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The Watts Connectedness Scale: a new scale for measuring a sense of connectedness to self, others, and world

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Rationale A general feeling of disconnection has been associated with mental and emotional suffering. Improvements to a sense of connectedness to self, others and the wider world have been reported by participants in clinical trials of psychedelic therapy. Such accounts have led us to a definition of the psychological construct of ‘connectedness’ as ‘a state of feeling connected to self, others and the wider world’. Existing tools for measuring connectedness have focused on particular aspects of connectedness, such as ‘social connectedness’ or ‘nature connectedness’, which we hypothesise to be different expressions of a common factor of connectedness. Here, we sought to develop a new scale to measure connectedness as a construct with these multiple domains. We hypothesised that (1) our scale would measure three separable subscale factors pertaining to a felt connection to ‘self’, ‘others’ and ‘world’ and (2) improvements in total and subscale WCS scores would correlate with improved mental health outcomes post psychedelic use. Objectives To validate and test the ‘Watts Connectedness Scale’ (WCS). Methods Psychometric validation of the WCS was carried out using data from three independent studies. Firstly, we pooled data from two prospective observational online survey studies. The WCS was completed before and after a planned psychedelic experience. The total sample of completers from the online surveys was N = 1226. Exploratory and confirmatory factor analysis were performed, and construct and criterion validity were tested. A third dataset was derived from a double-blind randomised controlled trial (RCT) comparing psilocybin-assisted therapy (n = 27) with 6 weeks of daily escitalopram (n = 25) for major depressive disorder (MDD), where the WCS was completed at baseline and at a 6-week primary endpoint. Results As hypothesised, factor analysis of all WCS items revealed three main factors with good internal consistency. WCS showed good construct validity. Significant post-psychedelic increases were observed for total connectedness scores (η2 = 0.339, p < 0.0001), as well as on each of its subscales (p < 0.0001). Acute measures of ‘mystical experience’, ‘emotional breakthrough’, and ‘communitas’ correlated positively with post-psychedelic changes in connectedness (r = 0.42, r = 0.38, r = 0.42, respectively, p < 0.0001). In the RCT, psilocybin therapy was associated with greater increases in WCS scores compared with the escitalopram arm (ηp2 = 0.133, p = 0.009). Conclusions The WCS is a new 3-dimensional index of felt connectedness that may sensitively measure therapeutically relevant psychological changes post-psychedelic use. We believe that the operational definition of connectedness captured by the WCS may have broad relevance in mental health research.
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Psychopharmacology
https://doi.org/10.1007/s00213-022-06187-5
ORIGINAL INVESTIGATION
The Watts Connectedness Scale: anew scale formeasuring asense
ofconnectedness toself, others, andworld
RosalindWatts1,2,3· HannesKettner1· DanaGeerts1,4· SamGandy1· LauraKartner1· LeaMertens1·
ChristopherTimmermann1· MatthewM.Nour1· MendelKaelen1· DavidNutt1· RobinCarhart‑Harris1,5·
LeorRoseman1
Received: 29 October 2021 / Accepted: 27 June 2022
© The Author(s) 2022
Abstract
Rationale A general feeling of disconnection has been associated with mental and emotional suffering. Improvements to a
sense of connectedness to self, others and the wider world have been reported by participants in clinical trials of psychedelic
therapy. Such accounts have led us to a definition of the psychological construct of ‘connectedness’ as ‘a state of feeling con-
nected to self, others and the wider world’. Existing tools for measuring connectedness have focused on particular aspects of
connectedness, such as ‘social connectedness’ or ‘nature connectedness’, which we hypothesise to be different expressions
of a common factor of connectedness. Here, we sought to develop a new scale to measure connectedness as a construct with
these multiple domains. We hypothesised that (1) our scale would measure three separable subscale factors pertaining to a
felt connection to ‘self’, ‘others’ and ‘world’ and (2) improvements in total and subscale WCS scores would correlate with
improved mental health outcomes post psychedelic use.
Objectives To validate and test the ‘Watts Connectedness Scale’ (WCS).
Methods Psychometric validation of the WCS was carried out using data from three independent studies. Firstly, we pooled
data from two prospective observational online survey studies. The WCS was completed before and after a planned psy-
chedelic experience. The total sample of completers from the online surveys was N = 1226. Exploratory and confirmatory
factor analysis were performed, and construct and criterion validity were tested. A third dataset was derived from a double-
blind randomised controlled trial (RCT) comparing psilocybin-assisted therapy (n = 27) with 6weeks of daily escitalopram
(n = 25) for major depressive disorder (MDD), where the WCS was completed at baseline and at a 6-week primary endpoint.
Results As hypothesised, factor analysis of all WCS items revealed three main factors with good internal consistency.
WCS showed good construct validity. Significant post-psychedelic increases were observed for total connectedness scores
(η2 = 0.339, p < 0.0001), as well as on each of its subscales (p < 0.0001). Acute measures of ‘mystical experience’, ‘emotional
breakthrough’, and ‘communitas’ correlated positively with post-psychedelic changes in connectedness (r = 0.42, r = 0.38,
r = 0.42, respectively, p < 0.0001). In the RCT, psilocybin therapy was associated with greater increases in WCS scores
compared with the escitalopram arm (ηp2 = 0.133, p = 0.009).
Conclusions The WCS is a new 3-dimensional index of felt connectedness that may sensitively measure therapeutically
relevant psychological changes post-psychedelic use. We believe that the operational definition of connectedness captured
by the WCS may have broad relevance in mental health research.
Keywords Psychedelics· Psilocybin· Alienation· Community· Transpersonal· Nature-connectedness· Relational·
Depression· Transdiagnostic· Therapy
Introduction
“Rarely, if ever, are any of us healed in isolation, heal-
ing is an act of communion”
— bell hooks
This article belongs to a Special Issue on Psychopharmacology on
Psychedelic Drugs
Extended author information available on the last page of the article
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Psychopharmacology
1 3
The psychological concept of felt connection or ‘con-
nectedness’1 has been discussed previously in the context of
psychedelic therapy (Thomas etal. 2013; Watts etal. 2017;
Yaden etal. 2017), but has not yet been clearly defined.
Participant accounts of psychedelic therapy often include
reference to an increased sense of connectedness with one’s
own senses, body and emotions; to friends, family and com-
munity; and to nature, the living world, global humanity,
purpose and meaning. Here, we offer a definition of con-
nectedness as ‘a state of feeling connected to self, others
and the wider world’.
Many have argued that a sense of felt connection to self,
other people and the world around us has a profound effect
on our individual and collective wellbeing (Alexander 2008;
Cacioppo and Cacioppo 2018; Hari 2019; Sorajjakool etal.
2008). Different types of connectedness have been defined
and measured previously, e.g. social connectedness (Aron
etal. 1992; Lee and Robbins 1998; Mashek etal. 2007),
nature connectedness (Mayer and Frantz 2004; Nisbet etal.
2009) and a connection to spiritual values or transpersonal
connection (Piedmont 2012; Reed 1991; Yaden etal. 2017,
2019). However, here, we hypothesise that each of these
domains of connectedness may be linked by a common gen-
eral factor that can simply be referred to as ‘connectedness’.
We also propose that the different domains of connected-
ness may inter-relate and, potentially, interact, i.e. sharing
a common relation with a perhaps latent, central or global
connectedness factor.
Connectedness as a construct spanning these three
domains has not been measured, or systematically studied.
Yet the experience of feeling connected to self and others,
and the interconnected living world, is commonly described
by psychedelic ‘users’—whether they use be in ceremonial
(Dobkin de Rios 1984; Gearin 2016; Kettner etal. 2021;
La Barre 1938/1975; Tramacchi 2000), festival (Forstmann
etal. 2020; St John 2009), dance party or ‘rave’ (Newson
etal. 2021) or therapeutic contexts (Agin-Liebes etal. 2021;
Argento etal. 2019; Belser etal. 2017; Loizaga-Velder and
Verres 2014; Noorani etal. 2018; Swift etal. 2017; Thomas
etal. 2013).
Previous research has highlighted the potential three-
dimensional structure of a ‘connectedness’ construct.
Specifically, in a study of ayahuasca-assisted therapy for
addiction, quotes from interviews conducted with par-
ticipants were grouped into the categories of ‘connec-
tion with self, connection with others, connection with
spirit and nature’ (Argento etal. 2019); themes which
corresponded very closey to findings of other ayahuasca
research (Thomas etal. 2013; Trichter etal. 2009). Fur-
thermore, previous psychedelic studies have found that
aspects of acute psychedelic experience—which include
connectedness (emotional, social or spiritual)—mediated
longer term mental health benefits (Kettner etal. 2021;
Roseman etal. 2019, 2017; Yaden and Griffiths 2020).
Just as psychedelic interventions may increase con-
nectedness across the domains, so too may non-psy-
chedelic interventions; a 2-week long ‘nature noticing’
intervention was found to increase not only connectedness
to nature, but also to other people and life as a whole,
based on survey responses (Passmore and Holder 2017).
Another study found a correlation between nature con-
nectedness and social connectedness scores in a sample
of 327 people (Lee etal. 2015). Mindfulness and loving-
kindness meditation exercises have been found to increase
scores on social connectedness and nature connectedness
measures, even though the interventions did not focus
specifically on nature (Aspy and Proeve 2017). Other
non-psychedelic studies using measures of personal con-
nectedness, social connectedness or nature connected-
ness have found them to be associated with wellbeing
and flourishing in healthy populations, and different types
of connectedness have been identified as key predictors
and mediators of psychological wellbeing (Capaldi etal.
2015; Cervinka etal. 2012; Lee etal. 2008; Ryff and
Keyes 1995; Saeri etal. 2018; Seligman 2012; Zelen-
ski and Nisbet 2014). As prosocial behaviour has been
associated with serotonergic functioning (Crockett 2009),
some proponents of pharmacological interventions might
explore their use to increase connectedness.
