Referring physician2021-03-18T12:24:12+01:00

FOR REFERRING PHYSICIAN

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Information events for referring physicians

CONCEPT

Learn more about our therapy

We would like to expand the treatment spectrum of mental illness with an innovative approach. There is broad evidence for the use of ketamine in the treatment of depression (Memon et al. 2020). Likewise, scientific studies show good efficacy in the use of altered states of consciousness in mental illnesses (Reiff et al. 2020)

Augmented Psychotherapy

In augmented psychotherapy, expanded states of consciousness are combined in a targeted manner with psychotherapy specifically designed for this purpose. These states are individually prepared in the therapy, induced by means of the patient-specific administration of ketamine i.v. or with non-pharmacological methods, accompanied therapeutically and the experience integrated psychotherapeutically. For this purpose we use therapeutic methods of mindfulness, cognitive-behavioral, psychodynamic as well as body-psychotherapeutic and humanistic approaches.

Repeated sessions of ketamine infusion with the experience of altered states of consciousness, as well as subsequent psychotherapy sessions for integration, allow us to make the rapid antidepressant effect of ketamine more sustainable. Thus, we embed the various coordinated therapy elements into an intensive short-term psychotherapy. The ketamine infusions are administered via perfusor by anesthesiologists with monitoring of vital signs. Psychotherapeutic support and treatment is provided by licensed therapists in depth psychology-based psychotherapy and behavior therapy.

Indication and costs

Augmented Psychotherapy is a psychotherapeutic approach and the indication for therapy is based on this. The indication for Augmented Psychotherapy with ketamine is based on the studies available for therapy with ketamine. The treatment of mental illness with ketamine i.v. is an off-label treatment. After Augmented Psychotherapy, further outpatient psychotherapeutic treatment may be useful to deepen the experience gained in therapy.

Our treatment is not yet covered by public health insurance and must be paid for by the patients themselves. However, it is possible for health insurance companies to cover the costs and this must be checked individually with the respective insurance company. The costs for Augmented Psychotherapy amount to 3000-4000 €, depending on the treatment units. It includes at least 5 therapeutically accompanied ketamine i.v. doses and at least 25 hours of therapeutic treatment.

  • Unipolar depression (F32,F33) with currently at least moderately severe depressive episode with therapy resistance to 2 attempts of lege artis medication or 2 attempts of psychotherapeutic therapy.
  • Unipolar depression with a current depressive episode of at least moderate severity and an explicit wish for augmented psychotherapy after a detailed explanation of the off-label status and guideline-based treatment alternatives.
  • Bipolar depression with current at least moderate depressive episode on stable medication phase prophylaxis with no manic episode in the past 6 months, no rapid cycling, and no history of psychotic symptoms.
  • Obsessive-compulsive disorder: Ketamine-assisted therapy as augmentation if psychotherapy has been given
  • Anxiety disorders: Ketamine-assisted therapy as augmentation when psychotherapy has occurred.
  • Somatoform disorders, especially somatoform pain disorder
  • Adjustment disorders in the presence of existential issues.
  • Existential fears in palliative situations
  • Schizophrenic disorders (including schizoaffective disorder) and organic delusional disorders.
  • Severe personality disorders
  • Florid substance dependence (especially party drugs, e.g. ketamine)
  • Florid bipolar disorder with regular manic episodes (rapid cycling, etc.)
  • severe eating disorders
  • Dementias and brain-organic disease (from moderate dementia or without the presence of depression).
  • Lack of capacity for insight due to mental or intellectual disorder

Contraindications: We cannot offer Augmented Psychotherapy with ketamine treatment to patients who have the following medical contraindications to therapy:

  • Structural heart disease (including heart failure)
  • Unstable, difficult to control or untreated hypertension
  • Unstable angina pectoris
  • Myocardial infarction and/or stroke in the past 12 months
  • Increased intracranial pressure
  • Untreated or inadequately treated hyperthyroidism
  • Glaucoma
  • Liver cirrhosis, severe liver dysfunction

If patients are still interested in therapy with us, they are welcome to contact us and we can review the possibility of Augmented Psychotherapy with non-pharmacological methods.

KETAMINE INFUSION

Ketamine as a psychotropic drug

Ketamine was developed as an anesthetic and analgesic and has been used worldwide for over 50 years. In lower doses it has a fast onset antidepressant effect without relevant effects on the cardiovascular system and vigilance. Because of this, it has gained importance in the treatment of depression in recent years and is used when classical therapeutic methods, such as antidepressants, fail. A combination with adapted psychotherapy leads to an increased effectiveness of the treatment.(Luckenbaugh et al. 2014).Intravenous administration of the substance allows for precisely controlled dosing to enable patients to access altered states of consciousness. Through integration in psychotherapy, this can be a healing, meaningful experience(Luckenbaugh et al. 2014)(Roseman et al. 2018). Furthermore, the rapid antidepressant effect creates therapeutically efficient treatment windows. The interaction of psychopharmacological effect and embedding therapy often leads to an optimized treatment outcome.

