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Psychedelics and connectedness

Article in Psychopharmacology · August 2017

DOI: 10.1007/s00213-017-4701-y

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Psychopharmacology
DOI 10.1007/s00213-017-4701-y

COMMENTARY

Psychedelics and connectedness

R. L. Carhart-Harris 1 & D. Erritzoe 1 & E. Haijen 1 & M. Kaelen 1 & R. Watts 1

Received: 18 June 2017 / Accepted: 19 July 2017

# Springer-Verlag GmbH Germany 2017

Abstract Psychedelic drugs are creating ripples in psychiatry for you, and if so how?’ and responses were analysed for
as evidence accumulates of their therapeutic potential. An consistent themes (Watts et al. 2017). Of the 17 patients who
important question remains unresolved however: how are psy- endorsed the treatment’s effectiveness, all made reference to
chedelics effective? We propose that a sense of connectedness one particular mediating factor: a renewed sense of connection
is key, provide some preliminary evidence to support this, and or connectedness. This factor was found to have three distin-
suggest a roadmap for testing it further. guishable aspects: connection to (1) self, (2) others and (3) the
world in general (Watts et al. 2017). For many, the sense of
connectedness featured acutely, during the treatment session
We are in the midst of a cultural zeitgeist with regard to psy- itself, but just as commonly, it endured for several weeks to
chedelic drugs such as psilocybin, LSD and DMT (ayahuasca) months afterwards, as can be seen here from a participant who
(Carhart-Harris and Goodwin 2017). April 2017 featured the remained in remission for 3-months post-treatment:
largest ever conference on the topic, ‘Psychedelic Science’, in
Oakland, California, attended by 3000 people from over 40 ‘This connection, it’s just a lovely feeling… this sense of
different countries. Among the 175+ speakers were Tom Insel connectedness, we are all interconnected.’ (male, aged
(former director of the National Institute for Mental Health) 52)
and Paul Summergrad (past president of the American
Psychiatric Association), speaking enthusiastically and en- A sense of disconnection is a feature of many major psy-
couragingly about the field, symbolic in some sense of its chiatric disorders, particularly depression (Karp 2017), and a
present ‘main-streaming’ (Carhart-Harris and Goodwin sense of connection or connectedness is considered a key me-
2017). diator of psychological well-being (Cervinka et al. 2012; Lee
The theme of connectedness was pervasive at Psychedelic et al. 2008), as well as a factor underlying recovery of mental
Science, featuring consistently among speakers’ presentations. health (Leamy et al. 2011). One of the most curious aspects of
To our knowledge, the concept was first given clear emphasis the growing literature on the therapeutic potential of psyche-
in psychedelic therapy by Watts et al. 2017, in a qualitative delics is the seeming general nature of their therapeutic appli-
research paper linked to our recent psilocybin for treatment- cability (Carhart-Harris and Goodwin 2017), i.e. they have
resistant depression (TRD) clinical trial (Carhart-Harris et al. shown promise not just for the treatment of depression but
2016)—see also (Belser et al. 2017). In 6-month follow-up for addictions, anxiety and obsessive-compulsive disorder
interviews, participants were asked: ‘Did this treatment work (Carhart-Harris and Goodwin 2017). This raises the question
of whether psychedelic therapy targets a core factor underly-
ing mental health. We believe that it does, and that
* R. Watts
connectedness is the key (Watts et al. 2017).
ros.watts@yahoo.co.uk Like any construct in psychology, connectedness requires
validation work. Validated measures of ‘social connectedness’
1
Psychedelic Research Group, Centre for Psychiatry, Department of (Lee and Robbins 1995) and ‘connectedness to nature’
Medicine, Imperial College London, W12 0NN, London, UK (Mayer and Frantz 2004) already exist. We recently showed
 Psychopharmacology

