Awe: a putative mechanism underlying the effects of classic psychedelic-assisted psychotherapy

This review paper (2018) presents a theoretical framework that awe is an underlying mechanism that, as a part of the psychedelic experience, promotes ego dissolution (small self, unitive experience).

Abstract

“A psychological model of classic psychedelic-assisted psychotherapy informed by contemporary scientific data is presented in this paper. It is suggested that classic psychedelic-occasioned mystical experience is characterized by profound awe, a discrete emotion experienced in the presence of a vast stimulus requiring accommodation of mental structures. Awe, in turn, promotes the small self, a construct that, in the extreme, is analogous to those of unitive experience and ego dissolution. The small self is conceptualized as key to understanding the downstream effects of mystical experience occasioned in the context of classic psychedelic-assisted psychotherapy. With this novel theoretical framework in mind, a number of clinical implications and recommendations are provided so as to advance this incipient field of study.”

Author: Peter S. Hendricks

Summary

Introduction

Classic psychedelic research is re-emerging, with many clinical trials for demoralization in long-term AIDS survivors, obsessive-compulsive disorder, major depressive disorder, nicotine dependence, cocaine dependence, alcohol dependence, and end-of-life distress being conducted. Yet, little is known about their mechanisms of action.

The current manuscript proposes that awe is the primary psychological mechanism of action undergirding the salubrious effects of mystical experience occasioned by classic psychedelic-assisted psychotherapy. It also discusses potential overlapping neurological mechanisms of awe and classic psychedelic-occasioned mystical experience.

The core features of awe and classic psychedelic-occasioned mystical experience

Awe is an emotion experienced in the face of two key appraisals: vastness and accommodation. It is typically elicited and assessed when one encounters something perceived as so vast and novel that one has to change the way they view reality.

Awe can be measured with single items using a Likert-type scale that demonstrate validity, and less frequently with multiple items using a Likert-type scale that demonstrate reliability and validity. Awe can be experienced as pleasurable, if not blissful, but it can also be infused with dread. From the perspective of a social functional approach to emotions, awe promotes subordination of one’s individual needs in deference to the social collective, or social integration.

Awe appears to orient attention to the present moment, elongate the perception of time, decrease tolerance for uncertainty, and increase the tendency to endorse the role of supernatural agents in the experience. Interestingly, emotion scientists have yet to consider the role of classic psychedelics in eliciting awe.

Classic psychedelic-occasioned mystical experiences appear to exemplify awe, as measured by the Mystical Experience Questionnaire (MEQ30). Other scales assess feelings of peace, ecstasy, and joy, as well as insight, sacredness, and time/space transcendence, which are all linked to awe. The Ego-dissolution Inventory and the Challenging Experience Questionnaire are newer measures of classic psychedelic effects, which emphasize the small self and acute feelings of emotional distress.

Classic psychedelic-occasioned mystical experiences are characterized by awe, and are consistently rated among the most personally and spiritually meaningful experiences of participants’ lives. They may represent the upper ranges of awe, similar to the most exceptional of organic awe phenomena.

Classic psychedelics have largely overlooked the potential centrality of awe to mystical experience, but recent publications have begun to focus attention on this discrete emotion.

Predictors and outcomes of awe and classic psychedelic-occasioned mystical experience

Awe is an epistemological emotion requiring accommodation. Individuals high in personality openness and related traits are more likely to experience awe, and a greater need for cognitive closure is related to a reduced experience of awe.

High trait absorption, neuroticism, mood, and context were all found to be strong predictors of awe, and instructing participants to fully absorb themselves in an external stimulus yielded stronger feelings of awe.

Classic psychedelic-assisted psychotherapy places an emphasis on openness to the forthcoming experience, and participants are urged to immerse themselves in the unfolding experience during the period of drug action. This approach was developed through trial and error, informed by clinical observation and empirical findings.

Awe has been shown to increase positive affect, well-being and life satisfaction, humility, and prosocial behaviour in the short-term, and may have a longer-term effect by increasing perceived time availability and decreasing levels of the proinflammatory cytokine interleukin-6.

The classic psychedelic literature offers parallels to awe-related outcomes, including increased positive affect, well-being and life satisfaction, humility, and a range of prosocial attitudes and behaviours. Moreover, naturalistic classic psychedelic use has been linked to a reduced likelihood of psychological distress, suicidality, and criminal behaviour.

Although awe has not yet been associated with increases in personality openness, mystical experience elicited by classic psychedelics leads to increases in this trait.

mechanisms of awe and classic psychedelic-occasioned mystical experience: considerations for future research

Classic psychedelics produce acute default mode network disintegration and whole brain integration, which are associated with self-reported ratings of ego dissolution post-classic psychedelic administration. This increase in global functional connectivity may be important to both awe and classic psychedelic-occasioned mystical experience. Serotonin plays an important role in social dominance, and classic psychedelics down-regulate serotonin-2A receptors in the prefrontal cortex, which may explain the association between awe and classic psychedelic-occasioned mystical experience.

Clinical implications and recommendations

Figure 1 presents the proposed psychological model of classic psychedelic-assisted psychotherapy, which consists of awe, increased global functional connectivity, sacredness, positive mood, transcendence of time/space, and ineffability.

Awe may be the quintessential binding emotion that drives social integration and cooperation, and may represent the pinnacle of human experience. Classic psychedelic-occasioned mystical experience may be characterized by a sense of connectedness or oneness with others and/or the external universe. This sense of connectedness may account for the promising effects of classic psychedelic-assisted psychotherapy across a range of applications.

Classic psychedelic-assisted psychotherapy is thought to spur quantum change, which is sudden, dramatic, and long lasting. This change is characterized by Ebenezer Scrooge-like enlightenment and rebirth.

Insofar as trait absorption is a strong predictor of psilocybin-occasioned mystical experience, and elevating state absorption by instructing participants to fully absorb themselves in an external stimulus produces stronger feelings of awe, the efficacy of classic psychedelic-assisted psychotherapy may be potentiated by promoting absorption during the period of preparation for drug administration. The modern era offers technological advances not available in the 1960s, and virtual reality paradigms may hold promise in their capacity to elicit awe. Music may also have a role in classic psychedelic-assisted psychotherapy.

Although classic psychedelic-occasioned mystical experience has been shown to produce enduring positive change, the ‘afterglow’ may wanes with time. Therefore, participants may benefit from activities that serve to maintain awe, such as exposure to nature, art, and music, and participation in spiritual or religious practices. Following classic psychedelic-occasioned mystical experience, a number of constructs with therapeutic value in their own right are expected to increase. This can be tapped into with mindfulness training or interventions designed to boost gratitude.

Conclusion

A psychological model of classic psychedelic-assisted psychotherapy was proposed, and clinical implications and recommendations were offered. The model is expected to generate new hypotheses and inspire new lines of research.