Here we validate a six-item ‘Emotional Breakthrough Inventory’. Emotional breakthrough is an important and distinct component of the acute psychedelic experience that appears to be a key mediator of subsequent longer-term psychological changes. Implications for psychedelic therapy are discussed.

Factor analyses revealed six emotional breakthrough items with high internal consistency (Cronbach’s alpha=0.932) and supported our prior hypothesis that emotional breakthrough is a distinct component of the psychedelic experience. Emotional breakthrough scores behaved dose-dependently, and were higher if the psychedelic was taken with therapeutic planning and intent. Emotional breakthrough, Mystical Experience Questionnaire and Challenging Experience Questionnaire scores combined, significantly predicted subsequent changes in well-being ( r =0.45, p =0.0005, n =75), with each scale contributing significant predictive value. Emotional breakthrough and Mystical Experience Questionnaire scores predicted increases in well-being and Challenging Experience Questionnaire scores predicted less increases.

Three hundred and seventy-nine participants completed online surveys before and after a planned psychedelic experience. Items pertaining to emotional breakthrough were completed one day after the psychedelic experience, as were items comprising the already validated Mystical Experience Questionnaire and the Challenging Experience Questionnaire. Emotional breakthrough, Mystical Experience Questionnaire and Challenging Experience Questionnaire scores were used to predict changes in well-being (Warwick-Edinburgh Mental Wellbeing Scale) in a subsample of 75 participants with low well-being baseline scores (⩽45).

Psychedelic therapy is gaining recognition and the nature of the psychedelic experience itself has been found to mediate subsequent long-term psychological changes. Much emphasis has been placed on the occurrence of mystical-type experiences in determining long-term responses to psychedelics yet here we demonstrate the importance of another component, namely: emotional breakthrough.

References

Abramson, HA ( 1960 ) The Use of LSD in Psychotherapy: Transactions. New York : Josiah Macy, Jr. Foundation .

Google Scholar

Barrett, FS, Bradstreet, MP, Leoutsakos, J-MS, et al . ( 2016 ) The Challenging Experience Questionnaire: Characterization of challenging experiences with psilocybin mushrooms . J Psychopharmacol 30: 1279 – 1295 .

Google Scholar SAGE Journals | ISI

Barrett, FS, Preller, KH, Kaelen, M ( 2018 ) Psychedelics and music: Neuroscience and therapeutic implications . Int Rev Psychiatry 1 – 13 .

Google Scholar Medline

Baum, D ( 2016 ) Legalize It All: How to win the war on drugs . Harper’s Magazine. Available at: https://harpers.org/archive/2016/04/legalize-it-all/ (accessed 28 November 2018).

Google Scholar

Belser, A ( 2016 ) Real, Relational, and Embodied: The First Qualitative Study of Patient Experiences of Psilocybin-Assisted Psychotherapy . In: Interdisciplinary Conference on Psychedelics Research (ICPR) , . Amsterdam . Youtube–Available at: https://www.youtube.com/watch?v=DUYDjV8lQxo

Google Scholar

Belser, AB, Agin-Liebes, G, Swift, TC, et al . ( 2017 ) Patient experiences of psilocybin-assisted psychotherapy: An interpretative phenomenological analysis . J Humanist Psychol 57: 354 – 388 .

Google Scholar SAGE Journals | ISI

Bogenschutz, MP, Forcehimes, AA, Pommy, JA, et al . ( 2015 ) Psilocybin-assisted treatment for alcohol dependence: A proof-of-concept study . J Psychopharmacol 29: 289 – 299 .

Google Scholar SAGE Journals | ISI

Bonny, HL, Pahnke, WN ( 1972 ) The use of music in psychedelic (LSD) psychotherapy . J Music Ther 9: 64 – 87 .

Google Scholar Crossref

Breuer, J, Freud, S ( 1895 ) Studies on Hysteria. London : Hachette UK .

Google Scholar

Budaev, SV ( 2010 ) Using principal components and factor analysis in animal behaviour research: Caveats and guidelines . Ethology 116: 472 – 480 .