that feelings of connectedness to nature are increased post- to ‘others’ and ‘world’ in various guises, and new measures
psilocybin (Lyons et al. 2017, under review)—and see also could be easily devised and developed.
(Forstmann and Sagioglou 2017)—and correlate with the ex- We are presently collecting longitudinal data on social con-
tent of past psychedelic drug-use and intensity of ‘ego-disso- nectedness in individuals who plan a psychedelic experience
lution’ experienced under a psychedelic (Nour et al. 2017). and provide web-based survey data on the process. Figure 1
There already exist ample behavioural indices of connection displays some relevant preliminary data from this project,
showing increased social connectedness and psychological
well-being 2 weeks after an experience, plus the significant
positive relationship between them. These data were collected
from a sample of over 200 people. Future work, featuring
mediation modelling could determine whether aspects of the
acute psychedelic experience such as ‘ego-dissolution’ (Nour
et al. 2016), ‘mystical experience’ (Barrett et al. 2015) and
‘awe’ (Piff et al. 2015) mediate the long-term positive effects
of psychedelics and whether increased connectedness is a
principal component of post-psychedelic therapeutic
change—as we suspect (Watts et al. 2017).
As noted above, connectedness, as it was described by pa-
tients in our TRD trial, encompassed not just connection to
others (i.e. social connectedness) and the world in general
(e.g. connectedness to nature) but also connection to the self
(Watts et al. 2017). Post-treatment, participants referred to feel-
ing reconnected to past values, pleasures and hobbies as well as
feeling more integrated, embodied and at peace with them-
selves and their often troubled backgrounds. It is a working
hypothesis of ours that connection-to-self is a bedrock from
which connection to others and the world can follow most
naturally. Another hypothesis is that positive therapeutic out-
comes could be jeopardised if the primary connection-to-self
stage is leap-frogged, e.g. due to incomplete psychological
integration (Richards 2015).

‘Yesterday I was clever, so I wanted to change the world.

Today I am wise, so I am changing myself.’ (Jalaluddin
Rumi)

A relevant scale for measuring connection-to-self might be

the ‘quiet ego scale’ (Wayment et al. 2015). However, we feel
there is much scope for a new connectedness scale that can
incorporate the three sub-factors identified in our recent qual-
itative analysis (Watts et al. 2017), namely connection-to-self,
others and world in general. The scales mentioned above
could serve as tools to test convergent validity; measures of
well-being and psychiatric symptoms could serve as tests of
clinical usefulness and comparator drugs could be incorporat-
Fig. 1 Measures collected before and 2 weeks after a planned ed to test the hypothesis that there is a selective relationship
psychedelic drug experience, as part of a longitudinal web-based survey
project that will be reported on in detail in future publications (https://
between psychedelics and connectedness that does not exist
www.psychedelicsurvey.com). Well-being was measured with the for other psychoactive drugs such as alcohol (chronic and
Warwick Edinburgh Well-being Scale (Tennant et al. 2007) and scores excessive use especially), stimulants and conventional psychi-
range from 14 to 70; social connectedness was measured with the Social atric medications such as the selective serotonin reuptake in-
Connectedness Scale (Lee and Robbins 1995) and scores range from 8 to
48. Significant increases in both measures were seen post-psychedelic
hibitors (SSRIs). It is notable in this regard that many patients
(n = 204, **p < 0.01, paired t test), and there was a significant positive in our TRD trial felt that the process and effect of being pre-
relationship between their respective change scores (r = 0.387, p < 0.01) scribed conventional treatments merely reinforced their sense
Psychopharmacology

