Consciousness Shifting Trauma Resolution (CSTR)
Trauma, simply defined, is the inability to digest sensory information that has thus far been unprocessed. A non-significant example of trauma is the inability to stop the earworm effect of a Bruno Mars song. A significant example of trauma is not being able to ride in any care after a severe car accident. An example of deep-seated trauma is unexplained anxiety with or without the ability to complete a task with several steps, or to be able to remember an event with several parts. With severe, deep-seated trauma, a person may “step out of themselves” at various times, giving their body a time-disconnected story with lots or starts and stops. Sometimes this last symptom is the only symptom a person is consciously aware of.
For therapy, we look to change the consciousness of the individual, bringing them to a place where a different, dissociated perspective can be obtained. Sometimes it is impossible to see your parent as being a narcissist when the tape of their messages won’t stop replaying in your mind. “You’re making a big deal of nothing” or “You don’t know what’s best for you, only I do” are the lens placed during childhood, impairing your ability to see clearly through your own self-developed lens.
While it is helpful to remember some of the erroneous messages you were given as you came into your own, often times the only messages we get are the repeating painful or uncomfortable episodes in the body. With deeper trauma, there can be a complete lack of sensation, which requires a deeper level of investigation in movement and other sensory pathways in the body.
One of the medications used in this treatment is ketamine, which has been studied and used extensively in trauma, PTSD, and depression*, **. Ketamine is a dissociative anesthetic that disconnects the frontal lobe from the midbrain. A patient once described it as similar to how novacaine acts in the mouth. You know something is happening, but you can’t quite locate the sensory pathway.
The benefit of ketamine is that is works directly with our sensory experience without the input of our conscious brain. It allows the brain to take a backseat to an experience. We have awareness of our surroundings through our sensory pathways so that we can interact with our environment. When we have had traumatic experiences, it changes our sensory experience. We see this in someone who has been in a fire. Whenever they smell smoke in the future, irrespective of the severity of the fire, the totality of the previously undigested fear from the prior fire attaches itself to the current (non-threatening) experience. Usually, the reason for the intense emotion isn’t so clear; it instead lives in the body as a vague seemingly isolated feeling. Some people report new onset headaches and pains in the neck after trauma, others report constant belly pain, still others report a complete lack of sensation.
What does it feel like? Patients report being “out of their body” and being able to see their environment, but not understanding it. They may see a door and not know that it is used to walk through. This “dissociation” is tolerated by many people (many of us are baseline dissociated as a normal response to sensory overload), but for those in whom this may be distressing, a small amount of a benzodiazepine is given so you “don’t care that you don’t know why.”
The sedation provides another perspective from which to view sensations in the body, one that is free from association and gives the opportunity to assign a new relationship to the feelings that surface. In this way, one can rewrite their traumatic experience. The work continues to happen for a few weeks after the treatment in the office. Each time you transition consciousness (going to sleep, waking up, yoga, and meditation are examples), you will go back to the experience you had in the office and see if any new awarenesses surface that can be shifted and then processed.
Allow one hour for this treatment, thirty minutes for sedation and time for prep and recovery. It is ok to eat lightly prior to your appointment, but if you are prone to motion sickness, you may certainly be just fine delaying food until after the treatment. Some report bigger gains when they fast from dinner the night before and food the day of the sedation. Regardless, stay (or become) adequately hydrated starting one week prior to the procedure. Room temperature glacial waters such as Icelandic, Evian, and Voss are good options. To increase the efficiency of your body’s transition out and back into consciousness, get daily morning and evening sunlight in your eyes and on your skin (as well as consuming zero screens and limited blue light before bed, and leaving your phone in airplane mode).
Be sure to arrange a driver to bring you home after your sedation. You should not drive or make any major decisions within 24 hours of the sedation.
Everyone has trauma. If you are alive in today’s world, you have trauma patterning in your body.
For Emergencies: Call 911
Articles of Interest
Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain Management From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists.
Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists.
2018 Summary ASRA Article on Ketamine
Antidepressant effects of ketamine in depressed patients.
A randomized trial of an N-methyl-D-aspartate antagonist in treatment-resistant major depression.
Intravenous Ketamine for Adolescents with Treatment-Resistant Depression: An Open-Label Study.
A Double-Blind, Randomized, Placebo-Controlled, Dose-Frequency Study of Intravenous Ketamine in Patients With Treatment-Resistant Depression.
Single i.v. ketamine augmentation of newly initiated escitalopram for major depression: results from a randomized, placebo-controlled 4-week study.
Ketamine for Rapid Reduction of Suicidal Thoughts in Major Depression: A Midazolam-Controlled Randomized Clinical Trial
* 6 infusions, 2 per week, Mount Sinai study
** ECT standard of care, ketamine works better and is safer.