Substance Use Disorders (SUD)

Emotional breakthrough and psychedelics: validation of the emotional breakthrough inventory

The authors validate a six‑item Emotional Breakthrough Inventory (Cronbach’s α=0.932), demonstrating that emotional breakthrough is a distinct, dose‑dependent component of the acute psychedelic experience that is more likely with therapeutic planning and intent. In a low‑well‑being subsample (n=75) emotional breakthrough and mystical-type experiences independently predicted subsequent increases in well‑being, whereas challenging experiences predicted smaller improvements.

Authors

  • Robin Carhart-Harris
  • Leor Roseman
  • Mendel Kaelen

Published

Journal of Psychopharmacology
individual Study

Abstract

Background

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.

Methods

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).

Results

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.

Conclusions

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.

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Research Summary of 'Emotional breakthrough and psychedelics: validation of the emotional breakthrough inventory'

Introduction

Psychedelic therapy is regaining attention as a treatment paradigm in mental health, and previous work has shown that qualities of the acute psychedelic experience help to determine longer-term psychological outcomes. Much prior research has emphasised mystical-type or "peak" experiences (commonly measured with the Mystical Experience Questionnaire, MEQ) and challenging experiences (measured with the Challenging Experience Questionnaire, CEQ) as important state predictors. The authors argue that these instruments do not clearly capture a related but distinct phenomenon: the overcoming or resolution of difficult emotions or memories during a psychedelic experience, which they term emotional breakthrough (EB). They note conceptual overlap between EB and historical notions of catharsis, and suggest EB may act as a positive predictor of subsequent mental-health improvements whereas CEQ scores have sometimes predicted worse outcomes. Roseman and colleagues set out to develop and validate a brief Emotional Breakthrough Inventory (EBI). The study aimed to assess the EBI's internal consistency, factor structure, discriminant validity versus the MEQ and CEQ, dose- and context-dependence, and its ability to predict changes in psychological well-being. The investigators tested five explicit hypotheses concerning dose-dependence, influence of therapeutic intention/setting, discriminability from existing scales, and predictive power for changes in well-being, both alone and combined with MEQ and CEQ measures. The work was conducted as a prospective, naturalistic online survey of self-selected psychedelic users rather than a controlled laboratory trial.

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Study Details

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Classic Psychedelic Use and Mechanisms of Mental Health: Exploring the Mediating Roles of Spirituality and Emotion Processing on Symptoms of Anxiety, Depressed Mood, and Disordered Eating in a Community Sample

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19 cited
Psilocybin in the treatment of anorexia nervosa: The English transition of a French 1959 case study

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Novel Treatment Approaches for Substance Use Disorders: Therapeutic Use of Psychedelics and the Role of Psychotherapy

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Prefrontal contributions to the stability and variability of thought and conscious experience

Zamani, A., Carhart-Harris, R. L., Christoff, K. · Neuropsychopharmacology (2021)

Turn on, Tune in, and Drop out: Predictors of Attrition in a Prospective Observational Cohort Study on Psychedelic Use

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Does psychedelic therapy have a transdiagnostic action and prophylactic potential?

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73 cited
Psilocybin as a Novel Pharmacotherapy for Treatment-Refractory Anorexia Nervosa

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Decreased brain modularity after psilocybin therapy for depression

Daws, R. E., Timmermann, C., Giribaldi, B. et al. · Research Square (2021)

Future Directions for Clinical Psilocybin Research: The Relaxed Symptom Network

Lewis-Healey, E., Laukkonen, R., Van Elk, M. · Psyarxiv (2021)

1 cited
Relational Processes in Ayahuasca Groups of Palestinians and Israelis

Roseman, L., Ron, Y., Saca, A. et al. · Frontiers in Pharmacology (2021)

30 cited
The Potential Role of Psychedelic Drugs in Mental Health Care of the Future

Gründer, G., Jungaberle, H., Gründer, G. · Pharmacopsychiatry (2021)