of disconnection (Watts et al. 2017). Moreover, stimulant use that the healthy demystification process that is presently taking
has been associated with hubris and individualism and alcohol place in psychedelic research relies in no small part on the
use with a lack of concern for nature and the environment identification of biological substrates of high-level subjective
(Nour et al. 2017). experiences, and we have no doubt that both an acute and
We are mindful of the scientifically delicate association enduring sense of connectedness have identifiable biological
between psychedelics and ‘mystical experience’. Despite substrates.
previously expressed concerns regarding this construct Our work on the neural correlates of ‘ego-dissolution’ may
(Carhart-Harris and Goodwin 2017), psychedelic-induced be considered part of a progressive initiative to demystify the
mystical experiences have been found to predict long- psychedelic experience (Tagliazucchi et al. 2016; Nour et al.
term increases in psychological well-being (Griffiths 2016). Like ego-dissolution and ‘entropy’ (Carhart-Harris
et al. 2006) as well as clinical improvements after psyche- et al. 2014), connectedness is particularly appealing as a con-
delic therapy (Carhart-Harris and Goodwin 2017). Given struct because it carries meaning in both mechanistic and sub-
the apparent positive mediational value of such experiences, it jective sense. Our finding of increased global functional con-
seems pertinent to better understand where their value lies, nectivity in the ‘psychedelic brain’ and its relationship to ego-
and again, we suspect that connectedness may be the key. dissolution (Tagliazucchi et al. 2016) may be considered a
Writing in 1960, philosopher Walter Stace referred to the candidate neural correlate of the unitive experience—i.e.
‘unitive experience’ (a sense of ‘oneness’ or ‘unity’) as the core connectedness in its acute form. How this relates to longer-
hallmark of the mystical experience. Items pertaining to a sense term feelings of connectedness, however, is perhaps a more
of ‘oneness’ form a major part of leading measures of mystical challenging question. Does the unitive experience leave a last-
experience, including the recently validated ‘mystical experi- ing memory trace, analogous to ‘the overview effect’ experi-
ence questionnaire (MEQ)’ (Barrett et al. 2015). The unitive enced by some astronauts (White 1987)—characterised by a
experience is closely related to the construct of connectedness. sense of ‘awe’ and perceived smallness in the presence of
We recently found that scores of psychedelic-induced unitive vastness (Piff et al. 2015) or does the psychedelic experiences
experience correlate highly with scores of ‘ego-dissolution’ cause lasting anatomical and/or functional brain changes?
(Nour et al. 2016). Conceptually, one can consider the ego as These possibilities need not be mutually exclusive, and only
a counter-force to connectedness. Consider for example, an properly supported empirical research can advance and even-
item from our recently developed ‘ego-inflation’ measure, tually resolve these matters. We hope that mainstream funding
scores on which correlated positively with cocaine-use and bodies be broadminded and brave enough to see the possibil-
negatively with psychedelic-use (Nour et al. 2016): ‘I felt more ities here, as the potential rewards for science and society may
important or special than others’. Note how this contrasts with be great.
items from the following: (1) our ‘ego-dissolution inventory’ or Finally, it seems remarkable that we can discuss high-level
EDI (Nour et al. 2016): ‘I felt far less absorbed by my own constructs such as ‘connectedness’ while knowing psyche-
issues and concerns’; (2) the MEQ: ‘Freedom from the limita- delics’ action at the molecular level. For example, we know
tions of your personal self and feeling a unity or bond with what that psychedelics initiate their signature subjective effects via
was felt to be greater than your personal self^; (3) the connect- serotonin 2A-receptor agonism (Carhart-Harris and Nutt
edness to nature scale (Mayer and Frantz 2004): ‘I often feel a 2017). Since psychedelics ‘hijack’ an existing system, it is
sense of oneness with the natural world around me’ and a natural to ask what evolutionary role that system has played
‘small self’ measure used in research on ‘awe’: ‘I feel the pres- throughout our species’ development—and whether under-
ence of something greater than myself’ (Piff et al. 2015). standing this may shed light on our understanding of the func-
Part of our focus within the Psychedelic Research Group at tioning of brain serotonin more generally. Relevant questions
Imperial College London has been to better understand the have recently been explored (Carhart-Harris and Nutt 2017).
brain mechanisms of psychedelics, including their putative In brief, we have proposed that brain serotonin 2A receptor
therapeutic actions, and while brain imaging adds a perceived signalling mediates a state of rapid plasticity that is conducive
sophistication to psychedelic research, psychological mecha- to major change (e.g. in outlook and/or behaviour)—when
nisms are at least as important—offering a level of explanation such change feels necessary (e.g. to aid mental or physical
that is closer to the lived-experience, broadly accessible and survival). Such a function may be related to humans’ unique
also potentially most useful, e.g. in terms of cost-effectively capacity for adaptability.
predicting treatment effectiveness (Carrillo et al. 2017). Moving forward, we intend to develop an operational defi-
Human brain imaging’s special appeal lies in its ability to nition of connectedness that incorporates not just connectedness
‘open the black box’—revealing insights about major un- in the subjective sense but also its biological basis and various
knowns—but imaging findings can also be misused, e.g. in behavioural manifestations. Crucially, such a definition should
terms of excessive reverse inference (Poldrack 2006) and be meaningful and useful not just in the context of psyche-
‘neuro-realism’ (Racine et al. 2010). Even so, we recognise delics—but universally.
 Psychopharmacology

