(Disclaimer: This transcript is using AI technology. Please excuse any errors.)

Music 0:00
Welcome to the Atheists in Recovery Podcast, where we talk about finding hope in recovery. And now your host, Dr. Adina Silvestri,

Adina Silvestri 0:11
Konbanwa Atheists in Recovery land, and welcome to Episode 95 of the Atheists in Recovery Podcast, where it's my job to interview individuals in long term recovery and look at their spiritual and scientific belief systems. In order to deconstruct their limiting thought patterns and introduce new behaviors you can use today, we are talking to Kristen Arden. From mind bloom, and Kristen is a nurse practitioner. And she is going to talk all about guided ketamine therapy. And I know that my clients are going to be very excited about this, because it's something that they've asked a lot about. And it makes sense. It makes sense with all of the research that's popping up at Johns Hopkins University right now with MDMA, being in stage three. And, you know, for individuals in which the SSRIs don't really help anymore, or maybe they never helped. And so looking for another tool to put in the toolbox, I think, is always a good thing. And so Kristen talks a bit about how these medicines are used to, to explore our defense mechanisms, access things we've been blocked off from access narratives that are no longer serving us from childhood. And then she gives specific examples of how to integrate these experiences with the ketamine from your journey into your life and integration, she says is key to making the lasting change that's needed. With this type of therapy. We get a little sciency and talk about the neurobiology of ketamine, but but nothing, nothing in great detail, as it's a 30 minute podcast, I say, but we also hit safety really, really hard as well. So okay, on to our guest, Kristen. Kristen Arden is a psychiatric nurse practitioner with over 15 years of experience working in mental health. As a clinician. Kristin is a proponent for alternative forms of treatment, and her approach to treatment is one that is client centered and driven by the ethos of harm reduction. She is the lead clinician at Mindbloom, a psychiatric medicine company, a clinician with Brooklyn based substance recovery program, and an adjunct professor at NYU teaching nurse practitioner students about substance use and recovery. Okay, guys, onto the show, Kristin Arden, welcome to the show.

Kristin Arden 2:49
Thank you so much for having me.

Adina Silvestri 2:51
So I'm always fascinated about how treatment providers and just people in general come to be where they are today in their career and otherwise. And so I was wondering if maybe you could give us just a little bit of background, maybe start with your deepest roots from childhood.

Kristin Arden 3:11
Sure. So

I grew up in in Los Angeles in California, my mom was a registered nurse and worked in the state hospital system. So early on, I went to daycare, actually in one of the state hospitals. So early on, I had around me people that were in native care. And an environment that was very mental health focus was just hearing my mom's experiences and then going to work with her. As I grew up, my life sort of shifted and what my primary focus was, I mean, my mom was always trying to talk me into going in nursing and working in mental health. For me, my passion was in music. And it was really focused in the music industry. And that was actually my first my first career. So working in music festivals, both producing music DJing, and throwing events promoting big events. And somewhere around my early 20s, I had this epiphany, I was looking at a partner of mine, who was very successful. And I looked at him and I said, you know, there's no guarantee for me here. And something that just triggered for me that I need to go and get my get an education. And as I was thinking about, what am I going to do, like, what am I going to do with my life? The voice that just kept coming into the back of my head or into my mind was my mom saying, you know, he should think about working in mental health, he would be really good working in mental health. Go the nursing route. So that's what I did. So, I started it working pursuing a mental health degree or career. I first started as a psychiatric technician in the state hospital system, which are is a non licensed role and really your your role is supporting people in their daily needs or giving up food, taking people for walks, hanging out having conversation, and I started working my way up way From there, so that my Rn license degree, I got my bachelor's in nursing. And then I pursued my nurse practitioner degree in psychiatry. And all the way up to now I'm in my doctorate do my doctorate studies at Rush University for the final step in my academia journey, as far as professionally goes, as sort of what was going along in parallel to my studies, was a state in the state hospital system, just following kind of the footsteps of my mother. I worked in this state mental health facilities in California for about a decade. And I then applied for a job at the VA hospital in Brooklyn, because it was an opening that was integrating the use of technology to support veterans mental health needs. And I always been really looking forward as to what our new technological innovations that we can utilize to really push forward change in mental health, both in our care delivery systems and how we treat and view people with mental health conditions. So I moved to left California and moved out to Brooklyn for that role. I was with the VA for about four years. And I began feeling frustrated with the overall bureaucracy around if you see something that will help people, you see a better way to do things. And there's so much red tape to make that change happened. That began to frustrate me. So I began to look for other opportunities with more like minded people that really are passionate about innovation in the mental health space. From that search, I found healthcare technology companies, I didn't even know that that was a thing, health tech startups, but it's this thing. And I somehow want that very fortunate to wind up with my blue where I've been for the last two years or so, which is a psychedelic medicine, practice using technology. So we're a telemedicine company.

