocol. iKAP was developed by Dr. Patricia Henrie-Barrus, Dr. Lynnette Averill, Anya Ragnhildstveit, and colleagues. For permission and use, contact Dr. Henrie-Barrus at firstname.lastname@example.org. For research information, contact Anya Ragnhildstveit at email@example.com.
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PREPARATORY PSYCHOTHERAPY (SET)
Thirty minutes of non-directive, person-centered psychotherapy is provided to prepare the patient for treatment. During this time, the patient will discuss their self-concept (attitudes, beliefs, and perceptions), individual needs, and goals for treatment with their therapist.
The patient may also work on integrating their experiences from previous sessions and session recordings (i.e., from "homework"). At the end of the 30 minutes, the patient and therapist will identify three positive psychology words via alliteration (e.g., courage, confidence, and compassion) that reflect the patient's desired areas to focus on.
The goal is to (1) foster the patient's process for self-understanding and self-discovery; (2) build therapeutic alliance between the patient and therapist; and (3) ready the patient for treatment.
SOCIAL ENVIRONMENT (SETTING)
A private, safe, and comfortable setting is provided to set the stage for the dissociative experience. Ambient or calming music is played to promote relaxed brain waves, lighting is dimmed to enable focus and introspection, and textile art (i.e., a mural tapestry) is place on the ceiling of the treatment room to guide visual changes.
These social components remain constant for all six iKAP sessions.
The goal is to manage the setting or context for the dissociative experience, which can profoundly effect and shape one's session.
GUIDED MIND-BODY SKILLS
Five minutes of guided mind-body skills is provided to center and ground the patient physically, mentally, and emotionally before treatment (i.e., regulate biopsychosocial pathways). The patient will practice mindfulness, diaphragmatic / deep breathing, and body scan meditation guided by their therapist. Pre-selected ambient music will also play in the background, which continues throughout the session.
The goal is for the patient to achieve a state of focused relaxation by deliberately paying attention to the present moment non-judgmentally: their thoughts, breathing patterns, and bodily sensations. This removes excess background noise (e.g., thoughts and feelings around school, work, and family), allowing the patient to ready themself for treatment.
GUIDED KETAMINE ASSISTED PSYCHOTHERAPY
Forty minutes of guided ketamine assisted psychotherapy is provided and delivered by an intravenous infusion (0.5mg / kg). An IV technician will administer and start the ketamine infusion, which is simultaneously paired with psychotherapy guided by the patient's therapist. Guided psychotherapy is based on the patient's previously discussed self-concept, individual needs, and goals for treatment as well as the three identified positive psychology words.
The therapist will also apply affective tactile grounding (ATG) during the session, which involves gently holding the patient's forearm during treatment, as way of grounding their dissociative experience. Ambient music will continue playing in the background.
The goal is to support the patient's overall ketamine experience by guiding their process for healing and self-discovery. *The session will be audio and video recorded on the patient's phone for personal reflection and integration purposes.
GUIDED MIND-BODY SKILLS
Five minutes of guided mind-body skills is provided to center and ground the patient physically, mentally, and emotionally after treatment (i.e., regulate biopsychosocial pathways). The patient will practice mindfulness, diaphragmatic / deep breathing, and body scan meditation guided by their therapist. Ambient music will continue playing in the background.
The goal is for the patient to achieve a state of focused relaxation by deliberately paying attention to the present moment non-judgmentally: their thoughts, breathing patterns, and bodily sensations. This helps situate the patient back into reality and begin to process their experience internally. (Most patients are not able to verbalize their thoughts and feelings immediately after regaining consciousness due to the side effects of ketamine.)
Forty minutes of integration psychotherapy is provided by the patient listening to their session recording while at home. The patient will listen to the recording once before their next session, exploring and integrating their experiences. Any outstanding questions and / or areas of focus are then addressed during the next preparatory psychotherapy session.
The goal is for the patient to sustain the effects of treatment and to further understand their ketamine experience with support from their therapist.
Steps 1 through 5 are then repeated for the next iKAP session. In total, there are 6 iKAP sessions, which are scheduled 2-3 days apart over the course of 2-3 weeks (e.g., Monday, Wednesday, and Friday x 2 weeks OR Tuesday and Thursday x 3 weeks).