Can I Keep Doing CBT While I’m in Ketamine Treatment? Timelines, Homework, and Privacy on Dosing Days

Many patients worry that starting ketamine therapy means they must pause their work in cognitive behavioral therapy (CBT). In clinical practice, it’s common to keep CBT going during ketamine treatment, adjusting pace and focus so the week stays manageable. 

This guide offers a practical plan so you can use CBT skills while you pursue ketamine for depression without adding pressure.

What “doing CBT during ketamine therapy” actually means

CBT is a structured psychotherapy that helps you notice patterns in thoughts and behavior, test those patterns, and practice alternatives. It is skills based and present focused. Ketamine therapy is a monitored medical treatment that may open a short window when brain cells are more inclined to reach out and connect to each other, talk to each other, what we call “neuroplasticity.” Doing them together does not mean cramming more into the week. It means choosing a few small, repeatable targets and placing them where they will be easiest to practice.

There are usually three groups on your care team:

• Your therapist guides CBT: behavioral activation, cognitive skills, exposure steps when relevant, and sleep supports.
• The Spravato or ketamine staff who help you through the process and monitor progress. Your prescribing clinician manages ketamine treatment and monitors response and safety.
• Yourself - bringing your expertise to the situation, your insights, your motivation.

Timelines that tend to work when combining ketamine therapy and CBT

Every plan is individualized. These examples show a gentle starting point. Each plan should be carefully crafted with input from your care providers who understand your unique situations. 

Week 0: preparation

• Clarify your goals for this month. Pick one or two life areas that matter now: sleep, school, work, relationships, or daily structure.
• Complete baseline scales if your CBT provider uses them, and share any safety preferences.
• If you want your therapist and Lumin Health to coordinate, sign a release of information.
  
  

Weeks 1–4: induction period

• If you are starting Spravato treatment, visits are usually twice weekly in a certified Spravato center with a ride home after observation. If you receive off‑label ketamine dosing, frequency is set together with your clinician. 
• Keep CBT to one session per week. Choose a behavioral target and a simple cognitive skill. Big insights are welcome, but not required.
• Plan rest on dose evenings. No driving after treatment on those days.
  
  

Weeks 5–8: early taper

• If response is emerging, Spravato may taper to weekly. Off‑label protocols vary.
• Continue weekly CBT if helpful. If energy is low, consider shorter skills sessions or biweekly visits for a few weeks.
  
  

Maintenance and beyond

• As ketamine/esketamine treatment spaces out, keep up a reasonable pace of CBT in accordance with how you think you are meeting your goals. 

Homework that fits the week (without flooding it)

The aim is to keep practice small, predictable, and connected to your values. Many patients find this rhythm workable, but please conduct whichever framework is most workable for you:

Pre ketamine/esketamine dose (morning of dosing day)

• Set a light intention: one sentence about how you want to move through the day. Example: “I will keep today simple and kind.”
• Choose one skill to try later in the week. Write it down.
  
  

0–24 hours post ketamine/esketamine dose

• Rest. Be sure to hydrate. Keep screens low if that helps. If you like to journal, please feel encouraged to do so as long as it feels comfortable. 
• The goal is recovery and feeling restored to yourself - however you find it.
  
  

24–72 hours post ketamine/esketamine dose

• Try one small step from your plan. A 10–20 minute values‑based activity, one thought record, or a single preplanned exposure step. If you complete it, stop. If you cannot, shrink its scope further and try again.
• Consider a check‑in with your therapist.
  
  

Between ketamine doses

• Repeat what worked. Consistency is more important than novelty. Notice what felt easier and what still feels sticky.
  
  

These steps can be used with Spravato treatment or with off‑label ketamine therapy. The content is similar; only the ketamine administration procedures differ.

Privacy and boundaries on ketamine dosing days

Your right is to control what is shared. Some patients prefer quiet after dosing and choose not to process content from the experience in detail. Some prefer a more detailed exploration. Go with your gut and try different approaches until you find one that works for you. Lumin Health values coordination with your therapist. We consider ourselves part of your care team (along with you!) all aligned with one mission: to help you achieve your goals.

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Risks, limits, and clinical humility when combining CBT and ketamine treatment for depression 

Not everyone benefits from combining CBT and ketamine therapy. Some patients do better when they focus on one thing at a time. Others feel that CBT helps them use any gains from ketamine treatment and protect momentum. Both paths are valid. At Lumin Health, we are happy to work with you to avoid turning the neuroplasticity window into pressure. The goal of ketamine therapy and CBT is aligned: to make small, humane changes that fit real life.

FAQs

Is CBT required for ketamine therapy?
No. You do not need to be in any sort of psychotherapy to begin ketamine therapy or Spravato treatment. Many patients choose to add CBT (or other therapies, for that matter) because it gives structure to the week, but it is optional.

How often should I meet my therapist for CBT during Spravato treatment?
Once weekly is enough for many people during induction. 

Can I do telehealth sessions on dose days?
Most people prefer rest after dosing. That said, some people appreciate more in-the-moment conversations. If you want to talk with your therapist on the same day, go for it. 

Are exposure exercises safe right after dosing?
No one knows for sure – investigate with some self check-ins to see how you feel. 

Who sees my therapy notes if I’m in a Spravato clinic?
Only the people you authorize. At Lumin Helath, because of the value in collaborating, we ask that patients provide consent for us to be in contact with your care team. This keeps your care integrated. 

Will insurance cover both esketamine therapy and CBT?
Coverage for CBT is often available with in‑network therapists, including telehealth. Spravato is commonly covered when criteria are met. Off‑label ketamine has less predictable coverage. Our team can help you review benefits.

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