Continued Studies Into Underlying Psychological Mechanisms Of KPT
Continued Studies Into Underlying Psychological Mechanisms Of Ketamine
Psychedelic Therapy (KPT)
Evgeny Krupitsky, M.D., Ph.D., and A.M. Burakov, M.D.
Since 1985, we have been conducting special studies of the underlying biochemical, neurophysiological and psychological mechanisms of KPT with alcoholics in order to explain its high rate of clinical efficacy for the treatment of alcohol dependency (Krupitsky, 1992, 1995; Krupitsky et al., 1990, 1992). The psychological studies shed the most light on the underlying mechanisms of KPT. The changes in the Minnesota Multiphasic Personality Inventory (MMPI) after KPT session testified to positive personality changes. Changes in the Color Test of Attitudes after KPT testified to a positive transformation of the unconscious emotional attitudes of our alcoholic patients towards themselves and their significant others. Changes in our Spirituality Scale testified to a significant increase in the level of spiritual development after the ketamine session. All these psychological changes favored sober life. As a rule, we also observed positive transformations in our patients' systems of life values, purpose and meaning, but these changes had not been previously measured quantitatively with psychological tests. Clinical impressions and indirect evidence from the Spirituality Scale suggested these changes, but not a rigorous scientific proof. Therefore, the study described below focused on measuring changes in life values, purpose and meaning caused by KPT in alcoholic patients. In this study, we also measured the changes in the locus of control of the personality of our patients, a factor which is closely associated with issues of life values actualization.
Subjects and Methods
Thirty alcoholic in-patients (age 40,1±1,8) were treated with KPT at the end of their 1.5 month treatment at the Leningrad Regional Center for Alcoholism and Drug Addiction Therapy. KPT was carried out as described in our previous publications (Krupitsky 1992, 1995). All 30 patients were assessed before the ketamine session and in the days after it with: the Questionnaire of Terminal Life Values (QTLV) developed in Russia by Senin (1991) and based on Rokeach's approach to human values and beliefs (Rokeach, 1972, 1973); the Locus of Control Scale (LCS) developed by J. Rotter (Phares, 1976) and adapted in Russia by Bazhin et al. (1993); and the Personal Orientation Inventory (POI) developed by Shostrom (1968) to measure self-actualization and adapted in Russia by Rukavishnikov (1993). Additionally, ten out of 30 alcoholic patients treated with KPT were assessed with repertory grids (Kelly matrixes, Fransella and Bannister, 1977). The repertory grid technique allowed as to assess subtle changes in patients' self-concept as affected by KPT. The grids were arranged so that their 11 elements were replaced by various aspects of the patient's "ego" and other significant persons such as "Me in the present," "Me in the past," "Me in the future," "Ideal image of self," "Wife," "Mother," "Father," "Alcoholic in recovery," "Drunkard," "Psychotherapist," and "A man who is well-adjusted." As for the constructs, 12 pairs of categories (construct poles) were preset to describe characteristics of the patient's personality and value orientations such as "Responsible / Irresponsible," "Exhibiting self control / Impulsive," "Strong-willed / Weak," "Active / Passive," Self-confident / Lacking in self-confidence," etc. We employed two techniques for filling the repertory grids. With the first (conventional) one, a patient placed each of the elements at a certain point of the calibrated scale preset by the construct poles. The second one was specially developed to measure changes in nonverbal (and in this sense, less reflexive) psychosemantics. This involved the following procedures: first, a patient arranged eight colors of the Luscher test in the order of their correspondence to each of the grid elements (from the most similar, suitable color to the most different, unsuitable one). Then, the patient arranged the same colors in the order of correspondence to the poles of each of the constructs. Comparing the colors' positions in the two arrangements, we quantitatively estimated the closeness of this element to the poles of the given construct. The color technique allowed us to obtain nonverbal, unconscious estimates of the elements in terms of the categories of given constructs. All ten alcoholic patients were tested with verbal and color repertory grids before KPT and after it. Then we calculated mean verbal repertory grid (MVRG) and mean color (nonverbal) repertory grid (MCRG) for all ten patients together. The final four MVRG and MCRG (2 before KPT and 2 after KPT) were processed by the standard programs of repertory grid computer-assisted analysis (Fransella and Bannister, 1977), and then semantic spaces of the personality were established. Semantic space of the personality, based on the basis of multidimensional assessments of elements with constructs, shows semantic interrelationships and interconnections between elements and/or constructs of the repertory grid.
