When Depression is in your bed

Ketamine Isn’t the Fix—It’s the Opening: How Intentional Integration Turned Insight Into Healing

• Trish Sanders, LCSW • Episode 45

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We explore how ketamine-assisted psychotherapy can quiet an overactive alarm system, reopen access to rest, and create a window where new habits take hold through integration. We share the science in plain language and the personal practices that helped changes last.

• stigma and misconceptions around ketamine and psychedelic-assisted therapies
• how amygdala quieting and parasympathetic activation support safety
• interoception and reconnecting with the body
• neuroplasticity and loosening rigid thought loops
• integration practices that make insights stick
• shifting from collapse to restorative rest
• cultivating durable self-compassion
• two core takeaways on nervous system healing and choice

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SPEAKER_00:

Hello and welcome to the When Depression is in your bed podcast. Today I'm going to continue exploring ketamine-assisted psychotherapy or CAP and how it can do far more than just create a temporary state of feeling good. I'll talk about how ketamine affects the brain and the nervous system in ways that can make genuine healing possible. And I'll share the benefits I've personally experienced through CAP and the neuroscience that helps explain why it works. I'm your host, Trish Sanders, and I am delighted that you are here. Let's get started. Before I dive in, I just want to give you a quick message. As I've shared in my previous episodes about ketamine and psychedelic assisted therapies, I am a licensed clinical social worker, and in this episode, I will be talking about ketamine and psychedelic assisted therapies. However, I will be sharing my personal experiences and my professional learning for educational purposes only. I'm not giving medical advice and I'm not making treatment recommendations or suggesting that anyone try any of these substances that I mentioned. And I certainly can't guarantee that anyone will have the desired impact or effect, or since I'm sharing my own experience, will have the same experience that I had. But if you are thinking about ketamine or psychedelic assisted therapies, I do recommend connecting with a healthcare professional who can safely guide you on your own journey. I want to talk today about my own experience with CAP, which I have been talking about over the last several episodes. And I want to focus today on not just what my experience was, but how the ketamine impacted my nervous system and brain that allowed for the healing that happened to occur. And I do want to be clear that at this point I'm not a CAP certified therapist. What I'm sharing today is based on my own experience and understanding that I have developed through my own research because I really wanted to understand how what happened to me happened. And that's really the framework that I'll be sharing through today. So this is not a complete neuroscience lesson by any means, but it is my intention to try to explain through the science of it all what I experience, which really was quite transformational for me. And I think part of the reason this feels particularly important to share is because I do think that there's a lot of misinformation out there about ketamine and psychedelic assisted therapies. And I think in part that stems from the fact that a lot of these medicines have been used at different times, either in history or currently, as what could be considered a recreational drug or a quote unquote street drug. And so I think that there's stigma that can be attached in a lot of different ways from either having a negative perspective about these medicines or even just minimizing them or writing them off. And I can certainly tell you that from my own experience with friends and family, personally and professionally, when I talk about CAP, sometimes people jokingly say something like, Oh, yeah, of course you feel better or you're on drugs or something to that effect, and they don't really understand the science. And I also have to say that for myself, as someone who has lived with depression for most of my life, I absolutely have a history of using substances to try to feel better or deal with my depressive symptoms, which of course is pretty common. And it even took me a little while to come around to CAP. And I think looking back, a part of me just didn't believe it or understand it. I think I had this idea that it must be a temporary relief kind of experience. And that didn't really appeal to me. And it wasn't until I heard about it many times that I finally was curious enough to really pursue it and look into it for myself. And what I found was that ketamine, while it's not magic, a switch that can just turn off depressive symptoms forever, there is more than something that is just temporary. And that's why I want to share my experience with you today because it's been over a year since my last CAP session. And granted, I've been doing a lot of healing in many different ways. So I can't say with absolute certainty that all of my healing is connected to my CAP experiences. However, I can tell you that I've been in talk therapy for decades and I've been on a journey of healing. I would say for most of my life, certainly the last 30, 35 years. And my experience with CAP was absolutely a game changer for me and it really shifted so many things. And while ketamine and other psychedelic assisted therapies might not be for everyone, they certainly are not for everyone. As a matter of fact, I think that if you have accurate information, then you can make the most well-informed decision about what you want to include in your healing journey. And as I've shared before, my original reason for pursuing CAP is because I kept hearing that ketamine could help people cultivate self-compassion and self-love. And as somebody who has struggled with depression for most of my life, I quite often held a pretty negative self-concept or a self-view. And even though with years and years of therapy and a lot of self-work, and I've talked about this in previous episodes, I've had more and more windows