Nonordinary Experiences, Well-being and Mental Health: A Systematic Review of the Evidence and Recommendations for Future Research

Throughout history, people have reported nonordinary experiences (NOEs) such as feelings of oneness with the universe and hearing voices. Although these experiences form the basis of several spiritual and religious traditions, experiencing NOEs may create stress and uncertainty among those who experience such events. To provide a more systematic overview of the research linking NOEs with mental health, we present a systematic review of studies focusing on NOEs, well-being and mental health indicators. In a search of ProQuest and PsycInfo, we identified 725 references, of which 157 reported empirical data and were included in our review. Overall, the studies reviewed suggest that the relationship between NOEs and mental health is complex, varying according to a series of psychological and social factors. In particular, they suggest that appraisal processes play a fundamental role in the mental health outcomes of these experiences. However, we also highlight important methodological challenges such as the conceptual overlap between NOEs and well-being or psychopathological constructs, the conflation between experiences and appraisal processes in the assessment procedure, and the need for clearer assessment of the duration, controllability, impact on daily functioning and general context of the experiences. We provide a qualitative summary of empirical evidence and main themes of research and make recommendations for future investigation.

Structural Relationships Among Mental Boundaries, Childhood Imaginary Companions, Creative Experiences, and Entity Encounters

This study investigated relationships between thin mental boundary functioning, creativity, imaginary companions (ICs), and anomalous '(entity) encounter experiences.' A convenience sample of 389 respondents completed the Revised Transliminality Scale, Oxford-Liverpool Inventory of Feelings and Experiences, Creative Experiences Questionnaire, Survey of Strange Events, and a measure of Childhood Imaginary Companions. Competing testing with path analysis found that the best-fitting model was consistent with the causal chain of 'Thin Boundaries (transliminality and schizotypy) → Creative Experiences → ICs → (Entity) Encounter Experiences.' These results suggest that deep-types of ICs (i.e., showing apparent independent agency) are perhaps most accurately characterized as syncretic cognitions versus hallucination-like experiences. The authors examine these findings relative to study limitations, as well as discussing the need for future research that approaches ICs as a special mental state that can facilitate allied altered-anomalous experiences. In this context, this study furthered understanding of relationships between conscious states related to mental boundaries, childhood imaginary companions, creative experiences, and entity encounters.

Case Study of Recognition Patterns in Haunted People Syndrome

Haunted People Syndrome (HP-S) denotes individuals who recurrently report various “supernatural” encounters in everyday settings ostensibly due to heightened somatic-sensory sensitivities to dis-ease states (e.g., marked but sub-clinical levels of distress), which are contextualized by paranormal beliefs and reinforced by perceptual contagion effects. This view helps to explain why these anomalous experiences often appear to be idioms of stress or trauma. We tested the validity and practical utility of the HP-S concept in an empirical study of an active and reportedly intense ghostly episode that was a clinical referral. The case centered on the life story of the primary percipient, a retired female healthcare worker. Secondary percipients included her husband and adult daughter, all of whom reported an array of benign and threatening anomalies (psychological and physical in nature) across five successive residences. Guided by prior research, we administered the family online measures of transliminality, sensory-processing sensitivity, paranormal belief, locus of control, desirability for control, and a standardized checklist of haunt-type phenomena. The primary percipient also completed a measure of adverse childhood events and supplied an event diary of her anomalous experiences. We found reasonably consistent support for HP-S from a set of quantitative observations that compared five proposed syndrome features against the family members’ psychometric profiles and the structure and contents of their anomalous experiences. Specifically, the reported anomalies both correlated with the family’s scores on transliminality and paranormal belief, as well as elicited attributions and reaction patterns aligned with threat (agency) detection. There was also some evidence of perceptual congruency among the family members’ anomalous experiences. Putative psi cannot be ruled out, but we conclude that the family’s ordeal fundamentally involved the symptoms and manifestations of thin (or “permeable”) mental boundary functioning in the face of unfavorable circumstances or overstimulating environments and subsequently acerbated by poor emotion regulation, histrionic and catastrophizing reactions, and active confirmation biases.

