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The Altered States Database: Psychometric data from a systematic literature review

This paper (2022) presents the development of the Altered State Database (ASDB). The ASDB was developed through a systematic literature review of psychometric questionnaire data on subjective experiences of altered states of consciousness (ASC). The ASDB allows for the calculation of comparable psychometric values of ASC experiences and of dose-response relationships of substances inducing ASC.

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Authors

Prugger, J.
Derdiyok, E.
Dinkelacker, J.

Published

November 23, 2022

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Abstract

In this paper, we present the development of the Altered States Database (ASDB), an open-science project based on a systematic literature review. The ASDB contains psychometric questionnaire data on subjective experiences of altered states of consciousness (ASC) induced by pharmacological and non-pharmacological methods. The systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Scientific journal articles were identified through PubMed and Web of Science. We included studies that examined ASC using the following validated questionnaires: Altered States of Consciousness Rating Scale (APZ, 5D-ASC, 11-ASC), Phenomenology of Consciousness Inventory (PCI), Hallucinogen Rating Scale (HRS), or Mystical Experience Questionnaire (MEQ30). The systematic review resulted in the inclusion of a total of 165 journal articles, whereof questionnaire data was extracted and is now available on the Open Science Framework (OSF) website and on the ASDB website, where questionnaire data can be easily retrieved and visualized. This data allows the calculation of comparable psychometric values of ASC experiences and of dose-response relationships of substances inducing ASC.

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Research Summary of 'The Altered States Database: Psychometric data from a systematic literature review'

Introduction

Earlier research has increased interest in systematically measuring altered states of consciousness (ASC), which are transient mental states characterised by marked changes in perception, self-experience, time, and sensation and which can be induced pharmacologically (for example by psychedelics) or non-pharmacologically (for example by meditation or sensory deprivation). Standardised, validated questionnaires have been developed to quantify the subjective phenomenology of ASC and to allow comparison across induction methods, study designs, and participant groups. Interest has recently intensified because of both basic science questions about consciousness and clinical trials exploring therapeutic uses of psychedelic drugs. Prugger and colleagues aimed to assemble and harmonise published psychometric questionnaire data on ASC into an open, reusable resource: the Altered States Database (ASDB). The project sought to identify all journal articles reporting questionnaire-based measurements of ASC, extract group-level summary statistics (means, standard deviations) for questionnaire factors and dimensions, and make these data available via the Open Science Framework and a dedicated ASDB website to support cross-study comparisons and dose–response analyses. This paper reports the systematic review methods, the extracted dataset, and the organisation and technical validation of the database.

References (101)

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Methods

The investigators conducted a systematic literature search of PubMed and ISI Web of Science to identify journal articles reporting ASC assessed with validated retrospective questionnaires. The PubMed query combined an extensive list of pharmacological agents (including classical psychedelics and other psychoactive drugs), a broad set of non-pharmacological induction techniques (for example meditation, breathwork, sensory deprivation), and the names and abbreviations of established psychometric instruments (Abnormal Mental States Questionnaire/APZ, 5D-ASC, 11-ASC, Hallucinogen Rating Scale/HRS, Mystical Experience Questionnaire/MEQ, and Phenomenology of Consciousness Inventory/PCI). Additional inclusion terms (e.g. phenomenology, psychometric, subjective experience) were added to capture relevant studies where questionnaire names might not appear in titles or abstracts, and exclusion terms were applied to remove animal, in-vitro, or otherwise irrelevant uses of abbreviations. The search was restricted to English-language publications dated 1975–2021 and used MeSH terms; the PubMed and ISI searches were performed on 2021-12-31. References retrieved from both sources were managed in Zotero. The initial yields were 6,414 items from PubMed and 614 from ISI Web of Science, totalling 7,028 records; 326 duplicates were merged, leaving 6,702 items for screening. Screening occurred in two stages: (1) title and abstract screening to exclude non-journal items, non-English, animal or in-vitro studies, reviews, studies using other questionnaires, or inaccessible articles, which removed 6,381 items and left 321 for full-text review; (2) full-text screening to assess whether accessible, extractable questionnaire data were reported, which excluded a further 38 full texts. The final extraction set included 165 journal articles. Data extraction recorded group-level means and standard deviations for each reported factor/dimension of the questionnaires. Where only the standard error of the mean was reported, it was converted to a standard deviation; where data were presented only graphically, values were digitised using WebPlotDigitizer v4.5. The authors defined an individual dataset as a unique combination of experimental conditions and questionnaire (for example, different induction methods or dosages in the same article could yield multiple datasets). The extracted data were organised into one Microsoft Excel file per questionnaire, structured to fit a mySQL database schema, and included fields such as number of subjects, control/experimental condition, questionnaire application time, and reference for the assessment. The OSF repository also contains a list of excluded studies with reasons for exclusion. To reduce bias, study selection and extraction were performed independently by multiple team members and cross-checked: screening was conducted independently by J.P. and J.D., and extraction was performed by J.P., E.D., and J.D. with subsequent cross-checking; discrepancies were resolved by consensus. No automated screening tools were used beyond duplicate detection in Zotero.