where I felt more positively about myself, but they would close much more quickly than I would like for them to close. And I seem to have an experience of stumbling into the window opening again. So what I mean is that I would feel good about myself for a while. I would feel clear, I would feel motivated, I would feel happy, joyful. I would even say I felt connected to my authentic self. And then that window would close. I would go back into some negative headspace, feeling overwhelmed, feeling shut down. And then the next time I felt better about myself, more often than not, was something that just happened. I wasn't quite sure how to make it happen again. So even though I had a little bit more awareness of what I needed to do to take care of myself, actually doing that pretty much felt hard. I would get back to whatever it was that I was doing, meditating or exercising or eating well or something like that. And then I would be able to have consistency for a very short while. And then I would fall off the self-care wagon for a very, very long time. And when it came to rest, it was very, very difficult for me to maintain healthy rest habits, slowing down during the day, being able to go to sleep at a decent hour at night, getting a full eight hours of restful sleep. Those were things that happened very, very, very infrequently, certainly very inconsistently. And CAP really was the beginning of changing all of that for me. And it was not temporary. It was not a temporary high. It was not just a short-lasting effect from being on quote unquote drugs, which I'm happy to report. It was really something that I was able to sustain. And I'll talk today about how I've been able to sustain that and encourage that and grow the positive impacts that I experience with ketamine. So, what I really want to focus on today is explaining, to the best of my knowledge and ability to explain, how ketamine can help support nervous system healing and how it can support our brain's neuroplasticity or its ability to rewire and learn new patterns, new healthier patterns, I would add. And how that really came into play in my own CAP experience. One of the things I learned about ketamine very early on is that it can help quiet the amygdala. Our amygdala is sort of like our brain's alarm system that goes off whenever there's danger. And it's a good thing that our amygdala does that. However, when someone has experienced trauma or relational wounding or attachment wounding or chronic stress, those sorts of things, our amygdala can overfunction. And it can either be triggered by very small things that aren't really signs of danger, but because of how our brain works, we have neural pathways that connect these seemingly small experiences to cues of danger and that triggers our alarm to go off, or it doesn't kind of ever go off. It's just on such high alert a lot of the time. And when we sit with ketamine, that part of our brain can sort of relax and the alarm bells stop ringing. And this is incredibly powerful. And this actually led not only to a greater ability to have self-compassion and self-love, which was wonderful. And in my very first session is exactly what my experience was, but it also led to something that I didn't realize would be so incredible and would come from ketamine. And as I mentioned earlier, I had a very difficult time my entire life resting. I used to think that I was really good at rest, but really I was really good at shutdown. And what I mean by that is if you think about coming home after work, I would think, oh yeah, I could like sit on the couch, let go of my thoughts from a busy day at work or my to-do list or whatever. But I wasn't really going into a restorative rest. I was going into what in nervous system language you could call a dorsal collapse. That my system, when I started to slow down, which was desirable, and being able to go into a restorative, restful place, being able to be renewed, I would bypass that very quickly and from slowdown, go right into shutdown, right into that collapsed, withdrawn, numbed out kind of space. So for me, a lot of the time that looked like me watching TV or movies or Netflix with a glass of wine or a beer. And in retrospect, I now understand that I was in shutdown, even though I didn't fully understand that at the time. So when I finally had the experience with the support of ketamine of having my amygdala be at ease, I suddenly had this space where I could breathe. And I talked about this in one of my previous episodes that in my second cap session, I actually had this thought of, oh, I can breathe here. And it was this embodied experience of my nervous system not being on guard, which was just honestly not an experience or sensation that I had hardly ever, because my system, as a result of my life experiences, was either in that dorsal collapse, that shutdown, withdraw, avoidance, numb going through the motions kind of state, or it was in a sympathetic fight or flight state of striving, trying to do as much as I can, feeling like there was never enough time to do all the things I had to do and feeling overwhelmed and pushing and doing and having a to-do list that was a hundred miles long and never feeling like I was making progress. And I pretty much fluctuated between those two states for most of my life. And of course, I had little windows of what I would, again, in nervous system language call ventral safety, that grounded, connected, pleasant feeling place where my nervous system felt safe enough that I could be at ease. But I was very, very rarely in that place. And when I had that experience being on ketamine, where I wasn't on alert anymore, it opened up this whole other possibility. And I would say it really helped me connect with my authentic self. Our authentic self is not our self that's in survival. That's an important part of ourself. It's an important function of ourself, but our true self can really only emerge, in my opinion, when we are not in survival, when we are safe enough. That's when who we truly are not only begins to emerge to others, but actually who we truly are begins to emerge to ourself because we can see ourselves clearly and we can see the world clearly and we can see others clearly in a