The Acceptance/Avoidance-Promoting Experiences Questionnaire (APEQ): A theory-based approach to psychedelic drugs’ effects on psychological flexibility

Abstract

Background: Many benefits and some harms associated with psychedelic use could be attributable to these drugs’ acceptance/avoidance-promoting effects and corresponding changes in psychological flexibility. Underlying psychological mechanisms are insufficiently understood. Aim: The purpose of this study was the validation of a psychological model of acceptance/avoidance-promoting psychedelic experiences, which included the development of a theory-based self-report instrument: the Acceptance/Avoidance-Promoting Experiences Questionnaire (APEQ). Its two main scales, acceptance-related experience (ACE) and avoidance-related experience (AVE), represent the theorized model’s core constructs. We aimed to test the model’s central assumptions of complementarity (ACE and AVE may occur alternatingly but not simultaneously, and are therefore empirically independent), intertwinedness (subaspects within ACE and AVE are mutually contingent and therefore highly inter-correlated), context-dependence (ACE and AVE depend on context factors) and interaction (longer-term outcomes depend on the interplay between ACE and AVE). Method: A bilingual retrospective online survey including 997 English- and 836 German-speaking participants. Each participant reported on one psychedelic experience occasioned by lysergic acid diethylamide (LSD), psilocybin, mescaline, or ayahuasca. Results: Whereas ACE and AVE were found to be relatively independent aspects of participants’ reported psychedelic experiences (complementarity), their subaspects were mostly distinguishable but strongly correlated among each other (intertwinedness). Therapeutic, escapist, and hedonic use motives were differentially associated with ACE and AVE (context-dependence), which were in turn associated with retrospective changes in psychological flexibility following participants’ reported experiences. The positive association between ACE and increased psychological flexibility was significantly moderated by AVE (interaction). Conclusion: These results provide an initial validation of the APEQ and its underlying theoretical model, suggesting the two can help clarify the psychological mechanisms of psychedelic-induced benefits and harms. Both should be further investigated in prospective-longitudinal and clinical studies.

Holding on or letting go? Patient experiences of control, context, and care in oral esketamine treatment for treatment-resistant depression: A qualitative study

“…In therapeutic approaches with classic psychedelics, preparation entails educating patients about the possibility of challenging experiences, and instructing them to accept, rather than resist, whatever emerges, however difficult (46, [49][50][51][52]. Supporting TRD patients to go along with potentially difficult and overwhelming experiences, instead of avoiding them, can promote patient care and comfort by reducing distress (53,54). The shift from avoidance/control to acceptance/surrender has been suggested as an important therapeutic mediator in treatment with classical psychedelics (51- 53,55,56); further research should investigate whether this process holds therapeutic promise for (es)ketamine treatment as well.…”

“…Supporting TRD patients to go along with potentially difficult and overwhelming experiences, instead of avoiding them, can promote patient care and comfort by reducing distress (53,54). The shift from avoidance/control to acceptance/surrender has been suggested as an important therapeutic mediator in treatment with classical psychedelics (51- 53,55,56); further research should investigate whether this process holds therapeutic promise for (es)ketamine treatment as well.…”

Psychedelics in the treatment of unipolar and bipolar depression

“…In recent psychotherapy approaches, especially of the so-called third wave, mindfulness and acceptance are important therapeutic strategies for the management of psychosocial distress (Khoury et al, 2015 ), and there is growing evidence that mindfulness techniques and psychedelics have synergistic positive effects (Heuschkel and Kuypers, 2020 ). Recent models aim at integrating increased psychological flexibility and acceptance into the framework of psychedelics-assisted psychotherapy (Watts and Luoma, 2020 ; Wolff et al, 2022 ). In a study with 39 experienced meditators receiving a single dose of 0.315 mg/kg psilocybin p.o.…”

Springtime for psychopharmacology

“…Caffeine has, of course, fascinated psychopharmacologists for many years and will no doubt continue to do so for many more (Fagan et al, 1988). Wolff et al (2022) present The Acceptance/Avoidance-Promoting Experiences Questionnaire (APEQ) and provide initial validation for the scale. The ideas of acceptance and avoidance-promoting psychedelic-induced experiences, which are concepts subsumed within the concept of psychological flexibility, contributed to the design of the APEQ.…”