Moral injury can occur following an action or event that conflicts with one’s core moral beliefs. It is frequently observed in treatment settings among veteran populations. Veterans with moral injury often experience guilt, shame, betrayal and a loss of meaning. These symptoms are combined with a loss of connection to loved ones and a sense of mistrust or anger towards others. Because of the way in which moral injury affects a person, the person is often resistant to standard therapeutic approaches, because these approaches fundamentally assume trust between client/patient and clinician where this is not possible at the early stages of moral injury treatment.

Ketamine, when administered intravenously, is known for its rapid antidepressant effects and ability to bring about neuroplasticity – which is the brains capacity to form new neural connections. Furthermore, it is known to reduce activity in the default mode network, which is associated with negative rumination and self-referential thinking. In the context of moral injury, ketamine can have multiple positive effects: a reduction in guilt and shame, and the ability to think more openly about self, others and the world Furthermore, IV ketamine can promote greater engagement in psychotherapy, allowing for improved insight and capacity to explore and process experiences contributing to moral injury.

In this presentation, we will discuss our ketamine treatment program, ‘ReviveMed’, which is a multimodal treatment within a multidisciplinary team. The treatment involves ketamine infusion therapy and adjunctive psychotherapy to treat symptoms of depression and PTSD, particularly with veteran populations. From our experience working in this space for over 5 years, we have also seen how this treatment can help treat moral injury. We discuss the ways in which IV ketamine relieves symptoms associated with moral injury and creates better outcomes in psychotherapeutic work, by allowing people to authentically engage in therapy despite their acquired distrust, to then re-establish a sense of trust in their world, and most importantly themselves.

We will discuss the three stages of the ReviveMed program and the ways in which each stage helps to treat moral injury. The stages in the treatment program are: (1) Revive, where patients are treated with an intensive phase of IV ketamine, (2) Rebuild, where patients begin rebuilding their lives with maintenance infusions plus psychotherapy, and (3) Thrive & recover, where we help patients create a more meaningful life.