way that when we're in survival, there's a filter on everything, how we look at the world and others and ourselves. And when the amygdala calm down, all of this new possibility opened to me. And ketamine also can help to turn on or activate our parasympathetic system, which when it's feeling safe, is our state of rest and digest. It's known as. And creating that space, the amygdala calmed down, the alarm was turned off, and the parasympathetic calm ease, groundedness was able to come back online in a way that it hadn't really been able to, because again, being stuck in survival, you're not really getting that ease, that restoration, that groundedness. Like I said, in a way that it just hadn't really been able to do for most of my life. In addition, ketamine can help increase our interoceptive awareness. And interoception is essentially how we feel what's happening inside of our body. I don't mean feel as in we feel our feelings of sad, mad, scared, glad, but I mean sensations in our body. I've been disconnected from my body for many, many, many, many years. And the cues for my body I was very disconnected from. And I was often numb to them, which is kind of interesting because ketamine is an anesthetic, so it does make you feel numb. So I can't fully explain the biology or the neuroscience of this with my limited knowledge, but experientially I can tell you that it didn't happen for me exactly while the ketamine was in my system. It was more in the days following that I just felt more connected to my body and more attuned to what the sensations were. I wasn't numb to them and I wasn't overwhelmed by them. And these new things started to happen. It was sort of like these doorways opened that had been closed. And I would say that as I understand it now, and the meaning I've made of my experience is that I was always so on guard that I was closed off. I was like sealed tight to these experiences. I was ignoring my body, I was disconnected from my body. I didn't want to feel things that were painful. And I was very stuck in this shutdown collapse a lot of the time. And I would only come out when I was pushing and striving and forcing myself to do whatever needed to be done in life. And then I would go back into that shutdown. And having all of these defenses soften allowed me to have this greater new perspective. And when all of this was occurring, I found I absolutely was able to see myself and others and the world with much, much more love and compassion, so much more understanding. I wasn't getting mad at myself or shaming myself or blaming myself. There were so many moments over my cap sessions where I would laugh and say, Oh, of course that's how I handled that situation. It wasn't that there was something wrong with me or I was bad or I should have been able to do it differently. Of course, that's how I handled that situation. That was the best I could do at that time, or I was under so much stress, that was a stress response. So of course that that's how I did that. The self-criticism just was absent, honestly. It just wasn't there anymore. And as someone who is intensely self-critical, this was a really new and very welcome experience for me. And also, what I came to realize in time was that when my body was feeling at ease and my nervous system was able to spend more time in that ventral, safe enough, connected space, that socially engaged space where I was able to connect with myself and others in the world in a much more profound and meaningful way. And also, when I was in that state, I was able to rest in a restorative way. I was able to pay attention to my body cues and I was able to say, I feel tired right now. I'm gonna go to bed. And I just went to sleep. And that was something also very new for me compared to my entire life. And something else that I find totally amazing, uh, which is very much connected to how ketamine can help the brain and neuroplasticity. But we can only really learn when we feel safe enough. And this makes a lot of sense if you think about it, because if you're trying to protect yourself, your only objective is survival. And so you're not really open to the learning process because biologically it's not necessary. You might figure out things out of necessity, but you're not actually learning when you're in survival. And so I think that again, from my experience, when I talked about these doorways opening, I think that that was also a part of it for me, that things felt available to me, doing things, whether it was resting, going to sleep when I felt tired, or sitting down and doing a task that felt really overwhelming to me, or creating space in my schedule, which is still something I'm working on. But those things felt available to me and possible in a way that they just hadn't before. And as I understand it, I feel like that is all part of the learning process that I often felt like I had no choice. This is how I had to do things, not necessarily because I wanted to do them that way, but because I didn't know how to do them another way. And my experience with CAP really helped me say, oh, look, there's another possibility here. And by practicing that new possibility, which I'll talk about what integration is, and that's essentially what integration is practicing these new things that come up through your academy experience, then I was able to create new neural pathways where these options became available to me more and more as I continued to practice them. And so basically, as I'm talking about neuroplasticity, which just refers to our brain's ability to change, to grow new neural pathways and adapt and create new connections throughout our whole life. And our brain can, in fact, do this throughout our entire lifetime. We used to think many years ago that this only happened in young children. We have learned that that's not true. Our brain can change throughout our entire lifetime. However, there are biological reasons that I won't go into too deeply now, but as we get older, our brain does tend to use the well-worn pathways more than create new pathways. And part of that reason is just simply it's efficient. It's easier for our brain that works very hard, taking in a lot of information all the time, to be able to quickly