Development of the Psychological Insight Questionnaire among a sample of people who have consumed psilocybin or LSD

This survey study (n=1661) introduces and validates the Psychological Insight Questionnaire (PIQ) that shows independent (from MEQ and challenging experiences) predictive power on changes in well-being and life satisfaction.

Abstract

“Background: Several measures have been developed to examine acute psychedelic effects (e.g. mystical-type and challenging experiences), but no measure assesses acute psychologically insightful experiences that may occur during psychedelic experiences.

Aim: The purpose of this study was to develop and examine the psychometric properties of the Psychological Insight Questionnaire.

Method: A cross-sectional survey study among psilocybin and LSD users. Respondents (n=1661; Mage=22.9, standard deviation=8.5; Caucasian/White=83%; non-Hispanic=91%; men=72%; United States resident=66%) completed an Internet-based survey.

Results: The Psychological Insight Questionnaire consists of 23 items with two subscales: (a) Avoidance and Maladaptive Patterns Insights and (b) Goals and Adaptive Patterns Insights. Construct validity of the Psychological Insight Questionnaire was supported by strong correlations of the Psychological Insight Questionnaire (and Avoidance and Maladaptive Patterns Insights and Goals and Adaptive Patterns Insights subscales) scores with the insight subscale of the Session Impacts Scale, and weak-to-moderate correlations with the Mystical Experiences and Challenging Experiences Questionnaires. Furthermore, Psychological Insight Questionnaire (and Avoidance and Maladaptive Patterns Insights and Goals and Adaptive Patterns Insights subscales) scores were moderately-to-strongly correlated with retrospectively reported increases in psychological flexibility, and well-being/life satisfaction that were attributed to a memorable psychedelic experience. Lastly, incremental validity was established showing that the Psychological Insight Questionnaire (and Avoidance and Maladaptive Patterns Insights subscale) scores predict unique variance in changes in psychological flexibility, and Psychological Insight Questionnaire (and Avoidance and Maladaptive Patterns Insights and Goals and Adaptive Patterns Insights subscales) scores predict changes in well-being and life satisfaction, beyond measures of acute mystical-type and challenging effects.

Conclusions: The Psychological Insight Questionnaire has the potential to extend the understanding of the acute and enduring effects of psychedelics. Further longitudinal research is necessary to determine the long-term predictive validity of the Psychological Insight Questionnaire and to examine the role of psychological insight in predicting therapeutic outcomes.”

Authors: Alan K. Davis, Frederick S. Barrett, Sara So, Natalie Gukasyan, Thomas C. Swift & Roland R. Griffiths

Summary

Introduction

Several measures have been developed to assess acute subjective psychedelic drug effects that occur in the laboratory and in naturalistic settings. These measures are time consuming and require that researchers administer the entire pool of items thus increasing assessment burden.

The Mystical Experiences Questionnaire (MEQ) is a widely used measure of acute mystical-type experiences. It was originally created based on the work of Stace’s conceptual model (1960) and Hood’s Mysticism Scale (Hood, 1975; Griffiths et al., 2006, 2011). The MEQ total scale score and factor scores have demonstrated good internal consistency reliability, and the MEQ is moderately-to-strongly correlated with the Hood Mysticism Scale. It has been shown to predict long-term positive therapeutic outcomes.

The Challenging Experience Questionnaire (CEQ) was created based on the Hallucinogen Rating Scale (HRS), the Altered States of Consciousness Rating Scale and the Five-Dimensional Altered States of Consciousness Rating Scale (Dittrich, 1975, 1998; Studerus et al., 2010). It measures acute challenging effects across different substances and settings.

Recent studies have examined the potential therapeutic effect of psychedelics used in the natural environment among people with an alcohol use disorder. The study found that participants with mystical-type and insight experiences had a significant reduction in alcohol use.

In another recent study, Roseman et al. (2018) hypothesized that the Oceanic Boundlessness (OBN) factor of the Altered States of Consciousness Questionnaire (ASC) would predict outcomes of psilocybin-assisted therapy of treatment-resistant depression. The results indicated that the insightfulness sub-factor of the OBN was predictive of decreased depression at follow-up. The Emotional Breakthrough Inventory captures qualities of emotional catharsis but lacks inclusion of other types of acute insight experiences.

A measure of insight has been developed for use in psychedelic studies, but several measures with disparate underlying operational definitions have been developed, including the Birchwood Insight Scale for Psychosis, Self-Awareness Outcomes Questionnaire, Self-Reflection and Insight Scale, and Psychological Mindedness Scale.

Several psychotherapy insight measures exist, but none of them assess acute insight experiences in the context of a discrete event. The only measure that does is the Session Impacts Scale, but it does not assess the various types of insight one might have during a psychedelic experience.

Current study

The present study was designed to create and test a new measure of acute experiences of psychological insight. It demonstrated good internal consistency reliability and demonstrated discriminant, convergent, and predictive validity.

Development of Psychological Insight Questionnaire (PIQ)

We began developing a measure of psychological insight through conversations with psilocybin session facilitators on our study team, and removed items that overlapped substantially with other items or did not appear to measure a specific type of insight.

Study procedure

Volunteers were invited to complete an anonymous Internet-based cross-sectional survey that was conducted by Motherboard/VICE. The survey was conducted via a secure Web-based survey and was approved by the Johns Hopkins University School of Medicine Institutional Review Board.

