Treatment Preparation Instructions
Schedule 1 on 1 Treatment Preparation
Schedule an appointment with your Better U Integration Guide before your first session (after receiving the medications) to help you prepare you for your journey, maximize your sessions, and answer any questions. This is required treatment protocol. Please schedule within 48 hours of doing your first session, to keep the information fresh.
Setting
• Avoid pets, partner, roommates or family members as external stimulation may lessen the inward journey.
• Put the meditation mask on after absorption is complete. Do not remove the meditation mask for at least 1 hour. Do not try to stand, walk, or use the restroom for 2 hours after administering the medicine. If you absolutely have to get up, ask your Peer Support to assist you.
• Find a comfortable and quiet room without distractions or any external interference. Consider adding aromatherapy.
Materials
• Journal: Keep a journal or voice recorder within arms length.
• Medication: Have the medicine ready.
• Head Phones: We strongly recommend using headphones during your session. (See MUSIC section)
• Meditation Mask: We strongly recommend wearing a meditation-mask during your session.
• Spit Cup
Set
Set refers to your mindset. How are you feeling right now? Psychedelics can amplify our internal state. If you're not in a good mindset, try meditating, journaling more, or doing some breathwork exercises to help calm your mind. The goal is to avoid bringing in stressful energy into your treatment sessions.
Guided Meditations
Breathwork
Progressive Muscle Relaxation
Journal Exercises (See Below)
Intention Setting
*Journal Prompt
Being intentional with our sessions is essential. Be mindful of your thoughts going into the experience and recognize it takes practice and effort to learn how to consciously shift your attitude or response to the feelings you are having.
• A great first step for setting your intentions is to think about what brought you to Better U and what you’re hoping to change in your life. Your intentions work best when they are personal, specific, and focused.
• Write down your intentions before each treatment session. Writing them down is crucial for solidifying these goals in your mind. Prepare 1-2 intentions per session.
• Journaling shouldn't be focusing on disempowering or negative thoughts. This is your time to rewrite the narrative. Let's not ruminate on the past: "From this day forward..." Make the decision to seek out and focus on the positives in our lives. Positive thinking is the inclination towards optimism rather than pessimism. It’s not about believing everything will always be wonderful! It's more of the understanding that there is good and bad in all aspects of life, and that it is within our control to notice the good more than the bad.
Common themes include:
• Improving awareness of strengths, weaknesses, blindspots, roadblocks, etc.
• Exploring creative problems and inspirations
• Healing from past traumas
• Improving relationships
• Overcoming bad habits
• Cultivating gratitude
Every morning write down 3 things that you are grateful for:
1. Experiences or relationships from the past *to displace negative memories/thoughts from the past
2. Something you are looking forward to in the future *to replace uncertainty/anxiety about the future
3. Something in your immediate surroundings *to stay present and achieve peace
Timing
Find a time when you don't have any responsibilities after the session. Some people prefer first thing in the morning on their day off, while others prefer to do a session at night. Make sure you have time after your session for reflection and integration.
• Some individuals may find the medicine interferes with sleep while for others it aids in sleep.
Fasting
We recommend not eating or drink for three hours prior to the ketamine treatments. Nausea is a potential side effect so we want the stomach to be completely empty.
• 3 hours before the session you should avoid all food.
• 2 hours before the session avoid all drinks.
Bathroom
Use the restroom prior to sessions - even if you don't feel like you have to, try. This is to avoid having to get up during or immediately after your session, since you will be feeling physically limited and should not attempt to walk unassisted.
Fall Precautions
• Make sure your Peer Support is there to physically support you in the event that you have to stand/walk.
• The biggest risk is falling when trying to walk during your session.
Overall, your PS has the following general responsibilities:
• Ensure your physical safety by laying eyes on you every 30 minutes (the goal is to not interrupt or disturb your relaxed/restful state)
• Support balance by escorting you to the restroom *if required.