The suggestion of the potential value of measuring
connectedness as a construct comprising multiple co-
occurring domains, rather than measuring these aspects
separately, was inspired by qualitative analysis of post-
treatment interviews with participants in a clinical trial
of psilocybin therapy for treatment-resistant depression
(Watts etal. 2017) where reports of a post-treatment shift
from feeling disconnected to self, other people and the
world—to feeling fundamentally more connected—were
especially common and strongly emphasised. Many par-
ticipants who experienced this feeling of connectedness
after psilocybin described the treatment as working in a
different way to antidepressants they had tried before,
which were described by many as having actually exac-
erbated a sense of disconnection from self, others and
the world (similar to emotional blunting (Price etal.
2009)). This observation implies a degree of orthogo-
nality or independence between depressive symptoms
severity and connectedness. After psilocybin, few people
reported feeling more connected in a singular domain but
rather described it as applying in a generalised way. This
generalised connected state was reported as feeling most
1 Note that we regard the vernacular terms ‘connection’ and ‘discon-
nection’ as synonymous with ‘connectedness’ and ‘disconnectedness’,
where the former can operate as verbs and the latter as nouns.
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Psychopharmacology
1 3
intense in the weeks to months after psilocybin therapy
and occurred alongside a temporary reduction in depres-
sion scores (Carhart-Harris etal. 2017). Witnessing this
association gave rise to the hypothesis that depression
can be linked to a fundamental, multidimensional and
generalised sense of disconnectedness and that psyche-
delic therapy (and other interventions) can bring about
an increase in this generalised connectedness (Carhart-
Harris etal. 2018; Watts etal. 2017).
We infer that connectedness holds transdiagnostic
relevance both in relation to psychedelic therapy spe-
cifically (Kočárová etal. 2021) and beyond it (Carhart-
Harris etal. 2018) in a similar way to other candidate
transdiagnostic factors, such as psychological flexibil-
ity (Close etal. 2020; Davis etal. 2020a; Kashdan and
Rottenberg 2010; Watts and Luoma 2020). Psychologi-
cal flexibility (Hayes etal. 2011; Kashdan and Rotten-
berg 2010) and connectedness are proposed to overlap
(Watts and Luoma 2020). Psychological flexibility
includes accessing a ‘larger’ self rather than a smaller
egoic self, and the ability to engage effectively with
one’s senses and feelings in order to be guided towards
value-led actions, rather than being trapped by habitual
and unhelpful patterns of thinking. Thus, psychological
flexibility typically focuses on the experience of the indi-
vidual and relates more closely with ‘connectedness to
self’. Connectedness includes ‘connectedness to self’, but
more strongly emphasizes connectedness to others and
world, incorporating inter-relatedness with community
and environment into concepts of wellbeing.
Some questionnaires that measure the acute psyche-
delic experience include emotional, social and spiritual
aspects of connectedness (Kettner etal. 2021; MacLean
etal. 2012; Roseman etal. 2019; Yaden etal. 2019), but
there are no measures to capture the multidimensional
connectedness which may be felt in the weeks after a
psychedelic experience and thus no tools to measure
when this state begins to fade. The Watts Connectedness
Scale (WCS) has been developed to enable measurement,
with a single tool, of ‘connectedness to self, others and
world’ in daily life, before and after any intervention
which might be hypothesized to improve it, including
psychedelic therapy. Whether or not the formulation of
connectedness proposed by the WCS will have validity
and usefulness is yet to be known; this measure has been
created in order that we might have a tool to answer that
question. If the separate aspects of connectedness pre-
viously studied are found to co-occur, then it will be
important to define, measure and understand connected-
ness as a construct that is itself interconnected across its
own domains.
In order to test the hypothesis that increased connect-
edness to self, others and world is a key mechanistic fac-
tor explaining therapeutic improvements post psychedelic
therapy, we devised a new self-rated scale, the WCS,
based on the findings of a thematic analysis of partici-
pant accounts of psychedelic therapy (Watts etal 2017)
and applied it in three independent studies. This is the
first scale that emerges from psychedelic research which
is not measuring the acute experience, but the changes
that happen after the experience. Validation of the WCS
was done by means of conducting exploratory and con-
firmatory factor analysis on scores for pre-selected items,
as well as reliability analysis. Data were pooled from two
prospective online surveys completed pre- and post-psy-
chedelic experiences (N = 1226). These data were used
to assess the internal structure of the scale. We evaluated
construct validity of the WCS by correlating WCS total
and subscale scores with scores on related measures and
tested postdictive criterion validity using measures of
the spiritual, emotional and social components of the
acute psychedelic experience. Specifically, the Mystical
Experience Questionnaire (MEQ) (MacLean etal. 2012;
Pahnke and Richards 1966), Emotional Breakthrough
Inventory (EBI) (Roseman etal. 2019) and Communitas
Scale (Kettner etal. 2021) were examined as predictors
of changes in connectedness pre- vs post-psychedelic.
We also evaluated sensitivity to change of the WCS in
a randomised controlled trial that compared psilocybin-
assisted therapy with the same therapy protocol deliv-
ered without the psilocybin, and with 6weeks of daily
escitalopram (an SSRI antidepressant medication). The
therapeutic intervention that both groups received is out-
lined in detail in the ACE (Accept, Connect, Embody)
manual (Watts 2021).
Specific hypotheses were as follows:
H1: WCS will assess a principal, generalised connect-
edness factor with 3 subtypes or factors, namely, con-
nectedness to self, connectedness to others and con-
nectedness to the world (a second-order latent variable
subsuming all three subscales will show high reliabil-
ity, suggesting the three subscales can converge into
one construct.)
H2: Criterion validity—WCS scores will increase after
psychedelic use.
H3: Criterion validity (postdictive)—the acute experience
(measured with MEQ, EBI and Communitas) will predict
WCS increases.
H4: Changes of WCS scores will be greater following
psilocybin than escitalopram, measured in a controlled
clinical trial.
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Psychopharmacology
1 3
H5: Changes in WCS scores will be greater in psilocy-
bin responders than escitalopram responders (response
is defined by a baseline to primary endpoint reduction
of at least 50% in depression symptoms measured on the
primary outcome QIDS).
Study 1: psychometric validation
Methods
The data used in the psychometric validation procedure
were obtained from two prospective, observational online
surveys, the Global Psychedelic Survey (GPS) and the
Ceremony Study (CS) (Kettner etal. 2021), investigating
psychedelic use in real-world settings and in ceremony or
retreat settings, more specifically in case of the latter. Both
studies were approved by the Imperial College Research
Ethics Committee and the Joint Research Compliance
Office at Imperial College. Five other papers on different
topics were published using data from these same studies
(Kettner etal. 2021; Kuc etal. 2021; Spriggs etal. 2021;
Timmermann etal. 2021; Zeifman etal. 2020).
Participant recruitment
The survey studies collected data about self-selected
individuals’ psychedelic experiences using an obser-
vational prospective cohort design. Individuals could
participate in either study if they were at least 18years
old, had a good comprehension of the English language
and if they intended to take a classic psychedelic within
2months. Participants who planned to take a psyche-
delic via their own initiative (GPS) or within a planned
ceremony or retreat setting (CS) could sign up online via
the platform www. psych edeli csurv ey. com. After giving
informed consent, participants received email reminders
including links to the surveys at different time points
before and after the indicated date of the experience. The
surveys were completed online on the platform Survey-
Gizmo. All obtained data were anonymous, and no per-
sonally identifying information was collected apart from
e-mail addresses—which we required for participants to
be sent the survey links. No data that could identify indi-
viduals or their responses have been shared, and no IP
addresses were collected.
Study design
Only measures relevant to the current analyses are
reported here. In both studies, a baseline survey was
completed 2weeks prior to the scheduled experience.
This included demographic information, psychological
trait variables related to connectedness and the 23-item
WCS (see below). In case of the ceremony study, a sec-
ond time point was then completed by participants the
day after the psychedelic session to assess, retrospectively,
acute subjective experiences linked to the psychedelic. The
WCS was repeated at three endpoints to assess sensitivity
to change and postdictive validity: 2weeks, 4weeks, and
again 6months following psychedelic use. Data from a
pooled sample of 1293 participants were analysed: 886
from the Ceremony Study and 407 from the Global Psy-
chedelic Survey.
Measures
Watts Connectedness Scale
Items of the Watts Connectedness Scale (WCS) were
inspired by the results of a thematic analysis of 6-month
follow-up interviews (Watts etal. 2017) done with twenty
participants from a psilocybin therapy for treatment
resistant depression open-label trial (Carhart-Harris etal.
2016). The first theme that emerged from the interviews
was a change process of moving from a state of discon-
nection to connection (17/20). Participants described
becoming more connected to senses (10/20), to them-
selves (16/20), to others (16/20), to the world (16/20)
and to a spiritual principle (9/20). Below are few excerpts
from the interviews which portray increased connected-
ness in the different domains:
A veil dropped from my eyes, things were suddenly
clear, glowing, bright. I looked at plants and felt their
beauty. I can still look at my orchids and experience
that: that is the one thing that has really lasted. (P3)
Things look different even now. I would look over at
the park and it would be so green, a type of green I’d
never experienced before. Being among the trees was
incredible, like experiencing them for the first time, so
vibrant, so alive. (P12)
[My wife and I] went for dinner for the first time in
6years: we were like a couple of teenagers. (P16)
I would look at people on the street and think “how
interesting we are”—I felt connected to them all. (P3)
Before I enjoyed nature, now I feel part of it. Before
I was looking at it as a thing, like TV or a painting.
You’re part of it, there’s no separation or distinction,
you are it. (P1)
Based on these qualitative findings, twenty-three items
were chosen pertaining to connectedness, which we
hypothesised would cluster into 3 dimensions, namely,
connectedness to self, connectedness to others and
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Psychopharmacology
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connectedness to the wider world and spirituality. Five
experts (academic and clinical professionals with psy-
chology backgrounds, working in psychedelic research)
assessed the items and revised them if needed (R Watts,
L Roseman, M Kaelen, M Nour, and R Carhart-Harris).
Items were rated on a 0–100 visual analogue scale (VAS),
where 0 corresponded to ‘not at all’ and 100 to ‘entirely’.