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SECTION

journal articles which studied ASC experiences by using defined questionnaires. The following substances that have been described to pharmacologically induce ASC were included in the PubMed search query: 2C-B, 4-FA, 4-Fluoroamphetamine, 5-MeO-DMT, Amanita muscaria, Amphetamine, Angel dust, Atropa belladonna, Ayahuasca, Buprenorphine, Cannabidiol, CBD, Cocaine, Dimethyltryptamine, DMT, Ergine, Ergotamine, Gamma hydroxybutyric acid, GHB, Hallucinogens, Hawaiian baby woodrose, Henbane, Heroin, Hyoscyamine, Ibogaine, Kava, Ketamine, Kratom, LSA, LSD, Lysergic acid amide, Lysergic acid diethylamide, Magic mushrooms, MDA, MDMA, Methamphetamine, Morning glory, Morphine, Myristicin, Nicotine, Nitrous oxide, Nutmeg, PCP, Peyote, Phencyclidine, Pituri, Psilocybin, Psychedelics, Salvinorin, San pedro, Tetrahydrocannabinol, THC, and Triazolam. The following techniques reported to induce ASC non-pharmacologically were included in the PubMed search query: Aikido, Alternate nostril breathing, Ananda marga, Ashtanga, Autogenic training, Binaural beats, Breathwork, Capoeira, Chanting, Dancing, Dehydration, Dream machine, Drumming, Electronic gaming machine, Fasting, Flicker light, Flotation tank, Ganzfeld, Hyperventilation, Hypnosis, Hypnotic, I-OBE, Isha shoonya, Kriya, Kundalini, Kung fu, Mantra, Martial arts, Meditation, Mind machine, Nidra, Perceptual deprivation, Poker machines, Pranayama, Progressive muscle relaxation, Qigong, Repetitive speech, Runner's high, Sahaja, Sensory deprivation, Slot machines, Stroboscopic, Sufi whirling, Sweat lodge, Tai chi, Trance, Vipassana, Yoga, Yogic breathing, and Zen training. The PubMed search query also included the following names of psychometric questionnaires for qualitative assessment of ASC experiences and their abbreviations: Abnormal Mental States Questionnaire, APZ, Altered States of Consciousness Rating Scale, 5D-ASC, Hallucinogen Rating Scale, HRS, Mystical Experience Questionnaire, MEQ, and Phenomenology of Consciousness Inventory, PCI. To further increase accuracy in identifying suitable journal articles and because questionnaire names or abbreviations could not be provided in the article titles or abstracts, the following "inclusion terms" were also added to the PubMed search query: Phenomenology, Psychometric, Psychometry, Subjective effect*, Subjective experience*, and Subjectively perceived. To exclude animal or in-vitro studies, as well as studies in which the above abbreviations were used in contexts other than the questionnaires or ASC-induction methods (e.g., "DMT" used for "dance movement therapy" instead of referring to the chemical substance), the PubMed search query also contained following "exclusion terms": These "exclusion terms" were chosen by manually scanning through the PubMed results of the search query without "exclusion terms" and identifying misleading uses of abbreviations etc. The above search terms were combined with PubMed Boolean operators to detect articles describing one or more of the listed ASC-inducing methods, in addition to one or more questionnaires, or one or more "inclusion terms", and exclude articles containing one or more "exclusion terms". The PubMed search query also comprised the following filters: • publication date was constrained to range from 1975 to 2021 (as the first published questionnaire contained in this review is the "Abnormal Mental States Questionnaire", which was published in 1975), • language filter was set to English. To enhance the search depth, MeSH (Medical Subject Headings) terms were activated. See Supplementary File 1 for the complete PubMed search query. The PubMed search was conducted on 2021-12-31.

ARTICLE IDENTIFICATION USING ISI WEB OF SCIENCE SEARCH.

