Unfolding States of Mind: A Dissociative-Psychedelic Model of Ketamine-Assisted Psychotherapy in Palliative Care.

Patients in palliative care often suffer from existential distress, loss of meaning, and emotional pain beyond physical symptoms. Ketamine-assisted psychotherapy (KAP) has emerged as a promising intervention for this complex suffering, but models tailored to palliative populations are scarce. This narrative review synthesizes evidence on ketamine's neurobiological, psychological, and experiential effects relevant to end-of-life care and presents a novel, time-limited KAP model. The model includes preparatory and integrative psychotherapy, two ketamine dosing sessions (one low-dose and one moderate-dose), concurrent psychotherapy, goals of care discussion, and optional pharmacological optimization. It leverages ketamine's effects on self-processing networks to address both bodily and narrative dimensions of distress, offering a compassionate, pragmatic approach to enhancing meaning, emotional resolution, and quality of life at the end of life.

Study at a glance

Abstract

Background/Objectives: Patients in palliative care often experience multifaceted forms of suffering that extend beyond physical symptoms, including existential distress, loss of meaning, and emotional pain. Ketamine-assisted psychotherapy (KAP) has emerged as a promising intervention for alleviating such complex forms of suffering, yet models specifically tailored to palliative populations remain scarce. This narrative review synthesizes current evidence on ketamine's neurobiological, psychological, and experiential effects relevant to end-of-life care, and presents a novel, time-limited KAP model designed for use in palliative settings. Methods: Drawing from both biochemical and psychedelic paradigms, the review integrates findings from neuroscience, phenomenology, and clinical practice. In particular, it incorporates a dual-level experiential framework informed by recent models distinguishing ketamine's differential effects on self-processing networks: the Salience Network (SN), related to embodied self-awareness, and the Default Mode Network (DMN), associated with narrative self-construction. This neurophenomenological perspective underpins the rationale for using two distinct dosing sessions. Results: The article proposes a short-course, time-limited KAP model that integrates preparatory and integrative psychotherapy, two ketamine dosing sessions (one low-dose and one moderate-dose), concurrent psychotherapy, goals of care discussion (GOCD), and optional pharmacological optimization. The model emphasizes psychological safety, meaning-making, and patient-centered care. The sequential dosing strategy leverages ketamine's unique pharmacology and experiential profile to address both bodily and narrative dimensions of end-of-life distress. Conclusions: This dissociative-psychedelic model offers a compassionate, pragmatic, and theoretically grounded approach to relieving psychological and existential suffering in palliative care. By integrating neurobiological insights with psychotherapeutic processes, it provides a flexible and patient-centered framework for enhancing meaning, emotional resolution, and quality of life at the end of life. Further research is needed to evaluate its clinical feasibility, safety, and therapeutic efficacy.