Music

Key Insights

• Music has long played a crucial role in psychedelic-assisted therapy (PAT) as it helps evoke emotions, guide patients through their inner journey, and create an optimal therapeutic environment. Modern guidelines recommend using music during PAT, and its importance has been recognized since the early stages of psychedelic research.
• The interaction between the psychedelic substance and the music experience significantly predicts the therapeutic outcomes of PAT. Well-selected music supports mystical-type experiences, which have predicted positive outcomes in patients with treatment-resistant depression (TRD). However, there can be unwanted effects of music, such as intensification of negative emotions or dissonance with the patient’s inner experience.
• The neuroscience behind the interaction of music and psychedelics is still emerging. Studies suggest that psychedelics alter brain connectivity patterns and change neuronal activity, affecting the response to musical stimuli. Understanding the neural correlates underlying these altered experiences can provide valuable insights into the efficacy of music in PAT and contribute to developing more effective therapy protocols.

Author: Dimitris Metaxas. Dimitris has a degree in Psychology and a deep interest in the reasonable and safe integration of psychedelics in modern society in spiritual, therapeutic and recreational settings. From the molecular to the societal level, he is fascinated by the effects of classic psychedelics and their potential to enrich lives.

History of Music in Psychedelic-Assisted Therapy

Be it in psilocybin, MDMA or LSD-assisted psychotherapy, therapists have long understood the importance of a generally non-directive approach, as well as the importance of the patient embarking on an inner journey [1,2,3]. In this context, music has been a nearly universal component. As it evokes emotions and is non-judgmental, music is an invaluable tool in psychedelic therapy.

Music allows the patient to experience emotions, memories and thoughts in a safe environment, and when appropriately chosen can guide the patient towards psychological states conducive to therapeutic outcomes. Thus, music adds both direction as well as depth to the therapeutic experience and is recommended in modern guidelines for psychedelic-assisted therapy.

The role of music as a facilitator for psychedelic-assisted therapy (PAT) has been recognized from the early stages of psychedelic research. Therapists providing LSD treatment for alcoholism considered music familiar to the patient a guiding and helpful factor, while patients undergoing such treatment considered music essential to the psychedelic session [4,5]. In these first attempts at psychedelic therapy, however, there was an acknowledged lack of consensus over what kind of music should be played during the session.

A more systematic approach emerged in the 70s, when music therapists worked alongside psychiatrists and psychologists, tailoring the music both to the patients’ needs as well as to the psychedelics’ subjective effects [6]. Different kinds of music were recommended, depending on the phase of the psychedelic experience and the patient’s history and music preferences. Emphasis was given to music selection around the time of peak subjective effects of the drug, as it was considered crucial from a therapeutic point of view. The contribution of music within psychedelic therapy was centred around its ability to place the patient in a good ‘set’, an essential prerequisite for good therapeutic outcomes.

To this day, the choice of music in clinical and research settings with psychedelics has primarily been shaped by these early approaches.

Effects of Music During Psychedelic-Assisted Therapy

Listening to music during therapy has been found to allow the patient to experience intense emotions. Well-selected music supports mystical-type experiences as well, which in turn have predicted positive outcomes in patients with treatment-resistant depression (TRD).

In an interview study, the role of music during psychedelic therapy with psilocybin for TRD was examined. Nineteen patients with TRD received two doses of psilocybin one week apart. A week after the second psilocybin dosing session (25mg), they were interviewed, and their depression severity was reassessed using the 16-item Quick Inventory of Depressive Symptoms (QIDS). Reductions in depression scores one week after psilocybin were significantly predicted by the music experience variables liking (r = 0.60, p = .006), resonance (r = 0.59, p = .008), and openness to the music-evoked experience (r = 0.57, p = .001), but not by drug intensity (r = 0.004, p = 0.98).

The results from this study reaffirm the centrality of music in psychedelic-assisted therapy. It appears that valuable therapeutic outcomes are not predicted only by the psychedelic substance (be it LSD or psilocybin) or only by the experience of the music used, but rather by the interaction of the two.

Notably, the same research also points out unwanted effects of music, even if they are much rarer. Intensification of negative emotions has been attributed to music, as well as a feeling of the music being dissonant with the subjective inner experience. In a few cases, patients have even expressed a strong dislike for the selected playlist.

Per a review on the subject, instructions to participants when listening to music vary significantly from study to study. However, they share common themes such as relaxation, openness to arising states, and surrendering to the experience. Since in many studies, researchers do not share enough details about the music used, it is harder to predict participants’ responses to it, as well as assess its effects. However, given the centrality of music in PAT, efforts have begun to create some common ground and guidelines around music selection.

