Development and psychometric validation of a novel scale for measuring ‘psychedelic preparedness’

Abstract

Preparing participants for psychedelic experiences is crucial for ensuring these experiences are safe and, potentially beneficial. However, there is currently no validated measure to assess the extent to which participants are well-prepared for such experiences. Our study aimed to address this gap by developing, validating, and testing the Psychedelic Preparedness Scale (PPS). Using a novel iterative Delphi-focus group methodology (‘DelFo’), followed by qualitative pre-test interviews, we incorporated the perspectives of expert clinicians/researchers and of psychedelic users to generate items for the scale. Psychometric validation of the PPS was carried out in two large online samples of psychedelic users (N = 516; N = 716), and the scale was also administered to a group of participants before and after a 5–7-day psilocybin retreat (N = 46). Exploratory and confirmatory factor analysis identified four factors from the 20-item PPS: Knowledge-Expectations, Intention-Preparation, Psychophysical-Readiness, and Support-Planning. The PPS demonstrated excellent reliability (ω = 0.954) and evidence supporting convergent, divergent and discriminant validity was also obtained. Significant differences between those scoring high and low (on psychedelic preparedness) before the psychedelic experience were found on measures of mental health/wellbeing outcomes assessed after the experience, suggesting that the scale has predictive utility. By prospectively measuring modifiable pre-treatment preparatory behaviours and attitudes using the PPS, it may be possible to determine whether a participant has generated the appropriate mental ‘set’ and is therefore likely to benefit from a psychedelic experience, or at least, less likely to be harmed.

Development of a digital intervention for psychedelic preparation (DIPP)

“…We deductively identified four main themes in participants’ description of preparatory activities, based on the four-factor model of ‘psychedelic preparedness’ developed in our previous paper 25 . Each of these themes had its own set of related subthemes, which were identified inductively.…”

“…The theoretical framework guiding this analysis was based on the four-factor model of ‘psychedelic preparedness’ developed in our previous paper 25 . The four factors/themes consisted of (i) Knowledge-Expectation (KE), (ii) Intention-Preparation (IP), (iii) Psychophysical-Readiness (PR) and (iv) Safety-Planning (SP).…”

“…This preparation is aimed at reducing the likelihood of psychologically distressing acute effects 18 – 20 and extended difficulties following psychedelic drug use 15 , as well as increasing the likelihood of a potentially therapeutic experience 6 , 21 – 24 . Although there is a consensus in the current scientific discourse around the importance of adequate psychedelic preparation 6 , 25 , there is a pressing need for more rigorous evaluation of the various approaches, techniques and frameworks used to prepare participants 16 , as well as research specifically dedicated to developing instruments to optimise this process. As noted in a recent review by Thal et al 17 , the current deficiency in available research means “it is impossible to draw definitive conclusions regarding the significance and impact of specific facets of preparatory sessions on therapeutic outcomes.” Advancing empirical research within this domain is therefore imperative to guide clinical best practices.…”

“…By contrast, the use of digital technologies to deliver structured and standardised self-directed strategies allows for extensive, tailored and convenient psychedelic preparation outside the clinical setting 28 . Our prior work, which established a four-factor model of psychedelic preparedness 25 , suggested that a sizeable proportion of psychedelic preparation strategies could indeed be standardised and delivered remotely/digitally. These included strategies aimed at enhancing (i) individuals’ understanding of psychedelic substances and clarification of their expectations regarding potential immediate and long-term effects (Knowledge-Expectation), (ii) the extent to which individuals are mentally and physically ready to navigate the psychedelic experience (Psychophysical-Readiness), (iii) the introspective inquiry integral to a participant’s decision to engage with psychedelics (Intention-Preparation), and ensuring (iv) a safe and supportive environment in the post-psychedelic stage (Safety-Planning).…”

“…In light of the recognised potential of digital and remotely-delivered psychosocial interventions within psychedelic science and therapy 5 , 61 – 63 , the purpose of this research was to develop and refine a self-directed Digital Intervention for Psychedelic Preparation (DIPP) using a person-centred, mixed-methods approach. Aligned with our recent four-factor model of psychedelic preparedness 25 , DIPP’s content and structure were developed through a phased process involving two studies: Study 1— Initial Intervention Development This phase of the project aimed to identify essential components for psychedelic preparation by conducting in-depth interviews with psilocybin retreat participants. The insights obtained were crucial in determining the foundational elements and thematic structure of DIPP, ensuring the intervention’s relevance to actual user experiences.…”