Adina Silvestri 7:01
Yeah, well, that's a that's a great segue into what we're talking about today, which is psychedelic therapy. And maybe you can talk to us a little bit more about the technology within mental health and, and maybe even just introduce ketamine 's role in mental health and where you see that going.

Kristin Arden 7:25
Yeah, absolutely. So I think one of the big things with leveraging technology in the delivery of healthcare and the thing specifically about mental health, is we have been plagued by issues with access to care. So one of the primary barriers for individuals being just sheer distance of travel to the closest mental health specialist. So utilizing technology as a really valuable tool to kind of cut out that access gap by people being able to access care from their own home where they feel safe, and also taking out that some people to travel two hours to the nearest mental health specialist. That's where I see one of the biggest ways in which we're leveraging technology, in mental health, just by that cutting out that access gap and making it more accessible to everybody. Yeah, as far as the the ketamine goes, so I think about ketamine, I think it's helpful to step back a little bit, thinking about traditionally what we've had to treat conditions like depression, anxiety, substance use disorders, we've traditionally have had tools or medications, we're thinking about the medication side of things. We have this abuse from illogical tools that are really focused on symptom management. So I feel depressed, I feel anxious, I'm having withdrawal symptoms or cravings. I'm going to take a medication that's going to flatten those things, or stunt those symptoms. Up until recently, as we're seeing this renaissance of the use of psychedelic psychedelic medicine such like ketamine that's shifted, and that these treatments, the way I think about them, is it kind of target a little bit further upstream? Or another way to think about that is kind of get to the root or a little bit deeper, deeper than what we're experiencing at the surface. So if the feeling that's coming up for us is, you know, the things like I mentioned the symptoms, what is it that upstream that's leading downstream to us, for us to feel that way? What is it that's deep within us that's kind of flailing around and fighting to get out that is just creeping up through our defenses and presenting his self deprecating top fighter flight or this like impulse to, you know, escape from things. So these tools, I think about them, it's really the work in twofold. So they do have the neurobiological component that works like traditional medicines and they say idea that following the medical model, the idea that We take something, something happens neuro neurobiological neuro biologically in our brain. And that has the intended output in mental health, the intended outcome being to reduce depression or anxiety. Now, the psychedelics do have that function. So they do have the each one their own individual mechanisms from a neurobiological standpoint of reducing symptoms, but they have this whole other piece, which is the thinking about just the experience overall, in working with the medicine. So on a high level, I think about the experiences kind of like using these medicines as tools to really loosen up or open up our defenses or our ego defenses and allow us to go deep within ourselves deep within our psyche, our subconscious, our soul, and connect with ourselves there, access things that we've maybe been blocked off to confront different narratives or perspectives that we've developed over time that are not self serving, or healthy. And we can have this opportunity that's being talked about ketamine, specifically, it's killing me as a dissociative. We're all disassociated from our usual train of thought, or usual state of consciousness. But there's some confliction in that, and that we all know, are disassociated. We are very present and aware. And we're very connected to the moment, but just from a deeper place. So that, okay, that connectivity, and that degree of awareness in a state where our defenses are lower, allows us to really be this like, alert, observer from within, and even collect things, collect things with us along the way, as we go through this process of internally reflecting and working from within, and take things with us from athletic these experiences I think about as kind of, like us collecting things along the way and putting them in our back pocket and taking them with us outside of the experience, and then doing something with them. So that's where the therapy comes in the integration piece comes in this starts after the, you know, these experiences and then the integration is really also a key part of this. So, okay, yeah,

Adina Silvestri 12:22
yeah. So let me just kind of go in summary just a little bit. But before I do, when you were saying ketamine is a dissociative, what did you mean by that?

