Ketamine is a prescription-only medicine that may be prescribed off-label by our medical team following a comprehensive assessment to assist in the psychotherapy.
Ketamine is a prescription-only medicine that may be prescribed off-label by our medical team following a comprehensive assessment to assist in the psychotherapy.
CONDITIONS WE WORK WITH
You’ve spent long enough living in survival mode.
Anxiety can make the world feel unsafe, even when part of you knows it isn’t. You may find yourself constantly anticipating problems, overthinking decisions, struggling to relax or feeling as though your nervous system is permanently switched on.
Ketamine-assisted psychotherapy may offer a different way of approaching anxiety — creating space for perspective, flexibility and therapeutic change when traditional approaches have not been enough.
Advanced
Treatment
Specialist
Psychotherapy
Support
Throughout
02 RECOGNITION
Anxiety is more than worry. It can feel as though your mind is constantly scanning for danger, trying to predict problems before they happen.
You may replay conversations long after they’ve ended. You may struggle to switch off, even when you’re exhausted. Small decisions can feel disproportionately difficult. Relaxation can feel unfamiliar, and rest can sometimes feel impossible.
Many people living with anxiety become exceptionally good at functioning. They continue to work, care for others and meet expectations, while privately carrying a nervous system that never feels entirely safe.
After enough time, it becomes difficult to remember what life felt like before anxiety became the background noise to everything.
THINGS YOU MAY RECOGNISE
“Anxiety can become so familiar that it starts to feel like part of your personality. It isn’t.”
03 WHY THIS HAPPENS
Anxiety doesn’t come out of nowhere. It develops for a reason. Understanding why it happens can help you stop blaming yourself and start making sense of what your mind and body have been trying to do.
YOUR BRAIN LEARNS FROM EXPERIENCE
Anxiety rarely appears without reason. Sometimes those reasons are obvious. Sometimes they are not. Stress, difficult life experiences, loss, trauma, prolonged uncertainty and even years of feeling responsible for other people can teach the brain that the world is less safe than it once believed.
YOUR NERVOUS SYSTEM STAYS ON HIGH ALERT
Once the brain begins expecting danger, it becomes increasingly good at finding it. You may become more aware of bodily sensations, more sensitive to uncertainty and more likely to imagine future problems before they happen. Over time, this state of alertness can begin to feel normal.
ANXIETY IS OFTEN AN ATTEMPT TO KEEP YOU SAFE
Anxiety can feel cruel, but its intention is usually protective. It is your brain’s attempt to prevent pain, embarrassment, loss, rejection or harm before they occur. The problem is that it can become so effective at protecting you that it becomes difficult to fully live.
“Anxiety is not evidence that something is wrong with you. It is evidence that your mind and body have spent a long time trying to keep you safe.”
Anxiety is not evidence that something is wrong with you. It is evidence that your mind and body have spent a long time trying to keep you safe.
UNDERSTANDING WHY IT HAPPENS IS THE FIRST STEP TOWARDS CHANGE.
04 WHAT THE SCIENCE TELLS US
THE ANXIOUS BRAIN
Anxiety is not generated by one isolated part of the brain. It emerges from a network involved in detecting threat, interpreting uncertainty, remembering previous danger and deciding whether the body can safely relax.
When that network becomes overprotective, harmless sensations and uncertain situations may be interpreted as warnings. Ketamine appears to influence several parts of this system while also promoting a temporary period of greater neural flexibility.
WHAT IT DOES
The amygdala helps detect emotionally important information, particularly possible threat. In anxiety, it can become more reactive, causing situations, bodily sensations or facial expressions to feel more dangerous than they objectively are.
WHY KETAMINE MAY MATTER
Human imaging studies suggest that ketamine can alter amygdala activity and amygdala-hippocampal connectivity, although most of this work has been conducted in depression and trauma-related conditions rather than primary anxiety disorders.
WHAT THIS MAY MEAN FOR YOU
The alarm may feel less dominant, creating enough distance to assess what is happening rather than responding automatically as though danger is already present.
WHAT IT DOES
The prefrontal cortex helps evaluate risk, regulate emotional responses and distinguish a genuine threat from an anxious prediction. When anxiety is intense, the alarm system can overpower this reflective part of the brain.
WHY KETAMINE MAY MATTER
Ketamine has been associated with changes in prefrontal connectivity and plasticity. Research suggests that the relationship between prefrontal regulation and amygdala reactivity may influence treatment response.