Possible effects in the targeted dosage in combination with the therapy setting are a feeling of detachment from usual thoughts, feelings and physical sensations. Vivid inner images and insights may occur. The experience of feelings is often heightened. There may be a limitation in the ability to communicate and motor skills are more difficult. Breathing ability is typically not impaired which makes it very safe as a medication.

MIND Foundation Ketamine Lecture Series

Ketamin in palliative medicine: Stopgap or extension of treatment options?
Ketamine for psychiatric indications: From the lab to the clinic
To the series

ALTERED STATES OF CONSCIOUSNESS

Application in our therapy

Altered awake states of consciousness are clearly different from the usual spaces of consciousness. In the context of these states of consciousness, there is a temporary significant change in perception, feelings and thoughts. The good effectiveness of altered states of consciousness in the treatment of mental illness is increasingly scientifically proven. Thus, during altered states of consciousness, a distancing from stuck thought loops and beliefs can be observed. Likewise, access to meaningful biographical content and the re-experiencing of a fuller range of emotions are reported. There is good recall for the experiences during the altered state of consciousness. We conduct the sessions with altered waking states of consciousness in well-prepared close therapeutic guidance with the aid of specific music and body therapy interventions. For the induction of altered states of consciousness, body therapeutic methods such as specially designed strobe light or specific breathing techniques can be used as non-pharmacological methods. Pharmacologically, we work with ketamine i.v. via perfusor under anesthesiological supervision. Hereby a patient-individual dosage can be given for the optimal induction of altered states of consciousness. Through weekly repetition of substance sessions during our short-term therapy, therapy effects can be psychotherapeutically solidified through content connections of experiences. During the altered states of consciousness, there may also be challenging experiences for the patients; it is precisely these that can initiate sustainable processes of change as part of a therapeutic process with the help of integration.

By integration we mean all processes that help to process the experiences made in the altered state of consciousness and thus make them useful for the patient. Within the framework of augmented psychotherapy we want to support an attitude that promotes integration and practice techniques of integration. Each experiential session is followed by at least one integration session in which the particular experiences are processed therapeutically, thus promoting integration. The goal of the integration process is to positively influence the experience, thoughts, behavior or general attitude from the experiences made. Mindfulness exercises learned at the beginning of therapy and the development of possible intentions and goals also contribute to this. Integration also has an important role in intensive awareness processes, which can be very challenging without therapeutic help. Here, embedding the experiences in a psychotherapeutic process with a sustainable therapeutic relationship is particularly important.

TREATMENT STEPS

We accompany our patients during the following steps

TREATMENT STEPS

We accompany our patients during the following steps

INTEGRATION THERAPY

We also offer integration therapy in our practice the offer

What is Integration therapy?

Intense emotional and existential experiences hold great potential for personal change. However, changes in life often do not occur slowly, but in spurts or leaps. Sometimes they are associated with crises. Experiencing altered states of consciousness is such a special, intense experience for many people. Scientific studies have shown that especially existential experiences in altered states of consciousness (for example – but not only – an experience under psychedelic substances) can lead to positive changes in psychological well-being(Roseman et al. 2018, Majic et al. 2015). 

However, it is not uncommon for very challenging experiences (occasionally also “bad trips”) to occur, which are difficult to reconcile with everyday life and can be stressful. In some cases, new psychological problems even arise from experiences that have not been processed. People do not have to leave the positive development out of such an experience to chance. In psychotherapy, there is a wealth of experience in dealing with intense psychological processes. Even and especially the challenging experiences that are difficult for individuals to understand and integrate into their lives hold the potential for positive change with the help of psychotherapeutic support.

Young man talks about his psychedelic experience

For whom is integration therapy useful?

Interested people can contact us if they have had an intense experience in altered states of consciousness (for example, an experience under psychedelic substances) and would like to better integrate this into their lives. For integration therapy we draw on knowledge and experience from behavioral therapy, depth psychology-based psychotherapy and humanistic methods.

As a private practice, we do not require an application process with a waiting period for self-pay patients. Psychotherapy can begin immediately and we work out an individual therapy plan with our patients with a flexible duration of treatment. If necessary, we will check with the public or private health insurance companies whether the services are covered by the insurance.