categorize things and do things in the same old way, because it's just easier to do it that way. And that's really not a bad thing. It really helps our brain function. However, if the way that we've been doing something has been an unhealthy or unhelpful thing, but we've been doing it for a really long time, it's just familiar and there's a lot of ease in doing it in that same old repetitive way. And certainly if there's trauma, chronic stress, relational wounding, attachment wounding, the pathways that we probably have been using and that are really well worn are in fact probably unhealthy and unhelpful, or at least a lot of them are. Certainly for me, that was absolutely the case. And so with ketamine, these pathways that we are so used to using, those tracks that we have in our brain, the rigidity of them starts to loosen temporarily. And that is temporary. But in that temporary little opening, that space, we can start to use new patterns and make new connections. And so there's more accessibility to these new ways of acting or being or thinking that are also linked to an embodied experience. And I talked about this in one of my last episodes when I talked about my first CAP session. I had this thought that the most beautiful place in the world is inside of me. And it didn't seem like a thought or something I was trying to convince myself. It just felt in my body true. That's what so many of these experiences were like for me, that it wasn't just this conceptual thought, this cognitive thing. It was like this embodied reality in a totally different way. And so all of these negative thought loops, the not good enough, the not worthy, my feeling incapable, or like a failure, those are all very, very common thought loops that I've held for a huge portion of my life. They just sort of loosen their grip quite a bit. Actually, when ketamine was in my system, they just seemed laughable. Like I said, I laughed quite a bit on ketamine. It was like, that's ridiculous. Like, of course I'm not a failure. Of course I'm good enough. But then in the hours and days afterwards, I was able to really integrate those experiences. And that really allowed me to carry those new thoughts with me in a way that talk therapy just wasn't really able to help, at least not in the same sustainable way. You want to be very clear. I'm not knocking talk therapy. I love talk therapy. It's a form of therapy that I use quite a bit. And it can create changes in the brain. It just takes a really long time because without going into all of it, when you create a new safe relationship with a therapist, you have what could be considered a disconfirming experience that not all relationships are painful or that you can trust people. And that can be really beneficial. But again, it takes a long time. And with ketamine and some of the other psychedelic-assisted therapies, you can get those connections much more quickly. And then you do have to do work to maintain them. This is not just fairy dust and magic that is an on-off switch that if you've been feeling not good enough for your whole life, you'll have a ketamine session and feel completely worthy. It's not exactly like that. You might actually feel really worthy in one session, but you have to do work to be able to maintain that afterwards. And I've mentioned integration quite a few times in each of the episodes about ketamine, but just really to dive into again this idea of what integration is and why it's so incredibly important is because of what I'm talking about. When you have ketamine in your system, you have this small window of time from when you're with the medicine to the hours following and the days following, maybe a week, where your ability to do activities that help your brain rewire is increased. And so you have this beautiful window. And if you take advantage of it, and this is what integration sessions are talking to a therapist or a trained healer to be able to support you in taking these new embodied experiences, these new knowings, if you will, because that's really what they felt like. Like I knew them to be true, and bring them into your life in a way where they become things that you practice daily. So you don't have to stay stuck using these old neural pathways. You have a chance where the door opens, where you have much more flexible, accessible choice to be able to do things in a new way. And so I was very intentional with my ketamine sessions. And the day of my ketamine session, I always planned it in such a way that it was really low stress. I chose different things depending on where I was at and what my intention was, what I was working with. There were some days that I did paperwork because paperwork could feel really overwhelming for me. So I would take advantage of this time where my alarm system wasn't going to go off and say, paperwork is so hard, I'm overwhelmed, I'm an idiot or whatever. Old stuff would happen. And I would sit down and say, like, okay, this is something that has felt hard for me. And I was able to sit with compassion about that. Say, let me just try a start and see what happens. And I would do the things that felt challenging for me. I made sure that I would have restful evening activities so that I would be able to pay attention to when I was tired. I mentioned I would make sure that my schedule for the next few days had some space in it, some space for me to take a break, some space for me certainly to meditate, certainly to move my body even throughout the day, not just exercise, although I did often include exercise as something that I wanted to incorporate in the days following, but also just time to get up throughout the day and move instead of just sitting at my desk for hours and hours on end. And so by doing these practices and by having the support of ongoing therapy with a therapist who was trained in providing cap, I was able to really keep these new practices going. And by practicing these new habits that were much more helpful and much more desirable and much more healthy, then I was able to really keep a lot of them going in a way that was very different than just talking about something, being like, Oh yeah, I really wish I could do my paperwork, or I really would like to go to sleep