Google Scholar Crossref

Campbell, DT, Fiske, DW ( 1959 ) Convergent and discriminant validation by the multitrait-multimethod matrix . Psychol Bull 56: 81 .

Google Scholar Crossref | Medline | ISI

Carbonaro, TM, Bradstreet, MP, Barrett, FS, et al . ( 2016 ) Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences . J Psychopharmacol 30: 1268 – 1278 .

Google Scholar SAGE Journals | ISI

Carhart-Harris, R, Bolstridge, M, Day, C, et al . ( 2017 a) Psilocybin with psychological support for treatment-resistant depression: Six-month follow-up . Psychopharmacology 235: 399 – 408 .

Google Scholar Crossref | Medline

Carhart-Harris, R, Roseman, L, Haijen, E, et al . ( 2017 b) Psychedelics and the essential importance of context . J Psychopharmacol 32: 725 – 731 .

Google Scholar SAGE Journals

Carhart-Harris, RL ( 2018 ) Serotonin, psychedelics and psychiatry . World Psychiatry 17: 358 – 359 .

Google Scholar Crossref | Medline

Cattell, RB ( 1966 ) The scree test for the number of factors . Multivariate Behav Res 1: 245 – 276 .

Google Scholar Crossref | Medline | ISI

Cohen, S ( 1959 ) The therapeutic potential of LSD-25 . In: Featherstone, RM, Simon, A (eds) A Pharmacologic Approach to the Study of the Mind. Springfield, Ill. : Thomas , pp. 251 – 257 .

Google Scholar

Controlled Substances Act ( 1970 ) Pub. L. No. 91-513, 84 Stat. 1236 (codified as amended at 21 U.S.C. § 812 (2012) . HeinOnline.

Google Scholar

Crocket, RW, Sandison, RA, Walk, A ( 1963 ) Hallucinogenic Drugs and Their Psychotherapeutic Use. London : HK Lewis .

Google Scholar

Cronbach, LJ ( 1951 ) Coefficient alpha and the internal structure of tests . Psychometrika 16: 297 – 334 .

Google Scholar Crossref

Dakwar, E, Anerella, C, Hart, C, et al . ( 2014 ) Therapeutic infusions of ketamine: Do the psychoactive effects matter? Drug Alcohol Depend 136: 153 – 157 .

Google Scholar Crossref | Medline

Dimascio, A, Klerman, GL ( 1960 ) Experimental human psychopharmacology: The role of non-drug factors . In: Sarwer-Foner, GJ (ed.) The Dynamics of Psychiatric Drug Therapy. Springfield, Ill. : Thomas , pp. 56 – 84 .

Google Scholar

Dishotsky, NI, Loughman, WD, Mogar, RE, et al . ( 1971 ) LSD and genetic damage . Science 172: 431 – 440 .

Google Scholar Crossref | Medline | ISI

Dittrich, A ( 1975 ) Zusammenstellung eines Fragebogens (APZ) zur Erfassung abnormer psychischer Zustände [Construction of a questionnaire (APZ) for assessing abnormal mental states] . Z Klin Psychol Psychiatr Psychother 23: 12 – 20 .

Google Scholar

Dittrich, A ( 1998 ) The standardized psychometric assessment of altered states of consciousness (ASCs) in humans . Pharmacopsychiatry 31: 80 – 84 .

Google Scholar Crossref | Medline | ISI

Dyck, E ( 2006 ) ‘Hitting highs at rock bottom’: LSD treatment for alcoholism, 1950–1970 . Soc Hist Med 19: 313 – 329 .

Google Scholar Crossref | ISI

Eisner, BG, Cohen, S ( 1958 ) Psychotherapy with lysergic acid diethylamide . J Nerv Ment Dis 127: 528 – 539 .

Google Scholar Crossref | Medline | ISI

Erritzoe, D, Roseman, L, Nour, M, et al . ( 2018 ) Effects of psilocybin therapy on personality structure . Acta Psychiatr Scand 138: 368 – 378 .