The instruction for the scale reads as follows: ‘Reflect-
ing on how you have felt over the past 2weeks, please
rate the following items on a scale from “Not at all” to
“Entirely” according to how you have felt over this time
period. Please answer every item, even if you are unsure
or feel the item is unclear or poorly worded. Drag the indi-
cator to a position on the scale that shows how much you
agree or disagree with each of the following statements’.
Previously validated measures ofconnectedness
andwellbeing
Social connectedness The Social Connectedness Scale
(SCS) (Lee and Robbins 1998) consists of 8 items measur-
ing belongingness, on a 6-point Likert scale.
Nature relatedness The NR-6 (Nisbet and Zelenski 2013) is
a short-form version of the Nature Relatedness Scale (NR)
that measures connection with nature on a 5-point Likert
scale.
Experiential avoidance The Brief Experiential Avoidance
Questionnaire (B-EAQ) (Gámez etal. 2014) contains 15
items that measure behavioural avoidance, distress aversion,
procrastination, distraction/suppression, repression/denial
and distress endurance, on a 6-point Likert scale.
Flourishing Flourishing was measured using Flourishing
Scale (Diener etal. 2010), which assesses perceived success
and competence in areas spanning relationships, self-esteem,
meaning and purpose in life through eight item rated on a
7-point Likert scale.
Wellbeing The 14-item Warwick-Edinburgh Mental Wellbe-
ing Scale (WEMWBS) (Tennant etal. 2007) was included
to measure psychological wellbeing. Responses were rated
on a 5-point Likert scale.
Trait anxiety The Spielberger State-Trait Anxiety Inventory’s
Short-Form Trait Version (STAI-SF) (Marteau and Bekker
1992) is a 6-item scale scored on a 4-point Likert scale.
Acute psychedelic experience
Few measures were used to assess the acute psychedelic
experience. These were administered retrospectively, 1day
after the experience. The measures represent the acute expe-
rience of connection on the three dimensions and hence are
potential mediators for long-term changes.
Emotional breakthrough The Emotional Breakthrough
Inventory (EBI) (Roseman etal. 2019) assesses moments
of emotional breakthrough, catharsis or release. It is a 6-item
scale scored on 0 to 100 visual analogue scale (VAS).
Mystical‑type experience The Mystical Experience Question-
naire (MEQ) (MacLean etal. 2012) is a 30-item scale scored
on a 5-point Likert scale. It consists of four factors which
measure different dimensions of the mystical-type experi-
ence: ‘mystical’, ‘positive-mood’, ‘transcendence of time
and space’ and ‘ineffability’.
Communitas The Communitas Scale (COMS) (Kettner
etal. 2021) assesses moments of being in harmony with the
group and feeling a sense of belonging and connection to the
group. It is an 8-item scale scored on a 7-point Likert scale.
Statistical analysis
Psychometric validation oftheWCS
Exploratory and confirmatory factor analyses (EFA and
CFA, respectively) were performed to determine and test
the factor structure of the WCS. The GPS sample (N = 407)
was used for EFA, the larger CS sample (N = 819) for CFA.
Exploratory factor analysis (EFA)
As a first step, the number of factors to be extracted was
identified through a combination of several heuristics,
including visual examination of the scree plot, the ‘Kaiser
rule’ (Kaiser 1960), which accepts as reliable factors, those
whose corresponding eigenvalue is larger than one, optimal
coordinate, parallel analysis and acceleration factor tests
(Raîche etal. 2013). Kaiser–Meyer–Olkin (KMO) meas-
ure of sampling adequacy and Bartlett’s test of sphericity
were used to test the sample adequacy for EFA. Maximum
likelihood estimation was chosen to allow for continuity
with CFA results. The selected rotation was oblimin, as this
rotation method favours interpretability and allows factors
to intercorrelate. The subscales were based on the factors
extracted and interpreted through investigation of covari-
ance-based factor loading patterns. To maximise clarity
and simplicity in interpretation, two guiding criteria were
considered. Each item assigned to a subscale should demon-
strate a minimum factor loading of at least 0.3 (Field 2013)
and maximum cross loading on any other factor should be
0.2 (Gaskin and Richard 2012).
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Psychopharmacology
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Confirmatory factor analysis (CFA)
Based on the factor structure determined through EFA,
three first-order latent variables were included, as well as
an additional second order latent variable (WCS total) that
was aimed to capture correlations between the first-order
subscales, which were all set to load onto this second-order
variable. To account for potential method effects, the error
terms between negatively worded items were allowed to cor-
relate. Metrics of each latent variable were determined by
fixing the loading of the first item to 1.0 for each factor.
Acceptable model fit was determined through a combination
of fit indices, including the comparative fit index (CFI > 0.9),
standardised root mean square residual (SRMR < 0.08) and
root mean square error of approximation (RMSEA < 0.08).
Coefficient Cronbach’s alpha was used to assess internal
consistency of the latent variables, with > 0.8 and > 0.9
representing high and excellent reliability, respectively
(Cronbach 1951). Additionally, composite reliability was
calculated. It is less prone to over- or underestimations of
reliability at a population level than Cronbach’s alpha, with
a threshold of 0.7 suggesting acceptable consistency (Hair
Jr etal. 2014).
Construct validity
The construct validity of the WCS was evaluated by
inspecting how total and subscale WCS scores related
to other previously validated measures. Pearson’s cor-
relations were calculated between WCS components
and other relevant measures taken at baseline within the
ceremony study sample (N in analysis = 819), including
the B-EAQ, SCS, NR-6, FS, WEMWBS and STAI-SF.
Resulting correlations were interpreted based on effect
sizes: negligible (up to 0.1; 0.1), low (between 0.1
and 0.3; between 0.1 and 0.3), moderate (between 0.5
and 0.3; between 0.3 and 0,5), and high (from − 0.5; 0.5)
(Chen etal. 2010).
Criterion validity
In order to test whether the psychedelic experience influ-
enced WCS scores in the Ceremony Study data, linear
mixed models (LMM) were fitted to assess longitudi-
nal changes in WCS and its subscales. The LMM used
restricted maximum likelihood estimation and included
in each case the WCS (subscale) score as dependent vari-
able, time as a fixed factor and a random intercept to
account for individual differences between participants.
Eta squared effect sizes are reported for each model,
where values of 0.02, 0.13 and 0.26 were considered to
be small, medium and large, respectively (Cohen 1988).
Postdictive validity was then assessed through Pearson
correlations between changes on WCS total score between
baseline and 2weeks post-experience and measures of
the acute psychedelic experience, including MEQ, EBI
and COMS.
All statistical analyses were conducted in RStudio (v1.2).
Results
Demographics
For demographics, see Table1.
Factor structure
All 23 original WCS items were entered into a maximum
likelihood–based exploratory factor analysis (EFA).
The global psychedelic survey (GPS) dataset was found
to be suitable for factor analysis, as its Kaiser-Meyer-
Olkin (KMO) measure of sampling adequacy was 0.92
and Bartlett’s test of sphericity was significant (χ2(22)
=188.75, p<0.0001) (Budaev 2010). Although a fourth
eigenvalue was found to be above 1 (at 1.007), visual
examination of the scree plot (see supplementary Fig-
ureS1), parallel analysis and optimal coordinate esti-
mates of the ideal number of factors to be extracted
pointed to a 3-factorial solution, which was chosen
for the subsequent extraction of factor loadings. Item
loading patterns (supplementary tableS1) revealed that
four items had significant cross loading (> 0.2), which
were therefore removed and the EFA repeated. These
excluded items were’“I have felt connected to deeper
aspects of myself’, ‘I have felt connected to insight intui-
tion’, ‘I have felt connected to my values, and ‘I have
felt connected to strangers. The remaining 19 items all
had satisfactory loading patterns, where the first factor
explained 22% of the variance, the second factor 16%
and the third factor 12%, amounting to a total of 50%
of variance explained in the final 3-factorial solution.
Based on the content of items that loaded on each fac-
tor, definitions were assigned that each represented a
subtype of connectedness, in line with the hypothesised
3-factorial structure of connectedness (supplementary
tableS1). Accordingly, the first factor was named ‘con-
nectedness to world’ (CTW), the second factor was
named ‘connectedness to self’ (CTS), and the third fac-
tor was named ‘connectedness to others’ (CTO)
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Psychopharmacology
1 3
Table 1 Demographic information of both observational survey studies collected at baseline
Absolute frequencies including corresponding percentages (in brackets) are presented
Plus–minus values are means ± SD
CS Ceremony Survey; GPS Global Psychedelic Survey
For more information on CS dataset, see Kettner etal. (2021)
* In the GPS sample, ‘associate/technical degree’ was not assessed separately; ‘postgraduate, master’s and doctorate degree’ were combined into
one response option
CS GPS
Total N819 407
Age 44.4 ± 12.6 30.46 ± 10.5
Gender Female 359 (43.8%) 123 (30.2%)
Male 455 (55.6%) 277 (68.1%)
Other 5 (0.6%) 7 (1.7%)
Nationality United States 359 (43.8%) 95 (23.3%)
United Kingdom 160 (19.5%) 107 (26.3%)
Australia 31 (3.8%) 8 (2.0%)
Germany 28 (3.4%) 21 (5.2%)
Canada 26 (3.2%) 31 (7.6%)
Other countries 215 (26.3%) 145 (35.6%)
Education None 6 (0.7%) 38
High school or equivalent (GED) 62 (7.6%) 160 (39.3%)
Associate/technical Degree 58 (7.1%) N/A*
College diploma 250 (30.1%) 118 (29.0%)
Master’s degree 275 (33.6%) 91 (22.4%)*
Doctorate or Professional degree 168 (20.5%)
Employment Student 46 (5.6%) 129 (31.7%)
Working full-time 520 (63.4%) 186 (45.7%)
Working part-time 120 (14.7%) 49 (12.0%)
Retired 73 (8.9%) 7 (1.7%)
Unemployed 60 (7.3%) 36 (8.8%)
Median household income ($/month) 9000 3200
Ethnicity White 743 (90.7%) 372 (91.4%)
Black or African American 12 (1.5%) 5 (1.2%)
Asian 48 (5.9%) 22 (5.4%)
American Indian or Alaska native 3 (0.4%) 6 (1.5%)
Unknown/prefer not to say 11 (1.3%) / 23 (2.8%) 10 (2.5%) / 16 (3.9%)
Marital status Cohabiting with partner 101 (12.3%) 70 (17.2%)
Married 340 (41.5%) 60 (14.7%)
Divorced 86 (10.5%) 18 (4.4%)
Separated 29 (3.5%) 10 (2.5%)
Never married 254 (31.0%) 247 (60.7%)
Widowed 9 (1.1%) 1 (0.2%)
Previous psychedelic use Never 330 (40.3%) 48 (11.8%)
Once 95 (11.2%) 26 (6.4%)
2–5 times 166 (20.3%) 91 (22.4%)
6–10 times 73 (8.9%) 78 (19.2%)
11–20 times 76 (9.3%) 65 (16.0%)
21–50 times 49 (6.0%) 54 (13.3%)
> 50 times 30 (3.7%) 45 (11.1%)
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Psychopharmacology
1 3
The 3-factorial structure consisting of 19 remaining items
showed satisfactory psychometric properties in the EFA and
then subjected to a subsequent confirmatory factor analysis
(CFA) in the separate Ceremony Study dataset (N=819),
to which a second-order WCS total score was added onto
which the three latent subscales were set to load. The model
showed acceptable fit with CFI = 0.902, RMSEA = 0.076
(confidence intervals 0.072–0.081) and SRMR = 0.060
(Maiyaki 2012). Standardised factor loadings of the result-
ing model are shown in Figure1. Cronbach’s alphas for
the three first-order latent factors were 0.84, 0.87 and 0.90,
while composite reliabilities were 0.79, 0.87 and 0.90, for
connectedness to self, others and the world, respectively. The
second-order latent variable subsuming all three subscales
had a composite reliability of 0.86.
