TIMBER (ketamine with mindfulness-based extinction and reconsolidation)

Domain VII · Transpersonal, psychedelic & altered states · Basant Pradhan · 2015 · Camden, New Jersey, USA

What it is

TIMBER (Trauma Interventions using Mindfulness Based Extinction and Reconsolidation of memories) is a manualised, mindfulness-based cognitive-behavioural psychotherapy developed by psychiatrist Basant Pradhan at Cooper University Health System. It can be delivered alone (first published with…

Format

• Psychotherapy dose: 12 TIMBER sessions in total, three in the first week (the first falling within the ketamine session window, then day 2 and day 8, per the blog summary), followed by nine weekly sessions of about 40 to 45 minutes. The paper's Methods section also describes twice-daily home…
• Phase 2, peri-ketamine module: two brief cycles of mini-TIMBER/STOPP during the window around the ketamine session, each combining short, controlled trauma-memory reactivation with rapid de-escalation and "mindful detached monitoring". The authors base this timing on a reconsolidation window of…

Who practises it, and how they are trained or regulated

• Population: the registry (as summarised by moreblossom) specifies adults aged 21 to 60 with chronic PTSD by DSM-IV, a PCL-C score of at least 51 and a CAPS score (first 17 items) of at least 50; the paper summary adds treatment-refractory PTSD for at least 6 months despite CBT and at least two antidepressant trials. Registry details: Phase II, quadruple-masked, target enrolment 50 (published reports describe 10 and…
• Design: randomised, placebo-controlled, crossover pilot. One arm received ketamine plus TIMBER, the other an inactive placebo plus TIMBER; placebo participants who had a sustained relapse (described in the blog as two weeks of relapse) crossed over to ketamine plus TIMBER. The pharmacist and statistician were unblinded; other study staff stayed blinded. Registry primary outcomes were change on CAPS and PCL about a…
• Setting: ordinary outpatient office. Developer-stated provider minimum: bachelor-level with some grounding in mindfulness and CBT; developer training is six hours over two days, onsite for a fee.

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

• physical discomfort, breath-related panic; adapt or omit.
• practice logged daily; increasing ease of returning attention.
• mood drop as the drug effect fades; hopelessness when relief does not last.
• belief ratings for the appraisal falling; less shame or self-blame language.
• gaps in logging as an early sign of avoidance or non-adherence (see section 5).

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.