Quantifying Psychedelic Insight – A Quick Peek at the Psychological Insight Questionnaire (PIQ)

Dr. Alan K. Davis and colleagues of the Johns Hopkins Center for Psychedelic & Consciousness Research recently developed a new psychometric tool called the Psychological Insight Questionnaire (PIQ) and put it to the test on a sample of self-reported LSD and psilocybin users.

by Eric M. Fortier, BA | Feb. 7, 2021

The Mystical Experience Questionnaire (MEQ) is famous in the field for being one of the best acute predictors of positive therapeutic outcomes following psychedelic experience—a matter well illustrated in the work going on at Johns Hopkins for several years now. So much so that despite the scale’s shortcomings (some of which you can learn about in Alex Belser’s terrific talk, The Psychedelic Mystical Experience), Imperial College London finally conceded to using it in some cases after great initial resistance.

Yet positive outcomes following psychedelic-assisted psychotherapy were recently observed in the absence of mystical experience, Davis and colleagues point out, citing Roseman et al. (2018).

Insight “as a general construct keeps popping up,” though, Davis tells me in personal correspondence, including “single item insight questions in our depression trial and other survey work.” GarciaRomeu et al. (2019), Roseman et al. (2018, 2019), and Studerus et al. (2010) have also examined psychedelic insight, the authors note, and psychedelic-induced experiences of insight—as measured via the Emotional Breakthrough Inventory (EBI)—were found to predict improved outcomes for alcohol use disorder and depression.

The use of altered states of consciousness for gaining insight is nothing new, though. Take Jacques Joseph Moreau, for instance, author of the first book written about a drug by a scientist, Du Haschish et de l’Alienation Mentale: études psychologiques (Hachisch and Mental Illness), published in 1845. Moreau wrote, based on controlled experiments with his patients, that oral doses of hashish (the concentrated form of cannabis) could help treat mental illness by revealing its origins through introspection and observation. Noticing chronic users becoming lethargic and anhedonic, however, he warned of the consequences of habitual use. But research has found that classical psychedelics like psilocybin have a markedly lower abuse potential than cannabis and other psychoactive substances.

While some psychometric questionnaires that are designed to quantify different facets of psychedelic experience have included items related to insight (including the EBI, the Altered States of Consciousness questionnaire (11D-ASC), and the Persisting Effects Questionnaire (PEQ)), the items that relate to insight are few and generally capture trait insight, feelings of insightfulness, and emotional catharsis associated to insight about emotional capacity, but not what’s called discrete event-related insight, they say; those tools don’t capture things like awareness about relationships, past events, goals, values, etc.

So Davis and the team began discussions with their psilocybin session facilitators to find what kinds of insights patients described following their sessions; things like realizations or discoveries about personality, relationships, memories, beliefs, behavioural patterns, and emotions.

They ended up with 23 items (rated from “1 – Not at all,” to “5 – Extremely. More than ever in my life”) in two components: Avoidance and Maladaptive Patterns (AMP), including items like “discovered how aspects of my life are affecting my well-being,” and “realized how current feelings or perceptions are related to events from my past,” as well as Goals and Adaptive Patterns (GAP), including items like “awareness of beneficial patterns in my actions, thoughts and/or feelings,” and “discovered new actions that may help me achieve my goals.”

They then tested the PIQ on a sample of internet users and also measured life-satisfaction/well-being and psychological flexibility by co-administering the Satisfaction with Life Scale (SWLS) and the Acceptance and Action Questionnnaire II (AAQII). They simultaneously assessed acute psychedelic experience using the abbreviated Mystical Experience Questionnaire (MEQ-30), and the Challenging Experience Questionnaire (CEQ).

In this sample (n=1661), they found evidence for the PIQ’s psychometric reliability and validity in assessing psychedelic-induced psychological insight.

What’s really notable, though, is that scores on the PIQ were more strongly correlated with retrospective improvements in psychological flexibility and well-being/life satisfaction than those of the MEQ.

I asked Dr. Davis how surprised they were about this finding:

“I agree that it’s very interesting that the PIQ is outperforming the MEQ in predicting outcomes […] I think it was only surprising because the MEQ had been so widely studied; however, from a clinical standpoint I can see how insight could be very valuable for longterm outcomes. And when they co-occur perhaps even more so.”

Additionally, scores on the PIQ were not substantially correlated with those of the Challenging Experience Questionnaire (with factors for fear, grief, distress, isolation, paranoia, and sense of dying), suggesting “that, despite any difficulties associated with insight experiences, these experiences were not necessarily interpreted as being substantially challenging.”

Of course, there are several limitations. Future research in clinical and laboratory settings will be needed to strengthen the scale’s predictive validity. And “selection bias is always an issue,” Davis reminds me; the usual things that come with online survey takers, like the predominant young white male respondents, mean more data is needed to generalize the findings. But, he tells me, “we have now replicated the finding (manuscripts under review) in other populations using the PIQ.”

For the time being, the Psychological Insight Questionnaire looks promising. And as for Davis and the team,

“We are very excited about producing this measurement tool and the implications that may have for the field.”

The study, “Development of the Psychological Insight Questionnaire among a sample of people who have consumed psilocybin or LSD,” was published in January 2021 in the Journal of Psychopharmacology, and was co-authored by Fred Barrett, Sara So, Natalie Gukasyan, Thomas Swift, and Roland Griffiths. It can be read in full on ResearchGate.

By the way, I’ve just released a new book, Psychedelotropism. It explores how psychedelic experience might help us see what’s most important, learn from our past, strategize, find a way forward, change our focus, re-orient our priorities and more effectively allocate our resources. It’s available in softcover and ebook formats at 20% OFF for the first 25 people to use the code INEFFABLE (link automatically applies it at checkout).

-E. M. Fortier
IG: @psychoactivepress

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