Opinion – Psychedelic Turn: It is necessary to uncomplicate psychological scales to help everyone

Anyone who has participated in clinical trials with psychedelics knows the perrengue of answering long questionnaires about their mental state. The infinity of sentences full of abstract words to try to capture feelings that are difficult to define is so annoying that the person starts to respond anyway, to get to the end.

However, the scales resulting from these interrogations are crucial to give some objectivity and quantify the therapeutic effects against depression, PTSD, anxiety and other disorders for which psychedelics are being reborn as a promising treatment option. You can’t run away from them. But is it possible to improve them?

Before proceeding, it is worth explaining that psychedelics, unlike, for example, available antidepressants, and if they are even approved for psychiatric use, they will not be pills for continuous use, to be taken every day. The idea under scientific investigation is to apply them as psychotherapy facilitators.

The treatment closest to approval in the United States is the use of MDMA (base of ecstasy) as a support for psychotherapy for post-traumatic stress disorder (PTSD). A mental condition typical of American war veterans, in a warmongering country like the USA, which exhibited more than 17 DAILY suicides of ex-combatants in 2019.

An important part of the psychedelic healing process is what is called integration. Until now, psychiatrists have not had a specific scale to measure, or attempt to measure, “the process by which the psychedelic experience translates into positive changes in the daily life” of the patient.

This definition is in quotation marks because it was taken from the article “The Psychedelic Integration Scales: Tools for Measuring Psychedelic Integration Behaviors and Experiences”, published a month ago in the specialized journal Frontiers in Psychology – Quantitative Psychology and Measurement.

Two of the authors, Tomas Frymann and Sophie Whitney, are members of the NGO Vets (Veterans Exploring Treatment Solutions). It was founded in 2019 by Marcus Capone, a former Marine, and his wife, Amber Capone, with a mission to reverse the suicide epidemic among ex-combatants and promote veterans’ access to psychedelic-assisted therapies.

The other two authors are David B. Yaden of the Center for Psychedelic Research and Consciousness at Johns Hopkins University and Joshua Lipson of the Department of Counseling and Clinical Psychology at Columbia University. Frymann also works at Columbia, and Whitney at Pacifica Graduate University.

This concept of psychological integration encompasses four axes: 1. It is a process, that is, it occurs over time; 2. It is oriented towards the connection, the translation of non-ordinary consciousness into changes in ordinary life; 3. Must have benefit, with an emphasis therefore on positive change as a natural outcome; 4. It involves incorporationthat is, changes achieved in day-to-day behaviors.

The article draws attention to the fact that at least 10% of the US population had used or used psychedelics in 2013. That number has certainly grown since then, with the increasingly common news about good results obtained in clinical trials. As they are illegal substances, most of these practices take place without the support of therapists, so there is no chance of integration with the help of trained professionals.

Furthermore, if psychedelics are approved for psychotherapy, it is almost certain that for a time there will be a lack of qualified people to offer the specialized service. Providing a succinct instrument, easy to apply and evaluate, was part of the motivation of the authors of the article in Frontiers.

“It is imperative that the scientific community better understand the further processing of these powerful experiences so that facilitators and users can both maximize the sustainable benefits of psychedelic experiences and minimize the irresponsible harm caused by inducing such experiences without a sufficient supportive framework,” they wrote. .

“The concept of integration is still relatively vague and lacks a greater foundation. The characteristics of an integration process are not very well defined and are often based on subjective criteria”, comments Lucas Maia, who participates in the study integration team with DMT for depression at the Brain Institute of the Federal University of Rio Grande do Norte (ICe/UFRN).

“The development of standardized instruments that allow an objective characterization of the integration process can be useful to investigate and better understand the therapeutic effects of psychedelics. The newly created scales seek to fill this gap”, says the researcher, who has worked with the psychiatrist Luís Fernando Tófoli, from Unicamp, and the nurse Ana Cláudia Garcia, from the Federal University of Alfenas (Unifal), in the translation and validation of other psychometric scales. The trio is already considering doing the same with the two scales presented in the article.

One of them, the EIS, would serve to assess the degree of patient involvement in the integration process. The other, IES, to assess the level of benefit incorporated by it into the daily life of the psychonaut. For each sentence, the person indicates their agreement on a seven-graded ruler, from “strongly disagree” (score 1) to “strongly agree” (7), through “neither agree nor disagree” (neutral, 4).

