This theory-building paper (2022) describes the development and initial validation of the Integration Engagement Scale (IES) to capture positive behavioural engagement with integration and the Experienced Integration Scale (EIS) to capture internal aspects of feeling integrated following a psychedelic experience. The scales were designed to inform the creation of enhanced integration support and the initial data indicates the scales are valid and reliable.
“In this study, we describe the development and initial validation of two psychometric scales for measuring psychedelic integration. Psychedelic integration refers to the post-acute period of time following psychedelic drug administration. We created the Integration Engagement Scale (IES) to capture positive behavioural engagement with integration and the Experienced Integration Scale (EIS) to capture internal aspects of feeling integrated. These scales were developed to measure post-acute psychedelic administration dynamics in order to inform the creation of enhanced integration support and to help refine a general conceptual understanding of the construct of psychedelic integration. The scales are brief and face valid instruments designed for practical use in applied and research settings. Scale items were generated and refined using the Iterative Process Model of scale development, with input from psychedelics experts and clinicians. Content validity, internal structure, and reliability were assessed via expert surveys, content validity analysis, cognitive interviewing, convergent validity analysis, exploratory factor analysis, and confirmatory factor analysis. The data indicates the scales are valid and reliable measurements of the behavioural and experiential forms of Psychedelic Integration.”
Authors: Tomas Frymann, Sophie Whitney, David B. Yaden & Joshua Lipson
Classic psychedelics can occasion effects ranging from self-dissolution to intense emotions, distortion of sensory awareness, and even a sense of death and rebirth. Psychedelic integration can help ensure that change resulting from psychedelic experiences happens as beneficially, sustainably, and smoothly as possible.
Psychedelics are currently utilized in a variety of contexts, including psychiatric treatment at medical clinics, clinical trials at university research centers, healing ceremonies at retreat centers, guided journeys with underground guides, and recreational use within a diverse range of settings.
In the 1960s and 70s, widespread LSD use in the United States encouraged people to disconnect from society. This message was at odds with healthy forms of integration. The festive free love movement led to problems related to reckless substance use, homelessness, STD rates, and children being born without resources to be cared for. Today, we are in a psychedelic renaissance, with rates of usage among adults increasing steadily.
The term “psychedelic integration” refers to the process of bringing together the non-ordinary experience occasioned by a psychedelic with the ordinary experience of daily life.
Our proposed definition of psychedelic integration aligns with scientific literature, including the Psychedelic Harm Reduction and Integration model (PHRI) and the Yale Manual for Psilocybin Assisted Treatment of Depression. It also fits with the description of therapeutic integration sessions in the PHRI.
Overview of the Domain and Subdomains of Psychedelic Integration
To measure psychedelic integration, two distinct scales were developed, the Integration Engagement Scale (IES) and the Experienced Integration Scale (EIS). These scales may be used individually or in tandem, depending on the context.
We developed two brief scales to predict beneficial outcomes from psychedelic experiences, following the Iterative Process Model, and conducted five studies to provide initial validity and reliability evidence on the scales.
We identified the subdomains of psychedelic integration based on a survey of the relevant literature, consultation with experts in the field of psychedelics administration and integration, and a factor analysis.
Engagement With Integration Reflection
In the aftermath of acute psychedelic experiences, individuals often need to reflect on their experience to make sense of it all.
In guided psychedelic experiences, the reflection process is actively supported. The process is best supported by guides who are deeply familiar with the effect of the psychedelic used by the participant, who have an empathetic presence, self-awareness, and integrity, and who can support, rather than directly influence the reflection process.
Personal reflection can occur through a variety of individual means, including journaling, silent contemplation, time in nature, reading books, watching videos, or any other means that help illuminate the experience.
The reflection process may be likened to the formation of an internal map for personal growth, where self-awareness grows and coalesces in the post-experience reflection stage. This map can serve as a compass for personal growth, initiating, motivating, and steering the course of personal growth.
Application refers to putting insights gained from a psychedelic experience into action, and may be expressed through ongoing daily life choices, as well as commitment to a range of different intentional practices.
Staying connected to the unique intentions set for a psychedelic journey is important for integrating the experience into daily life. Creating intention statements that capture personal values and engaging with values-congruent actions is an important facet of integration.
Committed practices or exercises can support integration and personal growth, depending on the particular intentions of each individual and the unique nature of their experience.
Mindfulness practice is particularly strong empirical support as a beneficial form of psychedelic integration engagement, as it helps to deepen and generalize insights, defuse maladaptive thoughts and behaviors, revitalize values and commitments, and maintain present-mindedness.
Psychedelics can produce dramatic changes in consciousness, including the surfacing of repressed psychological content, intensified emotions, sudden changes in core beliefs, ego death or inflation, and unprecedented stillness or invigorated motivation.
Intrapsychic imbalances can occur following extreme negative or positive experiences. By constructing a narrative which makes sense of challenging experiences, the accompanying emotions tend to resolve more quickly.
