Pictorial representation of illness and self measure (PRISM): A putative transdiagnostic tool for evaluating therapeutic effects of psychedelic treatments

Background: Patients with refractory conditions often identify themselves with their illness, which affects multiple aspects of their lives. The pictorial representation of illness and self measure (PRISM) is a tool used to assess the enmeshment of individuals’ perception of self with a particular medical condition, broadly termed self-condition enmeshment. Aims: This study aimed to evaluate changes in PRISM scores and how these changes relate to symptom changes following naturalistic psychedelic use. Methods: In this survey, we retrospectively assessed changes in PRISM scores in 297 individuals who self-engaged in naturalistic psychedelic use for therapeutic purposes. Participants also completed the Patient Global Impression of Change (PGIC) scale to report symptom changes resulting from their perceived most salient psychedelic experience (MSPE). Results: PGIC scores indicated that the majority of participants with depression (95.4%), posttraumatic stress disorder (98.36%), and anxiety (94.87%) reported symptom improvement following naturalistic psychedelic use. There was a significant decrease (p = 4.65 × 10⁻²⁵) in PRISM scores after MSPE compared to their PRISM scores before MSPE, indicating that individuals experienced a reduced identification of their identity with their condition following psychedelic use. PRISM change scores were also correlated with PGIC scores across all conditions (ρ = 0.41, p = 1.64 × 10⁻¹¹), indicating that reductions in self-condition enmeshment were associated with symptom improvement. Conclusions: Our results suggest that PRISM has transdiagnostic sensitivity for investigating the effects of psychedelics on self-perception. Interpretation is limited by convenience sampling, potential positive bias, retrospective reporting, and unclear doses and settings with natural psychedelic use.