Directly observing therapeutic connection during psilocybin-assisted therapy is feasible. In a clinical trial, three coders independently reviewed audio and video from four 8-hour psilocybin administration sessions, identifying 372 moments of therapeutic connection. Eighty-three percent of these moments were detected by at least two coders, and 41% by all three. Coders used both audible cues (speech prosody, words) and visible cues (body movements, eye gaze, touch) in 51% of observed events. The expressions of connection varied as the drug's effects on consciousness changed over time. The findings suggest that evaluating both sound and video is necessary to capture the full range of therapeutic connection.
A direct observation coding system can reliably identify moments when people narrate experiences of awe during psychedelic-assisted therapy. In 32 video-recorded therapy sessions from a Phase 2 trial of psilocybin-assisted therapy for advanced cancer, two coders independently identified 246 moments of awe narration across 16,760 minutes. Coders were substantially more confident when vastness was present (odds ratio 4.3). The coding system was refined to split accommodation into two components: initial cognitive disruption and later engagement with that disruption. Awe narration is observable using explicit definitional criteria, providing a foundation for larger-scale studies.