University of Arizona College of Nursing PhD student Jennifer Montjoy pursued a career in nursing for the noblest of reasons: to help people in a meaningful way using her skills as a psychiatric nurse practitioner (PMHNP). After graduating with her Masters of Science in Nursing (MSN) from Vanderbilt University in 2016, she relocated to the Grand Canyon State because NPs have the ability to practice to the full scope of their training and education, and soon began working on her PhD. With a passionate interest in holistic mental healthcare, Montjoy soon found a dissertation topic that holds great potential for mental health healing: the use of ketamine-assisted psychotherapy (KAP), specifically in the treatment of unremitting mental health conditions.
“There’s some exciting research going on in this arena,” Montjoy says. “Academic research of psychedelic medicines began in the 1940s and 50s and was put on hold by Congress in 1970. A few years ago, it would have been very taboo to use medicine in this way, we are now seeing a resurgence in the exploration and potential use of many of the same molecules from the ‘40s and ‘50s.”
“We have a small but mighty faculty. Faculty in the College of Nursing are very productive in securing NIH funding, as well as other types of extramural funding. The Blue Ridge rankings don’t even tell the whole story," ~Jennifer Montjoy, UA College of Nursing PhD Student
Montjoy’s research joins a growing field. MDMA, for example, is currently in phase three clinical trials with a likely outcome of the Food and Drug Administration approving clinical use for post-traumatic stress disorder (PTSD). “No one is suggesting providers’ prescribe ecstasy to take at home for recreational use,” she says. “This work is very much about the ecology of the healing space and specialized for licensed clinicians, including nurses. Johns Hopkins has been investigating psilocybin since the early 2000s. This field has recently begun to gain traction and legitimacy with research being published in peer reviewed journals.”
Montjoy is quick to point out that most of the clinics that offer ketamine as a treatment for depression as an intervention are intravenous (IV) infusion and are predominantly being managed by anesthesiologists, pain management, and emergency medicine clinicians. “These settings are not incorporating psychotherapy or mental healthcare clinicians,” she explains. “It’s a very medicalized approach, which is really different from KAP, the focus of my dissertation project.”
In addition to her PhD work, Montjoy runs Tucson-based Resilience Behavioral Health Solutions, which she founded two and a half years ago to provide non-IV ketamine-assisted psychotherapy and offers AANP-accredited 4-day KAP trainings for licensed clinicians and providers. Much of the data in her dissertation project were measures collected pre-and post-KAP treatment from clients Montjoy previously worked with in her practice.
Did Resilience Behavioral Health Solutions help influence your research direction?
I worked for UArizona’s Counseling & Psych Services (CAPS) for 2 years as I opened Resilience in Tucson. I was following the research around ketamine and I was pretty naïve. I didn’t know much about ketamine in terms of subjective effects or recreational use. I wanted to offer ketamine through Resilience but I knew I needed more education about administration, and about the medicine itself. When I started looking at certification programs, that’s when I learned ketamine induces a non-ordinary state of consciousness. I thought, what a missed opportunity for more in-depth healing that could be provided through psychotherapeutic support/facilitation.
What distinguishes your research on this subject from some of the other studies going on in this field?
For my dissertation I’m providing analyses on retrospective treatment-resistant depression and post-traumatic stress disorder clinical outcomes – and exploring whether potential correlates such as childhood adversity and self-transcendence influence outcomes, so it differs in methodology and focus. The primary difference, the ‘why,’ is that approximately 55% of folks with treatment-resistant depression have co-occurring PTSD. There is gap in current ketamine research measuring and analyzing trauma symptom severity in currently available literature. What’s more, we are experiencing an epidemic of suicide endemic in veterans, suicide is also the second cause of death in Americans 10 years and older. It’s really disturbing and exemplifies the need for additional and efficacious interventions.
I think what also sets my focus research focus apart is that is that it’s looking at childhood adversity as a variable that may influence outcomes. We’re collecting measures for three things: One, there’s not much research around ketamine (KAP) and PTSD; two, inclusion of childhood adversity as an exploratory variable; and three, inclusion of self-transcendence as a measure. I’m using a measure developed by one of my mentors, Dr. Pamela Reed. Dr. Reed’s self-transcendence scale may be a good fit for looking at the existential experience in relation to psychedelic medicine, an important aspect of the human experience and our suffering that’s not typically assessed or measured in ketamine research.
Tell us about your hypothesis for your dissertation.
The purpose of my dissertation project is to explore whether there is a reduction in depressive and PTSD symptom severity post-ketamine assisted psychotherapy (KAP). I am hypothesizing that self-transcendence will be moderate to high post-KAP, based on Dr. Reed’s theory of self-transcendence. The second aim is to elucidate any associations between self-transcendence and PTSD symptom severity and self-transcendence and depression severity post-KAP, and investigating if there’s a decrease in trauma-related symptoms, whether this correlates to a higher self-transcendence score between participants who reported history of childhood adversity compared to participants without or lower childhood adversity measurements. We’re trying to tease out who really might benefit from this therapy.
What changes do you envision this work making in terms of actual practice?
There’s still a lot of stigma around using ketamine psychotherapeutically, so I want to disseminate my findings in a language that is considered valid and reliable in the mental healthcare and medical communities. Most of the data published around ketamine are biomedically focused, and regard the psychedelic experience as an unwanted or undesirable side effect; I'm suggesting these subjective experiences during the psychoactive phase post-ketamine administration may be helpful when provided or facilitated by well-trained, specialized clinicians. At a minimum, I'm suggesting that the psychedelic or non-ordinary state induced by ketamine and other medicines merit further investigation; we need to listen to our patients, and nurses are particularly adept at this in clinical practice and in research.
What are your plans once you’ve earned your PhD this semester?
Long-term, I'm planning to continue to collect and disseminate KAP findings and to continue to provide specialized accredited training for licensed clinicians. Last year, I founded the 501(c)(3), the Transpersonal Research Institute of Psychotherapeutic Psychedelics (TRIPP), whose mission is to provide clinical research mentorship in the psychedelic sciences to female and BIPOC scientists and clinicians, and to expand KAP access to underserved peoples in southern Arizona. Whatever unfolds, I will be forever grateful for my time at UArizona’s College of Nursing and to my mentors, Drs. Thaddeus Pace, Kathleen Insel, and Pamela Reed.