Set and Setting: A Randomized Study of Different Musical Genres in Supporting Psychedelic Therapy

This further analysis of an open-label, counter-balanced study (n=10) with psilocybin (20-30mg/70kg) found that overtone-based music (e.g. gongs) was more effective than classical music (for smoking cessation, mystical experience – but only trends – very small sample size).

Abstract

“Mounting evidence supports the serotonin 2A receptor agonist psilocybin as a psychiatric pharmacotherapy. Little research has experimentally examined how session “set and setting” impacts subjective and therapeutic effects. We analyzed the effects of the musical genre played during sessions of a psilocybin study for tobacco smoking cessation. Participants (N = 10) received psilocybin (20–30 mg/70 kg) in two sessions, each with a different musical genre (Western classical versus overtone-based), with the order counterbalanced. Participants chose one genre for a third session (30 mg/70 kg). Mystical experiences scores tended to be higher in overtone-based sessions than in Western classical sessions. Six of ten participants chose the overtone-based music for a third session. Biologically confirmed smoking abstinence was similar based on musical choice, with a slight benefit for participants choosing the overtone-based playlist (66.7% versus 50%). These data call into question whether Western classical music typically used in psychedelic therapy holds a unique benefit. Broadly, we call for experimentally examining session components toward optimizing psychedelic therapeutic protocols.“

Authors: Justin C. Strickland, Albert Garcia-Romeu & Matthew W. Johnson

Notes

Although this study is the first to take a look at the music (setting) used in psychedelic therapy, it is still only a very small study that has many confounding factors that may tip the results in another direction. One should be cautious to draw conclusions at this moment.

This study is based on data from the open-label trial for smoking cessation (Johnson et al., 2014).

Summary

■ INTRODUCTION

The past decade has witnessed a resurgent interest in the therapeutic potential of classic psychedelic drugs, with clinical trials reporting efficacy for various psychiatric outcomes, including depression, anxiety, and substance use disorder symptoms.

Psychedelic science has long recognized the importance of set and setting when determining the behavioral and clinical effects of 5-HT2AR compounds. The use of standardized “psychedelic therapy” has remained largely unchanged since its inception.

Early observations suggested that environmental and psychological factors could influence psilocybin effects, but an experimental study found no substantial between group differences in long-term outcomes.

A study randomized 75 healthy individuals to receive psilocybin with varying levels of preparation and support, finding that a higher dose and more support were associated with sustained improvements in wellbeing.

One study evaluated five different musical contexts presented during LSD sessions for alcohol use, and found no significant differences in participant-reported effects of music or observer-rated effects of LSD.

Music is a standard feature in clinical psychedelic therapy and a consistent facet of the broader cultural and research context surrounding psychedelic drugs. Psychedelic drugs alter the neural response to the acoustic properties of music.

Psychedelic therapy has almost exclusively used classical music, predominately Western classical pieces, likely due to recommendations present in early guidelines. However, different musical genres may impact therapeutic outcomes, and this study evaluated the effects of Western classical versus overtone-heavy instruments on session experience and smoking cessation outcomes. Participants completed therapeutic psilocybin sessions with two different musical playlists accompanying those sessions. The outcomes of the sessions were analyzed by music genre, and the study identifies the core features of psychedelic therapy as well as those that may be modified, removed, or individualized to optimize patient-specific therapeutic outcomes.

After the resolution of drug effects, participants completed standardized subjective effect measures evaluating mystical experiences and challenging experiences that occurred during the psilocybin session. Overtone-based sessions were associated with higher overall scores compared to Western classical sessions, but this difference was not statistically significant.

Figure 2 contains Challenging Experience Questionnaire scores for individual participants by session and dose. Comparisons by musical genre were not statistically significant.

Participants were provided the opportunity to select their preferred musical genre for the completion of a third psilocybin session. 60% selected the overtone-based playlist.

Figure 3 contains MEQ30 and CEQ data for a participant-selected musical genre session. Western classical had higher MEQ30 scores than overtone-based sessions, but the difference was not significant.

Smoking abstinence was biologically confirmed by exhaled carbon dioxide, urinary cotinine, and participant self-report. Most participants who selected overtone-based music were abstinent at the end of treatment.

This analysis used data from an open-label trial to evaluate how different musical genres supporting psychedelic therapy may impact subjective and therapeutic outcomes. The results suggest that Western classical music typically played in psychedelic sessions holds no unique benefit.

Western classical music was not significantly better than overtone-based music for supporting psychedelic therapy, although Western classical music was somewhat higher in mean mystical experience scores when participants were able to select their preferred musical genre for a final session.

This study relied on a small sample, but utilized individual participant data analysis throughout to demonstrate the consistency of described patterns at a person level. Additionally, some minor overlap occurred between musical playlists, but this was mitigated by the fact that overlap occurred mostly near the beginning and end of sessions.

This study is the first to fully randomized test of different musical genres supporting psychedelic therapy, and it failed to identify any clear superiority of Western classical music. The findings support the idea that patient-specific music may improve therapeutic outcomes.

Data from an open-label study on psilocybin for smoking cessation are presented. The study involved 15 week treatment period, three psilocybin sessions, and a long-term follow-up at an average of 30 months post target quit date.

Participants were required to smoke at least 10 cigarettes per day, be physically healthy, and have no history of substance use disorder other than nicotine in the past 5 years.

Psilocybin was administered in opaque, size 0 gelatin capsules with approximately 180 mL of water. Staff provided nondirective interpersonal support for managing psilocybin effects but did not deliver smoking cessation-specific content.

Participants wore an eye mask and listened to a music program through headphones throughout the session. The music program was either a Western classical playlist or an overtone-based playlist, and the order of the playlists was randomized for each participant. Each participant provided 60 min of personally selected music before the first session, and the investigator playlist played at all other points during the session.

Participants completed a mystical-type subjective effect questionnaire and a challenging experiences questionnaire at the completion of each psilocybin session.

Three measures of cigarette smoking were used to determine smoking abstinence: timeline follow-back (TLFB), exhaled carbon monoxide (CO), and urinary cotinine level. Seven-day point prevalence abstinence was verified through smoking TLFB data and objective and biological verification.

Descriptive statistics were used to summarize subjective effect and smoking abstinence data throughout the study phases. A paired t-test was used to compare subjective effect between randomized musical genre sessions.

Author Contributions

M.W.J. developed the concept of incorporating musical genre comparison into the study design, A.G.-R. developed the analysis, and J.C.S. wrote the final draft.