Kristin Arden 12:31
What I say that ketamine is a dissociative, I'm referring to the type of substance that it is. So pharmacologically, ketamine is what we call a dissociative anesthetic. So when you take the medicine, there is this feeling of dissociation. So depending on the treatment model, the dissociation level might be different. So at Mindbloom, we target a moderate degree of dissociation. So I think helpful there, maybe describe what it is a little bit sure seem a little bit elusive. So what moderate this association might feel like some words that I hear a lot, that it feels like a deep meditative state, a trance like state, like lucid dreaming, like being in a sensory deprivation, float tank, some qualities or characteristics that I think are really prominent of that state, is you have this feeling like you've journeyed somewhere, or like you've left the room, all the while, you still know where you are, you know what you're doing, but you're just like separated from it a little bit. So you might see like your conscious mind over in the corner, and you're kind of sitting back and observing it. And that's that dissociation that separation from it, all the while in this moderate state, so aware, and dialed in and able to like, really engage.

Adina Silvestri 13:57
Okay, so you're still completely aware and dialed in? Because I think that that would almost scare people a little bit, you know, like, What do you mean, I'm moderately disassociating? But you're completely aware of what's going on the entire time? It sounds like,

Kristin Arden 14:12
Yes, absolutely. And I think that that's in working with the medicine in this kind of dosing range. And where we're at, I think that's one of the really positive qualities of this moderate degree of dissociation is, primarily we can remember the experience, right? Like we're having this really therapeutically valuable journey within really important to that therapeutic outcome would be to be able to remember it. Another part is, like you said, safety. So unless we feel really safe and secure, and know in the back of our mind, like I can be in control if I need to, it can be really hard for us to surrender and let go and, and allow an experience to kind of unfold in front of us or trust the the medicine. So I usually will tell people that if you ever felt overwhelmed, you can always take off your your headphones and your imass. This is the ketamine as we utilize it at Mind bloom, you're wearing headphones. And the iMac is a very inward focused experience. So I always remind people that you can always take that off and kind of hold on to something next to you, and be very grounded in your usual state or your usual state of consciousness. And I think people just knowing that they can do that. It really just helps with that safety and feeling secure and being able to let go because, you know, you have your, your way out if you need it.

Adina Silvestri 15:36
Yeah, no, I love that. And I think we'll probably even talk a little bit more about safety in a bit here. But before we do, I just kind of want to recap, because I feel like you said some really important things about the differences between the current state of mental health that we're in and, you know, utilizing some alternate routes to treatment or, you know, just some different things that we could put into our mental health toolbox like psychedelic therapies. And so you talked about, you know, the SSRIs, as we commonly know, them, maybe like the Lexapro and things like that is utilizing them is sort of this way to subdue the symptoms. So really just treating the symptoms alone, and that sort of where it ends. But then when you add something like a psychedelic treatment, you're really it's twofold. You're reducing the symptoms, but also, you're opening up, as you said, like this ego defense mechanisms, you're sort of getting to the ego, maybe being very curious about it getting to the root cause of the issues. Is that is that what I'm hearing?

Kristin Arden 16:47
Yeah, absolutely. So really just kind of going deep within and working from that deeper place of where might be things that you're feeling on a daily basis, that are distressing for you like, Where do they come from?

Adina Silvestri 17:01
Yeah, and I think that's really important. If you're looking at, you know, the mental health system that we currently have, where some people might be in therapy for years, and still not get to the root cause of the issue. But what you're saying is, you know, this psychedelic therapy can happen, and maybe not in a couple of sessions, but we mean, it could have lifelong effects. Maybe you can talk a little bit about that.