earlier and then no change really happening from there. And as a result of my cap and the integration, I definitely have had the experience of being able to cultivate and sustain much greater experiences of self-love and self-compassion, which has been really, really incredible for me. Again, as someone who's been depressed for most of my life, self-criticism and self-judgment can be extraordinarily high for me. That has not returned in the same way as before at all. And I can't say I never have a moment where I'm hard on myself, but I catch myself so much more quickly, like almost instantaneously. And I've talked about this in other episodes, and I'll talk more about my specific actual real lived experiences around some of these things to give you more understanding on what that really looks like. But my capacity to be able to notice and take care of myself and my commitment to taking care of myself, honestly. And it's still not perfect. It's not like I'm always doing the absolute best thing for myself constantly. I really can't emphasize enough that it's not magic that's happening, it's opening a doorway that is allowing you to walk through it instead of having the experience of trying to push open a door that's stuck shut or not even seeing the door and walking past it. I kind of have this image of walking around the hallways of your mind and just walking down the same hallways back and forth. And those are those same well-worn neural pathways, and you just keep walking by and walking by, and it feels like, well, where else am I supposed to go? And you have this experience with ketamine or potentially one of the other psychedelic assisted therapy medicines, and doors appear that were always there. You just didn't see them, they weren't accessible before. And when you open the door and you walk through, all of a sudden this new opportunity emerges. And for me, definitely the self-compassion and self-love came through. I also really reconnected with my body, which I've been very disconnected from for most of my life. And I started to feel like I was in my body, that I could listen to my body. I was more attuned to my body and the cues that it gave me for being overwhelmed, when I needed to slow down, certainly when I needed rest, things like that. And I really was able to embody what in polyvagal theory, Deb Dana calls safely still. And it is this grounded experience that I've talked about. Instead of when my system went into slowdown, falling into shutdown, actually being able to be in that beautiful, nourishing, slowdown place where I could be still and quiet, be with myself, be in nature, meditate, sit on the couch at night without having any urge or desire to have a beer or a glass of wine because I just feel okay and I'm just resting, or coming home and not feeling so exhausted from a day that I spent completely in sympathetic mode, going, going, going, doing, doing, doing, because I had some spaciousness in my day and being able to come home and say, oh, you know what? Uh, I want to work on this other task for my business that feels important to me, and being able to have energy for that at the end of the day, and then going to sleep when I was done, or reading, or doing something else that felt important and meaningful and satisfying to me at the end of the day, instead of just crashing. So these are some of the benefits that I've received personally from ketamine assisted psychotherapy and helping me understand what was happening to my nervous system and my brain has really helped me a lot and has really also led me to be a real big supporter of ketamine assisted psychotherapy and other psychedelic assisted therapies as well. And as I've said before, I'm not giving you medical advice. I'm not promising anything. I guess maybe I'd say there are two main takeaways that I hope you might take away from any of these episodes on cat. One is that you're not broken or defective or forever damaged, but rather your experiences likely have impacted your nervous system. And what you really need is nervous system healing. And if you know how to work with your nervous system and your brain, then your capacity for healing really increases. And there's so much more possibility there. And so it doesn't have to be ketamine or the psychedelics per se, but I do invite you and encourage you to look into healing modalities that have a component of nervous system work in them. And two, if you do choose to pursue CAP or psychedelic assisted therapy, it is not magic, but it does perhaps magically open a door if you want to walk through it. As our time comes to a close, I ask you to keep listening for just a few more moments because I want to thank you for showing up today. And I want to leave you with an invitation as you hit stop and move back out into the world on your own unique wellness journey. In order to move from where you are today to the place where you want to be, the path may seem long or unclear or unknown. And I want you to know that if that seems scary or daunting or downright terrifying or anything else, that is totally okay. Know that you do not have to create the whole way all at once. We don't travel a whole journey in one stride. And that is why my invitation to you today is to take a step, just one. Any type, any size, in any direction. It can be an external step that can be observed or measured, or it could be a step you visualize taking in your mind. It can be a step towards action or towards rest or connection or self-care or whatever step makes sense to you. I invite you to take a step today because getting to a place that feels better, more joyful, more connected than the place where you are today is possible for everyone, including you, and even when depression is in your bed. If today's episode resonated with you, please subscribe so you can be notified when each weekly episode gets released. I encourage you to leave a review and reach out to me on social media at Trish.sanders.lcsw. Your feedback will help guide future episodes, and I love hearing from you. Also, please share this podcast with anyone who you think may be interested or who may get something from what I have shared. Until the next time we connect, take care of yourself and take a step.