From here on, the total score of each of the subscales was
calculated by averaging all of the items that belong to this
subscale, and the total WCS score was calculated by averag-
ing the three subscales.
Fig. 1 Confirmatory factor analysis model with standardised load-
ings. Included in the model (N = 819) were 19 items of the Watts
Connectedness Scale which fulfilled loading criteria during explora-
tory factor analyses in a different sample (N = 407). Error terms
between negatively worded items were allowed to correlate to
account for method effects
Table 2 Pearson-correlation
coefficients between the
Watts Connectedness Scale,
its subscales and validated
secondary measures
WCS Watts Connectedness Scale; CTS connectedness to self; CTO connectedness to others; CTW connect-
edness to the world; bEAQ Brief Experiential Avoidance Questionnaire; FS Flourishing Scale; SCS Social
Connectedness Scale; NR-6 Nature Relatedness Scale; STAI: State-Trait Anxiety Inventory; WEMWBS
Warwick-Edinburgh Mental Wellbeing Scale; AVE average variance extracted
WCSTot al CTS CTO CTW bEAQ FS SCS NR-6 STAI WEMWBS
AVE
WCSTot al 1.00 0.85 0.80 0.86 − 0.57 0.71 0.69 0.36 − 0.61 0.79
CTS 0.88 1.00 0.52 0.62 − 0.53 0.51 0.49 0.28 − 0.46 0.58 0.72
CTO 0.67 0.52 1.00 0.51 − 0.51 0.72 0.78 0.15 − 0.67 0.82 0.62
CTW 0.90 0.62 0.51 1.00 − 0.39 0.55 0.47 0.46 − 0.42 0.60 0.76
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Psychopharmacology
1 3
Construct validity
Correlation coefficients between the WCS, its subscales
and other included measures are displayed in Table2.
Discriminant validity could be established among the
WCS subscales following the Fornell and Larcker (1981)
criterion; i.e. the square root of the average variance
extracted (AVE) was larger than any inter-construct corre-
lations, although correlations among WCS subscales were
generally high, ranging from 0.51 (CTO and CTW) to 0.62
(CTS and CTW). The highest correlations with second-
ary measures were observed between CTO and wellbeing
(WEMWBS, r = 0.82), social connectedness (SCS, r = 0.78)
and flourishing (FS, r = 0.72), which were greater than the
square root of the AVE, meaning that discriminant validity
for this subscale could not be established against the men-
tioned secondary measures.
Criterion validity
Mixed linear models were fitted to test for changes in con-
nectedness across time in the Ceremony Study data. Param-
eter estimates for each time point and subscale are pre-
sented in Table3; all values were significantly (p < 0.0001)
Table 3 Mixed linear effect
model results of WCS subscales
across time
WCS Watts Connectedness Scale; CTS connectedness to self; CTO connectedness to others; CTW connect-
edness to world
***It meansp < 0.0001
WCSTot al CTS CTO CTW
Intercept 54.31 (0.67)*** 61.34 (0.73)*** 59.88 (0.75)*** 41.69 (0.88)***
t = 2weeks 16.21 (0.78)*** 12.84 (0.89)*** 15.52 (0.88)*** 20.26 (1.09)***
t = 4weeks 14.84 (0.79)*** 11.66 (0.90)*** 13.68 (0.89)*** 19.19 (1.05)***
t = 6months 12.93 (1.2)*** 9.77 (1.38)*** 10.8 (1.36)*** 18.32 (1.6)***
Effect size η20.339 0.192 0.260 0.332
Fig. 2 Changes in connected-
ness following a psychedelic
experience in a guided group
setting. Connectedness across
all subscales was significantly
(p < .0001) enhanced 2weeks,
4weeks and 6months following
the experience compared to
baseline. Error bars indicate
95% confidence intervals. CTO,
connectedness to others; CTS,
connectedness to self; CTW,
connectedness to world; WCS,
Watts’ Connectedness Scale
(total)
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Psychopharmacology
1 3
increased at 2weeks, 4weeks and still at 6months following
the psychedelic experience (Fig.2), with consistently large
effect sizes ranging from η2 = 0.192 for connectedness to self
to η2 = 0.339 for changes in the overall WCS score. Estima-
tion of individual contrasts showed that for each subscale,
2weeks, 4weeks and 6months time points differed from
baseline at p < 0.0001; additionally, the overall WCS score
was significantly lower at 6months, compared with 2weeks
(mean difference = 3.28, se = 1.25, p = 0.027), as was con-
nectedness to others (mean difference = 4.72, se = 1.41,
p < 0.01). Postdictive validity was good; and Pearson cor-
relations between changes in WCS total scores from baseline
to 2weeks and measures of the acute psychedelic experi-
ence were significant in the case of mystical-type experience
(MEQ, r = 0.42, p < 0.0001), emotional breakthrough (EBI,
r = 0.38, p < 0.0001) and communitas (COMS, r = 0.42,
p < 0.0001) measured retrospectively 1day following the
psychedelic ceremony (Fig.3).
Discussion Study 1
The observed factor structure confirmed the three-facto-
rial structure of connectedness, including a connection to
self, connection to others and connection to the world. The
dimensions of the scale were in line with the hypothesised
constructs. The factor loadings showed a simple structure
with minimal cross loadings, which promoted a straightfor-
ward interpretation of scores (Worthington and Whittaker
2006), and the internal consistency of the scale was high.
Most importantly, in the confirmatory factor analysis, the
second-order total WCS score, which is comprised of the
three subscales, had a high composite reliability. This result
suggests that the three subscales can be converged into one
construct which measures a comprehensive spectrum of
connectedness.
The construct validity of the scale was assessed via com-
parison with other related scales that measured psycho-
logical flexibility, wellbeing, social connectedness, nature
relatedness and anxiety. High correlations were observed
between total WCS and its subscales and scores on the other
measures, showing high convergent validity with these
scales. The high convergent validity with a variety of scales
implies a broad, multidimensionality to the WCS. Regard-
ing divergent validity, CTS and CTW showed divergence
from other measures, while CTO did not diverge from few
of the other measures such as SCS and WEMWBS. Overall,
we can conclude that the total score of WCS does diverge
from other measures, yet there is still a need to investigate
divergent validity by comparing WCS with other measures
that were not included in the current study (e.g., the relation
between CTW and different measures of spirituality).
As CTO did not diverge from SCS, it is important to note
the relationship between them. The two scales converge in
Fig. 3 Correlations between A
mystical-type experiences, B
emotional breakthrough, and C
communitas and change scores
on Watts Connectedness Scale
(WCS) from before to after
2weeks of a guided psychedelic
group experience
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Psychopharmacology
1 3
terms of their shared reference to the negative affect that
can accompany social disconnection and only slightly dif-
fer on the degree to which actual social relationships exist.
One minor difference is that SCS features items that assess
social connectedness that go beyond one’s direct social envi-
ronment. Total WCS also had high correlations with SCS,
which most likely implies that social connectedness is an
important aspect of connectedness. This finding follows the
principal idea that humans are a species whose survival,
thriving and meaning-making depend on good social rela-
tions (Hagerty etal. 1993; Townsend and McWhirter 2005).
A recent big data study supported this notion by showing
that social connection is the most crucial protective factor
in preventing depression (Choi etal. 2020).
The postdictive validity of WCS was excellent. Previous
psychedelic research showed that different psychedelic expe-
riences can predict long-term changes, in naturalistic studies
(Haijen etal. 2018; Kettner etal. 2021) and clinical studies
(Griffiths etal. 2016; Roseman etal. 2017). Measures that
were used in previous psychedelic research (MEQ, EBI and
COMS) predicted in the current study long-term changes in
WCS. This means that the emotional, social and spiritual
components of the acute psychedelic experience impact
the sense of connectedness for a prolonged period after
the psychedelic has been metabolised. This result adds to a
large body of findings showing that acute subjective effects
induced by psychedelics are fundamental to the therapeu-
tic efficacy induced by psychedelics (MacLean etal. 2011;
Roseman etal. 2017; Schenberg 2018; Yaden and Griffiths
2020).
