Support Patient Communication in Ketamine Therapy to Improve Comfort and Retention

Patients Don’t All Walk In the Same - But We Often Treat Them Like They Do

When patients don’t feel safe enough to communicate their needs, they’re more likely to drop out.

Not every patient walks through your door with the same history, the same nervous system, or the same ability to speak up.

Some are holding trauma. Others are managing chronic pain, anxiety, or emotional shutdown. Many have learned to say “I’m fine,” even when they’re not; because masking distress became necessary somewhere along the way.

In ketamine therapy, nonverbal cues often speak louder than words. But without a reliable way to read those cues, critical needs can go unnoticed. And when patients don’t feel safe enough to express what’s happening internally, they’re more likely to disengage or abandon care entirely.

So how do we bridge that gap?

This article explores a deceptively simple, visual solution: a Comfort Menu. It’s a trauma-informed tool that helps patients name what they’re feeling; without needing the perfect words. When communication improves, so does connection, comfort, and treatment retention.

What Is the Comfort Menu?

Our Comfort Menu is a visual communication aid designed to help patients check in with themselves to identify and share their emotional state or preferences before, during, or after ketamine sessions. 

Think of it like a mood check-in using simple icons, words, and scales. Rather than relying on verbal interpretation, the patient points to what resonates, enabling clinicians to respond effectively while respecting emotional safety.

Why It Matters in Clinical Practice

1. Masking and Emotional Suppression

Many patients suppress their true feelings; not because they want to, but because they’ve had to. After repeated invalidation or emotional injury, people often learn to disconnect from their internal world as a way to cope or avoid judgment. Over time, this masking becomes second nature, and patients may not even realize how often they reflexively say, “I’m fine.”

By the time they arrive for ketamine therapy, many have experienced years of being dismissed, misunderstood, or gaslit. They may not feel safe being fully seen or heard.

The Limitless Comfort Menu offers a simple to use, nonverbal way for patients to express what they need, without having to navigate or explain complex internal experiences.

Mindset support tools like the Limitless Patient Comfort Menu, helps gently reverse the effects of chronic emotional suppression, offering patients permission to explore and express what’s really happening inside, at their own pace.

2. Nervous System Dysregulation

Approaching a ketamine session can trigger fight/flight or freeze responses. Especially if they are often in and out of those responses in their daily life. Finally getting the help they need, by walking through your door can be very triggering, even when there is likely symptom relief of their health issues, now that they are able to get care from your practice. 

It is important to recognize and meet patients where they are at with compassion for the often “long road” they have walked prior to finding your clinic. This is where a user-friendly visual aid can help patients shift into a ventral vagal state before dosing, improving emotional and physiological regulation. This aligns with polyvagal principles and supports integration later in their ketamine therapy plan.

3. Improved Engagement and Reduced Dropout

“When patients have a way to show how they’re really feeling - without having to explain it - they feel safer. We’ve seen better engagement and fewer dropouts since using this,” says an anesthesiologist who runs a ketamine clinic.

With increased clarity, patients are more likely to complete loading protocols and return for boosters, a key component of ketamine treatment retention protocols.

Why Non-Verbal Communication Options Work: Polyvagal Theory in Action

When patients feel safe, they heal more effectively. Polyvagal Theory, developed by neuroscientist Stephen Porges, explains how the autonomic nervous system responds to safety and danger cues, influencing emotional and physiological states. Through a process called neuroception, the body constantly scans the environment for signals. When safety is perceived, it shifts into a regulated, socially engaged state that supports emotional openness and connection.

Tools like the Limitless Comfort Menu help patients access this state. These visual cues act as nonverbal signals of safety, activating ventral vagal tone and creating the conditions for emotional regulation and therapeutic engagement.

This isn’t just theory, it’s a practical, research-informed strategy drawn from trauma science, neuroscience, and psychedelic medicine. Supporting the nervous system in this way can meaningfully enhance ketamine therapy outcomes.

1. Safety cues activate ventral vagal tone

Polyvagal Theory shows that the nervous system constantly scans for signs of safety, a process called neuroception. When it detects these cues, it shifts into the ventral vagal state- a calm, socially engaged mode that supports emotional openness and connection during care.

Perceived safety can activate these advanced neural circuits, dampen sympathetic responses, and promote physiological calm (Porges, 2009).

2. Visual tools offer nonverbal cues of safety

A Comfort Menu functions as a nonverbal “glimmer”, a visual cue that communicates: “You’re seen. You’re safe.” These sensory signals can help down-regulate stress responses and support parasympathetic activation, even without verbal processing.

