-->PONE-D-25-47007-->-->Making sense of the extraordinary: An exploration of the content and prevalence of appraisals of nonordinary experiences-->-->PLOS ONE

Dear Dr. Fischer,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has a great deal of merit but some revisions are required. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.-->--> -->-->======================================-->-->The reviewers have provided a really useful set of comments that – when addressed – should improve the manuscript. In addition to the comments from the reviewers, please consider the comments from me below.

Sub01AE1 = I think it would be very helpful for readers if a simple hyperlink (such as https://doi.org/10.1371/journal.pone.0287780.s001) was inserted in the MS, that ‘takes’ readers to a copy of the original INOE. This would make it easier for the reader to get a good understanding of the range of experiences classed as an ‘NOE’ (although that may just reflect my lack of familiarity with this concept).

Sub01AE2 = On line 355, the study’s pre-registration is mentioned and a citation is provided for that pre-registration. However, I do not think that the document cited is a pre-registration (although it may contain info about the pre-registration). I think this - https://osf.io/ze6cb/overview – link needs to be provided at line 355 instead? Apologies if I am mistaken.

Sub01AE3 = On lines 752-753, two papers are cited re: predictive coding and source-monitoring theories of hallucinations. I am not sure, however that these are particularly effective publications to cite here. Other papers – such as https://academic.oup.com/schizophreniabulletin/article/38/4/683/1870142 or https://www.cell.com/trends/cognitive-sciences/fulltext/S1364-6613(18)30282-1 or https://www.annualreviews.org/content/journals/10.1146/annurev-clinpsy-032816-045145 - may be better to cite (although it does depend on the precise point you ar emaking; especially if the aim is to cite a paper that supports the claim that being alone/socially isolated may affect predictive processing/source monitoring in a way that increases the likelihood of a hallucinatory experience).-->--> -->-->Sub01AE4 = Can you please make the OSF project page assocaited with the manuscript 'public' please? PLOS ONE operates single-blind peer review (reviewers can remain anonymous; authors do not), and so making the OSF project page will not 'unblind' the reviewers. The study data/materials were made available to me after you submitted the manuscript, but i think this was by adding me as a contributor to the project (I have now removed mysefl from the project, so that it is clear that I have no conflict of interest re: me acting as editor for this manuscript), and I believe the necessary data/scripts are available on the OSF. It would be great if the reviewers could examine this, too, when they review your resubmission.-->--> -->-->I should note, however, that both reviewers, as well as me, have a background in hallucinations/psychosis research. And so some of our comments/assumptions may well be shaped by that background-->

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PLOS ONE

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Reviewers' comments:

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Reviewer #1: Yes

Reviewer #2: Yes

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-->2. Has the statistical analysis been performed appropriately and rigorously? -->

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: No

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-->5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: Thank you for this paper. I have some minor revisions.

Study I

• Abstract

A stronger conclusion is needed. the meaning and importance of the paper is not clear.

Introduction

• It is difficult to follow across the Tables what the included appraisal items were. How they were worded? and why certain appraisal were included or excluded. The paper would benefit from a copy of the Appraisal Form either in a new Table, In Table 1 instead of the adaptations column or in supplemental material

o It was unclear whether appraisals of personal/ non personal, benevolent/ benign/ malevolent, omnipotence/ omniscience/ neutrality were included? These are important appraisals with the AANEX, and Beliefs about Voices questionnaires, and are predictive of distress and believability. If they were excluded, a justification should be given. God’s intentions, for instance, maybe appraised as benevolent or malevolent.

o Cognitive theories would suggest that it is when an negative appraisal is matched with safety behaviours that a maintaining process of distress occurs. (for instance https://doi.org/10.1016/j.brat.2012.10.008). A reflection on how benign experiences may become psychopathological would be helpful.

• Methods

o No demographic data was collected due to time restrictions- this is a limitation and should be noted especially in relation to validity and generalisability.

o “Sample size was determined by the stopping criteria described in the section entitled 'Decision criteria for item validation” could this be explained further in the text. N=160 seems small for a multi-item scale and strong justification is needed.

• Results:

• Missing data should be discussed at a sample and item level.

• VS= full wording should be used

o The table location and formatting through out the document is difficult to follow.

Study II

• Results- item level missing data should be report

• What was the missing data strategy?

Table 4 should be presented in the results section

• Discussion

o “This is particularly important when considering that a vast majority of experiences, including negative experiences, in the long run, were associated with positive effects overall. This shows the enormous potential of human resilience and requires more focused follow-up studies.”

o I’m particularly struck by this comment. It fits the wider literature, (i.e., https://doi.org/10.1002/wps.20301) and highlights the importance of protective factors, and natural human resilience. I wonder would this be an appropriate conclusion for the abstract?

