Effects of Setting on Psychedelic Experiences, Therapies, and Outcomes: A Rapid Scoping Review of the Literature

The investigators conducted a rapid scoping review following the Joanna Briggs Institute (JBI) methodology for scoping reviews and reported in accordance with PRISMA-ScR. A protocol was registered on the Open Science Framework in July 2021. Searches were run in June 2021 in PubMed, PsycINFO, and Embase; an experienced health sciences librarian developed and executed the strategy, and results were deduplicated and uploaded to Covidence for screening. The team also reviewed search outputs to identify additional relevant articles known to reviewers. Inclusion criteria used a PICOS framework. Population was humans of any age; intervention included any use of classic psychedelics (psilocybin, ayahuasca, peyote, LSD, mescaline, DMT) studied with attention to effects of the use-setting(s); comparators could be alternate settings (for example, different music, physical environment, participation format, rituals, facilitator attributes); outcomes encompassed any measures relating setting to acute or enduring psychedelic experiences; and study design permitted all empirical types as well as theoretical articles. Non-English articles (n = 4) and one inaccessible full text were excluded. Blinded pairs screened titles/abstracts and full texts in Covidence, with discrepancies resolved through discussion or a third reviewer. Data extraction captured study aims, designs, populations, drugs, setting components, comparators, doses/durations, instruments, and findings. Because this is a scoping review, included sources were not critically appraised for methodological quality. The formal search identified 1,160 records plus seven team-recommended articles; after screening, 43 articles met inclusion and were analysed. Of those, 29 reported primary empirical data: 14 controlled laboratory studies, eight large online surveys with retrospective ratings, and seven observational/naturalistic studies. Extracted descriptive data included publication years (1958–2021), countries of origin (10 countries), sample sizes, study designs (including RCTs, within-subjects, qualitative, quasi-experimental), and a taxonomy of outcome domains and instruments. The authors note that some methodological details were variably reported across included studies, which influenced coding and synthesis.

The 43 included articles span 1958–2021 and originate from ten countries. Among the 29 primary empirical studies, sample sizes varied widely: experimental/laboratory or clinic studies ranged 10–100 participants, online surveys ranged up to 6,877, and the overall mean sample size reported was 395.7 with a median of 31.5. Study designs included qualitative (n = 7), quasi-experimental (n = 6), randomized controlled trials (n = 5), within-subjects (n = 4), and various others. Populations most commonly studied were healthy volunteers (n = 8; 18.6%) and patients with mental health diagnoses or receiving therapy (n = 6; 13.9%), with other groups including people with prior psychedelic use, ritual participants, and people using other substances. Reporting of demographics was inconsistent: 21% of primary studies did not report sex, 62% did not report race/ethnicity, and eight studies did not report ages. LSD was the most frequently studied compound (n = 21 mentions), followed by psilocybin (n = 16) and ayahuasca (n = 12); some studies covered more than one psychedelic. In studies that administered drugs, nine compared different drug conditions (placebo in four studies and other pharmacologic comparators in a few), but no study systematically tested interactions between drug condition and setting condition. Across all included articles, music was the most commonly examined setting or aesthetic element (n = 15), followed by multi-component discussions (n = 7), ritual/ceremonial settings (n = 5), and other elements such as physical environment, group/social context, expectation, and naturalistic settings. Outcomes were classified into a ten-domain taxonomy. Subjective effects constituted the most commonly reported outcome (22 studies, 51.2%), with psychiatric outcomes and well-being/quality of life reported in 11 studies (25.6%). Fewer studies reported acute emotional effects, spiritual outcomes, personality, substance use outcomes, cognition, or neural effects. Across the 29 primary studies, 90 unique instruments were used, with standardised questionnaires/scales predominating. Findings varied by study type and quality. Several uncontrolled or quasi-experimental studies and theoretical articles supported the general hypothesis that setting and aesthetics influence psychedelic experiences, but rigorous, prospective tests were rare. Naturalistic and ethnographic reports suggested that environments designed to look or feel “psychedelic” can elicit self-reported psychedelic-like experiences even without drug intake. Social and cultural contexts—social support, perceived safety, group participation and intentions—were associated in surveys and observational work with reduced challenging experiences and increased reports of connectedness or mystical-type experiences, although these studies were subject to recall and selection biases and lacked experimental controls. Music-related work ranged from early non-randomised clinical reports to recent neuroimaging studies. Qualitative data from clinical trials indicated that resonance with and liking of music predicted therapeutic benefit, while pilot work showed that non-standard playlists (for example, overtone music) did not obviously impair outcomes. Functional neuroimaging during LSD indicated that personally meaningful music more strongly engaged somatosensory and self-referential brain regions, and that music increased coupling between memory-related regions and visual cortex during LSD—changes associated with music-evoked imagery. Ritual and ceremonial studies, including controlled and survey designs, suggested that ritual contexts may support self-insight, spiritual growth, and mystical experiences and in some cases may provoke psychotropic-like effects even without drug use, but they rarely isolated which ritual components are operative. Overall, fewer than a quarter of primary studies (n = 7) used setting comparators, and studies seldom disaggregated individual features of setting (artwork, furniture, lighting, scent, etc.) or tested for whom or under what conditions particular elements matter. Reporting gaps—particularly inconsistent demographic reporting and variable specificity in descriptions of settings—were repeatedly highlighted.

