Developing Methods for Observing Awe Narration in Psilocybin-Assisted Therapy.
Elise C Tarbi, Ian Bhatia, Nabil Balach, Suzannah Buehler, Magdalena Demeo-meres, Cailin Gramling, Tej Thambi, Julia Hart, Maija Reblin, Donna M Rizzo, Robert Gramling, Manish Agrawal, Emily Manetta
Healthcare (Basel, Switzerland) June 5, 2026 Peer reviewed DOI: 10.3390/healthcare14111589 via PubMed
Summary
Awe experiences during psilocybin-assisted therapy (PAT) can be observed and coded using specific criteria. In an analysis of 32 clinical trial recordings, coders identified 246 moments of awe narration across 16,760 minutes of video. They found that coders were significantly more confident in identifying awe when vastness was present. The study also refined the coding system to distinguish between cognitive disruption and engagement in accommodation, laying groundwork for scalable coding systems in PAT.
Study at a glance
| Design | observational cohort |
|---|---|
| Sample size | 8 |
| Population | participants from a Phase 2 clinical trial study of psilocybin-assisted therapy in advanced cancer |
| Key finding | Coders recorded 246 moments of awe narration during PAT, with increased confidence when vastness was present. |
Abstract
Background: Understanding the benefits of psychedelic-assisted therapy (PAT) will require scientific attention to the causal interaction between the therapeutic context and process. Measuring what actually happens during PAT in large-scale studies will be an essential component of this work. Objective: We aim to develop and preliminarily evaluate the feasibility and reliability of a direct observation coding system for narrations of awe experiences during PAT, one hypothesized therapeutic mechanism. Methods: We analyzed 32 PAT clinical trial encounter recordings involving eight participants from a Phase 2 clinical trial study of psilocybin-assisted therapy in advanced cancer. Using a conceptually grounded structured codebook, two human coders independently identified start and stop times for moments exhibiting definitional characteristics of awe narration, including expressions of vastness, need for accommodation and ineffability. We used coder agreement and degree of confidence to refine the coding system. Results: During 16,760 total minutes of video, coders collectively recorded 246 moments of awe narration. Of those moments, 42% (104/246) were identified by one coder and 58% (142/246) by two coders. Coders felt substantially more confident in their judgments about a moment of awe when vastness was present compared to when vastness was absent (OR: 4.3; 95% CI: 2.4, 7.8). Iterative refinement of the coding system led to accommodation being operationalized as two distinct components: an initial cognitive disruption followed by variable engagement in the process of accommodation. Conclusions: Awe narration is directly observable using explicit definitional criteria. This work provides the empirical foundation for scalable coding systems of awe narration during PAT.