Spontaneous Spiritual Awakenings: Phenomenology, Altered States, Individual Differences, and Well-Being

Spontaneous Spiritual Awakenings (SSAs) are subjective experiences characterised by a sudden sense of direct contact, union, or complete nondual merging (experience of oneness) with a perceived ultimate reality, the universe, "God," or the divine. These profound transformative experiences have scarcely been researched, despite extensive anecdotal evidence suggesting their potential to catalyse drastic, long-term, and often positive shifts in perception, world-view, and well-being. The aims of this study were to investigate the phenomenological variances of these experiences, including the potential differences between SSAs and Spontaneous Kundalini Awakenings (SKAs), a subset of awakening experiences that the authors postulate may produce a higher likelihood of both physical and negative effects; to explore how these experiences compare to other altered states of consciousness (ASCs), including those mediated by certain psychedelic substances; and understand their impact on well-being. Personality trait absorption and temporal lobe lability (TLL) were assessed as predictors of Spontaneous Spiritual and Kundalini Awakenings (SSA/SKAs). A mixed within and between-participants self-report survey design was adopted. A total of 152 participants reporting their most powerful SSA/SKAs completed questionnaires measuring nondual, kundalini, and mystical experience, as well as depth of ASC, and trait absorption and TLL. Spontaneous Kundalini Awakenings were found to be significantly more physical, but not significantly more negative than SSAs, and overall, both sets of experiences were perceived to be overwhelmingly more positive than negative, even in cases where the experience was initially challenging. The phenomenological distribution of SSA/SKAs was similar to other measured ASCs although greater in magnitude, and appeared most similar in distribution and in magnitude to drug-induced ASCs, particularly classic psychedelics DMT and psilocybin. Temporal lobe lability and trait absorption were found to predict the SSA/SKA experience. The limitations and implications of these findings are discussed.

Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice

Psychedelic Harm Reduction and Integration (PHRI) is a transtheoretical and transdiagnostic clinical approach to working with patients who are using or considering using psychedelics in any context. The ongoing discussion of psychedelics in academic research and mainstream media, coupled with recent law enforcement deprioritization of psychedelics and compassionate use approvals for psychedelic-assisted therapy, make this model exceedingly timely. Given the prevalence of psychedelic use, the therapeutic potential of psychedelics, and the unique cultural and historical context in which psychedelics are placed, it is important that mental health providers have an understanding of the unique motivations, experiences, and needs of people who use them. PHRI incorporates elements of harm reduction psychotherapy and psychedelic-assisted psychotherapy, and can be applied in both brief and ongoing psychotherapy interactions. PHRI represents a shift away from assessment limited to untoward outcomes of psychedelic use and abstinence-based addiction treatment paradigms and toward a stance of compassionate, destigmatizing acceptance of patients' choices. Considerations for assessment, preparation, and working with difficult experiences are presented.

Progress or Pathology? Differential Diagnosis and Intervention Criteria for Meditation-Related Challenges: Perspectives From Buddhist Meditation Teachers and Practitioners

Studies in the psychology and phenomenology of religious experience have long acknowledged similarities with various forms of psychopathology. Consequently, it has been important for religious practitioners and mental health professionals to establish criteria by which religious, spiritual, or mystical experiences can be differentiated from psychopathological experiences. Many previous attempts at differential diagnosis have been based on limited textual accounts of mystical experience or on outdated theoretical studies of mysticism. In contrast, this study presents qualitative data from contemporary Buddhist meditation practitioners and teachers to identify salient features that can be used to guide differential diagnosis. The use of certain existing criteria is complicated by Buddhist worldviews that some difficult or distressing experiences may be expected as a part of progress on the contemplative path. This paper argues that it is important to expand the framework for assessment in both scholarly and clinical contexts to include not only criteria for determining normative fit with religious experience or with psychopathology, but also for determining need for intervention, whether religious or clinical. Qualitative data from Buddhist communities shows that there is a wider range of experiences that are evaluated as potentially warranting intervention than has previously been discussed. Decision making around these experiences often takes into account contextual factors when determining appraisals or need for intervention. This is in line with person-centered approaches in mental health care that emphasize the importance of considering the interpersonal and cultural dynamics that inevitably constitute the context in which experiences are evaluated and rendered meaningful.

