ABS 022: There Are Not Enough Words: Developing A Measure of Unfolding Awe in Psychedelic-Assisted Therapy

Maggie Demeo-Meres ¹ , Elise Tarbi ¹ , Ian Bhatia ¹ , Suzannah Buehler ¹ , Nabil Balach ¹ , Cailin Gramling ¹ , Tej Thambi ³ , Donna M. Rizzo ¹ , Robert Gramling ¹ , Manish Agrawal ² , Emily Manetta ⁴

¹ University of Vermont,
² Sunstone Therapies
³ University of California, Los Angeles
⁴ University of South Carolina

Van Wickle (2025) Volume 1, ABS 022

Introduction: Psilocybin, the psychoactive compound found in magic mushrooms, has been used by humans for millennia, primarily within spiritual and ritualistic contexts. Historical records and archaeological findings indicate its use in Mesoamerican cultures dating back to at least the 16th century. In the mid-20th century, psilocybin gathered attention from scientists and psychiatrists who were legally permitted to study its potential therapeutic applications. However, this research was halted following the enactment of the Controlled Substances Act of 1970, which classified psilocybin as a Schedule I substance, denoting a high potential for abuse and no accepted medical use at the time. In recent years, psilocybin-assisted therapy (PAT) has re-emerged as a promising intervention for addressing the psychological and existential distress often experienced by individuals with serious life-threatening illnesses. Despite encouraging clinical outcomes, the underlying mechanisms through which psilocybin exerts its therapeutic effects in palliative care remain poorly understood. One proposed hypothesis by scholars is that the subjective experience of awe, and its subsequent narration, may serve as a central mediator in the efficacy of PAT. While instances of awe have been documented in the context of PAT, systematic investigation into the phenomenological characteristics of awe has been limited. Although awe has been broadly defined in theoretical literature, there remains a significant need to develop an operationalizable framework capable of reliably identifying and analyzing awe in PAT clinical settings. Thus, we aim to develop a mechanism by which human coders can reliably identify moments of Awe and evaluate them for key properties.

Methods: We analyzed audio and video data from a Phase 2 open-label study of psilocybin-assisted group therapy in patients with cancer and depression (Agrawal et al., 2024) (n = 23). Videos were independently coded by two analysts using a structured checklist to identify moments of Awe; coders recorded start-stop times, primary features (vastness, ineffability, accommodation), secondary qualities (e.g., gestures, figurative language, metaphors), and coder confidence levels, building off of previous literature. We report on two cycles of codebook refinement and ways in which these refinements provided insight into the manifestation of awe in this setting.

Results: Preliminary findings from the first and second rounds of analysis, using 60.4 hours of video, identified 184 moments of Awe with an average duration of 68 seconds. Vastness was the most common feature (associated with 55.4% of moments). Most Awe moments occurred during dosing (41.3%) and integration (55.4%) therapy sessions. A third cycle of codebook refinement and analysis is ongoing, focusing on dosing and integration sessions, to describe and characterize features of Awe in this context.

Discussion: Our account claims that Awe in PAT requires vastness, can be ineffable, and can disrupt existing cognitive frameworks. One of our most exciting findings is that we were able to take the intangible concept of awe and operationalize it into something that is not only observable but systematically identifiable. While scholars had observed awe in PAT, we are among the first to attempt to define it or explore its characteristics. By doing so, our team may be able to better understand the connection between awe experiences and therapeutic efficacy, and help clinicians better attend to awe during clinical practice.