Study 2: sensitivity andspecicity
ofoutcome inapsilocybin vs escitalopram
RCT
Methods
To test the WCS’ sensitivity to change and specificity of
effect to psychedelic compounds, data from a double-blind
randomised controlled trial (Carhart-Harris etal. 2021) was
analysed in study 2. A Schedule 1 drug license from the UK
Home Office was obtained by the investigators, and the trial
was approved by the Brent Research Ethics Committee, the
UK Medicines and Healthcare Products Regulatory Agency,
the Health Research Authority, the Imperial College London
Joint Research Compliance and General Data Protection Regu-
lation Offices, and the risk assessment and trial management
review board at the trial site (the National Institute for Health
Research [NIHR] Imperial Clinical Research Facility [CRF]).
Psilocybin (as COMP360) was provided by COMPASS
Pathways, and escitalopram and placebo were provided by
the Pharmacy Manufacturing Unit at Guy’s and St. Thomas’s
Hospital.
Participant recruitment
The inclusion criterion for the RCT was major depressive dis-
order (MDD) of a moderate to severe degree, diagnosed by a
doctor, and with the participant scoring 17 + on the 21-item
Hamilton Depression Rating scale [HAM-D])—as assessed
by a study psychiatrist at the point of telephone screening.
Exclusion criteria were current or previously diagnosed psy-
chotic disorder; immediate family member with a diagnosed
psychotic disorder; medically significant condition rendering
unsuitability for the study; history of serious suicide attempts
(requiring hospitalisation); history of mania; blood or needle
phobia; positive pregnancy test at screening or during the
study; and current drug or alcohol dependence; and any diag-
nosed or suspected psychiatric comorbidities felt to jeopardise
the formation of a good therapeutic relationship. Information
about the study’s recruitment was sent to general practition-
ers via the North West London Clinical Research Network.
However, patients were also allowed to self-refer to the study
if they were UK residents. Patients who initiated contact with
the research team (via email, letter or telephone) were sent
a study information sheet, a subsequent telephone screening
and further face-to-face medical and psychological screening
including liaison with all participants’ healthcare providers.
Study design
This was a phase 2 double-blind randomised controlled trial.
Participants were randomly assigned 1:1 to either a psilo-
cybin condition or an escitalopram condition. Participants
in both groups received the same therapeutic intervention
which focused on enabling participants to accept and allow
any difficult feelings, connect to any insights and engage
with their embodied ‘felt sense’ throughout the therapy
process. This approach is described in detail in the ACE
(Accept, Connect, Embody) model manual (Watts 2021).
The primary outcome measure was the change in self-rated
scores on the Quick Inventory of Depressive Symptomatol-
ogy (QIDS-16) from baseline to the primary endpoint. The
primary endpoint was 6weeks after the first psilocybin ses-
sion and 3weeks after the second psilocybin session (also
the day of the final dose of 6weeks of daily escitalopram).
Secondary measures included the Hamilton Depression
Rating Scale (HAM-D) and Montgomery-Asberg Depres-
sion Rating Scale (MADRS) clinical interviews to assess
depression symptoms, the Beck Depression Inventory (BDI)
self-rated measure of depressive symptom severity and other
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Psychopharmacology
1 3
self-rated scales including the WCS. Secondary measures
were administered at baseline and 6-week endpoint.
The psilocybin condition (n = 30) comprised two 4–6-h
sessions in which participants consumed 25-mg psilocybin
whilst listening to a therapeutic music playlist, under the
guidance of two therapists who were allocated to them for
the entirety of the trial. These sessions were 3weeks apart.
Participants in the psilocybin condition also took daily
capsules, containing placebo, from the day after the first
guided dosing session until the 6-week endpoint. The esci-
talopram condition (n = 29) comprised two 4–6-h sessions
in which participants consumed a very small dose of psilo-
cybin (1mg) whilst listening to the same therapeutic music
playlist, under the guidance of their two allocated therapists.
These sessions were also 3weeks apart. Participants in the
escitalopram condition took daily capsules, containing the
antidepressant medication escitalopram, from the day after
the first guided dosing session until the 6-week endpoint.
Participants in both groups received nine non-drug therapeu-
tic sessions with their two allocated therapists which took
place from 2weeks before the first psilocybin session until
the 6-week endpoint. A minority of the non-drug therapeutic
sessions (which were termed ‘preparation’ and ‘integration
sessions) took place with just one therapist via tele-health,
but most included both therapists and took place face-to-
face in a psilocybin therapy room. Both therapists were pre-
sent during the entirety of both guided dosing sessions, for
both conditions. The final non-drug therapeutic session at
the 6-week endpoint was followed by a research interview
in which participants completed primary and secondary
outcome measures. It is important to note that participants
in the escitalopram condition received the nine non-drug
therapeutic sessions under the guidance of one or both of
their two allocated therapist ‘guides’, and two 4–6-h guided
psilocybin sessions with both therapist guides. Therefore,
participants in both conditions received a large amount of
psychotherapeutic support and personal attention.
Measures
Depression
The Quick Inventory of Depressive Symptomatology (QIDS)
was the primary outcome of the RCT (Carhart-Harris etal.
2021), and is used in the current paper to define respond-
ers and non-responders to both psilocybin and escitalopram.
Response was defined as more than 50% reduction in QIDS.
Connectedness
In the original 23-item version of the WCS was included
in the trial, but for the purpose of this validation paper, we
usedonly the 19 items thatload well onto the aforemen-
tioned 3 dimensions of connectedness i.e. the subscales
CTS, CTO and CTW.
Statistical analysis
Groups were split into responders and non-responders based
on more than 50% reduction in baseline depression scores.
Mixed repeated measures ANOVA (2 × 2 × 2 between-
within) was used to measure whether WCS differed between
psilocybin and escitalopram (hypothesis H4), and whether
this was dependent on response rates (hypothesis H5). A
significant triple interaction would suggest that psilocybin
Table 4 Demographic
information of for psilocybin
and escitalopram (after
exclusion)
Absolute frequencies including corresponding percentages (in brackets) are presented
Plus–minus values are means ± SD
For more information on this data set, see Carhart-Harris etal. (2021)
Psilocybin Escitalopram
Total N 27 25
Age 42.3 ± 11.9 39 ± 10.2
Gender Female 10 (37%) 7 (28%)
Male 17 (63%) 18 (72%)
White Ethnicity 25 (92.6%) 20 (80%)
Education University level 20 (74.1%) 19 (76%)
Employment Employed 18 (66.7%) 19 (76%)
Student 2 (7.4%) 1 (4%)
Unemployed 7 (25.9%) 5 (20%)
Duration of illness (years) 21.4 ± 10.8 15.3 ± 11.5
No. of psychiatric medications previously used 2.15 ± 1.63 1.96 ± 1.51
Previous use of psilocybin 2 (7.4%) 0 (0%)
Previous use of psychotherapy 25 (92.6%) 22 (88%)
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Psychopharmacology
1 3
and escitalopram differ in their therapeutic mechanism and
that this difference is related to connectedness. WCS scores
were included as dependent variable, time as within-subject
effect with 2 levels (baseline and 6weeks) and condition
and response as between-subject independent variables with
2 levels each (psilocybin vs. escitalopram; and responders
vs. non-responders). The resulting three-way interaction was
time X condition X response. Multiple pairwise comparisons
were calculated to test simple main effects: within-group
comparisons (from baseline to 6weeks) at each level of the
group factor (psilocybin vs. escitalopram) and between-
group comparisons at each time-point (baseline and week
6) were calculated. To test that connectedness is part of the
mechanism of action in psilocybin but not escitalopram, it
was possible to use moderated mediation analysis. However,
we decided not to do so, as WCS and QIDS were measured
in the same time point (6weeks), and accurate mediation
analysis require that the mediating variable is tested before
the outcome.
All statistical analyses were conducted in RStudio (v1.2).
Results
Demographics
See Table4.
Changes inConnectedness
Four subjects in the escitalopram group came off the medi-
cation before the end of the trial and were excluded from
the analysis. From the psilocybin group, one subjectwas
excluded due to smoking cannabis on a regular basis dur-
ing the trial period, and two were excluded for not having
the second psilocybin dosing day due to COVID-19 lock-
down restrictions. After exclusion, the escitalopram group
consisted of 25 subjects and the psilocybin group, 27 sub-
jects.Based on changes in QIDS scores, 13 subjects were
defined as responders in the escitalopram group (52% of the
total escitalopram group), and 20 in the psilocybin group
(74% of the total psilocybin group). The mixed (2 × 2 × 2
between-within) rm ANOVA revealed a significant main
effect of time (baseline vs 6weeks) [F(1, 48) = 51.36,p <
0.0001,ηp2 = 0.517]; significant interaction effect for time
and condition (escitalopram vs. psilocybin), aligned with
hypothesis H4 [F(1, 48) = 7.39,p = 0.009,ηp2 = 0.133] (see
Fig.4); significant interaction effect for time and response
(non-responders vs. responders) [F(1, 48) = 28.73,p < 0.001
,ηp2 = 0.374]; and significant triple interaction for time, con-
dition and response, aligned with hypothesis H5 [F(1, 48) =
9.62,p = 0.003,ηp2 = 0.167]. Two-sample t-tests were used
to test whether WCS scores were different at baseline and at
6weeks. No significant differences were observed at base-
line for condition (mean difference = 1.8, Hedge’s g = 0.14,
p = 0.614) and response (mean difference = 3.73, Hedge’s
g = 0.29, p = 0.311), suggesting that the interaction effects
were not driven by difference at baseline. Significant differ-
ences in ΔWCS scores were observed for condition (mean
difference = 19.8, Hedge’s g = 1.07, p < 0.001, higher for
psilocybin) and response (mean difference = 24.9, Hedge’s
g = 1.45, p < 0.001, higher for responders). Paired samples
t-tests were used to compare WCS at baseline vs. 6-week
follow-up. There were no significant difference for both esci-
talopram non-responders (mean difference = 4.6, Hedge’s
g = 0.42, p = 0.158, n = 12) and psilocybin non-responders
Fig. 4 Change in connectedness in a randomised controlled trial com-
paring escitalopram (E) and psilocybin (P) for major depression from
baseline to 6weeks (endpoint). For the complete sample, significantly
greater increases in connectedness were observed. Furthermore,
a significant three-way interaction indicated significantly greater
increases in connectedness for psilocybin-responders, compared to
escitalopram responders, whereas non-responders did not increase in
connectedness in either condition. Escitalopram arm = blue, psilocy-
bin arm = red. Baseline = light colour, endpoint = dark colour
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Psychopharmacology
1 3
(mean difference = 2.99, Hedge’s g = 2.5, p = 0.512, n = 7).