This application aligns with polyvagal-informed therapy, where external cues of safety are used to help guide patients into a more regulated nervous system state (Deb Dana, Polyvagal Exercises for Safety and Connection: 50 Client-Centered Practices, W. W. Norton & Company, 2020.).

See also: Verywell Mind summary on “glimmers” for a patient-friendly explanation.

3. Ready mind and body = better integration

When patients enter a ketamine session in a regulated state, breathing steadily, muscles relaxed, and the nervous system attuned to safety; they are more receptive to emotional processing and insight. This ventral vagal state provides the neurophysiological foundation for meaningful integration.

Research on psychedelics and dissociative therapies shows that a patient’s internal state before dosing, especially their sense of safety and regulation, directly shapes the brain’s ability to process and retain therapeutic content. A grounded mindset creates optimal conditions for neuroplasticity, emotional insight, and long-term benefit (Carhart-Harris & Friston, 2019).

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Going Beyond Masking: Recognizing Different Communication Styles in Ketamine Patients

Every patient walks into ketamine therapy with a different emotional map. For some, trauma history makes expression feel risky. For others, anxiety or chronic pain distorts how they report distress. Without a structured way to check in, these unspoken experiences get missed- and clinical care suffers.

The Comfort Menu bridges that gap.

Common Patterns in Patient Communication

• PTSD or Trauma
  
  • Patients may appear detached, silent, or overly agreeable. Years of emotional invalidation can train them to hide what’s real. The Comfort Menu gives them a low-pressure way to share internal states without needing to find the “right” words.

• Chronic Pain
  
  • Many underreport symptoms or minimize discomfort as a way to cope. Saying “just a little pain” may mask exhaustion, hopelessness, or fear. A visual scale reveals nuance they may not verbalize.

• Anxiety or Depression
  
  • “I’m fine” is often a stand-in for dysregulation. An anxious system may default to masking emotion to avoid conflict, shame, or dismissal. Pointing to a feeling like anxious or not sure offers an entry point for connection.

• Dissociation
  
  • These patients might struggle to track time or respond mid-session. Subtle gestures, like pointing to “calm” when they mean numb, can cue clinicians to offer grounding tools and slow down their pacing to help the patient come into the present moment.

"This isn’t about checking boxes. It’s about giving an outlet to what their nervous system is communicating - even when the patient can’t find the words." says Cali, Founder of Limitless Guided Visualizations "It's important to meet patients where they are at, and support them in feeling safe and seen."

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• Visual aids help patients feel seen without vulnerability or cognitive overload. The menu creates an emotionally safe space to disclose distress on their terms.

• Icons serve as “glimmers,” small visual safety cues that support down-regulation and openness (Deb Dana, 2020).

• Journey Macrodose Intros and calming ambient audio help settle pre-session arousal without requiring patients to verbalize needs they don’t yet understand.
  

“You don’t have to explain. Just point to what fits. That gives us a starting place.”

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When patients can express emotional states visually, it can shift the clinical atmosphere, from apprehension to trust. Clinicians can be more responsive to non-verbal patient needs. Suddenly, they’re not guessing what’s needed to help the patient. They’re being met as they are, and that changes everything.

The Comfort Menu: Clinical Examples in Practice

These examples show how masking behaviors can be decoded using the Comfort Menu, and how aligning support can deepen emotional attunement and therapeutic benefit.

• Patient Initial State: High-anxiety
  
  • Masking Behavior: Says “I’m fine,” but breathes shallowly, eyes show distress
    
    • Menu Response: Points to Anxious‍
      
      • Suggested Support: Offer I Am Gentle, I Am Enough or Chill Music

• ‍Patient Initial State: Pre-Trauma Disclosure or Guarded
  • Masking Behavior: Avoids eye contact; gives brief answers like “okay” or nods only
    
    • Menu Response: Points to Nervous
      
      • Suggested Support: Begin with I Am Safe or I Am Supported Macrodose

• ‍Patient Initial State: Chronic Pain, Minimizing Symptoms
  • Masking Behavior: Dismisses discomfort, says “It’s the same as it always is.”
    • Menu Response: Points to Not Sure
      
      • Suggested Support: Offer I Am Aligned or I Am Resilient Macrodose

• Patient Initial State: Emotionally Flat or Shutdown
  
  • Masking Behavior: Says “I’m okay” with low affect and limited expression
    
    • Menu Response: Points to Calm
      
      • Suggested Support: I am Here or I Am Powerful Macrodose to build agency and engagement

• Patient Initial State: Overcompensating or Masked Positivity
  
  • Masking Behavior: Smiling, upbeat demeanor despite recent challenges; may avoid emotion
    
    • Menu Response: Points to Happy
      
      • Suggested Support: Offer I Am Limitless or I Am Gentle Macrodose to foster emotional depth safely

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