• Being a supportive, positive presence if you need any support or company during the session.
• Being a direct line of contact to your Better U Care Team if the need arises.
No Texting or Calls
Absolutely no texting people or making phone-calls during sessions or 1 hour after your session is complete.
• Phone must be on airplane mode or do not disturb.
Self-Administering the Medicine
Have your playlist ready and your phone on do not disturb. Sit upright on a couch or comfortable recliner during the absorption stage, then after 12-15 minutes, once the medicine is fully dissolved, you may lay down.
• Take the anti-nausea (Ondansetron/Zofran) 30 minutes prior to the ketamine.
• Sublingual: Hold the medicine under your tongue or in your cheeks bucally until completely dissolved, which may take up to 15 minutes.
*Keep holding the medicine in the mouth without swallowing for at least 12-15 minutes, circulating it periodically, and then either expel the remainder into a cup or ingest - depending on what your clinician advised.
Ingesting vs. Spitting
Spitting the medication in to a spit cup after 12-15 minutes of holding saliva in your mouth can give you a more defined window of how long the session will last and possibly reduce potential side-effects (~5% experience nausea).
Ingesting the medication could extend the duration of the session and also extend the time that it takes to return to your baseline.
*When you ingest, be aware the effects could come in "waves" 1-3 hours later, so be cognizant to remain in a restful position for the full duration.
*For proper absorption, the medicine/saliva must be held in your mouth for at least 12 minutes. Ketamine does not absorb as effectively once it reaches your digestive tract. Do not hold for more than 20 minutes, as we'd like you to relax into your session within 20 minutes of administering the medicine.
Breathe, Trust, Let Go, Be Open!
Breathe: Focus on your breath.
Repeat these 3 things out loud.
Trust. Let Go. Be Open.
Trust the Experience: Trust the medicine is doing it’s job. Trust yourself for taking proactive steps to improve your mental health.
Let Go: Let go of whatever may be on your mind, whatever happened yesterday, this morning, whatever it is, let it go. Let go of the intentions you just wrote down. Don’t try to navigate the experience. Focus on your breath and the music.
Be Open: Be open to the shifts in perspective, be open to the feelings and be open to the thoughts that may arise during your session.
Duration of Treatment
• Effects begin in around 10 – 15 minutes but may take up to 25-30 minutes for full effects.
• You should expect the journey to last around 45-90 minutes.
Dose Acclimation* IMPORTANT
• While your provider may have given you customized dosing instructions, they typically recommend starting with a 100MG dose (lozenges can be cut up into quarters) then working your way up from there, 50-100MG increase per session (this was determined by your clinician). Please refer to the instructions on your prescription for the strength of your lozenges/troches. If you are fearful or anxious about your first experience, a 50mg experience can be like training wheels.
• If the dosage does not induce a deep meditative experience, you may want to increase the dose. This will be determined between you and your Better U clinician.
• Since this is an at-home protocol, our dose acclimation phase is important for safety and as a way to find the appropriate dosage that works for you.
• Do not be discouraged if you are not experiencing profound psychological effects during the dose acclimation period. It’s not possible to gauge the success of the treatments by doing 1-2 sessions. You have only had 1-2 low dose sessions, we choose to err on the side of caution and dose slow in the beginning to help acclimate towards the desired effects. For some, it might feel like nothing happened. That is okay! Stick to the protocol that was discussed with your clinician during your intake appointment and increase dosage accordingly. Schedule treatment preparation with our Certified Integration Guides to properly prepare for your first treatment. This program was designed by Dr. Sam Zand who has been successfully treating patients with ketamine therapy since 2019 and is on the Speaker Bureau for SPRAVATO (derived from ketamine), an FDA-approved treatment for depression.
Frequency
Sessions will typically take place once or twice a week, determined between you and your Better U Clinician. In order to avoid tolerance and habit forming, we do not recommend sessions more than twice per week.