Google Scholar Crossref | Medline

Fisher, FM ( 2015 ) Therapy with Substance: Psycholytic Psychotherapy in the Twenty First Century. London : Muswell Hill Press .

Google Scholar

Frederking, W ( 1955 ) Intoxicant drugs (mescaline and lysergic acid diethylamide) in psychotherapy . J Nerv Ment Dis 121: 262 – 266 .

Google Scholar Crossref | Medline

Garcia-Romeu, AP, Johnson, MW, Griffiths, RR ( 2014 ) Examining the psychological mechanisms of psilocybin-assisted smoking cessation treatment: A pilot study . Drug Alcohol Depend 140: e66 .

Google Scholar Crossref

Gasser, P, Kirchner, K, Passie, T ( 2014 ) LSD-assisted psychotherapy for anxiety associated with a life-threatening disease: A qualitative study of acute and sustained subjective effects . J Psychopharmacol 29: 57 – 68 .

Google Scholar SAGE Journals

Griffiths, RR, Johnson, MW, Carducci, MA, et al . ( 2016 ) Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial . J Psychopharmacol 30: 1181 – 1197 .

Google Scholar SAGE Journals | ISI

Griffiths, RR, Richards, WA, McCann, U, et al . ( 2006 ) Psilocybin can occasion mystical-type experiences having substantial and sustained personal meaning and spiritual significance . Psychopharmacology 187: 268 – 283 .

Google Scholar Crossref | Medline | ISI

Grinspoon, L, Bakalar, JB ( 1979 ) Psychedelic Drugs Reconsidered. New York : Basic Books .

Google Scholar

Grof, S ( 1975 ) Realms of the Human Unconscious: Observations from LSD Research. London : Souvenir Press Ltd ; 2016 Edition.

Google Scholar

Grof, S, Hofmann, A, Weil, A ( 1980 ) LSD Psychotherapy (The healing potential of psychedelic medicine). Ben Lomond, CA : Multidisciplinary Association for Psychedelic Studies ; 2008 Edition.

Google Scholar

Haijen, ECHM, Kaelen, M, Roseman, L, et al . ( 2018 ) Predicting responses to psychedelics: A prospective study . Front Pharmacol 9: 897 .

Google Scholar Crossref | Medline

Hartogsohn, I ( 2016 ) Set and setting, psychedelics and the placebo response: An extra-pharmacological perspective on psychopharmacology . J Psychopharmacol 30: 1259 – 1267 .

Google Scholar SAGE Journals | ISI

Hartogsohn, I ( 2017 ) Constructing drug effects: A history of set and setting . Drug Sci Policy Law 3: 2050324516683325 .

Google Scholar SAGE Journals

Hintze, JL, Nelson, RD ( 1998 ) Violin plots: A box plot-density trace synergism . Am Stat 52: 181 – 184 .

Google Scholar ISI

Huxley, A ( 1945 ) The Perennial Philosophy. Toronto : New Canadian Library .

Google Scholar

Hyde, RW ( 1960 ) Psychological and social determinants of drug action . In: Sarwer-Foner, GJ (ed.) Dynamics of Psychiatric Drug Therapy. Springfield : Thomas , pp. 297 – 315 .

Google Scholar

Jackson, SW ( 1994 ) Catharsis and abreaction in the history of psychological healing . Psychiatr Clin North Am 17: 471 – 491 .

Google Scholar Crossref | Medline

Jensen, S ( 1963 ) Treatment of chronic alcoholism with lysergic acid diethylamide . Can Psychiatr Assoc J 8: 182 – 188 .

Google Scholar SAGE Journals

Johnson, FG ( 1969 ) LSD in the treatment of alcoholism . American Journal of Psychiatry 126: 481 – 487 .

Google Scholar Crossref | Medline | ISI

Johnson, MW, Garcia-Romeu, A, Griffiths, RR ( 2016 ) Long-term follow-up of psilocybin-facilitated smoking cessation . Am J Drug Alcohol Abuse 1 – 6 .

