People who have been diagnosed with advanced cancer can face intense existential distress in the wake of their diagnosis. Standard mental health treatments may not always fully meet the needs of such patients.
In an ongoing clinical trial, researchers at Huntsman Cancer Institute and Huntsman Mental Health Institute (HMHI), both at the University of Utah (the U), are testing a new form of therapy that integrates ketamine doses with talk therapy to try to help people when other interventions fall short.
Researchers in the Ketamine-Assisted Psychotherapy (KAP) Clinic hope that their unique combination of psychedelic medicine and psychotherapy may provide relief to patients dealing with a diagnosis of non-operable gastrointestinal cancer.
Addressing a constellation of challenges
Non-operable cancer, for which surgery is not possible, can be especially psychologically difficult. “Many people with newly diagnosed cancers see surgery as the best and most definitive treatment,” says Laura Lambert, MD, surgical oncologist and professor of surgery at Huntsman Cancer Institute, director of the peritoneal malignancy program at the U, and co-principal investigator on the clinical trial. “It makes sense to just cut it out. Unfortunately, when people are diagnosed with metastatic cancer, surgery is not often a meaningful option because not all of the cancer can be surgically removed. The true impact of the loss of hope for a surgical cure on existential distress remains unknown and is another aspect that the trial is investigating.”
A diagnosis of advanced cancer can introduce a spectrum of challenges that is distinct from other mental health conditions, explains Ben Lewis, MD, member of Huntsman Cancer Institute, assistant professor of psychiatry at HMHI, and co-principal investigator on the clinical trial.
“Patients with cancer are often grappling with what is meaningful in life, the nature of their own mortality, and conceptions about what their life was going to be like," Lewis says. "And they’re often dealing with other really difficult challenges—isolation, loneliness, symptoms of the illness, symptoms of treatment.”
“These are big, weighty issues that aren’t necessarily solved by a traditional antidepressant,” adds Kevin Byrne, MD, investigator at Huntsman Cancer Institute and clinical instructor of psychiatry at HMHI. “Traditional treatments work for some people, but we haven’t had enough tools in our toolbox for treating the issues surrounding existential distress.”
Anna Beck, MD, director of supportive oncology and survivorship at Huntsman Cancer Institute and director of the supportive and palliative care program at the Spencer Fox Eccles School of Medicine, says that a major advantage of ketamine-assisted psychotherapy for cancer patients is how quickly it often works. “Conventional antidepressants, which are commonly used to help address cancer-related distress, may take up to four weeks before an effect is apparent,” Beck says. But “with ketamine-assisted psychotherapy, patients commonly report relief in just a single session.” She adds that ketamine rarely interacts poorly with other medications, which is especially important for cancer patients on complex medication regimens.
The researchers hope that ketamine-assisted psychotherapy could potentially provide some aid by helping people break out of harmful patterns of thought. Like other psychedelic medicines, ketamine can induce a critical window of time during which the brain works differently, forming new connections between neurons more easily. Within this window, it can be easier for people to move away from painful patterns of thinking and start building something new, especially if the ketamine exposure occurs within a therapeutic context.
“For a period of time following administration of ketamine, the brain becomes more open and flexible to new learning and new ways of adapting,” Lewis explains. “Ketamine-assisted psychotherapy tries to use that opening to get in there and do some work.”
Embracing patients' experiences
Most other ketamine clinics focus on the medication alone, using a low dose to reduce the likelihood of potentially distressing mind-altering experiences. But at the KAP clinic, ketamine itself is only half the story. Rather than treating a dissociative experience as an unwanted side effect, the researchers aim to acknowledge and explore the experiences and insights that may be caused by ketamine, as well as the way those insights are related to patterns of suffering.
Before and after each ketamine dose, patients participate in talk therapy sessions designed to help process their experiences and make the most of the altered state of consciousness that ketamine can induce. "We carefully prepare patients for the mind-altering effects of ketamine, and we’ve curated an environment that enhances and supports their experience,” Byrne says. “With the help of therapists, we ensure that patients navigate this experience in the most fruitful way possible."
Suzy Mang is a patient in the KAP clinic and says that, while she was initially worried about whether the treatment would work, the controlled, professional environment was “a huge relief.” She adds, “It’s not a wild trip, it’s peaceful. There is always a medical professional in the room making sure I’m safe.”
While the clinical trial is still in progress, Byrne says that he has noticed several advantages of KAP for his patients experiencing existential distress. These include enhanced mood, reduced anxiety, changes in perspective, greater flexibility and openness, a sense of connection or unity with others, improvements to relationships, and even spiritual experiences. “Many patients find that a blend of these elements leads to a beneficial shift,” he says. “This shift helps them address and engage with the profound existential questions often triggered by a life-threatening diagnosis.”
“With a terminal diagnosis like mine, things get thrown into disarray,” Mang adds. “During these sessions, I started to feel more at ease and not worry about the past or present. I had a lot of fear and anxiety, but the sessions have shut that tension down.”
Ketamine loosens the mind’s grip on all the difficult things, and allows me to let life happen.
Using science to improve care
The researchers at the KAP clinic plan to back up their clinical trials with advanced data so that they can arrive at the best possible care. In a complementary clinical trial, Lewis and Byrne plan to use machine learning software to analyze videos of patients for behavioral cues that might predict which interventions would be most effective. The software can measure everything from facial expressions to speech patterns—“any behavioral metric you can think of,” Lewis says. By doing a deep dive into patient video data, the researchers hope to find patterns that will help them tailor this emerging treatment for different groups of people.
Byrne emphasizes that the research on using psychedelic medicines such as ketamine for existential distress is still preliminary, but that what he’s seen in his own clinical practice gives him a lot of hope. “The science of using psychedelics to treat existential distress and demoralization in life-threatening illnesses is young, but I’ve seen very powerful results in some of our patients,” Byrne says. “While we still need a lot more science to make sure we’re grounding our clinical practice in evidence-based medicine, I’m very hopeful about the idea that we are working to add promising new treatments for patients who desperately need them.”
To learn more about the KAP clinic or schedule an evaluation, call 435-658-9263 or email hmhikapclinic@hsc.utah.edu.
@hmhi_ Dr. Ben Lewis explains how #KAP can help #Depression, #Anxiety, and many other things. This innovative treatment targets the brain's neurotransmitters to enhance the psychotherapeutic process. Learn how it works! #Therapy ♬ Trendsetter - Connor Price & Haviah Mighty