WHAT THIS MAY MEAN FOR YOU
There may be more room between the anxious thought and the response: enough space to question the prediction, tolerate uncertainty and choose what to do next.
WHAT IT DOES
The hippocampus helps memories remain connected to time and place. It contributes to recognising that something was dangerous before is not necessarily dangerous now.
WHY KETAMINE MAY MATTER
Preclinical research suggests that ketamine can influence fear discrimination and extinction through circuits linking the hippocampus, amygdala and medial prefrontal cortex. This is promising, but not established clinical proof.
WHAT THIS MAY MEAN FOR YOU
The mind may become more able to separate ‘this reminds me of danger’ from ‘I am in danger now.’
WHAT IT DOES
Glutamate is the brain’s main excitatory messenger, while GABA is its main inhibitory messenger. Anxiety involves complex changes across both systems; it is not simply caused by ‘too much glutamate’ or ‘too little GABA.’
WHY KETAMINE MAY MATTER
Ketamine blocks NMDA receptors and briefly changes glutamate signalling, partly through effects on GABAergic interneurons. This can activate AMPA receptors and downstream pathways associated with BDNF, synaptic plasticity and network change.
WHAT THIS MAY MEAN FOR YOU
Brain systems that have been repeating the same alarm response may become temporarily less rigid and more open to learning a different response.
THE THERAPEUTIC WINDOW
Ketamine’s importance may not be that it simply suppresses anxiety. Research increasingly points towards neuroplasticity: the brain’s ability to alter connections, update predictions and learn from new experience.
During a period of greater flexibility, psychotherapy can help you:
Ketamine may loosen the old prediction. Psychotherapy helps the brain discover that another outcome is possible.
Important context: Ketamine is not currently an established first-line treatment for anxiety disorders. Much of the mechanistic evidence comes from depression, PTSD and preclinical research. Its relevance to anxiety is biologically plausible and clinically promising, but further controlled research is needed.
05 COULD KAP HELP?
HOW KETAMINE-ASSISTED PSYCHOTHERAPY MAY HELP
Anxiety is often maintained by a cycle. Something feels uncertain or threatening, the nervous system reacts, and we respond by worrying, seeking reassurance, controlling, checking or avoiding. Those responses provide short-term relief, but they can also teach the brain that the danger was real and that avoidance was necessary.
Ketamine-assisted psychotherapy may interrupt that cycle in two complementary ways. Ketamine can temporarily alter rigid patterns of thought, emotion and threat processing. Psychotherapy then helps you explore what anxiety has been protecting you from, practise a different response and carry that learning back into ordinary life.
The intention is not simply to make you feel calmer for a few hours. It is to use that period differently.
Ketamine may soften the grip of the immediate response.
Psychotherapy explores the protection beneath the symptom.
Integration turns insight into something you can live.
Ketamine may create a pause in the old anxiety cycle. Psychotherapy helps you decide what happens inside that pause.
WHAT DOES THE EVIDENCE SAY?
Early controlled and open-label studies have reported rapid reductions in symptoms among some people with treatment-resistant generalised and social anxiety. However, studies have generally been small, treatment methods vary, and the evidence for ketamine-assisted psychotherapy specifically is still developing. KAP should therefore be presented as a carefully assessed specialist option, not an established first-line treatment for anxiety.
The possibility is not that you will never feel anxious again.
It is that anxiety may no longer have to make every decision for you.
06 WHAT HAPPENS NEXT?
You do not need to decide whether ketamine-assisted psychotherapy is right for you before getting in touch. Many people arrive with questions rather than answers.
Our role is to understand your circumstances, explore whether this approach is appropriate and help you decide what would genuinely serve you best.
We begin with a medical screening and psychological assessment to understand your history, current challenges and treatment experience. We’ll discuss suitability and answer your questions openly.
We take time to understand what matters to you and set intentions for the work ahead. You’ll receive information, guidance and practical support so you feel informed, ready and grounded.
Ketamine sessions take place in a safe, supportive environment with medical supervision throughout. You are supported by the same therapist across your programme, from start to finish.
Integration sessions help you make sense of your experience and translate insight into meaningful change. This is where new patterns take shape and become part of your everyday life.
To learn more about how the programme works, visit the Emerge Programme page.
You’ll find full details of the structure, what to expect and how we support you throughout.