Neuroscience of Music and Psychedelics

The neuroscience behind music and psychedelics is scarce and has only recently begun to be explored. On its own, music engages several domain-general networks associated with emotion, memory and reward, with some of the same areas affected by psychedelics. Psychedelics, on the other hand, have been shown to change neuronal activity by disrupting brain networks and altering connectivity within and between several brain regions. 

The current consensus on the psychedelic state sees it as increasing entropy, with a higher level of global integration of information, and a flattening of the functional hierarchy of the brain. In other words, under psychedelics, connectivity and information flow between brain regions tend to increase, while connectivity within regions previously functioning as high-level association cortices that exert top-down control decreases. These greatly altered functional connectivity patterns modulate the response to musical stimuli, and gaining a better understanding of them will allow us to better grasp the neural correlates underlying the altered experience of music under the effects of psychedelics.

Substantial evidence exists that psychedelics act mainly by an agonist, or partial agonist, action at the serotonin 5-HT2a receptors. This is further confirmed by the blocking or reversing effects of 5-HT2a antagonist ketanserin on LSD’s subjective effects. The activation of the same receptors by LSD in healthy humans was also found to increase the attribution of meaning to previously meaningless and neutral musical stimuli. These increases were mediated by midline cortical structures, such as the anterior cingulate cortex (ACC) and the dorsomedial prefrontal cortex (dmPFC), higher-level structures involved in self-referential cognition and reflection. The same structures were consistently implicated in the effects of psilocybin, as measured by fMRI. Perhaps counterintuitively, activity in these areas decreases under psilocybin, whereas it is relatively high under normal conditions.

One of the predicting variables of a mystical-type experience during psychedelic sessions has been the trait of absorption. This refers to the “disposition for having episodes of ‘total’ attention that fully engage one’s representational (i.e., perceptual, enactive, imaginative, and ideational) resources” [7]. Music has been associated with a potentially increased state of absorption, and music in PAT specifically is mainly used to increase the absorption of the individual in his or her internal experience during therapy, undistracted by external stimuli [8]. Interestingly, at least one gene variation affecting 5-HT2a receptors has been associated with higher scores on trait absorption, revealing a possible way to explain individual differences regarding the altered perceptions of music during psychedelic therapy and the potential to have mystical-type experiences during it [9].

A study investigated the effects of LSD on music-evoked brain activity and reported music-evoked emotions (as measured by the Geneva emotional music scale –GEMS). Sixteen participants listened to two pieces of music, and the brain correlates for different acoustical features (representing aspects such as rhythm, tonality, and timbre) were examined. Results showed increased positive music-evoked emotions such as tenderness, transcendence and power, but not negative ones like sadness or tension.

Arguably the central finding of this study was the positive correlation between feelings of wonder and music-evoked activation to timbral complexity within the precuneus and the inferior frontal gyrus (IFG). The latter area especially has been implicated in evaluating emotional qualities in auditory stimuli and is highly connected to the auditory cortex. The precuneus, while also activated by music-induced emotions, isn’t as connected to the auditory cortex. However, it is thought to exert regulatory influence on the IFG. Therefore, disruption to its connectivity with the IFG can mean a reduced regulatory influence, and hence a strengthened response to the emotional aspects of musical stimuli.

Similarly, in a study examining the effect of LSD and music listening on mental imagery, increased functional connectivity between the visual cortex (VC) and the parahippocampal cortex (PHC) was observed, and correlated with more intense complex visual imagery. The PHC is a richly connected high-level region implicated in personal memory recollection, mental imagery, and music-evoked personal memories.

A possible explanation of the results proposed by the researchers is that reduced top-down regulation of the PHC by higher-order regions (due to LSD-suppressing activity in these regions themselves) might increase the PHC sensitivity to stimuli like music. The same findings may hold some promise to better understand the audiovisual synaesthetic-like experiences often reported under psychedelics.

Another study, this time from a clinical setting, found that changes in music-evoked emotions can even be sustained after psilocybin therapy for depression. One week after the treatment, which included music, pleasure ratings for music listening were higher, and anhedonia reductions persisted for up to three months.

While the study was somewhat limited by the small sample and open-label methodology, as well as no comparison with healthy participants, it seems that structures of the so-called Default Mode Network (DMN), which is associated with referential processing and interoception, had reduced regulation of limbic regions (particularly, the nucleus accumbens). This is another case of higher-order cortical regions having attenuated functional connectivity to brain structures or regions involved in emotion processing.

From the micro to the macro level, changes in brain function and connectivity under psychedelics have started to be explored, along with the accompanying alterations in music perception. Psychedelics set the stage by modifying the processing and evaluation of musical stimuli, while these stimuli themselves contribute to an enhanced psychedelic and/or therapeutic experience, by helping memories, emotions and thoughts come to the surface. We can better understand the neuroscience of both music perception and psychedelic effects, as well as the attribution of meaning and emotional value to stimuli, when we explore how these two factors interact. Some of the main areas implicated in the research so far include structures that are part of the DMN, the auditory cortex, and the limbic system, whereas the visual cortex has a role to play when examining musically-induced visual experiences of a synaesthetic nature.