With euphoric or transcendent experiences, the risk of poor integration may pertain to imbalances in ego-centrism. A sense of humility is necessary to achieve settledness.
Integration refers to the process of uniting different things. Psychedelics use can occasion non-ordinary states of consciousness that can lead to a change in personal belief structures.
Psychedelics can cause fundamental beliefs to flex, which can open individuals to unconsidered potentials. The successful formation of novel intrapsychic connections is a core factor underlying positive mental health change following psychedelics use.
Psychedelic experiences often entail discomfort during the session and integration phase, which is due to the surfacing of repressed content related to the root causes of psychological ill-being. If resistance to the repressed content persists, the experience may become increasingly challenging, and the resolution of root causes delayed.
Psychedelic experiences can be predominantly enjoyable, with positive feelings pervading most or all of the experience. This may lead to felt life improvement, such as increased openness to actions and values, and psychological flexibility, which is strongly associated with psychological wellbeing.
The acute post-experience period of improved wellbeing that can follow after a psychedelic experience is often referred to as the “psychedelic afterglow”. This period can be used to process difficult unconscious blocks and emotions and can be used to reify positive changes. Integrating psychedelic experience into life can transform the afterglow from a fleeting state to a lasting change.
In this study, we identified subdomains of psychedelic integration and created a list of indicators and sub-indicators based on the sub-domains. We conducted cognitive interviews with individuals who had experienced psychedelic integration to verify the items were interpreted correctly.
A convenience sample of 13 participants, mostly White, educated, and male, was recruited. They were between the ages of 27 and 58 and were predominantly male.
Revisions were made to items that were vague, poetic, double-barreled, or didn’t reflect the indicators they were meant to measure.
We administered items to researchers and clinicians with expertise in psychedelic experiences, and received feedback on the proposed definition and conceptualization of psychedelic integration. We then created a new item pool of 149 items and reached out to 14 experts for feedback on item quality.
Feedback on definition quality was indicated on a four-point Likert scale, and item quality was indicated on a nine-point scale. Experts were given the instructions to indicate whether the following statements is overall a good item to include in the psychedelic integration scale.
The definition of psychedelic integration originally proposed was “The intentional application of psychedelic derived awareness into daily life”. The definition was assessed as having a quality rating between “Near Target” and “On Target”.
Qualitative feedback regarding the proposed definition of psychedelic integration suggested that integration is a process, that intentionality may be a part of the process, and that helpful change is inherent to the occurrence of integration.
The IES retained 31 items with average item quality scores above seven, and the EIS retained 101 items with average item quality scores above seven.
Four top experts in the psychedelic integration field provided feedback on the remaining 31 items of the IES and 31 items of the EIS for content validity.
Each item was assessed for relevance to the measurement of psychedelic integration on a four-point scale. The scale representativeness index was computed as the average of the item relevance index scores.
The final IES and EIS demonstrated an S-CVI of 0.96 and a representativeness index of 1.0, respectively.
Overall, the content validity index scores indicate that the final items are highly relevant to the measurement of psychedelic integration, with the exception of three items that were rated as “somewhat relevant” by a single expert.
Participants were adults from the US, mostly White, educated, and balanced between males and females.
We collected a sample of 232 respondents from M-Turk, who had used psychedelics at least once, and administered a survey using Qualtrics, a secure online survey distribution and data collection program.
Participants were asked to consider their most recent psychedelic experience and rate each statement on a scale of 1 to 7.
Participants responded to 31 items from the IES item pool and 31 items from the EIS item pool. A succinct scale with high-quality items was created by filtering out items with I-CVI scores below 0.75 and removing overly redundant items.
An EFA was run on 232 individuals who responded “yes” to the prompting question “Have you ever had a psychedelic experience?”. Factor solutions were generated using SPSS with a Promax rotation.
12 items each remained for the IES and EIS. Promax rotation revealed a single-factor model for the IES, and parallel analysis and Minimum Average Partialing supported a single-factor solution for the EIS.
For the IES and EIS, a single factor accounted for 50.87 percent and 56.13% of the total variance, respectively. Factor loadings were good, with the exception of two items from the EIS, which were high.
Due to a high constraint on redundancy and quality of items, a single-factor solution was found in our analysis. The final scales demonstrated excellent internal consistency.
In this study, 600 participants who reported having had a psychedelic experience completed the IES and EIS. The IES and EIS demonstrated strong positive associations with the PEQ, MEQ, and Awe Scales, and medium correlations with the Satisfaction with Life Scale.
We collected a sample from M-Turk of 315 individuals who had used psychedelics, and administered a survey using Qualtrics, a secure online survey distribution and data collection program.
Participants were mostly White (80.6%), educated (70.5% had bachelor degree or higher), and broadly balanced between males and females. They had most recently used mushrooms (50.2%), LSD (20.8%), MDMA (9.0%), DMT (9.0%), Ketamine (2.8%), Ayahuasca (7.0%), Other (0.6%, n = 2), and Iboga (0.4%, n = 2).