Study recruitment flow

We recruited 15,470 people from June 2018 to February 2019 and used 3177 consented respondents. Of these, 996 were excluded because they reported using more than one substance in their psychedelic experience.

Identification of single most insightful experience after taking psilocybin or LSD

We created the PIQ to assess the intensity with which respondents experienced 28 acute insight experiences after taking a classic psychedelic.

Psychedelic experience

The MEQ was used to assess the degree to which subjective mystical-type phenomena occurred during the reported psychedelic experience. The mean score was calculated using 30 items.

The CEQ was used to measure the degree to which challenging experiences occurred during the reported psychedelic experience. The total mean score was calculated to measure the overall intensity of challenging experiences.

The Session Impacts Scale (SIS) was used to measure overall general insight that occurred during the reported psychedelic experience. The SIS-Insight subscale is a five-item self-report measure of the experienced impacts of psychotherapy sessions.

Changes in psychological flexibility

The Acceptance and Action Questionnaire II (AAQII) was used to measure psychological inflexibility. The AAQII is a seven-item measure and lower scores indicate greater psychological flexibility, while higher scores indicate greater psychological flexibility.

Changes in well-being and satisfaction with life

The Satisfaction with Life Scale (SWLS) was used to examine the degree of changes in well-being and satisfaction with life that respondents experienced from before to after the identified psychedelic experience.

Respondent characteristics

A sample of young adult men from the USA was interviewed. Approximately one-half reported income greater than or equal to US$50,000.

analysis strata

The sample of 1661 responses was stratified into two sub-samples, and demographic data were compared between strata using a two-sample t-test for age and chi-squared independence tests for all other demographic variables.

Scale development, replication, and reliability

The exploratory stratum was analyzed using principal component analysis with varimax rotation, and a simple factor structure was yielded. Standardized Cronbach’s alpha, item-total correlations, and average inter-item correlations were then assessed to determine internal consistency of the scale items.

Parallel analysis on the remaining items for each component identified a single principal component for each component. Cronbach’s alpha, corrected item-total correlations, and average inter-item correlation indicated high internal consistency between and among the remaining items.

The PIQ was constructed from the exploratory stratum and confirmatory stratum data. Its components were named the Avoidance and Maladaptive Patterns Insights (AMP) and Goals and Adaptive Patterns Insights (GAP), and they are strongly correlated to the mean of all items on the PIQ.

Construct validity

The construct validity of the PIQ was explored using the entire sample (n=1661) and found to be linear. Weak-to-moderate correlations were found between mean PIQ, and AMP and GAP subscale, scores, and mystical-type effects as measured by mean MEQ and CEQ, and a strong correlation was found between mean PIQ and insight measured by mean SIS.

Predictive validity based on retrospective reports of changes in psychological flexibility and well-being/life satisfaction

A correlation was found between the PIQ, the AMP and GAP subscales and changes in psychological flexibility and life satisfaction. A moderate correlation was found between the PIQ, the AMP and GAP subscales and changes in general well-being and life satisfaction.

Incremental validity

Two regressions were conducted to examine the incremental validity of the PIQ in predicting changes in psychological flexibility and well-being and life satisfaction beyond mystical experiences and challenging experiences. The PIQ contributed unique variance in predicting both changes in psychological flexibility and well-being and life satisfaction.

Two stepwise linear regressions were conducted to examine whether the AMP and GAP subscales of the PIQ contributed unique variance in predicting changes in psychological flexibility (AAQII) and changes in well-being and life satisfaction (SWLS). Both models were significant.

Discussion

A self-report measure was developed to measure acute psychological insight that may occur in the context of a psychedelic experience. The measure demonstrated high internal consistency, had two subscales, and demonstrated moderate to strong correlations with increases in psychological flexibility and well-being/life satisfaction.

The PIQ scale may capture experiential qualities that are distinct from those that fall under the category of mystical-type experiences, and may therefore be a valuable clinical tool to examine how phenomena that are otherwise difficult to describe may produce tangible shifts in one’s mental health.

Our findings were generally consistent with other literature on insight as it relates to psychedelic drug effects. The correlation between the PIQ and the MEQ was different in this study compared to Garcia-Romeu et al. (2019), but future research will need to explore this relationship.

The present results are difficult to understand in the context of the existing literature on insight in traditional psychotherapy, because of the varying definitions of insight and the use of different assessment tools. The literature does reveal a few applicable studies that are largely consistent with our findings, including Kivlighan et al. (2000) and Grande et al. (2003), which both found that patients who gained insight over the course of psychotherapy had improved ability to cope. As Mallinckrodt (1994) suggested, insight may be an evolving process. O’Connor et al. (1994) found that insight followed a “high-low-high” pattern over a 16-week course of psychotherapy.

This cross-sectional study has several limitations, including the use of an anonymous Web-survey and the lack of independent ratings or validation of content validity. Additionally, the study consisted primarily of young white men and lacks questions related to the context in which the psychedelic was ingested.

This study suggests that psychological insight may be a distinct facet of the psychedelic experience that is associated with long-term positive outcomes. Future research should evaluate the relationship between psychological insight and other measures of acute psychedelic effects.