This qualitative study (n=28 interviews) of participants in a psilocybin-assisted therapy trial for cancer-related depression found that therapeutic benefits were closely tied to participants’ ability to “surrender” (accepting and remaining open to the experience’s intensity and unpredictability), with a safe, supportive, and ethical environment critical to fostering trust and engagement, and preparation and integration key to maximizing benefit, whilst music played a significant but variable role and ceremonial elements added meaning for many despite the clinical setting providing safety.
Abstract of Set and setting in psilocybin-assisted therapy
“Background Psilocybin-assisted therapy (PAT) shows promise for cancer-related depression, yet little research has examined how therapeutic context shapes patient experiences. While set (mindset) and setting (environment) are considered central to psychedelic treatment, empirical evidence on their role in PAT acceptability remains limited. This study explores factors influencing the acceptability of PAT from the perspective of patients with cancer and depression.
Methods We conducted semi-structured interviews with participants in a clinical trial of psilocybin-assisted therapy. Using template analysis, we examined themes related to the acceptability of the experience and the surrounding therapeutic environment.
Results Participants (n = 28) described the psilocybin experience as intense and demanding, with therapeutic benefits closely tied to their ability to “surrender”—a term used to describe accepting and remaining open to the experience’s intensity and unpredictability. A safe, supportive, and ethical environment was critical in fostering trust and engagement. Preparation and integration were key to maximizing benefit. Music played a significant but variable role, sometimes enhancing and other times distracting. While the clinical setting provided safety, ceremonial elements added meaning for many.
Conclusions Findings highlight how therapeutic structure, preparation, and setting shape PAT acceptability, supporting the need for patient-centered approaches to optimize care and outcomes.“
Authors: Yvan Beaussant, Elise Tarbi, Kabir Nigam, Skye Miner, Zachary Sager, Justin Sanders, Michael Ljuslin, Benjamin Guérin, Roxanne Sholevar, Kimberly Roddy, James A. Tulsky & Manish Agrawal
Summary of Set and setting in psilocybin-assisted therapy
Beaussant and colleagues examine how non-pharmacological elements such as preparation, therapist presence, music, and integration shape the acceptability of psilocybin-assisted therapy for people living with cancer and major depressive disorder. The authors anchor their inquiry in the well-established concepts of set (a person’s mindset going in) and setting (the environment and social frame), arguing that outcomes hinge on the interplay between drug effects and the therapeutic container. They position their work as filling a gap: despite frequent assertions about the importance of set and setting, empirical, patient-centred accounts of how these elements affect acceptability have been scarce.
The paper builds on a recent Phase II open-label clinical trial in which small cohorts underwent simultaneous dosing within a structured model that blended individual and group work. Earlier research from that parent programme reported feasibility, safety and promising symptom change. Here, the authors extend the qualitative lens to focus squarely on how preparation, the physical space, music, therapist behaviour, and integration practices shaped participants’ experiences of intensity, surrender, safety, and meaning.
Methods
Study design and participants
Find this paper
https://doi.org/10.1016/j.genhosppsych.2025.10.010
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Cite this paper (APA)
Beaussant, Y., Tarbi, E. C., Nigam, K., Miner, S., Sager, Z., Sanders, J., ... & Agrawal, M. Set and Setting in Psilocybin-Assisted Therapy: A Qualitative Study of Patients with Cancer and Depression. Available at SSRN 5292945.
Study details
Compounds studied
Psilocybin
Topics studied
Palliative Care
Depression
Study characteristics
Original Re-analysis
Interviews
Participants
28
Humans
Compound Details
The psychedelics given at which dose and how many times
Psilocybin 25 mg | 1xLinked Research Papers
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