Psychosis or spiritual emergency? A Foucauldian discourse analysis of case reports of extreme mental states in the context of meditation

Meditation is becoming increasingly popular in the West and research on its effects is growing. While studies point to various benefits of meditation on mental and physical health, reports of extreme mental states in the context of meditation have also been published. This study employed Foucauldian discourse analysis to examine how the experience of extreme mental states has been constructed in case reports and what kind of practices were employed to address them. The study analyses how extreme mental states associated with meditation are framed within the scientific literature and how such differential framings may affect the meaning making and help-seeking of persons experiencing these states. A systematic scientific literature search identified 22 case studies of extreme mental states experienced by practitioners of various types of meditation. The analysis suggests a discursive divide between two dominant framings: a biomedical discourse which constructs such experiences as psychiatric symptoms and an alternative discursive, which understands them as spiritual emergencies. Both approaches offered distinct therapeutic avenues. This divide maps onto the disciplinary divides within the mental health field more generally, which may obscure a better understanding of these experiences. However, the two discourses are not necessarily mutually exclusive and authors of three articles chose to blend them for their case reports. A supportive environment could help those experiencing extreme state integrate them into their lives. Our findings encourage collaboration between clinicians, therapists and spiritual teachers in order to make a range of approaches available.

Alexander Nikolaevich Scriabin (1872-1915): Enlightenment or illness?

The similarity between psychotic symptoms and aspects of mystical experiences is well known. It has long been recognized that there are similarities between mystical and spiritual and psychotic experiences. The content of an experience alone usually does not determine whether an individual is psychotic. The Russian composer Scriabin (1872-1915) was among the most famous artists of his time. Scriabin infused his music with mysticism, evolving a modernistic idiom through which he created a musical counterpart to the Symbolist literature of that period. In this paper, we discuss the question that arises from perusing Scriabin's life is whether the composer was a mystic genius or whether he suffered from affective psychopathology with psychotic features.

Normal or abnormal? 'Normative uncertainty' in psychiatric practice

The 'multicultural clinical interaction' presents itself as a dilemma for the mental health practitioner. Literature describes two problematic areas where this issues emerges--how to make an adequate distinction between religious rituals and the rituals that may be symptomatic of 'obsessive compulsive disorder' (OCD), and how to differentiate 'normative' religious or spiritual beliefs, behaviours, and experiences from 'psychotic' illnesses. When it comes to understanding service user's 'idioms of distress', beliefs about how culture influences behaviour can create considerable confusion and 'normative uncertainty' for mental health practitioners. In the absence of clear diagnostic and assessment criteria on distinguishing between 'culture' and 'psychopathology', practitioners have had to rely on their own intuition and seek out possible 'strategies' or 'procedures' from a contradictory and cross-disciplinary evidence base. Decontextualisation of service users' experiences may result in the pathologisation of culturally 'normative' phenomenon, 'category fallacy' errors, and poor health care experiences and outcomes for service users.This paper situates this dilemma within a wider debate that has concerned both the biomedical and social sciences, namely, the unresolved question of 'normality' or 'abnormality'. Indeed, issues that arise from dilemmas surrounding the question of 'culture' or 'psychopathology' are intimately tied to wider cultural ideas about what is considered 'normal'. The disciplines of psychiatry, psychology, and medical anthropology have struggled to establish workable criteria against which to judge behaviour as 'normal', 'abnormal', or 'pathological'. Three models for understanding mental 'abnormality' are evident in 'transcultural psychiatry' (what is now commonly known as 'cultural psychiatry'), and these models have corresponded closely to the interpretive models used by anthropologists attempting to make sense of the apparent diversity of human societies. The three models of 'absolutism', 'universalism' and 'cultural relativism' have not only important consequences for the nature and conduct of research enquiry, but also have implications for how the dilemma of 'culture' or 'psychopathology' is attended to in clinical practice.

Spirituality as a scientific construct: testing its universality across cultures and languages

Using data obtained from 4004 participants across eight countries (Canada, India, Japan, Korea, Poland, Slovakia, Uganda, and the U.S.), the factorial reliability, validity and structural/measurement invariance of a 30-item version of Expressions of Spirituality Inventory (ESI-R) was evaluated. The ESI-R measures a five factor model of spirituality developed through the conjoint factor analysis of several extant measures of spiritual constructs. Exploratory factor analyses of pooled data provided evidence that the five ESI-R factors are reliable. Confirmatory analyses comparing four and five factor models revealed that the five dimensional model demonstrates superior goodness-of-fit with all cultural samples and suggest that the ESI-R may be viewed as structurally invariant. Measurement invariance, however, was not supported as manifested in significant differences in item and dimension scores and in significantly poorer fit when factor loadings were constrained to equality across all samples. Exploratory analyses with a second adjective measure of spirituality using American, Indian, and Ugandan samples identified three replicable factors which correlated with ESI-R dimensions in a manner supportive of convergent validity. The paper concludes with a discussion of the meaning of the findings and directions needed for future research.