Thank you for this paper

Reviewer #2: Overview:

These studies offer valuable contributions to the literature on non-ordinary experiences, addressing the important and thorny issue of attempting to disentangle NOEs and appraisals of these experiences. The studies and analyses themselves are generally well done. However, the paper in terms of its framing, language and overall communication of the studies and their position in the wider literature needs substantial editing.

There are times where the goals and scope of the paper are unclear. There is also a need for a fair bit of editing in terms of language precision. I have included a number of specific language edits in my recommendations below, but please proofread the whole paper for grammar and clarity of language.

Changes needed:

The definition and scope of NOEs as a concept need to be made clear at the outset. At one point you refer to “subjectively salient” experiences (lines 104-106) and towards the end of the paper (705-706) they appear to be officially defined this way. However, this needs to be stated clearly early on.

Furthermore, a discussion of the reasoning behind focusing on experiences which are subjectively salient, as discussed by Taves et al. (2023), is needed. You’ve described quite a wide array of experiences ranging from voice-hearing to love and despair as non-ordinary experiences (e.g. lines 96-99). The paper needs to directly address the fact that this wide range of experiences are being discussed as part of the same category.

The paper should also provide a short, clear definition of appraisal early on. As reference, Taves et al.’s original paper includes the following clear definition: “Appraisal, as used here, refers to the outcome of a multi-level process that humans and other animals rely on when determining what is happening, that is, to interpret situations and events”

89 There is a conjunction missing before the word “strong”

97-99 “On the other hand, phenomenologically comparable experiences are being used in psychiatric manuals as symptoms of dissociation or hallucinations” This is unclear because hallucination is a symptom, not a condition. One way to fix this would be say change the word “hallucinations” to “psychosis”.

105-106 “In this study, we aim to focus squarely on the appraisals and situational factors surrounding a broad set of experiences. When and where are subjectively salient experiences likely to happen?” The word “squarely” doesn’t make sense here. Remove the word “squarely” or change it to something like “in particular” or “specifically”.

In the introduction, there are a number of places where specific examples would make the paper easier to follow. For instance: 120-122: provide an example of the way in which the description of the experience may incorporate an appraisal.

115-116 “to see if there are patterns that can be used to describe the human cognitive system used to make sense of” This sentence is unclear. I think you mean “patterns that can shed light on the cognitive processes involves in making sense of…”

118-120: do you actually mean “conceptual overlap” or do you mean that the causal relationships are difficult to disentangle?

159-160: “We draw on multiple theoretical approaches”. More info is needed. The following section goes on to describe only one theoretical framework.

232-233: “A substantive number of participants in the original validation study thought that chance might be a good reason” The word should be “substantial”, not “substantive” and the sentence overall needs proof-reading.

240-241 I think you are correct that there is a need for broader information about situational factors. But the paper needs to explicitly make the case for WHY this information is needed. Overall, there needs to be a clearer explanation given as to why Taves et al.’s original list of appraisal options is insufficient.

245-253: More information is needed about how this study’s list of new appraisal options were generated from the previous list.

256. Explain what you mean by “based on these insights”. Which insights? Did you take all the appraisal options listed in these papers and divide them into the categories that you outline? Please explain the process in greater detail. Here, once again, the explanation would benefit from reference to specific examples.

381: Change “till” to “until”

403: Explain (perhaps via a brief example) the distinction between cause and reason

411-413: I think you mean “selected by a small number of participants”. If so, change to make clearer.

424 There are words missing in the title: appraisals across what?

439: Should be “a unique” not “an unique”

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Reviewer #1: No

Reviewer #2: No

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Making sense of the extraordinary – An investigation of the content and prevalence of appraisals of nonordinary experiences

PONE-D-25-47007R1

Dear Dr. Fischer,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. It's a really strong paper, which I think will be very valuable for researchers working across a nmber of different fields.

I am very sorry for the delay in obtaining reviews of your re-submission. I extended the deadline for one reviewer twice, as they had provided such a careful review of your first submission, and this was the cause of the delay.

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Kind regards,

David Smailes, Ph.D.

Academic Editor

PLOS One

Additional Editor Comments:

Thank you for the detailed and clear responses to the reviewers' comments. All comments were responded to effectively.

Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.-->

Reviewer #1: All comments have been addressed

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-->2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. -->

Reviewer #1: Yes

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-->3. Has the statistical analysis been performed appropriately and rigorously? -->

Reviewer #1: Yes

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-->4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #1: Yes

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-->5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #1: Yes

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-->6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: (No Response)

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Reviewer #1: Yes:  Keith Gaynor

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