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University of Virginia School of Medicine researchers are working to enhance the scientific rigor of research tools to assess near-death experiences — brushes with death that often transform people’s lives.

UVA’s Marieta Pehlivanova, PhD, and Bruce Greyson, MD — working with external colleagues Rense Lange, PhD, and James Houran, PhD — analyzed two scoring scales that are used to evaluate near-death experiences, commonly called NDEs. 

The first scale, the 16-item Near-Death Experience Scale (NDE Scale), was developed at UVA in 1983 by Greyson and used extensively in hundreds of studies. The second, the Near-Death Experience Content Scale (NDE-C), was created in 2020 in hopes of addressing limitations of the NDE Scale. The new scale added several items for additional perceptions, adapted the wording of items and changed the response scale. 

The new analysis suggests the two scales are comparable, but the older NDE Scale remains the gold standard, Pehlivanova and colleagues conclude. The analysis, however, identifies areas where both scales can be improved.

“We found that both scales measure the same underlying near-death experience construct, but the new items added to the NDE-C did not consistently fit in the hierarchy of perceptions as validated by advanced psychometric analysis,” Pehlivanova said. “Improving our tools to assess near-death experiences accurately and efficiently is important to advance the research, especially in clinical settings.”

Optimizing Near-Death Research Tools

Greyson, a longtime leader in the field of near-death research, developed the NDE Scale to serve as a framework for scientific analysis of experiences that, on their face, seem to defy scientific explanation. Near-death experiencers, for example, often report that their world views are radically changed by the things they saw or experienced while they were clinically dead or in a medical crisis. These brushes with death give many experiencers renewed purpose in life, a desire to serve others and an appreciation for being part of a greater whole. But others can struggle to make sense of the experience, especially if their NDE conflicts with their religious or existential beliefs, personal values or scientific views.

Greyson’s scale has been the benchmark for scientific research into these experiences for decades. But he has been eager to find ways to improve the research tools available, prompting him and his colleagues to do the direct comparison with the newer NDE-C Scale.

To conduct an impartial evaluation, Pehlivanova, Greyson and their colleagues used “Rasch modeling” — a math-based tool widely employed to assess the effectiveness of measurements used in health, psychology and education research. The model was applied to questionnaires from both scales completed by more than 700 near-death experiencers.

The model identified problems in the response categories of both scales. Near-death experiencers often find the experience to be “ineffable” — almost impossible to describe — and the data shows that it may be difficult for them differentiate meaningfully between the intensity of different perceptions as measured by the scales. The newly added items in the NDE-C scale relate to additional perceptions in these experiences (such as the feeling of being dead), but they do not consistently fit in the psychometric model assessed in the study.  

“Although both scales can be further refined and additional work needs to be done in assessing near-death experiences, we recommend continued use of the original NDE scale,” the researchers report in a new scientific paper. “This instrument has already been used in hundreds of studies since the 1980s, providing a consistent basis for comparison with new research. Rasch modeling indicates that near-death experience perceptions as measured by this scale form a continuous spectrum, which has now been replicated in two independent samples, strengthening the case for its adoption as a well-established assessment.” 

The analysis suggests specific areas for improvement in both scales. Greyson’s, for example, could benefit from improving the response categories, the scientists report. The results, the researchers say, will ultimately enhance how we explore and understand near-death experiences.

“These findings have implications not only for how we assess near-death experiences in research and clinical settings, but also for our theoretical understanding of these experiences,” Pehlivanova said. “An accurate measurement model of near-death experiences can help inform theories of their underlying causes.”

Findings Published

Pehlivanova, Greyson and their colleagues have published their analysis in the scientific journal Consciousness and Cognition. The scientists report no financial interest in the work.

About UVA’s Division of Perceptual Studies (DOPS) 

Established in 1967 under the leadership of UVA psychiatrist Ian Stevenson, MD, UVA’s Division of Perceptual Studies stands as the most productive university-based research group in the world dedicated to exploring phenomena that challenge conventional scientific paradigms concerning human consciousness. At the core of DOPS’ research mission lies the commitment to rigorous evaluation of empirical evidence surrounding exceptional human experiences and capacities, including utilization of a state-of-the-art neuroimaging lab. DOPS extends its focus beyond fundamental empirical research and explores the profound implications of such research for scientific theory and society at large. By actively sharing insights and findings, DOPS strives to contribute meaningfully to the understanding of consciousness, bridging the gap between scientific inquiry and public awareness.   

To keep up with the latest medical research from UVA and UVA’s new Paul and Diane Manning Institute of Biotechnology, bookmark the Making of Medicine blog.