Golden and colleagues interpret the assembled literature as showing broad consensus that setting and aesthetics matter for psychedelic experiences and therapies, alongside substantial theoretical interest. Nevertheless, they emphasise that this consensus has not translated into consistent, rigorous empirical testing. Many included studies either presume setting effects or offer observational or retrospective support, but few provide prospective, controlled manipulations that would clarify causal effects, mechanisms, moderators (for whom), or boundary conditions (under what circumstances). The authors identify specific evidentiary gaps: a lack of granular comparisons between elements of setting (for example, different music types, artwork, or furniture), limited mechanistic understanding (music being a partial exception where neuroimaging suggests plausible brain mechanisms), and insufficient evidence to inform evidence-based best practices or personalised approaches. Reporting shortcomings further hinder synthesis; inconsistent demographic reporting and variable specificity in describing setting components limit generalisability and reproducibility. The review also notes that many practices now standard in clinical settings (pleasant rooms, curated playlists, facilitator rapport) are driven more by clinical tradition than by systematic evidence. At the same time, the review highlights opportunities for focused research. The literature has laid groundwork around several ‘‘centre of gravity’’ categories—music/sound, ritual/ceremony, group versus individual formats, sociocultural expectations, and the physical environment—that could be prioritised for experimental and translational work. The authors suggest that studying participant preferences and allowing some agency in setting choice may be productive, and that extraclinical or group settings might prove optimal for certain populations or outcomes. They also acknowledge pragmatic challenges: integrating social and cultural variables into trials complicates standard pharmaceutical RCT models and may entail risks of neutral or negative outcomes when testing novel setting manipulations. Despite these difficulties, the investigators argue that failing to study setting will limit the ability to personalise and optimise psychedelic therapies. The review recognises its own limitations: the rapid search was confined to three databases and English-language publications, no hand-searching was performed, and coding decisions required adaptation across heterogeneous article types. The authors state these constraints may have missed some relevant studies but judge that they would be unlikely to alter the principal conclusions.

This scoping review provides a structured mapping of 43 studies addressing setting and aesthetics in classic psychedelic experiences and therapies. Golden and colleagues conclude that while there is widespread theoretical and clinical agreement that setting matters, the empirical literature remains limited in scope and rigour: few studies experimentally isolate setting components or test interactions with drug conditions, and reporting inconsistencies impede evidence synthesis. The authors call for theory-driven, practice-informed empirical research to operationalise, personalise, and optimise setting elements—work they argue could both improve psychedelic therapies and offer insights applicable to non-psychedelic health interventions.