Two clinical psychologists from the United States, Steven Gold and Michael Quiñones, who work with victims of complex PTSD (C-PTSD), shared their experience of using ketamine in trauma therapy. Their article reveals the paradoxical nature of treatment: dissociation, which is a symptom of the disorder, can be the key to recovery.
The problem of modern trauma therapy
Although 40 years have passed since PTSD was officially recognized as a diagnosis, many patients still cannot find adequate treatment. In real-world settings, approximately 50% of patients prematurely discontinue therapy, and some even experience worsening symptoms.
What is K-PTSD?
Complex PTSD is a syndrome first described by psychiatrist Judith Herman in the 1990s, which was officially recognized in the ICD-11 classification of diseases. Unlike conventional PTSD, C-PTSD includes not only typical symptoms of trauma, but also three additional components - persistently negative self-esteem, problems in interpersonal relationships, and difficulties with emotional regulation.
C-PTSD often occurs as a result of prolonged traumatic experiences in childhood. It is not just the consequences of traumatic events, but also the result of growing up in an environment that did not provide adequate psychological support for development.
Neurobiology of trauma
Studies have shown that both traumatic experiences and lack of secure attachment negatively affect brain development, leading to abnormal patterns of neural connections. This disrupts the development of important structures such as the hippocampus, amygdala, and cerebral cortex.
Contextual trauma therapy
The authors have developed an approach called Contextual Trauma Therapy, which takes into account that C-PTSD arises not only because of traumatic events, but also because of a lack of positive influences in childhood. Therefore, treatment should begin not with direct processing of the trauma, but with the elimination of developmental deficits - establishing trusting relationships, working with negative self-perception, and training emotional regulation skills.
Ketamine as a therapeutic agent
Ketamine has been called a "dissociative psychedelic" because it induces dissociative experiences such as depersonalization, derealization, and time distortion. Paradoxically, these effects can be therapeutic.
Ketamine promotes neuroplasticity through the creation of new synapses between neurons and the growth of new neurons. It also changes the functional connections between different brain structures, which can help repair disrupted neural networks caused by trauma.
The paradox of dissociation
The authors explain a paradox: although dissociation is a major problem in C-PTSD, ketamine-induced dissociation can have a therapeutic effect by creating an emotional distance that allows trauma survivors to face traumatic material without feeling overwhelmed.
The calming effects of ketamine can neutralize common difficulties, such as mistrust, feelings of danger, and the inability to withstand distress. This makes it easier to safely process traumatic memories.
Preliminary results
The authors' clinical experience shows impressive leaps in psychological development and trauma resolution after a relatively small number of ketamine therapy sessions. They believe that ketamine can radically reduce treatment time compared to traditional psychotherapy.
This article demonstrates how understanding the neurobiology of trauma and the innovative use of ketamine can open up new treatment pathways for people with complex post-traumatic stress disorder.
