What to Think About During Ketamine Therapy

• Ketamine-assisted psychotherapy (KAP) uses ketamine’s dissociative and neuroplastic effects alongside therapy to help shift rigid negative thought patterns and support healing.
• Although ketamine differs from classical psychedelics, it shares therapeutic benefits such as increased cognitive flexibility, emotional access, and enhanced neuroplasticity.
• Your mindset and environment (“set and setting”) play a major role in shaping the experience, making preparation and emotional safety essential.
• During sessions, noticing thoughts without judgment, using grounding phrases, remembering your intention, and communicating with your care team can help maintain calm and clarity.
• Integration after the session helps translate insights from ketamine therapy into lasting change.

Ketamine therapy for the treatment of depression, trauma, anxiety, and addiction recovery has become increasingly popular across the U.S. in recent years, with even several prominent figures like Elon Musk, Chrissy Teigen, and Halsey speaking openly about their experiences. During ketamine therapy, you may experience a significant shift in your normal perception and thought patterns. It’s most helpful to stay open and compassionate toward whatever thoughts, sensations, or emotions arise. How you shape your actions and thoughts before and after ketamine are also important to maximize the benefits of ketamine-assisted psychotherapy (KAP). In this article, we’ll talk about how ketamine can make you feel and what to think about during these experiences to stay calm and get the most out of the therapy.

Ketamine is a chemical compound that was originally developed as an anesthetic, but has since expanded to use in mental health care. When it comes to treating psychiatric disorders, ketamine is used in three main models:

• Ketamine infusions - Ketamine is provided as an intravenous or intramuscular injection to help rapidly alleviate mental health symptoms. It is provided in a clinical setting under medical oversight.
• Spravato - Spravato (esketamine) is derived from ketamine. It is a nasal spray that is self-administered under medical supervision and is FDA-approved for treatment-resistant depression (TRD) and suicidal ideation. It can act as a standalone treatment for depression.
• Ketamine-Assisted psychotherapy (KAP) - Ketamine is provided alongside talk therapy to help patients understand the causes behind their mental health disorder. Patients typically have talk therapy sessions before and after ketamine treatment.

KAP aims to make use of ketamine’s psychedelic effects. Psychedelic substances are those that can cause temporary changes in perception and thought patterns. These effects can help you gain fresh perspectives and overcome “stuck” negative thought patterns when used in a therapeutic context.

Ketamine is considered to be a non-classical psychedelic. Classical psychedelics include substances such as LSD and psilocybin mushrooms, and these drugs differ from ketamine in both effects and how they act in the brain. Key differences include:

• Visual effects: Classical psychedelics often produce vivid visual hallucinations, including geometric patterns and enhanced colors. Ketamine rarely produces these kinds of visuals.
• Body sensations: Classical psychedelics can intensify physical sensations, while ketamine often creates a sense of dissociation from the body, making you feel detached or in a dream-like “floaty” state.
• Dissociation: Ketamine’s effects are primarily dissociative, whereas classical psychedelics tend to create a more connected and immersive experience.
• Duration: Ketamine sessions are typically shorter, lasting 30–60 minutes for infusions, whereas classical psychedelics can last several hours.
• Neurological mechanism: Classical psychedelics primarily interact with serotonin receptors in the brain, whereas ketamine interacts with the glutamate system.

However, there are several similarities between classical psychedelics and ketamine, which are particularly important in the context of therapy. These include:

• Increased cognitive flexibility: Both ketamine and classical psychedelics can temporarily shift how you think. This can help you view problems, emotions, or thought patterns from new perspectives.
• Increased neuroplasticity: Research shows that both types of substances can promote neuroplasticity, the brain’s ability to form new connections and reorganize itself. Increased neuroplasticity supports learning and the integration of new behaviors or emotional patterns after therapy.
• Emotional release: Both ketamine and classical psychedelics can facilitate access to emotions that are usually difficult to reach. This can help release suppressed feelings, process past experiences, and reduce emotional rigidity. In a therapeutic setting, this emotional release supports healing and personal growth.

Set and setting describe mindset and environment. Both of these factors play an important role in psychedelics, setting the tone and ultimately shaping the experience.

Set refers to your mental state before and during treatment. Mood, stress level, expectations, and emotional safety all influence how the experience feels. A calm and open mindset generally helps you have a smoother journey. Setting, on the other hand, refers to the physical and social environment. Lighting, sound, privacy, and the presence of support all affect comfort. Ketamine clinics specifically design spaces to help you feel calm and safe.

As KAP generally takes place in a clinical environment, the setting is typically controlled. However, there are options to receive ketamine therapy at home. In that case, you should aim to make your space as clean and comfortable as possible.

Unlike setting, set can vary widely from day to day. While it may seem less easy to control, there are some preparatory measures you can take to support an overall positive mindset to support you with ketamine therapy.

Self-care

Self-care in the lead-up to ketamine therapy helps you enter the experience in the best possible mindset. This includes:

• Eating well
• Exercise
• Mindfulness exercises
• Having a good bedtime routine and trying to get adequate sleep
• Spending time in nature
• Keeping a relatively clear schedule and not taking on extra responsibilities that could be stressful

Intention-setting

Intentions are therapeutic goals that help direct the experience. You may have a specific mental health intention, such as addressing a certain trauma or changing a certain habit. However, your intention could also be focused on the ketamine experience itself, such as remaining calm or being open and curious about what might happen.

Whatever your intentions are, these gentle goals provide a focus for the session.

Notice changes in thoughts and feelings

During ketamine therapy, attention often shifts on its own. You don’t need to focus on trying to control your thoughts; instead, you should surrender to any sensations, images, and emotions that arise. Often, thoughts and feelings that occur during these experiences can hold value, but you don’t need to get caught up in trying to analyze them. Rather, notice them without judgment, knowing you can discuss them with a therapist in a later session.

Grounding phrases

Grounding phrases can help during moments of worry, or if you feel out of control. Simple mantras such as “I am safe” or “This will pass” can help you reassure yourself. Remember, the main psychoactive experience will only last around half an hour.

Remember your intention

Your intentions can remain in the background of your mind. Briefly remind yourself of these goals before your session, and come back to them if you feel disoriented or confused.

Allow yourself to express any emotions

If any emotions, positive or negative, come up during your ketamine experience, allow yourself to feel and express them. Sometimes difficult feelings can arise, but it's important to acknowledge them, rather than trying to suppress them. You may feel like you want to scream or cry; expressing these is welcome, as they can help emotions move through you.

Communicate with your medical team

Whether it’s a medical provider or a therapist present with you, you should take advantage of their presence and communicate with them in case you have any concerns during the experience. This instant support is one of the key benefits of in-person treatment rather than at-home ketamine therapy.

Integration refers to processing the experience after ketamine therapy. This phase supports lasting benefit.

Immediately after your session, you may feel mentally tired so immediate reflection may be difficult; you may want to have a brief word with your provider before resting. However, in the week following, you should try to reflect on your experience. This could include:

• Journaling - Writing about any thoughts or feelings that came up
• Meditating - Noticing any changes in your normal patterns of thinking and feeling
• Speaking to a professional - You’ll typically have an integration session with your ketamine provider to discuss your experience and any insights. If there are no sessions planned, you could seek support from an integration therapist or a psychotherapist who understands altered state experiences.
• Speak to friends and family - They may not fully understand what you experienced, but you can try to convey how ketamine has made you feel.

You can also take this time to reflect on your wider intentions and think about actionable steps to help you move closer to achieving these goals. Ketamine’s neuroplastic effects last beyond the session, so the week following your experience is a key opportunity to implement positive lifestyle changes.