There were significant differences for both escitalopram
responders (mean difference = 14.3, Hedge’s g = 0.95,
p = 0.004, n = 13) and psilocybin responders (mean differ-
ence = 38.58, Hedge’s g = 2.29, p < 0.001, n = 20). To test
whether the change in WCS scores for psilocybin respond-
ers was higher than for escitalopram responders, as hypoth-
esised, a two-sample t-test was used to compare the change
in WCS scores. Aligned with hypothesis H5, ΔWCS was
significantly greater for psilocybin responders compared
with escitalopram responders (mean difference = 24.5,
Hedge’s g = 1.52, p < 0.001), but not greater for psilocybin
non-responders compared to escitalopram non-responders
(mean difference = 1.6, Hedge’s g = 0.14, p = 0.76). Overall,
results were consistent with our prior hypotheses, showing
that changes in WCS were larger for psilocybin vs escitalo-
pram and larger for psilocybin responders vs escitalopram
responders (see Fig.4).The significant triple interaction
suggests that while both psilocybin and escitalopram can
alleviate depression, psilocybin leads to stronger increases
in connectedness even when comparing clinical respond-
ers from both groups. This suggests that the mechanism
of action by which psilocybin and escitalopram improve
depression is different and that this difference is related to
connectedness which is higher for psilocybin.
Further descriptive analysis of the three dimensions
was conducted. For escitalopram non-responders, CTS
and CTO did not show significant changes (CTS, Hedge’s
g = − 0.064, p = 0.823; CTO, Hedge’s g = 0.37, p = 0.21),
while CTW did show significant increase (Hedge’s g = 0.73,
p = 0.023). For escitalopram responders, CTS did not show
significant changes (Hedge’s g = 0.27, p = 0.34), while CTO
and CTW did show significant increases (CTO, Hedge’s
g = 1.46, p < 0.001; CTW, Hedge’s g = 0.79, p = 0.012). For
psilocybin non-responders, none of the dimensions showed
significant changes (CTS, Hedge’s g = − 0.237, p = 0.476;
CTO, Hedge’s g = 0.11, p = 0.739; CTW, Hedge’s g = 0.56,
p = 0.113). For psilocybin responders, all of the dimen-
sions showed significant increases (CTS, Hedge’s g = 1.85,
p < 0.0001; CTO, Hedge’s g = 1.45, p < 0.0001; CTW,
Hedge’s g = 1.4, p < 0.0001).
Discussion
The result of our analyses support the validation of the WCS
as an instrument to measure connectedness as a construct com-
prising three categories (connectedness to self, others, world).
Aligned with our primary hypothesis, the validation of the scale
has shown that those three categories can be grouped together
into one single factor to measure a generalised type of connect-
edness. The WCS, and all of its subscales, showed significant
increase up to 6months after a psychedelic experience in three
independent studies. Importantly, three different elements of
the acute psychedelic experience—emotional, spiritual and
social—predicted the long-term changes in WCS. Finally, in
a double-blind randomised controlled trial comparing psilo-
cybin-assisted therapy with escitalopram-assisted therapy for
depression, the WCS showed robust post-treatment changes
with psilocybin-assisted therapy that were significantly larger
than for escitalopram-assisted therapy, even when comparing
just the responders from both groups. These results confirm the
hypothesis that was developed in the exploratory qualitative
research which kindled the current quantitative investigation
(Watts etal. 2017), which proposed that the therapeutic mecha-
nism of psychedelic-assisted therapy is different to conventional
antidepressants, with an increased sense of connectedness to
self, others and the world being specific to psychedelic therapy.
Connectedness asaconstruct
Many constructs which were originally conceptualised to be
related to one particular aspect of connectedness (i.e. experi-
ential avoidance to CTS, social connectedness to CTO, nature
connectedness to CTW) were found to correlate with the total
score of WCS. This supports the suggestion of a more gen-
eral connectedness at the root of the various specific types of
connectedness that have been previously studied. Based on
the findings of this study, we now predict, for example, that
an individual reporting feeling connected to a sense of mean-
ing and purpose as well as their body and emotions would
also report feeling connected to other people; or that someone
describing feeling connected to nature would also report feel-
ing connected to humanity at large and their own emotions.
There will of course be exceptions to this, with a whole range
of unique profiles of connectedness, but overall high scores on
one domain (self/others/world) suggest high scores on others,
just as low scores in one aspect suggest a disconnection across
multiple domains. Extending on this theme, we hypothesise
that high multidimensional connectedness may be a protective
factor for mental health and wellbeing.
The construct of ‘connectedness’ has developed over
time to have different meanings and different applications
(Townsend and McWhirter 2005). Many older conceptualisa-
tions described connectedness as some form of interpersonal
relatedness (Townsend and McWhirter 2005), some empha-
sised the self-in-relation-to-others context-dependent nature
of connectedness (Hawkley etal. 2005; McWhirter 1990;
Newcomb 1990; Newcomb and Bentler 1988), whereas oth-
ers have favoured more internally focused experiential and
emotion-oriented interpretations (Hagerty etal. 1993; Lee
and Robbins 1995; Townsend and McWhirter 2005). Other
types of connectedness have also been discussed in older
literature, but have remained relatively underexplored. Bell-
ingham etal. (1989) is a notable exception, conceptualising
connectedness with three subtypes of connectedness (self,
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Psychopharmacology
1 3
others and a larger purpose in life) which maps closely onto
the model presented here. It is our hope that the WCS is
able to capture both the core essence and multidimensional
nature of the phenomenon of connectedness, and we hope
that future use of this scale will help to revive an interest
in the science of connectedness and its relevance to health.
Connectedness toself
Psychedelic therapy tends to be experienced in a more embodied
way than traditional talking therapy. During a 5–6-h psilocybin
session, participants are encouraged to be with their felt sense in
the body and refrain from speaking very much until afterwards,
in order to more fully connect with somatic and emotional
aspects of experience, rather than getting distracted by cogni-
tion or communication (Richards 2015). Participants engaging
in psychedelic therapy tend to describe feeling connected to
deeper aspects of themselves than they usually feel, and being
able to ‘sit with’ more intense and often uncomfortable emo-
tions than they can usually access or tolerate. Therefore, ‘self-
connectedness’ in psychedelic therapy tends to be described as
connectedness to the senses, the body, and emotions.
Previous conceptualisations of ‘self-connection’ have
been largely cognitive, emotional and behavioural (Belling-
ham etal. 1989; Klussman etal. 2020, 2021) and have not
included embodied/somatic aspects. CTS, as formulated by
the WCS, acknowledges embodied qualities of ‘the self’,
e.g., with the inclusion of the specific items ‘I have felt con-
nected to my body’ and ‘I have felt connected to my senses.
The original 23-item version of the WCS, CTS contained
a number of items that map on to Klussman etal.’ s concep-
tualisation of CTS (values, insight, self compassion) but were
removed because they were found to cross load with CTW: ‘I
have felt connected to deeper aspects of myself’,‘I have felt
connected to insight/intuition’ and ‘I have felt connected to
my values’. A further item,‘I have felt connected to a purpose
in life’, was hypothesised to load into the CTS subscale until
factor analysis placed it in CTW. By removing these four items
from the subscale, CTS becomes a more visceral, emotional
and embodied connection to self. Of all CTS items in the origi-
nal scale, the items with the highest factor loadings for CTS
were those relating to emotions (i.e. the highest loading was for
“I have felt connected to a range of emotions). This could be
viewed as reflective of a differential ‘willingness to feel’ in the
CTS subscale, as well as the core affective and interoceptive
quality of CTS, as defined by this subscale’s six items.
Connectedness toothers
CTO maps closely on to the well-researched concept of social
connectedness, which has been described by Lee and Robbins
(1995) as being related to one’s view of the self in relation to
others or as a 'cognitive structure representing regularities in
patterns of interpersonal relatedness’ (Baldwin 1992 p. 461).
One model of social connectedness is derived from a factor
analysis of the UCLA Loneliness Scale (UCLA LS-R). Loneli-
ness has been defined as the inverse of human (social) connect-
edness (Hawkley etal. 2005; Newcomb 1990; Van Bel etal.
2009). The UCLA LS-R has a three factor model: isolation,
relational connectedness and collective connectedness (Hawk-
ley etal. 2005). Relational connectedness refers to actual social
networks, whereas isolation refers to an individual’s mental
representations of how socially connected or disconnected they
are. The WCS includes all three factors of the UCLA LS-R: the
CTO subscale covers isolation and relational connectedness
and collective connectedness is included in CTW.
In a recent large-scale population survey study in the UK,
social connection was found to be the strongest protective factor
against depression (Choi etal. 2020). The quality and quantity
of individuals’ social relationships have been linked not only to
mental health but also to both morbidity and mortality; a large
meta-analysis found that social relationships are more effective
at helping people to live long lives than any other factor, includ-
ing hypertensive treatment (Holt-Lunstad etal. 2010). Human
social genomics has begun to analyse how loneliness affects our
immune system and causes chronic inflammation as a precur-
sor to disease (Cole 2014). Combining community develop-
ment with healthcare has been found to dramatically reduce
emergency hospital admissions in a project in the UK where a
town was shaped into a ‘compassionate community’ via various
interventions whereby people of the town were given the means
to connect with each other (Abel 2018).