Acknowledgements RLC-H is supported by the Alex Mosley Griffiths RR, Richards WA, McCann U et al (2006) Psilocybin can oc-
Charitable Trust. RW is supported by Compass Pathways. casion mystical-type experiences having substantial and sustained
personal meaning and spiritual significance. Psychopharmacology
Author contributions RW conceived of the notion and importance of 187:268–283 discussion 284-292
connectedness through her follow-up to our recent psilocybin for TRD Karp DA (2017) Speaking of sadness: depression, disconnection, and the
trial. RCH wrote this paper with feedback from RW, DE and MK. MK meanings of illness, Oxford. Oxford University Press, New York
and EH provided the data for Fig. 1, and EH made the figure. DE pro- Leamy M, Bird V, Le Boutillier C et al (2011) Conceptual framework for
vided intellectual input regarding the central construct plus editorial ad- personal recovery in mental health: systematic review and narrative
vice. All authors read and approved the final manuscript. synthesis. Br J Psychiatry 199:445–452
Lee RM, Robbins SB (1995) Measuring belongingness—the social
Compliance with ethical standards connectedness and the social assurance scales. J Couns
Psychol 42:232–241
Conflicts of interest The authors declare that they have no conflicts of Lee RM, Dean BL, Jung KR (2008) Social connectedness, extraversion,
interest. and subjective well-being: testing a mediation model. Personal
Individ Differ 45:414–419
Mayer FS, Frantz CM (2004) The connectedness to nature scale: a mea-
sure of individuals’ feeling in community with nature. J Environ
References Psychol 24:503–515
Nour MM, Evans L, Nutt D et al (2016) Ego-dissolution and psyche-
Barrett FS, Johnson MW, Griffiths RR (2015) Validation of the revised delics: validation of the ego-dissolution inventory (EDI). Front Hum
mystical experience questionnaire in experimental sessions with psi- Neurosci. doi:10.3389/fnhum.2016.00269
locybin. J Psychopharmacol 29:1182–1190 Nour MM, Evans L and Carhart-Harris RL. (2017) Psychedelics, person-
Belser AB, Agin-Liebes G, Swift CT, Terrana S, Devenot N, Friedman ality and political perspectives. J Psychoactive Drugs: 1–10
LH, Guss J, Bossis A, Ross S (2017) Patient experiences of Piff PK, Dietze P, Feinberg M et al (2015) Awe, the small self, and
psilocybin-assisted psychotherapy: an interpretative phenomenolog- prosocial behavior. J Pers Soc Psychol 108:883–899
ical analysis. J Humanist Psychol 57(4):354–388 Poldrack RA (2006) Can cognitive processes be inferred from neuroim-
Carhart-Harris RL, Goodwin GM (2017) The therapeutic potential of psy- aging data? Trends Cogn Sci 10:59–63
chedelic drugs: past, present and future. Neuropsychopharmacology. Racine E, Waldman S, Rosenberg J et al (2010) Contemporary neurosci-
doi:10.1038/npp.2017.84 ence in the media. Soc Sci Med 71:725–733
Carhart-Harris RL, Nutt DJ (2017) Serotonin and brain function: a tale of Richards WA (2015) Sacred knowledge: psychedelics and religious ex-
two receptors. J Psychopharmacol (in press) periences. Columbia University Press, New York
Carhart-Harris RL, Leech R, Hellyer PJ et al (2014) The entropic brain: a Tagliazucchi E, Roseman L, Kaelen M et al (2016) Increased global
theory of conscious states informed by neuroimaging research with functional connectivity correlates with LSD-induced ego dissolu-
psychedelic drugs. Front Hum Neurosci 8:20 tion. Curr Biol 26:1043–1050
Carhart-Harris RL, Bolstridge M, Rucker J et al (2016) Psilocybin with Tennant R, Hiller L, Fishwick R et al (2007) The Warwick-Edinburgh
psychological support for treatment-resistant depression: an open- mental well-being scale (WEMWBS): development and UK valida-
label feasibility study. Lancet Psychiatry 3:619–627 tion. Health Qual Life Outcomes 5:63
Carrillo FSDF, Sigman M, Ashton P, Fitzgerald L, Stroud J, Carhart-
Watts RDC, Krzanowski J, Nutt DJ, Carhart-Harris RL (2017)
Harris RL (2017) Natural speech predicts therapeutic effectiveness
Patients’ accounts of increased ‘connection’ and ‘acceptance’
of psilocybin for treatment-resistant depression. J Affect Disord (in
after psilocybin for treatment-resistant depression. J Humanist
press)
Psychol. doi:10.3389/fnhum.2016.00269
Cervinka R, Roderer K, Hefler E (2012) Are nature lovers happy? On
Wayment HA, Bauer JJ, Sylaska K, et al. (2015) The quiet ego scale:
various indicators of well-being and connectedness with nature. J
measuring the compassionate self-identity. J Happiness Stud. 16pp
Health Psychol 17:379–388
Forstmann M, Sagioglou C (2017) Lifetime experience with (classic) White F (1987) The overview effect: space exploration and human evo-
psychedelics predicts pro-environmental behavior through an in- lution. Houghton Mifflin, Boston
crease in nature relatedness. J Psychopharmacol 31(8):975–988

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