Google Scholar

Kaelen, M, Giribaldi, B, Raine, J, et al . ( 2017 ) The hidden therapist: Evidence for a central role of music in psychedelic therapy . Psychopharmacology 235: 505 – 519 .

Google Scholar Crossref

Katzenelbogen, S, Fang, AD ( 1953 ) Narcosynthesis effects of sodium amytal, methedrine and LSD-25 . Dis Nerv Syst 14: 85 – 88 .

Google Scholar Medline

Klavetter, RE, Mogar, RE ( 1967 ) Peak experiences: Investigation of their relationship to psychedelic therapy and self-actualization . J Humanist Psychol 7: 171 – 177 .

Google Scholar SAGE Journals | ISI

Kurland, AA, Grof, S, Pahnke, WN, et al . ( 1972 ) Psychedelic drug assisted psychotherapy in patients with terminal cancer . J Thanatol 2: 644 – 691

Google Scholar

Lasagna, L ( 1963 ) The relation of drug induced changes to personality . In: Rinkel, M. (ed.) Specific and Non-specific Factors in Psychopharmacology. New York : Philosophical Library , pp. 114 – 129 .

Google Scholar

Leary, T, Litwin, GH, Metzner, R ( 1963 ) Reactions to psilocybin administered in a supportive environment . J Nerv Ment Dis 137: 561 – 573 .

Google Scholar Crossref | Medline | ISI

Lebedev, AV, Kaelen, M, Lovden, M, et al . ( 2016 ) LSD-induced entropic brain activity predicts subsequent personality change . Hum Brain Mapp 37: 3203 – 3213 .

Google Scholar Crossref | Medline | ISI

Leuner, H ( 1961 ) Psychotherapy with hallucinogens . Hallucinogenic Drugs 67: 67 – 73 .

Google Scholar

Loizaga-Velder, A ( 2013 ) A psychotherapeutic view on therapeutic effects of ritual ayahuasca use in the treatment of addiction . MAPS Bull 23: 36 – 40 .

Google Scholar

Ludwig, AM ( 1985 ) Cognitive processes associated with ‘spontaneous’ recovery from alcoholism . J Stud Alcohol 46: 53 – 58 .

Google Scholar Crossref | Medline | ISI

MacLean, JR, MacDonald, DC, Byrne, UP, et al . ( 1961 ) The use of LSD-25 in the treatment of alcoholism and other psychiatric problems. New Haven : Laboratory of applied Biodynamics, Yale University .

Google Scholar

MacLean, KA, Johnson, MW, Griffiths, RR ( 2011 ) Mystical experiences occasioned by the hallucinogen psilocybin lead to increases in the personality domain of openness . J Psychopharmacol 25: 1453 – 1461 .

Google Scholar SAGE Journals | ISI

MacLean, KA, Leoutsakos, JMS, Johnson, MW, et al . ( 2012 ) Factor analysis of the mystical experience questionnaire: A study of experiences occasioned by the hallucinogen psilocybin . J Sci Study Relig 51: 721 – 737 .

Google Scholar Crossref | Medline | ISI

Martin, AJ ( 1957 ) LSD (lysergic acid diethylamide) treatment of chronic psychoneurotic patients under day-hospital conditions . Int J Soc Psychiatry 3: 188 – 195 .

Google Scholar SAGE Journals

Maslow, AH ( 1959 ) Cognition of being in the peak experiences . J Genet Psychol 94: 43 – 66 .

Google Scholar Crossref | Medline

Maslow, AH ( 1964 ) Religions, Values, and Peak-Experiences. Columbus : Ohio State University Press .

Google Scholar

Nour, MM, Evans, L, Nutt, D, et al . ( 2016 ) Ego-dissolution and psychedelics: Validation of the ego-dissolution inventory (EDI) . Front Hum Neurosci 10: 269 .

Google Scholar Crossref | Medline | ISI

O’Reilly, P, Funk, A ( 1964 ) LSD in chronic alcoholism . Can Psychiatr Assoc J 9: 258 – 261 .