Trial of Psilocybin versus Escitalopram for Depression

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927 cited
Increased sensitivity to strong perturbations in a whole-brain model of LSD

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A qualitative and quantitative account of patient’s experiences of ketamine and its antidepressant properties

Sumner, R. L., Chacko, E., Mcmillan, R. et al. · Journal of Psychopharmacology (2021)

51 cited
Psychedelic Communitas: Intersubjective experience during psychedelic group sessions predicts enduring changes in psychological wellbeing and social connectedness

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157 cited
Combining Psychedelic and Mindfulness Interventions: Synergies to Inform Clinical Practice

Payne, J. E., Chambers, R., Liknaitzky, P. · ACS Pharmacology and Translational Science (2021)

55 cited
On the Relationship between Classic Psychedelics and Suicidality: A Systematic Review

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Predicting Reactions to Psychedelic Drugs: A Systematic Review of States and Traits Related to Acute Drug Effects

Aday, J. S., Davis, A. K., Mitzkovitz, C. M. et al. · ACS Pharmacology and Translational Science (2021)

Psychedelic drugs and perception: a narrative review of the first era of research

Aday, J. S., Bloesch, E. K., Wood, J. R. et al. · Reviews In The Neuroscience (2021)

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

Davis, A. K., Streeter Barrett, F., Griffiths, R. R. et al. · Journal of Psychopharmacology (2021)

108 cited
Psychedelics and Psychotherapy

Nayak, S., Johnson, M. W. · Pharmacopsychiatry (2020)

The History of Psychedelics in Psychiatry

Nichols, D. E., Walter, H. · Pharmacopsychiatry (2020)

Pivotal Mental States

Brouwer, A., Carhart-Harris, R. L. · Journal of Psychopharmacology (2020)

Psychedelic drugs: neurobiology and potential for treatment of psychiatric disorders

Vollenweider, F. X., Preller, K. H. · Nature Reviews Neuroscience (2020)

Positive effects of psychedelics on depression and wellbeing scores in individuals reporting an eating disorder

Spriggs, M. J., Kettner, •. H., Carhart-Harris, •. R. L. · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity (2020)

Psychedelic Treatments for Psychiatric Disorders: A Systematic Review and Thematic Synthesis of Patient Experiences in Qualitative Studies

Breeksema, J. J., Niemeijer, A. R., Krediet, E. et al. · CNS Drugs (2020)

Psychedelics and virtual reality: parallels and applications

Aday, J. S., Davoli, C. C., Bloesch, E. K. · Therapeutic Advances in Psychopharmacology (2020)

Post-Psychedelic Reductions in Experiential Avoidance Are Associated With Decreases in Depression Severity and Suicidal Ideation

Zeifman, R. J., Wagner, A. C., Watts, R. et al. · Frontiers in Psychiatry (2020)

82 cited
Integrating psychotherapy and psychopharmacology: psychedelic-assisted psychotherapy and other combined treatments

Greenway, K. T., Garel, N., Jerome, L. et al. · Expert Review of Clinical Pharmacology (2020)

Long-term effects of psychedelic drugs: A systematic review

Aday, J. S., Mitzkovitz, C. M., Bloesch, E. K. et al. · Neuroscience and Biobehavioral Reviews (2020)

Reviewing the potential of psychedelics for the treatment of PTSD

Krediet, E., Bostoen, T., Breeksema, J. J. et al. · International Journal of Neuropsychopharmacology (2020)

Learning to Let Go: A Cognitive-Behavioral Model of How Psychedelic Therapy Promotes Acceptance

Wolff, M., Evens, R., Mertens, L. J. et al. · Frontiers in Psychiatry (2020)

Long-term follow-up of psilocybin-assisted psychotherapy for psychiatric and existential distress in patients with life-threatening cancer

Agin-Liebes, G. I., Malone, T., Yalch, M. M. et al. · Journal of Psychopharmacology (2020)

292 cited

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