To identify further studies, references of questionnaires assessing the subjective experience of ASC were tracked using the ISI Web of Science search engine. Original publications of the questionnaires of Tablewere identified in the ISI Web of Science search engine and forward citation tracking was undertaken. Review articles were excluded. The ISI Web of Science search was conducted on 2021-12-31. The process of item identification and screening is shown schematically as flow chart in Fig.. The PubMed search yielded 6414 items and the ISI Web of Science search yielded 614 items. The results from PubMed and ISI Web of Science were collected in the reference manager Zotero () and totaled 7028 items. Of these, 326 duplicates were detected and merged, leaving 6702 items eligible for the screening procedure. article screening. The study selection process comprised of a first screening step in which only the title and abstract of the articles were analyzed, and a second screening step, in which full-texts and questionnaire data of the articles were examined. The aim of the first screening step was to determine whether the articles collected matched our review interest. Items were excluded if the item type was "book", "book section" or "video recording", if the language was not English, if they reported on animal or in-vitro studies, if they were reviews or other secondary literature, if they used other types of questionnaires or if the articles were not accessible. In the first screening stage, 6381 items were excluded, and 321 items were included for the full-text screening. The aim of the second screening step was to assess whether included items contain accessible and extractable data on the questionnaire results generated during the described study. For data extraction, full texts containing data on questionnaire results were collected. The second screening step resulted in the exclusion of 38 full texts that did not contain accessible data and were therefore Data extraction. 165 journal articles were included in the data extraction process, of which 68 contained data on the 5D-ASC, 48 on the 11-ASC, 43 on the HRS, 22 on the MEQ30, 17 on the APZ, and 16 on the PCI (note: several articles contain data from more than one questionnaire). The means and standard deviations of the responses to each of the factors and dimensions of the questionnaire described by the journal article were extracted. If only the standard error of the mean was given, it was converted to the standard deviation. When data were provided graphically only, they were extracted using WebPlotDigitizer v4.5.

RESULTS OF INDIVIDUAL STUDIES AND STATISTICAL SYNTHESES.

This systematic literature review results in the inclusion of data from 165 journal articles reporting a total of 674 datasets (experiments); these contain a total of 4689 data points as group-level summary statistics for all the factors/dimensions of all questionnaires combined (i.e., counting the data points of each dimensions/factors of a questionnaire for all datasets); these, in turn, result from a total of 17792 measurements (number of applications of all questionnaires on individual study participants). An individual dataset was defined as any unique combination of experimental conditions and questionnaire to capture that a research article may contain multiple datasets (i.e., applications of different induction methods and/or dosages result in different datasets). Tablereports a summary of the amount of extracted data regarding different ASC induction methods. Tableprovides references to the articles from which data were extracted, sorted according to the different questionnaires. In total, 145 articles report on pharmacologically induced ASC and 20 report on non-pharmacologically induced ASC. The most common questionnaire to assess pharmacologically induced ASC experiences is the 5D-ASC, (65 articles, 90 datasets, 1792 applications), followed by the 11-ASC (43 articles, 144 datasets, 2321 applications), the HRS (43 articles, 128 datasets, 1804 applications), the MEQ30 (21 articles, 58 datasets, 5183 applications), the APZ (15 articles, 45 datasets, 551 applications) and lastly the PCI (1 article, 1 dataset, 22 applications). For non-pharmacologically induced ASC experiences, the most frequently used questionnaire is the PCI (15 articles, 32 datasets, 1450 applications), followed by the 11-ASC (4 articles, 7 datasets, 151 applications), the 5D-ASC (3 articles, 6 datasets, 133 applications), the APZ (2 articles, 4 datasets, 170 applications), and lastly the MEQ30 (1 article, 9 datasets, 401 applications).

DATA RECORDS

The results of the reported systematic literature research and the full report of extracted psychometric questionnaire data on ASC experiences are available on Open Science Framework (,)in the folder "ASDB_v2.0_12-2021". The psychometric questionnaire data is organized in one Microsoft Excel file per questionnaire. The data contained in the files are listed according to each individual application of the respective questionnaire. The data files are structured to fit a mySQL database structure as previously described. Following data columns are described: • number of subjects • control or experiment condition • questionnaire application time • reference of experience assessment Table. Summary of included data sorted according to ASC induction methods. This table contains, the sum of journal articles reporting on each of the identified induction method ("Articles"), the sum of experiments conducted ("Datasets"), the sum of all applications of the questionnaires on individual study participants ("Applications"), as well as the sample size per dataset given as mean ± standard deviation ("Mean sample size per dataset ± SD"). *MAO: Monoamine oxidase † Olfactory Epithelium Stimulus is not an induction method itself, but it is investigated as the mechanism underlying breathing techniques. • comments on additional information on the data extraction process such as the conversion of standard error of the mean to standard deviation. In addition to the questionnaire data files, the OSF also contains a list of excluded studies, containing their PubMed ID, publication year, first author, and a comment on the reason for exclusion. In addition to the data availability on OSF, questionnaire data can also be retrieved and visualized on the ASDB website (), providing easy and direct access.

TECHNICAL VALIDATION

To validate the search strategy, a comparison was made with the 105 journal articles already included in the previous version of the ASDB (last updated 2020-12-28). The references of the articles were retrieved from OSF (). The comparison showed that all articles from the older version of the ASDB were covered by the current systematic literature review. To reduce the risk of bias in study identification and selection, the study selection process was performed independently by J.P. and J.D. and subsequently cross-checked. The data extraction process was performed by J.P., E.D., and J.D. and then cross-checked as well. Any discrepancies on study eligibility and data extraction were resolved by consensus. Reasons for exclusion are documented and can be obtained together with the overall data set. No automated tools were used in screening studies, other than detecting but not merging duplicate studies in Zotero. The selection of studies should not be prone to error, as we tried to include all available studies in this research area.

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