Esketamine with acceptance and commitment therapy

Domain VII · Transpersonal, psychedelic & altered states · Mathai, Mora, Garcia-Romeu · 2022

What it is

This is a proposed research model, not a manualised therapy. Mathai et al. describe a planned randomised pilot. People with treatment-resistant depression (TRD) who are starting standard esketamine (Spravato) treatment get either treatment as usual or treatment as usual plus "preparatory counseling…

Format

• Criteria for moving between phases: the published design sets none. Phase transitions follow the medical treatment course, which the prescriber decides. Useful clinical checkpoints are: (a) before the first treatment session, the client can describe the plan, the therapist's role and a personal…
• Optional adaptation, a parallel weekly ACT course [borrowed from NCT06620276]: the CHUM protocol gives ACT as eight weekly 50-minute individual sessions alongside ketamine treatment, in person preferred (remote allowed), each combining teaching and experiential exercises: week 1 control strategies,…

Who practises it, and how they are trained or regulated

• Format: individual, in person, at the certified treatment setting. Session length is not stated, but it is bounded by the observation period [inferred].
• Measures named by the authors: depression outcomes; subjective and dissociative-type drug effects (e.g. the CADSS, which they discuss); psychological flexibility (they cite the AAQ-II as the PF measure in psychedelic research); therapeutic alliance; need for maintenance treatment. These are licensed or published instruments; use the published versions and do not adapt the items.
• Legal and regulatory status (as of sources, 2022–2026).

Evidence status, as the guide reports it

• What it is. This is a proposed research model, not a manualised therapy. Mathai et al. describe a planned randomised pilot. People with treatment-resistant depression (TRD) who are starting standard esketamine (Spravato) treatment get either treatment as usual or treatment as usual plus…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• framing the choice as willpower. Stress noticing instead.
• the diary turning into rumination or self-criticism. Make it shorter.
• values stated as feelings or outcomes ("to be happy"). Reframe them as ways of acting.
• goals set while the client feels elevated in the window may be too big later. Halve them.
• compassion feeling threatening ("I don't deserve it"). Treat that as a thought to defuse from.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.