Kristin Arden 17:25
Yeah, absolutely. Think, yeah, we do definitely see that. I think one of the it's kind of the twofold, right, so it goes back to how this medication works. So on one side, we remember I talked about how ketamine does have neurological benefits to the reduction of depression and anxiety, to talk a little bit about a little bit more about what that is. So essentially, a high level ketamine, to think about it as kind of like a fertilizer for our brain. So we know based on imaging studies, that things like depression, anxiety, through our response to stress, like the release of cortisol, that it's all damaging, and caustic to our, our tissues, specifically in areas of our brain that we need for higher level cognitive thought processing, emotional regulation, for memory. So ketamine on a neurobiological level really goes in and replenishes those areas. It also enhances neuroplasticity, which means that it's laying out new pathways for us to then go and utilize. And if you think about what that why does that even matter, we think about what's happening on the on the other side of this treatment is we're going through an experience, where we're learning things, we're having experiences with ourselves, where we're confronting thoughts that we've had, that we have or beliefs that we carry, we're confronting maybe memories from our past and kind of seeing them from a different vantage point, all of that these new insights and experiences that we're getting, we're doing so in a time where a brain has been really primed to do so. So we're really kind of coupling up the psychological experience with in working with the medicine in a neurobiological state that's primed for healing and growth. And those two pair together really has compounding effects that support lasting change from these treatments. So it's really interesting process to see somebody go through and that it's, you're learning things, you're seeing things, you're having an embodied experience. So going through that. It's a whole different thing than today, it felt a little bit less depressed. We're, we're having this functional shift from deep within, that is embodied. And so I think that that's really what's key in these lasting changes is that the process of like, once you see something, it becomes hard to unsee and then we do a series of treatments. Imagine if each treatment, you go into this experience and you say, you know i Want to confront the things that that I'm fearful about, and you show up, you surrender, you let go. And you're taken to a place where none of those scary things come in, even if you try to make them come in all you feel is this immense sense of connectivity, and that everything is going to be okay. And you hold that space with yourself for an hour. And that very kind of aware state, like I mentioned, and you come out of that experience, and then you do that, again, in a series of treatments, that part of yourself that just got moved to center stage, while you out there and they experience it moves back that fearful state into the back of the stage, that that other part of yourself that you've become connected to, it's it sticks, and we can become more just usual, it becomes more usual for us to really work from that space too. Hmm.

Adina Silvestri 20:55
So this is really interesting to me. So I do hypnotherapy and, and also brain spotting as part of private practice that I have in Richmond. And so I talk a lot about neuroplasticity, and I've even had clients come in and utilize, they've said, you know, as an adjunct to the ketamine sessions that I'm having, I want to also utilize hypnotherapy. And so I thought, you know what, I need to learn more about

Kristin Arden 21:20
ketamine. Because

Adina Silvestri 21:22
it's, you know, it's it's coming, whether I'm learning more about it or not, I mean, the clients are coming to me saying, you know, where, where can I get ketamine? Or where can I learn more about psychedelic treatments? And so, like, I'm just really thankful that you know, that you were able to come on today, but back to the neuroplasticity? What if, so, I'm getting that, you know, we're, we're laying down new tracks, when we're going into these sessions with the ketamine. What happens after the sessions? How do you keep those new tracks from getting washed

Unknown Speaker 21:59
away?

Unknown Speaker 22:01
Okay, okay.

Kristin Arden 22:02
Yeah.

So there's a saying that I love. And it's the saying is that neurons that fire together, wire together. And if you don't use them, you lose them. So I think about that a lot when I'm working with people in doing education around integration. So after the treatment is when we start talking about integration, we actually start talking about it before treatment, when we start talking about intention setting, right, because our attentions in our preparing our mindset, setting up our space, all of that is feeding into our integration process. So integration, I see as really us using things that we've learned over time, through science around how behaviors, how habits are formed, how behavior patterns are formed, how habits are formed, we're really utilizing that science and applying it to integration to work in our favor. Think about the science that's out there, that tells us that, you know, we don't wake up one day with a habit. a habit is something that's been reinforced and positively reinforced over time, to the point that it's so well ingrained in this automatically see the trigger, right, like it's just we our brain has been programmed through this memory response patterning. So that doesn't happen just instantaneously, right? Like the science out there tells us it takes about 90 days or so for somebody to make a new habit or to break a habit. So always think about that, when I think about integration is for taking that same science have this repetition, of engaging with our thoughts. And we're utilizing that to really reinforce the new pathways that have been laid out with the hopes that they will then turn into these well, very well reinforced autonomic pathways that they we hope that they would come into supporting us we come into contact with our triggers, right? So I'm thinking about that a little break it down a little bit more granular in a way that is more easy to apply. So I think about integration as a three step process. So we always recommend journaling, after these experiences, both to collect the information or the thoughts, the feelings that came up for you after the experience or during the experience. And also as just to capitalize on that therapeutic, cathartic release of just getting it out somewhere. The first step then in integration would then be pulling out your journal, thinking back to Okay, what were my intentions, looking at what you wrote or what your experience was for you? And making sense of it? Right? Just trying to make sense. Yeah, this is my intentions. This is what happened. Like, what does this mean? Right. The next step is then to kind of break it down a little bit further by pulling out like key salient takeaways. from experience, I think about it as kind of, like when we read something, and we bullet point out, like the key things we want to remember from that are key takeaways. So we go through that process of streamlining it down. The third step is an action. So what is something that we can do daily, to engage with these key things that came out of it came out of this experience for us, and then commit to engaging once a day with the things that were your key takeaways from these experiences. And the thought behind that being that while we're doing that, we're really kind of going through a process of trying to reinforce that new pathway that's been laid out for us, and becoming comfortable with that, with that narrative or that thought pattern. And same thing, like we talked about how we go through this process to make habits, the same thing that we're applying here. And the idea being that over time, it just becomes more naturally ingrained. These key things that we've taken away from us with these experiences.