God put a thought into my mind: the charismatic Christian experience of receiving communications from God

The agentive aspects of communicative religious experiences remain somewhat neglected in the social sciences literature. There is a need for phenomenological descriptions of these experiences and the ways in which they differ from culturally defined psychopathological states. In this semi-structured interview study, eight congregants attending an evangelical church in London were asked to describe their experiences of God communicating with them. Communications from God were related to current events rather than to the prediction of future events. These communications were received as thoughts and do not generally reveal metaphysical insights, but rather they relate to the mundane world. They provided direction, consolation and empowerment in the lives of those receiving them. Individuals recounted that on occasion God sometimes speaks audibly, or accompanied by supernatural phenomena, but in the vast majority of cases, the way God speaks is through thoughts or impressions. In all instances, agency is maintained, individuals can choose to obey the thoughts/voices or not. The findings are discussed in relation to externalisation of agency and the phenomenon of thought insertion in schizophrenia.

Religiousness and spirituality in patients with bipolar disorder

BACKGROUND

Religiousness and spirituality (R/S) are often neglected features among psychiatric patients but important both for quality of life and coping strategies for mental disorders. In patients affected by bipolar disorder (BD), R/S can sometimes be confused with symptoms related to the psychiatric disorder. This study aimed to perform a clinical review of the relationship between R/S and BD.

METHODS

Data sources included Medline (OvidSP), CINAHL (Ebsco), EMBASE (Ovid), PsychINFO (Ebsco), Angeline, Cochrane Database of Systematic Reviews and Database of Abstract of Reviews of Effects, searching for pertinent Keywords: 'religiousness', 'spirituality' and 'bipolar disorder'.

RESULTS

Nine works were found but only five used homogeneous samples with BD patients. R/S were important when facing symptoms and relapses in the lifeworld. These beliefs influenced the relationship with psychiatrists and spiritual figures of reference.

CONCLUSIONS

R/S play a role as a psychosocial variable in the course of BD. However, the hypothesis that the R/S factor can be relevant both in terms of providing a protective effect as well as a provocative element in depressive or hypomanic phases was not fully supported at the moment.

Assessing Spiritual Crises

What feels like spiritual experience to believers could seem like psychosis, a break from reality, to another. Validating measures that discriminate spiritual experiences from psychopathology reduce iatrogenic effects of misdiagnosis. We tested the reliability and validity of the Spiritual Emergency Scale (SES), assessing internal consistency, test–retest reliability, structural, convergent, and divergent validity. The reliability and validity of the Experiences of Psychotic Symptoms Scale (EPSS) were tested to explore potential convergent and divergent relationships between SE and psychosis. Feedback from a spiritual pilot sample prompted scale amendments to the SES and EPSS, whereby 5-point Likert-type scales replaced true–false options. We sampled 98 people from online spiritual forums, 94 undergraduate psychology students, and 20 of their friends and family. Scales included the following: SE, positive symptoms of psychosis, alogia (disfluency of thought and speech), spirituality, depression, anxiety, stress, and mysticism (experiences of connectedness that escape language). The SES-R and EPSS-R exhibited good internal consistency and structural validity, adequate test–retest reliability, and convergent and divergent validity. SE emerges as a distinct measurable construct, overlapping with positive symptoms of psychosis, distinguishable from the negative dimension of psychosis by its divergent relationship with alogia.

Bereavement and transformation: a psycho-spiritual and post-traumatic growth perspective

In the aftermath of loss, it is not uncommon for individuals to disclose psycho-spiritual experiences that lead to personal changes and psychological growth. This article argues for and outlines a broad conceptual framework that captures and acknowledges the significance of these subjective experiences. The model synthesises and integrates two approaches to healthy growth: Lawrence Calhoun and Richard Tedeschi's post-traumatic growth model and Stanislav and Christina Grof's model of psycho-spiritual transformation. A rationale for a broader model and underpinning theory is briefly discussed, and their shared understandings about the human potential for growth in the struggle through loss are explored.

Religion and the DSM: from pathology to possibilities

Many individuals seeking psychological services refer to their religious or spiritual beliefs during treatment (Shafranske and Maloney in Psychotherapy 27: 72-78, 1990). Although psychology has consistently pathologized religion and/or spirituality in the past, it is vital that clinicians understand their impact on diagnosis and treatment. The evolution of the DSM, as explored in this manuscript, is evidence of continued attempts to expand clinicians' religious and/or spiritual sensitivity. In order for religion to be incorporated as a cultural component, psychologists need appropriate training. The author concludes with a case illustration and recommendations for continued development of religion as a cultural factor in the DSM-V.