Literature Collection

Ketamine-Assisted Therapy (KAT) presents a promising alternative for addressing mental health challenges, particularly in treatment-resistant conditions, yet little exists in the literature guiding its implementation in an Indigenous context, for Indigenous participants, or describing culturally adapted delivery models. This paper presents insights and lessons learned from a collaborative pilot program between Siksika Health Services and ATMA CENA to design and deliver a culturally responsive KAT program within the Siksika First Nation in Alberta Canada. The initiative aimed to explore the feasibility and therapeutic impact of KAT in an Indigenous healthcare setting, while also being conscious of cultural relevance and opportunities for continued clinical and quality improvement of the program. The pilot followed a five-phase approach: collaboration, knowledge acquisition, lived experience, data collection, and follow-up. Recruitment resulted in 6 participants completing care (3 Indigenous and 3 non-Indigenous). Findings demonstrated notable improvements in symptoms of depression, anxiety, and PTSD, with participants reporting increased emotional regulation and stronger cultural connections. Cultural elements including shared meals, traditional decor and blankets, community orientation, and a mid-program break for cultural events, were central to participant reported safety, trust, and meaning making. Notably, the Indigenous and non-Indigenous participant groups, who were treated together, reported comparable gains in safety, trust, and mental, emotional, and spiritual well-being. These shared outcomes suggest the model may hold relevance for reducing inequities in group KAT delivery. Challenges and lessons learned included need to address stigma and systemic influences experienced by Indigenous participants, barriers affecting timely intention setting and integration therapy, and overcoming logistical barriers when working in rural First Nation environments. This pilot program implementation underscores the importance of culturally responsive mental health interventions and highlights key considerations for expanding psychedelic-assisted therapies in Indigenous communities.

Depression and anxiety disorders are the most prevalent mental disorders in the world. The transdiagnostic approach to the study of these emotional disorders suggests that certain diagnostic categories, such as depression or anxiety disorders, share common underlying factors. This paper evaluated several models of common maladaptive cognitive factors in depressive and anxiety disorders (Study 1) and the predictive validity of these models (Study 2). In Study 1, 1703 primary care patients with suspected emotional disorder completed brief scales to assess the following cognitive factors: worry, rumination, attention to threat, and metacognitions. We found that the model with the best fit was the bifactor model, estimated through an exploratory structural equation model (ESEM). This bifactor model suggests that individual cognitive factors can be explained by a general factor plus four independent factors, evidencing the existence of a transdiagnostic cognitive factor (TD-C factor). In Study 2, a subgroup of 178 participants (from Study 1) were clinically diagnosed by semi-structured clinical interviews with major depressive disorder, generalized anxiety disorder, and/or panic disorder. The predictive validity of TD-C factor was acceptable (AUC > 0.80), but specific factors were not predictive (AUC < 0.70), indicating that TD-C factor was a significant predictor for each diagnosis. This study supports the claim that there is a transdiagnostic cognitive factor that can predict the diagnosis of various depressive and anxiety disorders, thus potentially representing a useful transdiagnostic assessment.