Google Scholar SAGE Journals

Oram, M ( 2012 ) Efficacy and enlightenment: LSD psychotherapy and the drug amendments of 1962 . J Hist Med Allied Sci. Epub ahead of print 16 August 2012 . DOI: 10.1093/jhmas/jrs050.

Google Scholar Crossref | Medline

Oram, M ( 2014 ) The trials of psychedelic medicine: LSD psychotherapy, clinical science, and pharmaceutical regulation in the United States, 1949–1976. PhD Doctorate. University of Sydney, School of Philosophical and Historical Inquiry, Department of History .

Google Scholar

Osmond, H ( 1957 ) A review of the clinical effects of psychotomimetic agents . Ann N Y Acad Sci 66: 418 – 434 .

Google Scholar Crossref | Medline | ISI

Pahnke, WN, Richards, WA ( 1966 ) Implications of LSD and experimental mysticism . J Religion Health 5: 175 – 208 .

Google Scholar Crossref | Medline

Pahnke, WN, Kurland, AA, Goodman, LE, et al . ( 1969 ) LSD-assisted psychotherapy with terminal cancer patients . Curr Psychiatr Ther 9: 144 – 152 .

Google Scholar Medline

Pahnke, WN, Kurland, AA, Unger, S, et al . ( 1970 ) The experimental use of psychedelic (LSD) psychotherapy . JAMA 212: 1856 – 1863 .

Google Scholar Crossref | Medline | ISI

Richards, WA ( 2015 ) Sacred Knowledge: Psychedelics and Religious Experiences. New York : Columbia University Press .

Google Scholar Crossref

Richards, WA, Rhead, JC, DiLeo, FB, et al . ( 1977 ) The peak experience variable in DPT-assisted psychotherapy with cancer patients . J Psychedelic Drugs 9: 1 – 10 .

Google Scholar Crossref

Roseman, L, Nutt, DJ, Carhart-Harris, RL ( 2017 ) Quality of acute psychedelic experience predicts therapeutic efficacy of psilocybin for treatment-resistant depression . Front Pharmacol 8: 974 .

Google Scholar Crossref | Medline

Ross, S, Bossis, A, Guss, J, et al . ( 2016 ) Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: A randomized controlled trial . J Psychopharmacol 30: 1165 – 1180 .

Google Scholar SAGE Journals | ISI

Sandison, R ( 1955 ) LSD treatment for psychoneurosis: Lysergic acid diethylamide for release of depression . Nurs Mirror 100: 1529 – 1530 .

Google Scholar

Schenberg, EES ( 2018 ) Psychedelic-assisted psychotherapy: A paradigm shift in psychiatric research and development . Front Pharmacol 9: 733 .

Google Scholar Crossref | Medline

Stace, WT ( 1960 ) Mysticism and philosophy. London : Macmillan Publishers .

Google Scholar

Strassman, RJ, Qualls, CR, Uhlenhuth, EH, et al . ( 1994 ) Dose-response study of N, N-dimethyltryptamine in humans: II. Subjective effects and preliminary results of a new rating scale . Arch Gen Psychiatry 51: 98 – 108 .

Google Scholar Crossref | Medline

Studerus, E, Gamma, A, Vollenweider, FX ( 2010 ) Psychometric evaluation of the altered states of consciousness rating scale (OAV) . PloS One 5: e12412 .

Google Scholar Crossref | Medline | ISI

Studerus, E, Gamma, A, Kometer, M, et al . ( 2012 ) Prediction of psilocybin response in healthy volunteers . PloS One 7: e30800 .

Google Scholar Crossref | Medline | ISI

Taggart, F, Stewart-Brown, S, Parkinson, J ( 2015 ) Warwick-Edinburgh Mental Well-being Scale (WEMWBS) User Guide, Version 2 . NHS Health Scotland .

Google Scholar

Tennant, R, Hiller, L, Fishwick, R, et al . ( 2007 ) The Warwick-Edinburgh mental well-being scale (WEMWBS): Development and UK validation . Health Qual Life Outcomes 5: 63 .

Google Scholar Crossref | Medline | ISI