A Semantic Scale Network analysis of the revised Mystical Experiences Questionnaire: A call for collaboration

The present paper makes case for using Semantic Scale Network (SSN) analysis in order to help inform researchers of the most appropriate scales in psychedelic clinical research. The Mystical Experience Questionnaire is analysed using SSN analysis as an example, confirming some of the scale’s novelty and convergent validity while revealing unanticipated links with constructs outside of psychedelic research (e.g. awe, stress).

Abstract

“Background and aims: Multiple laboratories have proposed measures of subjective effects of psychedelics as potential mediators of their therapeutic impact. Other work has identified individual differences that covary with subjective responses in informative ways. The range of potential measures of responses, traits, and outcomes is vast. Ideas for new measures are likely numerous. The field will progress efficiently if proposed new scales can add incremental validity. Semantic Scale Network analyses identify conceptual overlap among scales based on items (rather than participant ratings), which could help laboratories avoid putting effort into measures that are unlikely to account for unique variance. Semantic Scale Network analyses can also reveal links to constructs from disparate research literatures, potentially helping investigators generate novel hypotheses and explain connections among disparate findings. The results of Semantic Scale Network analyses have the potential to improve as more investigators enter their scales into the corpus.

Method: Example analyses using the revised Mystical Experiences Questionnaire (MEQ) underscore the uniqueness and discriminant validity of the MEQ subscales.

Results: Findings dovetail with published theorizing and suggest potentially novel links with different therapeutic effects. The MEQ total or subscales overlap with measures of awe, inspiration, regret, dissatisfaction, transcendence, depression, fatigue, and spirituality. Links with measures of stress, alexithymia, and gender identity suggest lines of further work.

Conclusion: This analytic approach might suggest unique applications for psychedelic-assisted treatments and provide perspectives on phenomena outside the field. As psychedelic researchers enter their scales to the corpus for Semantic Scale Network analyses, the field will benefit.”

Authors: Mitch Earleywine, Fiona Low & Joseph De Leo

Summary

Abstract

Integration therapy is an integral part of psychedelic-assisted treatment. It involves making sense of the psychoactive experience after subjective effects have subsided, and is a bridge between the psychedelic experience and daily life.

Clinical trials reveal that psychedelic-assisted treatments have considerable potential. These treatments usually involve three steps, dubbed preparation, guided administration, and integration, and involve a professional who explains the process, helps set reasonable expectations, and offers reassurance during challenging moments associated with acute effects.

Early research rested on psychodynamic theories, and subsequent research combined the psychedelic experience with empirically validated psychotherapies. Some research groups point out that the same mechanisms known to underlie empirically supported treatments might also be responsible for the therapeutic effects of psychedelics.

Authors vary in their emphasis on the need for support throughout the process of psychedelic therapy. Some clinicians emphasize the importance of integration sessions, while others focus on the client’s needs, personal perspective, and commitment to spirituality.

Current work does not reveal sufficient details to generate extensive, testable hypotheses about the process of psychedelic integration, so we interviewed people who provide the service to see how they define it.

Participants

Participants were 30 interviewees who lived in the United States, Canada, Mexico, Costa Rica, or Trinidad and Tobago. Eleven were female, two were nonbinary, two were two-spirit or fluid, and 15 were male. The modal education group included those with a master’s degree or higher in clinical or counseling psychology, a high school diploma or equivalent, a Bachelor’s degree in psychology, a Doctorate in clinical or counseling psychology, and one who was currently working on a doctorate.

We placed advertisements on social media, emailed members of integration lists and social networks, and contacted personal networks willing to send the request to relevant colleagues. 31 participants agreed to participate for at least an hour in exchange for a US$50 gift certificate.

Procedures

All procedures were approved by a North American Institutional Review Board, and interviews were conducted via zoom or telephone. The interviews were audio-recoded and transcribed verbatim.

Qualitative Coding

The interviewer and two other authors identified recurring themes in the interviews, and the two authors who had not conducted the interviews took input from the interviewer, read all transcripts, and generated lists of themes independently. They met to discuss emerging patterns among themes, and refined definitions.

Two coders without personal contact with the interviewees coded all the transcripts based on the provided definitions. Nineteen of the 21 proposed codes had acceptable values of agreement, and two codes were dropped.

Quantitative Analyses

We used nonparametric analyses to examine the presence and absence of qualitative themes in the interviewees and how they varied with demographic variables, orientation, and training.

Overview

Coding of the interviews suggested that integration is a bridge from the psychedelic experience to everyday life. Integration therapists mentioned a lack of client response to the treatment, client resistance to the treatment, and self-care needs of the integration therapists.

Interviewee Orientations or Techniques

Participants reported using an array of techniques and approaches, including Family Systems, Mindfulness, Breathwork, Transpersonal, Jungian, Grofian, Existentialism, Narrative, Cognitive Behavioral, Motivational Interviewing, Hakomi, Eastern Traditions other than Mindfulness, Somatics, and Embodiment.

Coding Themes: Defining Integration

Seven reliably coded definitions of integration were found, with the most common definition focusing on integration as a bridge between the psychedelic experience and daily life. No other codes were associated at statistically significant levels.

Coding Themes: Challenges

Interviewees explained what challenges they faced while performing integration therapy. The most common challenge concerned client nonresponse, the next most common challenge concerned client resistance, and the third most common challenge involved therapist self-care.

Coding Themes: Concerns

Interviewees expressed concerns about the commercialization of integration therapy, misunderstandings of psychedelics as a panacea, cultural issues in the way that psychedelic therapy is currently conducted, and power differentials in the relationship between clients and therapists.

Additional Themes

Three additional themes appeared in interviewee responses, including concerns about personal use of psychedelics for the therapists, the importance of a practitioner community familiar with psychedelics, and the need to take a client-centered, nondirective approach for integration therapy.

Discussion

Analyses of the interview data revealed multiple recurring themes, including definitions, challenges, and concerns. These themes were independent of demographic characteristics or certification status of the therapists, and can inform subsequent research on integration.

Integration Defined

Interviews with 30 integration therapists suggested a multifaceted definition of integration that includes making sense of the psychedelic experience in everyday life.

Domains for Challenges and Concerns About Integration

Interviewees discussed challenges and concerns related to psychedelic integration.

Integration therapists mention issues relating directly to clients, such as nonresponse and client resistance. They suggest that future research should focus on identifying predictors of treatment outcomes and on helping practitioners to maximize their impact via self-care and relevant social support.

Limitations and Future Directions

The current data provide novel empirical information about integration, but further research is needed to determine the effectiveness of the psychedelic treatment process.

Generalizable, stratified sampling could reveal covariation with approaches to integration, and a focus on speakers of languages other than English could provide a different view of the practice of integration.

The identified view of integration therapy parallels motivational interviewing, a brief intervention based on Rogerian Therapy that utilizes client-centered social interactions to improve health behaviors. Many integration therapists might behave in ways that are consistent with the motivational interviewing approach.

Motivational interviewing and psychedelic integration might work in similar ways, and coding for variables like these in recorded integration sessions could provide valuable insights into how to maximize the impact of integration therapy.

Despite limitations, the 19 themes identified in the present study appeared frequently enough to recommend serious consideration. Further research could focus on identifying predictors of efficacy, and on identifying specific definitions of integration, associated techniques or approaches, and awareness of challenges and concerns.