We also work out with our patients to what extent a longer outpatient psychotherapy can be helpful, which goes beyond the scope of a pure integration therapy. Either you can do this with us or we can help you find an experienced outpatient psychotherapist. If you have patients in your psychotherapeutic treatment, integration therapy can also take place as a supplement during a break in psychotherapy, or as preparation for therapy with you.

Psychiatric co-treatment

Patients can also contact us if they have experienced severe or persistent psychological problems such as anxiety, flashbacks, depressive symptoms or symptoms of altered perception with, for example, derealization, feelings of persecution or hallucinations after consuming psychedelic substances. Often, psychotherapeutic integration of the experiences in the altered state of consciousness can also lead to an improvement of the symptoms. In some cases, psychiatric medication can also be helpful. Here we develop an individual therapy plan consisting of integration therapy and supportive medication, if this should be necessary. Furthermore, we can help you find further or even inpatient treatment, if this is needed.

ADVANTAGES

Integration therapy can help …

TEAM

Our team is looking forward to exchanging with you

FAQ

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What are the physical contraindications for Augmented Psychotherapy with ketamine?2021-05-19T09:25:06+02:00

Contraindications: We cannot offer Augmented Psychotherapy with ketamine treatment to patients who have the following medical contraindications to therapy:

  • Structural heart disease (including heart failure)
  • Labile, difficult to control or untreated hypertension
  • Unstable angina pectoris
  • Myocardial infarction and/or stroke in the past 12 months
  • Increased intracranial pressure
  • Untreated or inadequately treated hyperthyroidism
  • Glaucoma
  • Liver cirrhosis, severe liver dysfunction

If patients* are still interested in therapy with us, they are welcome to contact us and we can review the possibility of Augmented Psychotherapy with non-pharmacological methods.

What are the side effects of taking ketamine?2021-05-19T09:06:40+02:00

The altered states of consciousness that occur during ketamine administration are desired and encouraged in Augmented Psychotherapy. In other applications of ketamine, these perceptions are considered mere side effects. We conceive of altered states of consciousness as an authoritative therapeutic tool. In the context of these altered states of consciousness, there is a temporary marked change in perception, feelings and thoughts. Under certain circumstances this change of consciousness can be very intense. That is why we embed it in a specifically developed psychotherapy.

Other physical side effects include a moderate increase in blood pressure and an increase in heart rate. Nausea, vomiting and blurred vision may also occur. Allergic reactions are very rare. All patients are informed in more detail about possible risks and side effects during medical information sessions.

What distinguishes your clinical approach from other institutions that treat depression with ketamine?2021-05-19T10:30:46+02:00

We understand the use of ketamine as an addition (augmentation) to a well-founded psychotherapy. In augmented psychotherapy, the use of medication thus differs significantly from the classic psychopharmacological approach, which focuses more on the neurobiological antidepressant effect. We see the therapeutic potential of ketamine not only in its direct antidepressant effect but also, among other things, in its mind-altering effect. These altered states of consciousness often make it possible to take a different perspective on oneself and the environment. Working with unconscious content and recognizing and breaking old patterns is possible more often. This can enormously enrich and intensify a psychotherapeutic process. In our practice, ketamine is administered intravenously via a syringe pump (perfusor). The administration of ketamine is always monitored by anesthesiologists. Continuous ECG and oxygen saturation monitoring is performed. With the help of the syringe pump, the anesthesiologists can find the optimal dosage of ketamine for therapeutically valuable altered states of consciousness.

How many doses of ketamine do patients receive during this therapy?2021-05-19T09:36:23+02:00

Augmented Psychotherapy is an intensive short-term psychotherapy over approximately 9 weeks. Of these, 5 weeks in the middle form the core, in which a 2-hour session with ketamine administration and an integration psychotherapy session on the following day take place. Thus, patients usually receive 5-6 sessions of ketamine administration. If patients need more or less therapy units, our concept can be flexibly adapted to individual needs.

Can patients have unpleasant experiences in altered states of consciousness?2021-05-18T17:54:04+02:00

Patients may also have intense challenging experiences during substance use sessions. Through therapeutic support and assistance with integration, the greatest insights can often be gained from challenging experiences. However, in order to find the optimal ketamine dose for our patients and to keep the risk of feeling overwhelmed as low as possible, an individual dose determination takes place at the beginning of each therapy. Furthermore, it is possible to discontinue ketamine administration at any point in the therapy if this should be medically or therapeutically necessary.

How long does a ketamine session last?2021-05-20T18:01:26+02:00

A complete session usually takes 2 hours. Approximately 60 minutes of this time are spent administering the substance. Patients are accompanied therapeutically and anesthesiologically monitored during this period. After the session, patients have time to reflect on what they have experienced and can rest or engage in creative activities in our specially designed integration room. During this time, you can still discuss the experience with our therapeutic staff if necessary.