Connectedness toworld
CTW items represent a state of ‘transpersonal’ ego-tran-
scendence which may be a vital aspect of the therapeutic
process catalysed by psychedelics (Pahnke etal. 1970;
Roseman etal. 2017; Yaden and Griffiths 2020) and other
practices. The CTW subscale relates to ‘self-transcendence’,
defined as the capacity to transcend self-boundaries (Reed
1991). The expansion of self-boundaries can occur at the
interpersonal (opening up one’s sense of self to include
other beings) and transpersonal (connecting with nature
and a spiritual principle) levels (Reed 2008).
All items in the CTW subscale relate to connecting with
the world beyond each individual, which is captured also by
the item ‘I have felt connected to a purpose in life’. This item
was originally hypothesised to belong to the CTS subscale but
analyses found it to load onto CTW, suggesting that ‘purpose’
is not related to the good of the individual, but to the good of
the world.
CTW contains one item relating to nature connectedness,
and one item relating to interconnectedness of everything. Both
of these items represent a kind of self-transcendence commonly
reported by people after psychedelic experiences, whereby one
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Psychopharmacology
1 3
feels part of an interconnected web of life, and recognises one’s
place in the patterns and fabric of the natural world (Noorani
etal. 2018). This sense of inter-relatedness is a fundamental
aspect of indigenous worldviews from all over the globe. Many
indigenous belief systems share a view of people and nature as
part of an extended ecological family: for example, the Māori,
indigenous people of Aotearoa; the Shipibo of Peru; the Rara-
muri of Chihuahua, Mexico; and the Skokomish of Washing-
ton; the Druids of Wales. These different groups, and many
more, separated by geography, culture and time, have described
this phenomenon. The Māori worldview (te ao Māori) acknowl-
edges the interconnectedness of all living and non-living things
(Rameka 2018). The Raramuri worldview includes ‘Iwigara’:
the total interconnectedness of all life, physical and spiritual
(Salmón 2000). From the point of view of these belief systems,
feeling separate from nature would signify a state of discon-
nectedness and constitute a significant rupture in wellbeing.
Connectedness to ourselves as part of an inter-related
web of life may be essential to the survival of our spe-
cies (Arce and Winkelman 2021), and this appears to be
a common insight occurring during psychedelic therapy,
as many quotes from participants in psychedelic research
studies attest (Agin-Liebes etal. 2021; Andros Aronovich
2019; Belser etal. 2017; Watts etal. 2017). Such insights
are often reported to lead to pro-environmental behaviours
(Forstmann and Sagioglou 2017).
If scientific study of connectedness should find that the
feeling of being interconnected with nature is associated
with wellbeing and pro-environmental behaviour, it will be
important to recognise the original, longstanding provenance
of this knowledge and include indigenous perspectives in
the study of connectedness. For example, the University of
Auckland is including the WCS in a study of connected-
ness and existential distress in Māori and non-Māori people
with a life-limiting illness. The project is designed and led
by Māori colleagues, who have added two additional CTW
items, which reflect Te ao Māori, to supplement the 19-item
WCS: ‘I have felt connected to toku whakapapa, my family
ancestry’ and ‘I have felt connected to toku whenua, my
land’. The dual meaning of ‘whenua’ (‘land’ and ‘placenta’)
exemplifies Māori wairua (spirituality), whereby intercon-
nectedness with everything is both grounded and sacred.
The WCS also contains items relating to connecting to a
source of universal love and connecting to a spiritual principle,
themes which are common in psychedelic therapy, and which
again map onto indigenous spiritualities, which can be differ-
entiated from religion and are based on a sense of connected-
ness and respect for the ‘earth, ancestors, family and peaceful
existence’ (Christakis and Harris 2004) ‘an internal connection
to the universe’ (Department of Economic and Social Affairs,
UN 2009) or an ‘intrinsic, autonomous, and subjective sense of
connection with a sacred dimension of reality, which provides
meaning, purpose, connection and balance’ (Valentine etal.
2017). The inclusion of spiritual items within the WCS may
be considered by some to be antithetical to scientific enquiry.
However, as many of the participants in our previous qualita-
tive research (Watts etal. 2017) who indicated spiritual con-
nectedness had been previously non-spiritual, this change in
metaphysical beliefs seems like an integral aspect of the psy-
chedelic experience (Timmermann etal. 2021). The importance
of mystical-type experience as a predictor of positive outcomes
(Roseman etal. 2017; Yaden and Griffiths 2020) requires us to
investigate further the relationship between connectedness and
spirituality, which the CTW items may facilitate.
Connectedness asatransdiagnostic factor
Psilocybin showed (statistically significantly) larger change
on the WCS than escitalopram. Importantly, the larger change
was also statistically significant when looking only at the
responders of both groups based on change in depression
scores. A triple interaction effect was found between condi-
tion (psilocybin vs escitalopram), response (responders vs
non-responders) and time (before therapy vs 6-week follow-
up). This triple interaction effect supports the hypothesis that
the therapeutic mechanism of psilocybin is different from
that of escitalopram’s. While both are effective in reducing
depression, the clinical response in the psilocybin group was
strongly associated with increased connectedness, and less
so in the escitalopram group. That there were still increases
in WCS scores seen in the escitalopram responders group
does not match qualitative reports from patients indicat-
ing that SSRI antidepressants can actually lessen a sense of
(emotional) connectedness, by making them feel emotionally
numbed (Watts etal. 2017). The increases in WCS scores in
the escitalopram responders group may be linked to the fol-
lowing: (1) improvements in other domains of connectedness
than CTS, as data shows; (2) the extensive personalised care,
attention and therapeutic support that participants in both
treatment arms of this trial received. In common healthcare
practice (in the UK, at least), SSRI medications are adminis-
tered without extensive psychotherapeutic care; and (3) some
non-orthogonality between depression and connectedness.
Psychedelic-assisted therapy is currently applied to dif-
ferent conditions such as depression, anxiety, addiction, ano-
rexia, obesity, chronic pain, OCD and PTSD (Siegel etal.
2021). In case such transdiagnostic application will prove
to be effective, a search for an underlying mechanism will
become relevant. Alienation, ‘dislocation’ and disconnec-
tion have been hypothesised to underlie many mental health
conditions, supporting the idea that disconnectedness is a
transdiagnostic phenomenon: these include eating disor-
ders (Huemer etal. 2011), borderline personality disorder
(Kverme etal. 2019), PTSD (Kearney etal. 2012), depres-
sion (Choi etal. 2020; Hari 2019; Karp 2017; Sorajjakool
etal. 2008; Watts etal. 2017), addiction (Alexander 2008),
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Psychopharmacology
1 3
anxiety (Taylor etal. 2020) and ADHD (van den Berg and
van den Berg 2011). It might be that traumatic experiences
in relationships with caregivers, others and society can dam-
age our access to a sense of connectedness and that psyche-
delic (and other) profound experiences can enable sudden
access to that state. This resonates with the reports of people
who have had meaningful psychedelic experiences.
To test whether and confirm that the phenomenon of a
foundational multidimensional connectedness has validity
and clinical utility, it will need to be measured in a range of
different clinical populations pre and post ‘treatment’. Future
observational and experimental research studies in various
settings looking at many different populations are including
the WCS in their battery of measures. The CIPPRes Clinic
(Central North West London-Imperial Psychopharmacology
& Psychedelic Research Clinic) will measure changes in
WCS scores for different clinical presentations (i.e. anorexia
nervosa, chronic pain, depression, anxiety). This transdiag-
nostic research avenue will be important for a ‘psychedeli-
cisation’ of medicine, because a successful integration—
and not assimilation—of psychedelics into psychiatry may
require a change in the way mental and emotional suffering
is understood by the dominant paradigms (Schenberg 2018).
Alongside transdiagnostic clinical research, psychedelic ses-
sions in group contexts will be a crucial avenue for study,
because of the additional boost to connectedness that is
experienced in such settings (Kettner etal. 2021).
In the current study, emotional, social and spiritual qualities
of the psychedelic experience predicted the changes in con-
nectedness. Psychedelic therapy is intensely context depend-
ent (Hartogsohn 2020)—and thus, the extent to which a par-
ticipant is able to experience emotional, social and spiritual
insights will itself rest on how they are therapeutically prepared
for the psychedelic experience, supported during it, and after
it. The ‘integration’ phase post dosing is considered essential
for acute experiences of connectedness to be consolidated and
incorporated into daily life. Integration sessions, where psy-
chedelic therapy has been effective, typically focus more on a
person’s wishes for making changes to how they behave within
their community and ecosystem than on biomedical issues like
changes to their symptoms of depression. Considering connect-
edness (or its absence) as a transdiagnostically foundational
factor is a reminder that—while connectedness can be tempo-
rarily boosted by psychedelic therapy—ongoing psychological,
communal, political, ecological and spiritual work is needed to
maintain connectedness. We believe that the multiple dimen-
sions of connectedness must be addressed by modern models of
psychedelic-assisted therapy in order for its safety and efficacy
to be optimised. In this way, psychedelics may assist in shifting
the dominant biomedical mental health model into a ‘biopsy-
chosocial’ model (Engel 1980; Winkelman 2010), or even a
‘bio-psycho-social-environmental-spiritual’ model, where
mental and emotional suffering is not considered as simply a
function of individual pathology, but linked to much broader
social, environmental and spiritual factors. Interestingly, this
model of health maps onto the Shipibo conception of health as
encompassing connectedness to self, community and the world
(Weiss etal. 2021) and the already well-established model of
Māori health, Te Whare Tapa Wha (Rochford 2004), which
comprises spiritual, mental, physical and family connectedness.
Connectedness maintenance post‑psychedelic
session
One of the biggest challenges facing psychedelic therapy is
how to help participants hold on to the benefits which are often
lost after a few months (Ortigo 2021). If multidimensional
connectedness is one of the main benefits, then being able to
study it easily will enable researchers to study different ways of
maintaining it after sessions. Without this kind of ‘integration
work’, there is a risk that people will become dependent on fre-
quent psychedelic experiences in order to feel connected, rather
than developing other practices and contextual changes. It is
hoped that the WCS will enable future quantitative measure-
ment of how connectedness typically wanes over time, which
may inform the development of therapy protocols with guid-
ance around when repeat sessions could occur. Also, integration
approaches for maintaining connectedness, such as community
and ecotherapy interventions, can be evaluated and compared.