We used SPSS AMOS structural equation modeling software to compute chi-square, Comparative Fit Index, and Root Mean-Square Error of Approximation (RMSEA) for the 12-item 1-factor models of the IES and EIS.
A subset of items from the PEQ and MEQ were used to assess convergent and divergent validity, and were chosen a priori as items that would at face value be relevant to the measurement of convergent validity. Eight items were chosen from the MEQ, which include feeling profoundly sacred and holy, experiencing unity with ultimate reality, feeling joy, experiencing timelessness, feeling that the experience cannot be described adequately in words, and feeling challenged to mentally process the experience.
To assess divergent validity, the Satisfaction with Life Scale was used, which includes the items “In most ways my life is close to my ideal”.
For the IES, the CFI was good (0.969) and the RMSEA was good (0.032), and the chi-square value was less than twice the degrees of freedom (54) of the model, demonstrating good fit.
A strong positive association was demonstrated between the PEQ, MEQ, and AWE-S and the IES and EIS, indicating robust convergent validity. Divergent validity was demonstrated by the correlation between the Satisfaction with Life Scale and the IES and EIS.
CFA supported the results of Study 4’s EFA, and demonstrated strong positive associations with PEQ, MEQ, and AWE-S items.
The correlation between the IES and EIS was 0.83, indicating a lack of discriminant validity between the two scales. The authors hypothesize that divergent validity would be particularly pronounced with first time or novice users of psychedelics, particularly with high dose experiences.
The item selection process may have resulted in lower factor loadings and a lower AVE, which may have affected discriminant validity.
The Psychedelic Integration Scales are intended to help facilitators and clinicians gain a sense of a participant’s integration process. With more data collected, the scales may be used to identify meaningful cutoff scores for levels of integration engagement and experience associated with mental health outcomes.
Different facets of integration are expected to be accomplished at different rates, depending on factors such as the strength of dose administered or the degree of challenging content addressed during the psychedelic experience.
The purpose of this research is to validate a pair of scales measuring psychedelic integration. The scales measure the behavioral and intrapsychic aspects of integration.
Given that psychedelic experiences can have a powerful psychological impact, integrating these experiences is particularly important. Legalization of therapeutic psychedelic use is predicted to expand over the coming years.
Given the extensive training required to be a qualified provider of psychedelics, many unintegrated experiences will likely result from the hundreds of millions of total psychedelic journeys that will likely occur in the coming years.
The psychedelic integration scales have the potential to support both benefit maximization and harm reduction related to psychedelics use. They are based on the idea that setting and setting are two fundamental aspects of creating a positive environment conducive to harm reduction and benefit maximization during an experience.
The integration scales will grow in utility with data collection, and future research may contribute to the identification of cutoff scores indicating beneficial or concerning levels of post-acute psychedelic integration, an optimal frequency and time scale during which to administer the scales, and more.
Psychedelics are proposed to be treatments that address the root cause of mental health issues, and present hopeful alternatives to traditional psychiatric medication. However, the actualization of sustainable positive change resulting from psychedelics use depends on the integration of the psychedelic experience into daily life.
In current psychedelic research trials, therapy is an integral part of the treatment design. However, psychedelic integration extends beyond just therapy and includes engagement with nature, supportive communities, seasoned psychedelic guides, personal contemplation, and physical and spiritual practices.
Different psychedelics have different properties, may be used in different dosages, and evoke different types of experience. Additionally, each individual’s character, stage of life, and cultural context is unique, and as a result, optimal integration of each particular psychedelic experience will vary drastically.
The study used M-Turk users based in the United States to gather data, and an attention check filter was used to increase data quality. However, the pool of participants is culturally and demographically limited, and the data are most relevant to the use of classic psychedelics.
The authors prioritized arriving at succinct scales with conceptually diverse items, but the IES and EIS both showed correlations with each other that exceeded the square root of AVE, statistically indicating a lack of discriminant validity.
Future studies may use the full PEQ and MEQ scales to gain a more robust metric of convergent validity, or use the PEQ and MEQ scales in conjunction with the Awe scale.
The formation of integration scales may be one step further towards psychedelics being used in a responsible and beneficial manner.
THE PSYCHEDELIC INTEGRATION SCALES
Participants are asked to state their level of agreement with the following statements, considering the time period since their most recent psychedelic experience.
TF and SW jointly conceived of the presented idea, TF wrote the majority of the article, SW wrote a minority of the article, DY provided edits to the writing, and JL provided confirmatory factor analysis and convergent validity analysis.
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Authors associated with this publication with profiles on BlossomDavid Yaden
David Bryce Yaden (Ph.D.) is a Research Fellow at Johns Hopkins University School of Medicine. His research focus is on the psychology, neuroscience, and psychopharmacology of psychedelics and other positively transformative experiences. Specifically, David is interested in understanding how brief experiences can result in such long-term changes to well-being.