Navigating ‘k-land’: a qualitative exploration of participants’ experiences of ketamine-assisted psychotherapy for methamphetamine use disorder
Kathryn Fletcher, Nadine Ezard, Krista J. Siefried, Sophie van der Helder, Jack Freestone, Jonathan Brett, Robert May, Liam Acheson, Brendan Clifford
Frontiers in Psychiatry June 24, 2026 DOI: 10.3389/fpsyt.2026.1873497 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Qualitative study embedded within an open-label pilot trial Pilot study Peer reviewed |
|---|---|
| Sample size | 14 |
| Population | Participants with methamphetamine use disorder who completed core components of ketamine-assisted psychotherapy |
| Intervention | Ketamine-assisted psychotherapy |
| Topics | Esketamine Ketamine Psychedelic-assisted therapy |
| Keywords | Thematic analysis Context archaeology Cognition Qualitative research Intervention counseling Perception Openness to experience Psychological intervention Cognitive behavioral therapy Psychotherapist Clinical psychology Relaxation psychology |
| Key findings | Ketamine-assisted psychotherapy for methamphetamine use disorder was experienced as a context-dependent process in which ketamine facilitated a temporary state of 'psychological space' that supported engagement with psychotherapy, while sustained behavioral change depended on ongoing therapeutic and contextual factors. |
Abstract
Background: Methamphetamine use disorder (MAUD) is associated with substantial psychiatric and physical morbidity, and current treatment options remain limited. Ketamine-assisted psychotherapy (KAP) has shown promise in substance use disorders, but little is known about how individuals experience and interpret this intervention, particularly in MAUD. Qualitative investigation may provide insight into perceived mechanisms, acceptability, and factors influencing engagement. This study aimed to explore how participants experienced, interpreted, and evaluated KAP for MAUD.
Methods: This qualitative study was embedded within an open-label pilot trial of KAP for MAUD. Fourteen participants who completed core components of the intervention undertook semi-structured interviews following treatment. Interviews explored motivations for participation, experiences of ketamine dosing and psychotherapy, and perceptions of change. Data were analysed using reflexive thematic analysis.
Results: Four interrelated themes were generated: (1) treatment entry, characterised by prior treatment experience with limited sustained benefit and pragmatic openness to a novel approach; (2) a structured and supportive context for engagement, highlighting the importance of relational safety and clinical containment; (3) altered states and psychological shifts, in which participants described reduced emotional and cognitive reactivity following ketamine sessions; and (4) translation of psychological shifts into behavioural change, describing variable and contingent changes in methamphetamine use. Participants described ketamine as creating a temporary state characterised by reduced emotional and cognitive reactivity and enhanced receptivity, which we interpret as ‘psychological space’. This state appeared to support engagement with psychotherapy, although behavioural change was variable and contingent on ongoing therapeutic engagement, personal motivation, and contextual factors. Acceptability was generally high within a supportive clinical environment. Participants expressed uncertainty regarding whether changes were attributable to ketamine, psychotherapy, or contextual factors.
Conclusions: KAP for MAUD was experienced as a multi-stage, context-dependent process rather than a stand-alone pharmacological treatment. Ketamine was characterised as facilitating a temporary state of ‘psychological space’ that appeared to support engagement with psychotherapy, while sustained change appeared to depend on the integration of these experiences into ongoing cognitive and behavioural processes. These findings support a model in which pharmacological, psychotherapeutic and contextual factors interact, and highlight the need for further research to clarify mechanisms and optimise intervention design.
In the evidence
This study is part of the evidence base for a synthesis in the library. Here is how each one recorded it.
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Participants experienced ketamine-assisted psychotherapy as a context-dependent process in which ketamine created temporary psychological space supporting psychotherapy engagement, while sustained behavioral change depended on ongoing therapeutic and contextual factors.
Synthesized
Comparable studies
Other non-randomized and open-label trials on ketamine and psychedelic-assisted therapy, most cited first.