What are the risks of Augmented Psychotherapy?2021-05-04T16:33:51+02:00

As with any psychotherapy, augmented psychotherapy can lead to a brief intensification of symptoms before an improvement occurs. This is exactly why it is important to us that our patients feel well cared for through close-meshed support. If ketamine is not tolerated, therapy can be continued with altered states of consciousness through non-pharmacological methods. If further help is needed at the end of our therapy, there is the option of extension in integrative psychotherapy. Likewise, we help in arranging further outpatient treatment if it does not already exist. In the case of a relapse, a shortened therapy protocol for interval treatment is conceivable.

Is ketamine approved for the treatment of mental illness?2021-05-18T17:58:52+02:00

Ketamine is an anesthetic and painkiller that has been in use for over 50 years. It is not covered by the Narcotics Act. There is a broad range of studies on the use of ketamine in mental illnesses, especially in the treatment of treatment-resistant depression. The esketamine-containing nasal spray Spravato® is currently the only product approved as an add-on for treatment-resistant depression. It is currently still very expensive and is not covered by all health insurers. We use ketamine i.v. via perfusor under anesthesiological supervision. This allows a patient-specific dosage to be administered and the treatment can be discontinued at any time. Ketamine i.v. is used here as an “off-label” drug, which is explicitly explained. In contrast to conventional psychopharmacotherapy, ketamine is only used in a few targeted individual doses as part of the therapy; there is no substitution treatment with continuous intake, as is the case with antidepressants, for example.

Ketamine has been used for over 50 years. It has few side effects and is safe to use. For example, there are no changes in respiratory drive. There is a low dependence potential, which mainly affects people with existing substance use disorders. This risk is explicitly clarified in the preliminary discussions.

How does Augmented Psychotherapy interact with an ongoing outpatient psychotherapy?2021-05-18T18:00:38+02:00

A combination with outpatient psychotherapy can be carried out if Augmented Psychotherapy can thereby be meaningfully embedded in the longer-term therapy process. Thus, by working with altered states of consciousness, Augmented Psychotherapy can deepen long-term positive therapy processes and add a new dynamic to psychotherapy.  Also, the direct antidepressant effect of ketamine can be very beneficial for long-term therapeutic work, as it allows psychotherapy with less symptom burden. We see the combination of Augmented Psychotherapy as a specific short-term therapy over about 9 weeks in combination with outpatient longer-term treatment as highly useful. Here we strive for a transparent and constructive exchange between the treatment providers in the interest of the patients. In most cases, a pause of the outpatient psychotherapy for the duration of the augmented psychotherapy is appropriate.

Can Augmented Psychotherapy be helpful in the process of discontinuing antidepressants?2021-05-19T10:24:44+02:00

We develop an individual treatment plan, which can also include the possibility of phasing out and discontinuing psychiatric medication. With Prof. Dr. med. Gerhard Gründer, university professor for psychiatry at the University of Heidelberg and head of the DGPPN department for psychopharmacology, the practice has a psychiatrist who specializes in the process of weaning off and discontinuing psychiatric medication as one of the practice’s psychiatrists at its disposal with his expertise. We are happy to work out an individual therapy plan for discontinuation with the use of augmented psychotherapy and relapse prophylactic therapy.

Can long-term psychotropic medication be continued during therapy?2021-05-18T09:25:01+02:00

Continued use of long-term medication is possible during Augmented Psychotherapy and accordingly also during the sessions with ketamine. Under certain circumstances, a dose reduction can be attempted over the course of therapy.

Is the treatment reimbursed by health insurance?2021-05-19T12:51:27+02:00

For privately insured individuals, coverage by the health insurance is often possible. This also depends on the insurance conditions. For people with statutory insurance, the health insurance company usually decides based on the individual course of the disease, previous treatments and the severity of the disease. If various therapy attempts have already been made and have not led to sufficient improvements, reimbursement is usually possible. In any case, we recommend that our patients contact their health insurance company to find out whether reimbursement – or cost sharing – is possible. Usually, the health insurance company will also require a cost estimate from us, which we are happy to provide after the initial psychiatric evaluation.

How can I refer patients to you?2021-02-26T09:55:17+01:00

You are welcome to refer your patients to our therapy offer and mention our website. We will also be happy to send you brochures with further information about the therapy. We also organize regular information events for patients. The dates for these events can be found on our website under Info events.

You can obtain materials at info@augmentierte-psychotherapie.de

Are there information events for interested colleagues?2021-05-18T10:13:20+02:00

Once a month, on the first Monday of the month at 6:00 pm, we organize an online information event for referring physicians and interested colleagues. You can find the dates here.

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