Ketamine-Assisted Psychotherapy for PTSD Related to Racial Discrimination

This work is a single‑case, descriptive report of an intensive outpatient programme (IOP) combining ketamine administration with psychotherapeutic preparation and integration. The client, given the pseudonym Robyn, was a 58‑year‑old African American woman with diagnoses of PTSD and major depressive disorder (persistent depressive disorder was noted historically). Baseline assessment included a structured diagnostic interview (MINI), the Beck Depression Inventory‑II (BDI‑II), the Posttraumatic Cognitions Inventory (PTCI), the UnRESTS (used to characterise race‑related trauma), and culturally oriented tools such as an ethnocultural genogram. Therapists also used daily cognitive logs (ABCD) during treatment. Treatment took place over 13 days and comprised preparatory sessions, four ketamine dosing days, and multiple integration sessions. Ketamine was given sublingually at 150 mg on four occasions during the IOP (the authors note a typical KAP sublingual range of 75–300 mg and that sublingual bioavailability is variable). A multidisciplinary clinical team provided care: two psychotherapists (one Black, one multiracial), a prescribing clinician (advanced nurse practitioner), and supervisory oversight from an African American clinical psychologist. Psychotherapeutic modalities integrated into preparation and integration sessions included Mindfulness‑Based Cognitive Therapy (MBCT) and Functional Analytic Psychotherapy (FAP) as primary orientations, with Cognitive Behavioural Therapy (CBT) techniques, Internal Family Systems (IFS) interventions, somatic work, art directives and safety planning also employed. Safety procedures included a medical and psychiatric evaluation to rule out contraindications, pre‑session checks (e.g. blood pressure), lifestyle guidance (e.g. regarding benzodiazepines), brief risk assessments after each dosing session, and explicit development of safety plans when needed. Outcomes were assessed by repeated administration of the BDI‑II and PTCI, clinician observations and participant self‑report at the end of the IOP and at follow‑ups at approximately 2 weeks, 3 months and 6 months. Analysis was descriptive and bounded to the single‑case data presented.

At intake Robyn met criteria for PTSD and major depressive disorder on the MINI, scored 40 on the BDI‑II (severe depression range) and 207 on the PTCI (over one standard deviation above typical PTSD medians). During the 13‑day IOP Robyn received four sublingual 150 mg ketamine doses with preparatory and integrative psychotherapy interspersed. Symptom measures showed marked improvement by the end of the programme: BDI‑II score decreased by 27 points (from 40 to approximately 13), bringing depressive symptoms into a subclinical range, and PTCI score decreased by 70 points (from 207 to about 137). Robyn also reported improved sleep (from around 4 hours per night pre‑treatment to 8–10 hours per night during and after treatment), decreased rumination, and greater ability to tolerate distress. Functionally, she engaged in job applications during treatment, received further interviews and by the 3‑month follow‑up had obtained a new job and begun preparations to relocate. Social engagement increased, she ended an unsupportive romantic relationship, and she participated in peer meet‑ups. Safety and adverse events: at baseline Robyn reported frequent suicidal ideation (thoughts about suicide roughly four times per week). During the second dosing session she experienced intense traumatic material and transient suicidal ideation; therapists used regulation strategies, IFS interventions, risk assessment and a safety plan, and she reported no plan or intent at session conclusions. No major medical adverse events are described. At 6 months, Robyn experienced a partial symptom relapse: her BDI‑II score increased by 16 points to 29 and PTCI was effectively unchanged from end‑of‑IOP scores (reported as 136), a change the authors attribute in part to relocation stress and the onset of the COVID‑19 pandemic. A supplementary 75 mg sublingual ketamine dosing session was delivered at 6 months, after which Robyn reported mood improvement. Overall, early gains were sustained at 2‑week and 3‑month contacts but attenuated by 6 months, requiring ongoing care.

Halstead and colleagues interpret Robyn's course as supportive of KAP as a feasible and potentially effective adjunctive treatment for complex PTSD linked to racial trauma and comorbid depression in a client who had been treatment‑resistant to prior modalities. They emphasise that the combination of ketamine's putative neuroplastic window with targeted psychotherapeutic work (MBCT, FAP and complementary interventions) appeared to facilitate cognitive and somatic processing of both childhood abuse and accumulated race‑based injuries, producing measurable reductions in negative cognitions, depressive symptoms and functional impairment. The authors place particular weight on cultural attunement: a diverse clinician team, explicit psychoeducation about racial trauma and use of ethnocultural genograms and culturally appropriate de‑escalation and integration strategies were described as integral elements that helped build trust and permitted effective processing. They also highlight practical safety considerations that arose in the case — continuous suicidality monitoring, culturally informed de‑escalation, careful dosing choices for clients with dissociative PTSD, and the need for robust informed consent — and recommend that clinicians have medical screening and alternative treatment options available when KAP is not suitable. Key limitations and uncertainties are acknowledged: the report is a single‑case description, limiting generalisability; multiple concurrent therapeutic components and post‑treatment life events (relocation, the COVID‑19 pandemic) make causal attribution to ketamine alone impossible; and access barriers (cost, travel, limited availability of culturally competent providers) constrain broader implementation. The authors therefore call for more inclusive research with participants from marginalised backgrounds and for clinicians to incorporate cultural humility, thorough safety planning and ongoing follow‑up when offering KAP.