Adina Silvestri 26:01
Yeah, so it sounds a lot like, you know, journal journaling, I love journaling, I do journaling, you know, I use it every single day, but it's the, the actual treatment, right, like, so you're taking this pill with, with, again, with a guide, and I'm sure you'll talk about that as well. But then you're also having these follow up treatments to sort of solidify what you've learned. And it's almost like talk therapy in a way, you know? Yeah,

Kristin Arden 26:30
yeah, I think that the work in both integration and on therapy is really key to compound the outcomes for this treatment. So I think about integration as a little bit different than therapy. So integration is really our active, understanding the experience, and then taking the the insights gained from this from the experience and using it to kind of patch up holes that we've identified maybe like, within our psyche, or subconscious or soul, right. So taking that step back and seeing, like, Where do I feel like there's voids? And where do I feel like there's something missing? And how does this experience the things that came up for me through that experience? How do I then use those things to kind of patch up those places where I feel like there's some emptiness. So it's really that process of taking the experience with the medicine, and your experience working with the medicine, the days that follow, and integrating it into yourself to with the goal of kind of supporting, developing wholeness, when I think about therapy, and a little bit different than that in a different kind of context and straight integration, straight integration, think about, there's often a really strong need for processing work. So be thinking about kind of, like I did, how I described that ketamine is kind of like this tool to go deep within our, our, our subconscious and stir up the pot and bring things to the surface. So if we can imagine somebody that maybe has trauma, or something deep within that, it came up, that's challenging for them, there's a chance that they could feel a little bit worse before they felt better. And if they labeled that feeling, you know, after treatment of, I feel unsettled, or I feel a little bit more down, if they go through their, their automatic labeling of that is bad. This is bad that I feel this way, because it's uncomfortable, and I need to push that away, we're kind of counteracting a lot of how this treatment can be really therapeutic and valuable. So that's really where the therapy comes in is like someone that you know, and trust that you can go to and say, Hey, this was the experience I've had, this is how I've come to understand this experience. This is what came up for me, this is how I'm feeling? How can I process that in a way where I can heal, maybe from things from my past or heal from that deeper level, that part of me. And so that's what that therapy really gets valuable of coming in like that deeper processing work, so that these experiences don't become something that leaves us unsettled, but really assures that we're like processing and healing and moving forward. Okay.

Adina Silvestri 29:04
Yeah. Yeah, that makes that makes sense. So having these sessions with, with the place like mine bloom, and then also maybe then going to your therapist afterwards and processing some of this, this deep inner work that you've done, and making some more sense of it. Okay, Kristen, I'm wondering if you could talk a little bit about the safety of this because So, so some of the questions that I hear regarding ketamine treatment is virtual, right. So that sort of telehealth is, you know, what's gonna happen during these sessions? You know, how is this done is am I going to be safe? And so I'm sure you guys have thought of everything. So maybe you could just give us a little outline of what that looks like. Yeah.

