Imagine that you’re sitting in a chair with VR goggles on, staring at kaleidoscope-like patterns resembling forests and seascapes as an audio recording guides you to breathe deeply. You get lost in the colorful psychedelic swirls as your mind drifts into thoughts about your childhood or the nature of the universe.
At Mindscape ketamine center in Houston, TX, this isn’t some far-off reality: Patients receive ketamine infusions while wearing virtual reality headsets connected to the app Tripp, which provides guided meditations, ethereal sounds, and abstract visuals to create an immersive experience. Mindscape says this combination allows people to detach from their physical surroundings, calm their minds, and focus on the psychedelic journey.
“The feedback we’ve received is that people find it helps with the dissociation effect,” says Andrew Charrette, VP of Regulatory Affairs at Wellbeing Digital Sciences, the company that owns Mindscape. “We really try to limit the dose, and this helps with that ‘letting go’ that a lot of people think is the reason that they benefit from the ketamine therapy. It’s kind of that ego dissolution escape effect that, on its own, ketamine at higher doses will provide.”
Ketamine therapy has become increasingly popular over the past few years, with clinics popping up in most major U.S. cities where people can legally receive the drug through an IV or intramuscular injection. People come to ketamine therapy to work on a host of issues including anxiety, depression, PTSD, and chronic pain.
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Because of its ability to open up the mind and make new possibilities apparent, ketamine can help people see themselves and the world more positively. It also may alter the brain in ways that can have a long-lasting impact on mood. For instance, it may create new pathways that brain cells can use to send signals to one another.
At Mindscape, patients take ketamine via IV under the supervision of a physician and a psychiatric mental health nurse practitioner. The VR headset is optional, as many find it helpful while others dislike it. “Some people just don’t enjoy the experience because it involves putting a headset over your eyes and partially over your nose,” says Charrette. “It’s maybe a little bit restrictive feeling, and I know some people feel sick with a VR headset as well. People going in for a ketamine experience already can feel nauseous just from the ketamine itself.”
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Wellbeing Digital Sciences is still planning clinical trials on this modality, which was first developed by Mindscape co-founder Dr. Quang Henderson. But Charrette has observed that in general, people get a lot out of the VR, as it compounds the effects of the ketamine. “It’s really taking them out of their own day-to-day mindset, and a lot of people define that to be the beneficial element of ketamine,” he says. “A lot of them are looking for that escape from their ruminating.”
Because large amounts of ketamine can send someone into a “K hole”—a sometimes frightening state where they completely lose awareness of themselves and their environment—creating a strong effect at low doses through VR (Mindscape starts at 0.5 mg/kg) can make the process safer, says James Giordano, professor of neurology and biochemistry at Georgetown University Medical Center. “When the experience itself is guided and the individual can be talked into or away from cognitive and conscious experiences or phenomena, this keeps them safe and within the boundaries,“ he says. And at the same time, “you sort of get ego separation, and what the individual gets is profoundly healing for them.”
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VR and guided meditations may also be beneficial during ketamine therapy because ketamine leaves you “very open,” presenting the opportunity to put new ideas in front of your mind, says Dr. Sam Zand, practicing psychiatrist and Chief Medical Officer for the at-home ketamine therapy provider Better U. “You’re in this neuroplastic state,” he explains. “When your brain is susceptible to new perspectives, when you’ve gotten past the rigid patterns, we have this ability to engage in whatever is going on in whatever way is new.”
Because ketamine can leave you impressionable, it’s important that ketamine providers pay close attention to the messages in the audio recordings patients will be listening to, as well as the images they see, says Zand. “They can be very subliminal; it can leave an imprint,” he explains. “It can help guide their journey, but it’s also a double-edged sword. It has to be very carefully done.”
The best way to combine VR and ketamine is probably to make the visuals and audio very basic and general, according to Zand. For instance, people might look at images of nature and listen to empowering verbal affirmations. “There’s an argument that it’s taking away from our subconscious journey and our internal projector, but it can augment the experience if it’s not too over-stimulating, if it’s not too specific,” he says. In addition, the approach should ideally be customized, since everyone’s responses to these sensory stimuli, as well as the ketamine itself, will be different.
Even then, doing ketamine without VR still may be more valuable for some. Sitting with your own thoughts—and nothing else—can allow you to explore the dark caverns of your mind. “If things are too rainbows-and-butterflies, maybe we don’t have a chance to address the shadow side,” says Zand. “But if the VR is taking us someplace dark, it might be too heavy.”
Giordano agrees that VR could bring someone into or away from the questions and issues that are important to them. “The question then becomes, how will the individual on ketamine apprehend that virtual reality?” he says. “Are they detaching, or is that double level of detachment eliciting a psychedelic response? I think there’s a bit of information to suggest that the potential for either or both is there.”
There’s still more testing and experimentation to be done—and Mindscape is actively partaking in that. In 2021, Wellbeing Digital Sciences, formerly called Ketamine One, also began developing a ketamine service incorporating scent-based VR. Since scents are known to trigger memories, the idea was that by smelling various scents, patients could revisit significant times in their lives. This project didn’t take off and got put on the backburner, but it’s possible the company will revisit it, according to Charrette. They’d also like to develop VR specifically for psychedelic therapy rather than just using an external app.
While ketamine is Wellbeing Digital Sciences’s current focus since it’s legal in the U.S., VR technology could also one day help intensify the effects of other psychedelics, says Zand—although with long-lasting substances like mushrooms, the VR set would probably only be used for part of the trip.
Zand could also see technology being taken even further to offer psychedelic-assisted AI therapy, where the therapist can help patients select the visuals, or virtual exposure therapy for those with phobias or PTSD. “Even for depression, being exposed to something beautiful, connecting with nature, understanding life around us…the programming will go a long way,” he says.
Perhaps, for instance, a VR-enhanced psychedelic experience could allow someone to explore the galaxy and see the big picture in a way they could not in ordinary reality. “To go to outer space in VR in your psychedelic experience would almost make it feel real,” Zand imagines. “Maybe before, they were looking at their lives very individually, but now, they’ve gotten to experience what only very few astronauts have, and they get to see the Earth in its entirety and get a sense of the ecosystem we live in and the connectivity of everything and the interplay with nature. Talking about it or listening to it or just watching it on TV would not be as profound as if they were actually there on psychedelics.”
Still, it’s important to carefully develop and test these kinds of tools before making them widely available, he adds. “We don’t have to go too fast; we can take our time.”