The WCS may also help identify some of the risks of
psychedelic therapy and could offer particular usefulness in
helping us learn more about some commonly experienced dif-
ficulties in the much understudied integration phase (post-psy-
chedelic therapy), as clinical trials only collect data for a few
months after the session. Sometimes, the integration period
can be a time of confusion and overwhelm. Therapists work-
ing with people who have had psychedelic sessions and need
further support (integration therapists) tend to advise staying
present in the body, senses and emotions in the weeks after a
psychedelic session. Embodied self-awareness and connection
to a supportive and understanding community are both essen-
tial to psychedelic integration, in order to ‘ground’ a profound
and potentially destabilising connection to new ideas. Whereas
connection to world can be thought of as the branches of a tree
reaching up to the sky, connection to self can be considered
the trunk of the tree, and connection to others the root system.
Thus, ‘over-connecting’ to the world (CTW) without a
solid foundation of connection to self (CTS) could indicate
the need for psychotherapeutic integration and grounding,
rather than further psychedelic sessions. Some examples of
over-connecting to CTW without a strong CTS could be an
‘ontological shock’ (Davis etal. 2020b; Timmermann etal.
2021)—whereby assumptions about what it is to be a con-
scious living being on earth are deeply challenged—which
can sometimes precipitate hypo-manic or manic reactions
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Psychopharmacology
1 3
(Hendin and Penn 2021), ‘spiritual bypassing’ (Masters
2010) and ‘spiritual narcissism’ (Lasch 1979/2018; 1987).
Another risk of the integration period of psychedelic therapy
is the experience of intense disappointment. For individuals who
have felt disconnected for much of their life, a sudden burst of
connectedness that lasts for a few months but then dwindles may
be a risk factor in self-harm or suicide. Therefore, measuring an
individuals’ connectedness to self, others and the world in the
months after a psychedelic session may be important for safety,
Limitations
The current validation of WCS has a number of limitations:
(1) The validation of the WCS is limited by a self-selection
bias for the online questionnaire, and potentially also the
RCT—e.g., where the majority of volunteers were psilo-
cybin therapy preferring (vs. the SSRI treatment). Pop cul-
ture surrounding psychedelics tends to feature elements
of connectedness and it is possible that survey and RCT
participants were familiar with related topics and how
psychedelics may enhance them. Study participants were
predominantly WEIRD (white, educated, industrialised,
rich, democratic) (Henrich etal. 2010) reflecting a perva-
sive problem in psychedelic research (George etal. 2020).
Future studies should test the scale in the wider population.
(2) Many participants dropped out of the survey study, which
could have created attrition bias effects; e.g., those who
did not benefit from their psychedelic experience may
have been more likely to discontinue. Future studies
should take measures to solve such problems, possibly by
introducing more incentives for completion of the study.
(3) Comparison with more questionnaires are required to further
test the convergent and discriminant validity of the WCS.
(4) Following the advice by Jackson etal. (2014) on multiple
publications from the same study sample, the following
publications should be noted, which are based on the
same survey study samples used for internal validation
of the WCS: Kettner etal. (2021) researched group expe-
riences of psychedelic communitas; Timmermann etal.
(2021) studied changes in metaphysical beliefs; Zeifman
etal. (2020) researched experiential avoidance; Kuc etal.
(2021) researched the interaction of psychedelics with
cannabis; and Spriggs etal. (2021) researched changes
in wellbeing in individuals with eating disorders. Impor-
tantly, however, these publications explored clearly dis-
tinct research questions from the present paper.
(5) The item creation process for the WCS was based
on qualitative reports from a depression study and
may therefore be biased by this sample—and by the
qualitative nature of that original analysis. In order
to assess whether the final validated measure was
considered an accurate and appropriate tool by those
who had themselves experienced a psychedelic-
assisted therapy–induced connectedness, the WCS
was submitted to the Psychedelic Participant Advi-
sory Network, (PsyPAN) who were asked to review
it and consider whether there were any aspects of
psychedelic therapy–induced connectedness that
were not represented by the measure, or any exist-
ent items which they thought did not belong there
or were disagreed with. PsyPAN’s feedback was that
the measure could have asked about connecting to
personal values as part of ‘connectedness to world’,
for example, becoming vegetarian, changing to a
more meaningful job or joining activist networks.
An item relating to ‘connectedness to values’ was
in fact in the original 23-item WCS in the CTS scale
but removed after factor analysis because it loaded
onto both connectedness to self and connectedness
to world. Two other items were removed for the same
reason: ‘I have felt connected to deeper aspects of
myself’ and ‘I have felt connected to insight/intui-
tion’. These three items taken together point perhaps
to a type of self-connectedness which has not been
included in the final WCS, which could be conceptu-
alized as less changeable than embodied, sensory and
emotional experience, which tends to be transitory.
A ‘deeper’ more immutable aspect of self may need
to be re-introduced to measures of connectedness,
despite its crossloading here on both CTS and CTW.
This crossloading in itself is worthy of future study.
(6) The 19-item measure is not exhaustive. There will be
aspects of connectedness that are not included in the
current WCS. This 19-item measure is a starting point.
It is hoped that others will suggest items that are rel-
evant based on their observations. It would be possible
to have different versions of this scale validated for dif-
ferent populations, perhaps with the ‘W’ removed and
replaced with a more appropriate letter for that context.
Until that time, we hope the current validated WCS will
be a starting point for the quantitative study of the state
of feeling connected to self, others and the world.
Conclusions
Previous findings that many different dimensions of connected-
ness are linked to positive mental health outcomes suggest that
connectedness, in all its forms, should be carefully explored and
defined. The present work supports the view that a fundamental
multidimensional state of connectedness exists and has devel-
oped a scale that defines and measures this phenomenon. Previ-
ously, research findings regarding connectedness have tended to
probe only sub-dimensions of the phenomena, making it difficult
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Psychopharmacology
1 3
to compare results and build the research corpus. Having a sin-
gle measure comprising multiple dimensions of connectedness
may help to consolidate the view that these sub-dimensions are
inter-related and underpinned by a common generalised con-
nectedness. If used widely, the WCS may help us understand
how different aspects of connectedness relate to each other and
the interventions and conditions under which connectedness is
experienced and maintained. Psychedelic-assisted therapy may
prove to be one of the most effective interventions for increas-
ing connectedness among individuals and groups of people—
and future research may reveal how important this effect is for
improving and maintaining mental health.
Supplementary Information The online version contains supplemen-
tary material available at https:// doi. org/ 10. 1007/ s00213- 022- 06187-5.
Acknowledgements The lead author would like to thank Eva Morunga,
Hineatua Parkinson, Alesha Wells and Lisa Reynolds from the University
of Auckland for their reflections and contributions to the manuscript. We
would like to thank the Alexander Mosley Charitable Trust for funding the
psilocybin vs escitalopram clinical trial. We would also like to acknowl-
edge the funders of the Center for Psychedelic Research, Imperial College
London, which supported this study: Shamil Chandaria (Ad Astra Trust),
Anton Bilton, Tim Ferriss, The Nikean Foundation and The Tamas Family.
Declarations
Conflict of interest RW is a clinical advisor to Synthesis Institute and
Usona Institute, a consultant clinical psychologist to Small Pharma, and
the founder of Acer Integration Ltd. CT is a scientific advisor to En-
theon Biomedical. RCH is a scientific advisor to Entheon Biomedical,
Mydecine, Maya Health, Osmind, Synthesis Institute, Tryp Therapeu-
tics, Journey Collab, Beckley Psytech and Usona Institute. DN receiv-
ing consulting fees from Awakn, H. Lundbeck, and Psyched Wellness,
advisory board fees from COMPASS Pathways, and lecture fees from
Takeda Medical Research Foundation and owning stock in Alcarelle.
Open Access This article is licensed under a Creative Commons Attri-
bution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long
as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes
were made. The images or other third party material in this article are
included in the article's Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in
the article's Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/.
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Psychopharmacology
1 3
Authors and Aliations
RosalindWatts1,2,3· HannesKettner1· DanaGeerts1,4· SamGandy1· LauraKartner1· LeaMertens1·
ChristopherTimmermann1· MatthewM.Nour1· MendelKaelen1· DavidNutt1· RobinCarhart‑Harris1,5·
LeorRoseman1
* Rosalind Watts
contact@drrosalindwatts.com
* Leor Roseman
Leor.roseman13@imperial.ac.uk
1 Centre forPsychedelic Research, Imperial College London,
London, UK
2 Acer Integration, London, UK
3 Synthesis Institute, Amsterdam, Netherlands
4 Department ofNeuropsychology andPsychopharmacology,
Faculty ofPsychology andNeuroscience, Maastricht
University, Maastricht, Netherlands
5 Psychedelics Division, Department ofNeurology, University
ofCalifornia San Francisco, Neuroscape, USA
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... Use of the term "connectedness" to refer to this phenomenon, as proposed by Watts et al. (2017), seems particularly useful for clinically-oriented psychedelic research as it stands in opposition to disconnectedness, a detrimental state commonly reported by depressed patients before undergoing psychedelic therapy . Secondly, the related Watts Connectedness Scale (Watts et al., 2022) distinguishes between three distinct kinds of connectedness: with self, with others, and with the world. All three types are believed to be beneficial to an individual's mental wellbeing and health. ...
... Only two aspects of "connectedness" as proposed by Watts, i.e., with others and the world/universe, are synonymous with "oceanic boundlessness" and "oneness". The third category, connectedness with (own) self, does not overlap with these terms sufficiently as for instance oceanic boundlessness can be described as "positively experienced depersonalization" (Studerus et al., 2010) rather than reconnection with the "deeper aspects" of the individual self (Watts et al., 2022). Therefore "connectedness with self" is not investigated in this study. ...
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