Music and Psychedelics in Clinical Practice

In clinical practice outside the research environment, music curation is largely in the hands of the therapist, perhaps in prior arrangement with the client/patient. This can mean a pre-selected and often agreed upon playlist is played during the session, or the therapist(s) may choose pieces and songs as the session unravels. The goal is for the music to direct, reflect and intensify emotions if they are deemed therapeutically valuable in the moment, or to alter them if the patient would likely benefit from moving in a different direction or seems to be stuck.

As psychedelic-assisted therapy is becoming more widespread and the centrality of music in it is also being acknowledged, a more standardized approach to its use in clinical settings is being sought. The initially somewhat uninformed and intuitive approaches to its use are giving way to evidence-based curation of music according to specific acoustic features and drug effects. In this way, by adopting a more specific and shared approach to music curation, the effects of music will also be easier to study and assess, since its characteristics will not differ drastically from setting to setting. At the forefront of this attempt to best incorporate music in psychedelic therapy sits Wavepaths.

Wavepaths provides a music platform for psychedelic therapy sessions, based on research findings about which elements in music are conducive to healing experiences. Importantly, the music played isn’t necessarily in the form of a playlist but in a dynamic and smoothly transitioning manner. This allows the therapist to set up the parameters for the session (such as drug, dosage, and duration), and be free to tend to the patient without the need to change or adjust the music often. The used music pieces are explicitly created with therapeutic goals in mind. Their overall character can change according to the patient’s needs, for example, to soothe emotions or redirect them, to facilitate openness or even introduce periods of silence for the patient to better integrate the lived experience.

Overall, as the science behind the music in psychedelic-assisted therapy advances, so do the forays of the private sector into it, gradually bringing investment and further research into it, to discover the most effective approaches. New possibilities are being explored by combining AI-powered dynamic approaches and the human understanding of the lived experience. While we are far from optimized music usage in the clinical setting, therapists have received direction from newly emerging research, and much progress is waiting to be made in this field.

Selecting Music for Psychedelic-Assisted Therapy

Research around selecting music for psychedelic-assisted therapy is also just emerging. A method of music therapy, developed after the first wave of psychedelic research ended, has been used in a recent approach to curating music for psychedelic-assisted therapy [10,11]. The researchers created a new music program to be used in sessions involving doses of psilocybin. Criteria for music selection were:

1. The music should reflect the intensity profile of a medium/high dose of psilocybin
2. It should present a broad range of genres and cultural styles
3. Vocal music, whenever present, should avoid languages familiar to the patient
4. The music should be free of religious connotations

Overall, the music was selected with the phases and lengths of the psychedelic experience taken in mind. Ascent, peak and descent (broken into sub-phases) were the three phases, for each of which different music was chosen. Researchers also drew inspiration from already existing playlists for psychedelic research (links to openly available playlists can be found below). Well-known pieces and pieces with lyrics in familiar languages were avoided. 

To ensure a smooth passage from one piece to the next, the playlist was stitched together such that connected pieces were in the same or relevant keys or with the same basic note or one scale step up or down in modal music. The tempo of the music generally didn’t differ significantly between the two connected pieces either. At points, deliberate alternations between musical styles and instrumental/vocal music were used to “induce a sense of alertness or direct the listener in new directions“.

The selected music was then assessed with a rating tool of music intensity [12]. The subscales of the rating tool are linked to aspects of music such as complexity, dissonance, mood, quality, and melodic-harmonic development.  In this way, it was attempted to select music with the most fitting psychological characteristics for each part of the therapy session.

While this tool has not been initially developed for use with music in a psychedelic setting, but rather for general music assessment, it provides a sound basis for music curation as long as the differences between its original purpose and its use in psychedelic therapy are considered. In any case, the music selected is not necessarily the same for all patients since their preferences and history will have to be considered, as well as their cultural background. Finally, while this playlist was created for use in research with psilocybin, its length can be adjusted for different drugs, such as LSD or MDMA, with minor modifications to the selection procedure.

Within psychedelic therapy, the role of music is not to bring about the therapeutic effects themselves, but rather to create the right conditions for them. Some early research is being done to this end, examining the effects of different kinds of music in the context of psychedelic-assisted therapy, as well as possible effects of music selection by the patients themselves. It is crucial to better understand the influence of music selection by the participants themselves, since the music that carries meaning for the individual can evoke strong emotions and trigger autobiographical memories. It is important to parse these influences from the influences of the musical elements themselves, and therefore research with novel (to the individual) music will be of value.