The initial suggestion is to apply the scales 48 hours after the psychedelic trip and then every 7 days for 8 to 12 weeks. The red light on the integration process would light up when a preponderance of “slightly disagree” responses (grade 3) down appeared.

The proponents of the scales point out that the results measured can vary greatly with factors such as dosimetry and education. A high dose, for example, can result in temporary disturbance and imbalance, while deep experiences continue to reverberate in everyday life. The first low scores on items such as tranquility and harmony, therefore, should not be taken as indicators of failure in integration.

It is encouraging to find in the article that “important aspects identified in the integration […]engagement with nature, supportive communities, experienced psychedelic guides, personal contemplation, and physical and spiritual practices […]have been present in the ways of life and ceremonies seen in indigenous peoples around the world, who have used psychedelics as sacraments for hundreds and thousands of years”.

This openness to accumulated traditional knowledge, practices consecrated by use and diverse populations of highly educated Western whites – precisely where the volunteers and researchers who participated in the validation of EIS and IES came from – needs to be taken to its ultimate consequences.

The way in which the sentences are formulated, with a profusion of abstract concepts, will serve to measure little useful in terms of the well-being of low-income populations in Brazil, for example, SUS patients.

See, below, a hasty translation from English for the proposed scales and, right after each item, in italicsan even more hasty proposal to “metatranslate” the sentences into simplified Portuguese:

SCALE OF INVOLVEMENT WITH INTEGRATION (EIS)

I gave myself mental space to reconnect with the experience [psicodélica]

I got my head around thinking and reliving what it was like to go through this [experiência psicodélica]

I read, watched or listened to informational content relevant to my experience

I looked for things written, saw on TV or heard important things to give an account of what I lived in those moments

I gained understanding of my experience through conversations with understanding people

I was able to better understand what happened after talking to friends

I took time for silent contemplation of my experience

I spent some time in silence thinking about what I experienced in those moments

I dedicated time in nature to enrich my experience

I spent time in beautiful places in nature to keep those feelings alive in me.

I followed up my experience later with focused attention practices (meditation, mindfulness, mantras, journaling, visualization, etc.)

I spent some time after the experience meditating, praying, singing, writing, visualizing, or thinking carefully about what I experienced.

I applied lessons from my experience to my life

I used lessons learned from those moments to improve my everyday life.

I have found ways to carry the intentions in my experience into my everyday life.

I was able to apply the good intentions with which I arrived in that experience on a daily basis.

Because of my experience, I have prioritized my general well-being.

After going through all that, I started to give more importance to my own well-being, in general.

I have spent time in environments that help me stay attuned to the lessons that followed my experience.

I’ve looked to spend more time in places that help me stay connected to those lessons I learned from the experience.

I have become more understanding of others as a result of my experience

I became a nicer and more open person with others after experiencing all that

I made healthy life choices for myself because of my experience

I chose to seek out and do healthier things after that experience.

EXPERIENCED INTEGRATION SCALE (IES)

I feel at peace with my experience [psicodélica]

I feel at peace with everything I lived in those moments

I feel more balanced since my experience

I feel more balanced after going through all that

I have an ongoing, open-minded sense of curiosity about my experience

I always feel curious and open-minded to understand that experience

I feel harmony between my experience and my inner being

I feel a harmony between what I experienced at that time and what happens inside of me.

I feel harmony between my everyday life and my experience

I feel a harmony between everyday life and those moments I experienced

I feel a lasting connection to my experience

I feel connected all the time with those moments

I feel more connection in my life because of the experience

I feel more connected to life each day after going through that

I have a deep sense of connection between nature and my experience.

I feel a very deep connection between nature and what I experienced in those moments

I feel more self-aware after my experience

I feel like I pay more attention to what goes through my head after that experience

I feel the benefit of my experience translated into my life

I feel that good things gained from those moments are still present in my life.

I feel the positive effect of the way I interpret my experience

I feel good things came from stopping to think about that experience.

I feel the benefit of my experience extends beyond myself to my community

I feel that the good things from that experience not only served me, but also the people in my community.

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To learn more about the history and new developments of science in this area, including in Brazil, look for my book “Psiconautas – Travels with Brazilian Psychedelic Science”