07 TRUST & EVIDENCE
Promising results. Important limitations. A carefully assessed treatment.
Ketamine has a much larger evidence base for treatment-resistant depression than for anxiety disorders. However, a small number of controlled trials and case studies have reported rapid reductions in anxiety symptoms among some people with treatment-resistant generalised and social anxiety.
The findings are encouraging, but the studies have generally involved small numbers of participants, several routes and doses of ketamine, and limited long-term follow-up. Ketamine-assisted psychotherapy for anxiety should therefore be understood as an emerging specialist approach rather than an established first-line treatment.
FEATURED STUDY
YALE
UNIVERSITY
RANDOMISED, PLACEBO-CONTROLLED CROSSOVER TRIAL
Response Rate with Ketamine
Response Rate with Placebo
“This proof-of-concept trial provides initial evidence that ketamine may be effective in reducing anxiety.” — Bloch et al. (2017)
WHY IT MATTERS
One of the first controlled studies to show that ketamine may reduce symptoms in a primary anxiety disorder rather than anxiety secondary to depression.
IMPORTANT LIMITATION
Small proof-of-concept study (n=15) testing a single ketamine infusion, not a course of ketamine-assisted psychotherapy.
SUPPORTING STUDY 01
University of Otago
DOSE-RELATED EFFECTS UP TO 1 WEEK
In a study of 12 people with treatment-resistant generalised anxiety and/or social anxiety (without current depression), subcutaneous ketamine produced reductions in anxiety within approximately one hour. Effects persisted for up to seven days, with higher doses producing larger effects alongside greater dissociation and cardiovascular changes.
WHY IT MATTERS
Suggested ketamine’s anti-anxiety effects were not simply a by-product of improving depression.
LIMITATION
Very small study (n=12). Dose-ranging design, not a conventional RCT.
SUPPORTING STUDY 02
University of Otago
RAPID IMPROVEMENT FOR UP TO 1 WEEK
A later double-blind, psychoactive-controlled study again enrolled 12 people with treatment-resistant generalised or social anxiety. Anxiety ratings improved within an hour of ketamine and remained lower for up to one week. Midazolam (active control) produced only minor and short-lived changes.
WHY IT MATTERS
Attempted to replicate the earlier findings with a stronger control.
LIMITATION
Small sample size. Examined medication effects, not KAP.
WHAT THE RESEARCH CURRENTLY SUGGESTS
Rapid symptom reduction
Supported by small trials
Effects lasting several days
Reported repeatedly
Maintenance treatment
Evidence still limited
Added value of psychotherapy
Not yet established
Long-term outcomes
Further research required
Systematic reviews (2021, 2022) including six randomised controlled trials across anxiety-spectrum disorders conclude that ketamine shows potential, but the evidence remains preliminary and heterogeneous.¹²
Ketamine may be a potential therapeutic option for treatment-resistant generalised and social anxiety disorders. — Glue et al. (2020)
Professor Paul Glue
Professor of Psychological Medicine, University of Otago
This proof-of-concept trial provides initial evidence that ketamine may be effective in reducing anxiety. — Bloch et al. (2017)
Professor Michael Bloch
Associate Professor of Psychiatry, Yale School of Medicine
The evidence is encouraging, but not yet definitive. Assessment remains essential to determine whether this approach is appropriate for you.
The evidence gives us a reason to explore the possibility. Assessment tells us whether that possibility is appropriate for you.
1. Wilkinson, S. T., Ballard, E. D., Bloch, M. H., Mathew, S. J., Murrough, J. W., & Feder, A. (2021). Efficacy of ketamine for treatment-resistant anxiety spectrum disorders: A systematic review and meta-analysis. Journal of Affective Disorders, 296, 1016–1027.
2. Mathai, D. S., Upadhyay, J., Sadanandan, A. D., et al. (2022). Efficacy of ketamine in anxiety spectrum disorders: A systematic review. Journal of Psychiatric Research, 153, 214–223.
There is no pressure, no obligation and no expectation that ketamine-assisted psychotherapy will be the right fit. If this page has resonated with you, we’re happy to answer your questions and help you understand what your options are.
Your enquiry comes directly to Paul.
We typically respond within one working day.
No obligation or commitment.
The goal of this page was not to convince you that ketamine-assisted psychotherapy is right for you. It was to help you understand whether it may be worth exploring.