Another study that provides some direction into music selection procedures examined differences between pieces and songs recommended for pre-peak versus peak stages of the psilocybin experience. Both qualitative and quantitative analyses were performed on music endorsed by experienced psilocybin guides (not necessarily clinical practitioners or with formal training in administering psilocybin).  Results showed that music chosen for the stage of peak effects showed greater consistency, predictability, and continuity of sound, perhaps building up slowly over time, compared to music chosen for the pre-peak phase. There were no discernible patterns for the latter, and the variation of music features was greater. 

A new area of research is opening regarding music in the psychedelic therapy space. The better we understand the physiological and phenomenological effects of each psychedelic, the better music therapy will be able to inform music curation for psychedelic-assisted therapy. At the same time, more research can be done on what aspects of music hold more predictive power of positive therapeutic outcomes and meaningful experiences, as well as the role of silence in the same setting.

Standardization of procedures for music curation for PAT can be beneficial, while standardization of procedures for personalized music curation might be even more promising.

Links to playlists for psychedelic-assisted therapy

Mendel Kaelen – Playlist for psilocybin-assisted psychotherapy for depression studies

Justin Strickland – A playlist for Johns Hopkins psilocybin-assisted smoking cessation pilot study

Bill Richards

Kelan Thomas – Made for psilocybin research at the Chacruna Institute

Rosalind Watts

Catharina Messell – Copenhage Music Program for Psilocybin

Michael Rasa

https://soundcloud.com/search?q=This%20Journey%20We%20Take

External references for Music and Psychedelics

All resources available on Blossom are directly linked on this topic page. Find even more background about this topic with these external references.

1. Guss, J., Krause, R., & Sloshower, J. (2020). The Yale Manual for Psilocybin-Assisted Therapy of Depression (using Acceptance and Commitment Therapy as a Therapeutic Frame). PsyArXiv. https://doi.org/10.31234/osf.io/u6v9y

2. MAPS. (2022, May 12). Treatment Manual: MDMA-Assisted Therapy for PTSD – Multidisciplinary Association for Psychedelic Studies – MAPS. Multidisciplinary Association for Psychedelic Studies – MAPS. https://maps.org/mdma/mdma-resources/treatment-manual-mdma-assisted-psychotherapy-for-ptsd/

3. Watts, R. (2021). Psilocybin for Depression: The ACE Model Manual. PsyArXiv. https://doi.org/10.31234/osf.io/5x2bu

4. Eagle, C. T. (1972). Music and LSD: An Empirical Study. Journal of Music Therapy, 9(1), 23–36. https://doi.org/10.1093/jmt/9.1.23

5. Gaston, E. T., & Eagle, C. T., Jr. (1970). The Function of Music in LSD Therapy for Alcoholic Patients. Journal of Music Therapy, 7(1), 3–19. https://doi.org/10.1093/jmt/7.1.3

6. Bonny, H. L., & Pahnke, W. N. (1972). The Use of Music in Psychedelic (LSD) Psychotherapy. Journal of Music Therapy, 9(2), 64–87. https://doi.org/10.1093/jmt/9.2.64

7. Tellegen, A., & Atkinson, G. (1974). Openness to absorbing and self-altering experiences (“absorption”), a trait related to hypnotic susceptibility. Journal of Abnormal Psychology, 83, 268–277. https://doi.org/10.1037/h0036681

8. Hall, S. E., Schubert, E., & Wilson, S. J. (2016). The Role of Trait and State Absorption in the Enjoyment of Music. PLOS ONE, 11(11), e0164029. https://doi.org/10.1371/journal.pone.0164029

9. Ott, U., Reuter, M., Hennig, J., & Vaitl, D. (2005). Evidence for a common biological basis of the absorption trait, hallucinogen effects, and positive symptoms: Epistasis between 5-HT2a and COMT polymorphisms. American Journal of Medical Genetics – Neuropsychiatric Genetics, 137 B(1), 29–32. Scopus. https://doi.org/10.1002/ajmg.b.30197

10. Beebe, L. H., & Wyatt, T. H. (2009). Guided imagery and music: Using the Bonny method to evoke emotion and access the unconscious. Journal of Psychosocial Nursing and Mental Health Services, 47(1), 29–33. https://doi.org/10.3928/02793695-20090101-02

11. Messell, C., Summer, L., Bonde, L. O., Beck, B. D., & Stenbæk, D. S. (2022). Music programming for psilocybin-assisted therapy: Guided Imagery and Music-informed perspectives. Frontiers in Psychology, 13. Scopus. https://doi.org/10.3389/fpsyg.2022.873455

12. Wärja, M., & Bonde, L. O. (2014). Music as Co-Therapist: Towards a Taxonomy of Music in Therapeutic Music and Imagery Work. Music and Medicine, 6, 16. https://doi.org/10.47513/mmd.v6i2.175