Why Ketamine Sand Tray and Group Together? ​

        Group therapy offers a direct antidote to the isolation and social disengagement that characterizes PTSD and complex traumatic stress disorders (1).  The access to treatment is also increased through a group modality as psychedelic treatments are still largely not covered by insurance carriers and the costs of professional labor is distributed amongst the members of the group more efficiently.

          Altered state medicines, and ketamine specifically, have shown evidence to appropriately address the negative effects of post-traumatic experiences and increase the mental health of persons affected by such experiences.  Through the chemical processes of neurogenesis (2), inhibition of the default mode network (3), and novel stimulus perceptions of altered states (4), ketamine provides an ideal set and setting for the abstract and poetic work of sand tray to flourish.

          One of the effective mechanisms of Sand Tray therapy is the ability to assist persons express significant life experiences through symbolism that is not attached to language.  Traumatic events tend to first be processed by the right hemisphere of the brain as sensory elements which trigger the fight/flight response (5).  As memory continues to process, the left brain ideally can further sort out the sensory inputs into a context of time, space, and language.  However, when the sensations are too intense, the right brain may experience a freeze response and inhibit the left brain from being able to make sense of the event.  This can explain why trauma is re-experienced as flashbacks and without context of the full event, as the right hemisphere continues to be overwhelmed when some sensory input triggers the overwhelming memories.  As Dr. Bessel van der Kolk observes in his book, The Body Keeps the Score, “All trauma is pre-verbal” (6).  Being able to express the events in ways that do not immediately require a linear story or use of narrative language, such as through dreams, art therapy, play therapy, or sand tray, allows the sensory stimulations to be mitigated in exposure and prevent the left-brain inhibition.​

References:

1. Courtois, C. A., & Ford, J. D. (Eds.). (2009). Treating complex traumatic stress disorders: An evidence-based guide. The Guilford Press, 415.

2. Austin J. Peters, Laura E. Villasana, Eric Schnell; Ketamine Alters Hippocampal Cell Proliferation and Improves Learning in Mice after Traumatic Brain Injury. Anesthesiology 2018; 129:278–295 doi: https://doi.org/10.1097/ALN.0000000000002197

3. Lehmann, M., Seifritz, E., Henning, A., Walter, M., Böker, H., Scheidegger, M., & Grimm, S. (2016). Differential effects of rumination and distraction on ketamine induced modulation of resting state functional connectivity and reactivity of regions within the default-mode network. Social cognitive and affective neuroscience, 11(8), 1227-1235.

4. Griffiths, C., Walker, K., Reid, I., da Silva, K. M., & O'Neill-Kerr, A. (2021). A qualitative study of patients' experience of ketamine treatment for depression: The ‘Ketamine and me’project. Journal of Affective Disorders Reports, 4, 100079.

5. Van der Kolk, B. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.

6. Schore, A. N. (2009). Right-brain affect regulation: An essential mechanism of development, trauma, dissociation, and psychotherapy. In D. Fosha, D. J. Siegel, & M. F. Solomon (Eds.), The healing power of emotion: Affective neuroscience, development & clinical practice (pp. 112-144). W. W. Norton & Company.