Kristin Arden 29:49
Yeah. So I will say, there's been a ton of science kind of research done that really validates the safety and efficacy of ketamine. One following therapeutic treatment model, I think there's more than 10,000 or so studies out there looking looking just at that just at this academy. So as far as things that we do for it to support safety. So as far as my Blum and how we approach safety, the first step would be the screening process. So you do meet with a clinician that specializes in this medicine and you go through a whole psychiatric evaluation to really get an understanding of your mental health symptoms and needs, and then also a full medical history review to really get an understanding of, of any medical history or needs. So as long as there, you're don't have any contraindications for treatment, you would then go into the this part of the evaluation or that consultation where we review your your home situation. So the next step would be to make sure that you have a place at home that is private, safe, secure, free of distractions, and that you also have somebody there, or somebody that can come over and support you through these treatments. So we call them a peer treatment monitor, so somebody that you feel safe or secure with or somebody that is a completely neutral party, so you cannot do the treatments home alone. So that's another big part of our of our safety protocol. Okay, ruling out any conditions that could impose possible risks with the ketamine treatment, and then ruling out any issues in the home setting, or issues with support that could complicate treatment with doing the treatment at home.

Adina Silvestri 31:37
Okay, great. Do you know of any medicines that are contraindicated? Or is there just such a long list that it's better just to do the assessment?

Kristin Arden 31:46
Yeah, you know, I'd say one of the positives with ketamine, and specifically, the treatment of mental health is that it works through a different receptor system than most of the traditional treatments for depression and anxiety. So it works with the NMDA receptors were like SSRIs work through start with serotonin and nor norepinephrine. So I think that's a positive is that we don't have to worry as much about the drug to drug interactions. Really the the primary things that we're looking for is interactions with stimulants, because ketamine is a mild stimulant, and then interactions with benzodiazepines, because there's some science out there that shows us that the benzodiazepine might actually reduce the efficacy of the ketamine. However, those aren't things where if the person was taking them, it would be it would be prevent them from moving forward treatment, we would just have to make sure that the person is able to, not to able to tolerate not taking those medications for that day while they're doing the ketamine treatment.

Adina Silvestri 32:46
Okay, that's good to know. Okay, so we've covered safety, we've covered sort of what a brief overview of what would be contraindicated, or anything else that we need to know, Kristin.

Kristin Arden 33:02
Alright, so as far as next things that might be helpful to know is maybe if you're curious about ketamine treatment, how you might be able to explore that option a little bit further. So I would really recommend checking out our website, which you can find that mine bloom.com. So on our website, we do have a blog that has a ton of really valuable detailed information about ketamine, both on the neuro biological side about ketamine therapy, then that might be a really interesting place to check out and get some more information. And also, if you're curious about speaking with a clinician and hearing more about if this treatment would be a good option for you go through the process of signing up and scheduling a consultation with a clinician.

Adina Silvestri 33:47
Yeah, that sounds that sounds great, Christine, I think, you know, it's exciting to see the current research and you know, MDMA, I think is in like state clinical trials, stage three clinical trial trials, is that right?

Kristin Arden 34:00
Yes. Uh huh.

Adina Silvestri 34:02
for PTSD, and so I think it's, it's coming. I mean, it's here, right, like, here, so we just have to embrace it. And, and it's exciting also, in that, you know, there's so many individuals in which SSRIs don't, you know, aren't working for them? I think we, we were talking a little bit before we hit record that people that have tried 10 different SSRIs are saying, you know, I don't know what else to do, I might as well go back to using, you know, where, where are my opioids? Where am I? You know, so I think this would be really important for them to do some more research on as well.

Kristin Arden 34:40
Yeah, absolutely. I really just encourage anybody that's struggling, and really kind of feeling like they have ran out of options. Or maybe they're doing okay, but not feeling 100% better, and kind of fed up with the options that have been presented to them to reach out to us. If not us. To another psychiatric clinician that specializes in this in this area of practice or these treatments and in please reach out ask questions. I mean, we're the people to go to go to if you're wondering if this is something that is safe for you could be helpful for you. Please reach out to us with with any either us or any other professionals that you can find out there. And please don't hesitate to get more information.

Adina Silvestri 35:25
Well, as we end today Kristin again, I just want to thank you for for being on and I will link to all of mine blooms, links in the show notes.

And again, thank

you so much.

Kristin Arden 35:36
Thank you so much Adina. It's been great spending some time with you today.

Music 35:39
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