Ketamine in Psychotherapy: Opportunities to Explore by Will Van Derveer, MD


Default mode network is a survival mechanism that protects us, looking for what’s not right in the situation.

The role of meditation experience is associated in DMN activity and connectivity shows that the medial frontal and posterior cingulate cortex were relatively deactivated in experience meditators across all meditation types. DMN works subconsciously which implies that talk therapy often times falls short of getting the job done with changing patterns in the DMN.

Ketamine’s role in the DMN is very specific so much so that it aids to normalize the connectivity between the DMN and Insula (a part of the brain that is responsible for shame and physical pain).

Immersing one’s self in mystical experiences helps a person to perceive one’s self to see a bigger perspective and perceive to be part or be an element of that environment but not separate from it.

Ketamine offers a window into a possibility for changes creating opportunities but not necessarily addressing root causes.

FULL TRANSCRIPT:

The default mode network is a wandering mind that has negativity bias. So, this is a survival mechanism, this is a mechanism that protects us. This is what has us scanning the environment, scanning our email scanning our text thread scanning Facebook, scanning our families and the faces of the family members we have at home looking for what’s wrong looking for who’s upset at me or what’s not right in this situation.

The default mode network has also been studied in experienced meditators. This study by Brewer showed, that meditation experience is associated with differences specifically the medial frontal and posterior cingulate cortices were relatively deactivated in experienced meditators across all meditation types. The point in bringing up the default mode network in this talk is that the default mode Network really represents the self. It operates very subconsciously, so talk therapy, oftentimes, falls short of getting the job done with changing patterns in the default mode network.

We also know that ketamine has very specific impacts on the default mode network. In this study connectivity between the insula and the default mode network was normalized, compared with healthy controls two days after, and this change was reversed after 10 days, and didn’t appear in the placebo scan. So, insula is a part of the brain involved in shame and it’s also involved in physical pain.

I think it’s interesting for us to think about mystical experiences as relates to the default mode network because if you are deep in your self-referential ego perspective, it’s a little bit like being stuck inside a heavily armored and walled city and you can’t even see over the wall to see what’s going on outside of your ego. The mystical experiences I think of as the dropping down of that wall and the ability to see a bigger perspective but also see oneself as a part of the bigger picture of them to perceive oneself as a, an element of the universe but not separate from it. You can think of the mystical experiences as the dropping down of that wall and the ability to see a bigger perspective but also see oneself as a part of the bigger picture or to perceive oneself as an element of the universe but not separate from it.

 

Making changes to habitual patterns is not easy, it requires a lot of work. You can see from the direction of this talk that that my perspective is that, chronic depression is a multifactorial situation and ketamine offers a window into a deep possibility for change. But like our other medications, it’s really not addressing a root cause. It creates an opportunity but it doesn’t get to the bottom of things, which is what we need to do by supporting the virtuous cycles exploring new resources, journaling, exercising, diet upgrades, reworking relationships.