Results and Discussion: Life Values
This study has demonstrated a number of significant positive changes in patients' values as a result of KPT. KPT enhanced the importance of such life values as creativity, self-improvement, spiritual contentment, social recognition, achievement of life purposes and individual independence. These changes were mostly expressed in such areas of life values actualization as family, education and social life. It is evident that such a positive transformation in a patient's life values system enhances motivation for a sober life and favors sobriety.
Locus of Control
It was established in our study that locus of control in the personality of alcoholic patients became significantly more internal after KPT (from 11,1±4,8 to 30,3±5,3; P<0,01). This means that patients became more confident in their ability to control and manage different life situations and they became more responsible for their lives and futures after KPT.
Personal Orientation Inventory
There were no statistically reliable changes in any scale of POI. A possible reason for this is that Shostrom's paradigm of self-actualization was unusual to our alcoholic patients and therefore they had trouble adequately understanding the statements of Shostrom's inventory.
Repertory grids (Kelly matrixes)
The results of this study have demonstrated some positive changes in the semantic space of the personality of alcoholic patients, particularly in the space of personality characteristics of the color repertory grids. Before KPT, the image "Me in the present" was close to the image "Drunkard" and far from the group of such positive images as "Alcoholic in recovery," "Ideal image of self," "Wife," "A man who is well-adjusted" and others in the semantic space of the MCRG. After KPT, the image "Me in the present" moved closer to the group of positive images described above and further from the image "Drunkard" in the space of MCRG. At the same time, the image "Drunkard" moved towards the image "Me in the past." These data testify that alcoholic patients emotionally perceived or identified themselves as drunkards before KPT. After KPT their emotional perception of themselves had changed: they emotionally identified themselves with the alcoholic in recovery and other positive images in the semantic space of personality characteristics and value orientations, and identified themselves as drunkards only in the past. The changes in the verbal repertory grids were not so significant as in the color repertory grids. Only the image "Drunkard" moved further from the group of positive images and more closely to the image "Me in the past." It is possible to conclude from these data that KPT improved the unconscious self-concept of the alcoholic patients. Thus, the results of this study and our previous studies of underlying psychological mechanisms of KPT show that the patients grew more self-confident, more sure in their abilities and their futures, less anxious and neurotic, more balanced, emotionally open and self-sufficient, and more responsible for their life and future. We observed a transformation of patients' emotional attitudes, a decrease in the level of anxiety and internal tension, discomfort, and emotional isolation, along with an improvement of self-assessment and the appearance of a tendency to overcome the passive aspects of their personalities. We observed a certain positive transformation of the patients' system of life values and meaning and even some world view (spirituality) changes. All these changes favor sober life.
Purpose in Life
Ten alcoholic patients (age 41,1±2,4) were studied before and after KPT with the Purpose in Life Test (PLT) elaborated by Crumbaugh (1968) and based on Frankl's concept of man's aspiration for the meaning of life. The PLT was adapted in Russia by Leontiev (1992) in the Department of Psychology of the Moscow State University.
This study has shown that KPT significantly increased the index of grasping the meaning of life in alcoholic patients (from 89,7±5,7 to 115,3±3,2; p < 0,01). Before KPT the index of grasping the meaning of life was below the average normal level, but after KPT it was higher than that level. These changes indicate that after KPT patients were better able to grasp the meaning of their lives, their life purposes and perspectives. Life became more interesting, emotionally saturated and filled with meaning for them after KPT. They felt better able to live in accordance with their concept of the meaning of life and life purposes. Such changes favor sober life particularly from the standpoint of Frankl's approach, which considers alcoholism as an "existential neurosis", as a consequence of the loss of the meaning of life and the appearance of a specific "existential void" (Frankl, 1978) which we believe KPT is able to fill at least to some extent.
Work in the United States
In March 1995 I visited Dr. John Krystal at the Department of Psychiatry of Yale University during my almost ten week MAPS-supported visit of different universities and psychedelic research centers of the United States. I discussed our studies of ketamine alcoholism therapy with Dr. Krystal and his team. Dr. Krystal told me about his investigations of human psychopharmacology of ketamine in healthy volunteers. At that time we also discussed some interesting ideas of ketamine human psychopharmacology studies in alcoholics. We decided to apply for funding for those studies through the National Institute of Alcohol Abuse and Alcoholism (NIAAA), where I had been lecturing right before my visit to Dr. Krystal's laboratory. Now, one year after my visit, the funds for the ketamine psychopharmacology studies in alcoholics have been granted by the NIAAA. I am starting the one-year study of ketamine psychopharmacology in alcoholics at Yale at the end of April 1996. To this end, I am leaving my laboratory in St. Petersburg for about one year to carry out ketamine studies at Yale with Dr. John Krystal.
We are very much thankful and grateful to MAPS and Rick Doblin, MAPS President, for the support of this research which made this study possible.