Instructions: Looking back on the entirety of your psilocybin session, please rate the degree to which at any time during that session you experienced the following phenomena. Answer each question according to your feelings, thoughts, and experiences at the time of the psilocybin session. In making each of your ratings, use the following scale:

0 – none; not at all; 1 – so slight cannot decide; 2 – slight; 3– moderate; 4 – strong (equivalent in degree to any other strong experience); 5– extreme (more than any other time in my life and stronger than 4)

Factor 1: Mystical

1. Freedom from the limitations of your personal self and feeling a unity or bond with what was felt to be greater than your personal self.

2. Experience of pure being and pure awareness (beyond the world of sense impressions).

3. Experience of oneness in relation to an “inner world” within.

4. Experience of the fusion of your personal self into a larger whole.

5. Experience of unity with ultimate reality.

6. Feeling that you experienced eternity or infinity.

7. Experience of oneness or unity with objects and/or persons perceived in your surroundings.

8. Experience of the insight that “all is One”.

9. Awareness of the life or living presence in all things.

10. Gain of insightful knowledge experienced at an intuitive level.

11. Certainty of encounter with ultimate reality (in the sense of being able to “know” and “see” what is really real at some point during your experience.

12. You are convinced now, as you look back on your experience, that in it you encountered ultimate reality (i.e., that you “knew” and “saw” what was really real).

13. Sense of being at a spiritual height.

14. Sense of reverence.

15. Feeling that you experienced something profoundly sacred and holy.

Factor 2: Positive Mood

1. Experience of amazement.

2. Feelings of tenderness and gentleness.

3. Feelings of peace and tranquility.

4. Experience of ecstasy.

5. Sense of awe or awesomeness.

6. Feelings of joy.

Factor 3: Transcendence of Time and Space

1. Loss of your usual sense of time.

2. Loss of your usual sense of space.

3. Loss of usual awareness of where you were.

4. Sense of being “outside of” time, beyond past and future.

5. Being in a realm with no space boundaries.

6. Experience of timelessness.

Factor 4: Ineffability

1. Sense that the experience cannot be described adequately in words.

2. Feeling that you could not do justice to your experience by describing it in words.

3. Feeling that it would be difficult to communicate your own experience to others who have not had similar experiences.