This rapid review of 10 studies (n=180) found music to be a central component of psychedelic therapy, profoundly shaping emotional, imagery and embodied experiences—simultaneously anchoring and propelling participants—and that participant openness and participant-centred music selection associate with better immediate and longer-term outcomes. The authors recommend richer reporting on musical stimuli and greater involvement of music therapists to develop flexible, optimised music protocols for psychedelic-assisted treatment.
Bonny Method of Guided Imagery and Music emerged following discontinuation of psychedelic therapy research in the early 1970s, but psychedelic therapy research has since revived. Music remains a vital component. This study examined participants’ experiences of music in psychedelic therapy research. A rapid review of qualitative and quantitative journal articles in four major databases was conducted in February to April, 2019, using the terms hallucinogens, psychedelic, “lysergic acid diethylamide,” psilocybin, ayahuasca, music, and/or “music therapy.” Of 406 articles retrieved, 10 were included (n = 180; 18–69 years old). Participants had varied backgrounds. Music was widely considered integral for meaningful emotional and imagery experiences and self-exploration during psychedelic therapy. Music transformed through its elicitation of anthropomorphic, transportive, synesthetic, and material sensations. Music could convey love, carry listeners to other realms, be something to “hold,” inspire, and elicit a deep sense of embodied transformation. Therapeutic influence was especially evident in music’s dichotomous elicitations: Music could simultaneously anchor and propel. Participant openness to music and provision of participant-centered music were associated with optimal immediate and longer-term outcomes. Many studies reported scarce details about the music used and incidental findings of music experienced. Further understanding of participants’ idiosyncratic and shared responses to music during drug therapy phases will inform optimal development of flexible music protocols which enhance psychedelic therapy. Music therapists could be involved in the psychedelic therapy research renaissance through assisting with research to optimize music-based protocols used. If psychedelics become approved medicines, music therapists may be involved in offering psychedelic therapy as part of therapeutic teams.
Papers cited by this study that are also in Blossom
Barrett, F. S., Preller, K. H., Kaelen, M. · International Review of Psychiatry (2018)
Slevc, L. R., Barrett, F. S., Robbins, H. et al. · Frontiers in Psychology (2017)
Belouin, S. J., Henningfield, J. E. · Neuropharmacology (2018)
Belser, A. B., Agin-Liebes, G. I., Swift, T. C. et al. · Journal of Humanistic Psychology (2017)
Psychedelic drugs such as LSD and psilocybin act primarily on serotonin 5HT2A/2C receptors and produce alterations in emotion, cognition, and perception. Research into their therapeutic use began in the mid-20th century and indicated potential benefits for conditions including anxiety, depression, addiction, and existential distress among patients with life‑threatening illness. Political and regulatory backlash from the 1970s greatly reduced clinical research until a resurgence from the 1990s onwards, with contemporary studies emphasising psilocybin because of its low toxicity and relatively short duration of action (typical sessions about 8 hours). Music has been a persistent component in psychedelic-assisted sessions since early work, with historical and contemporary researchers proposing that carefully chosen music can support emotional release, peak or mystical experiences, and continuity during altered states. O'Callaghan and colleagues carried out a rapid review to examine participants’ first‑hand experiences of music used in psychedelic therapy employing psilocybin, LSD, or ayahuasca. The stated aim was to synthesise participant-reported music experiences to inform playlist design and broader guidance for music provision in forthcoming psilocybin-assisted psychotherapy research, particularly in work addressing depression and anxiety associated with life‑threatening illness. The review therefore focuses specifically on participant self‑reports about music, rather than therapist perspectives or ethnographic descriptions of nonclinical use.
The review was conducted as a rapid review between February and May 2019. A librarian assisted with search term development; searches were run in major health databases and the team reports searching Medline and Embase, while the extracted text does not clearly list all databases searched. The rapid review approach prioritised timeliness and a streamlined search and synthesis relative to a full systematic review; reporting followed PRISMA where applicable. Inclusion criteria required primary peer‑reviewed research on participants aged 18 or older involving psychedelic therapy with psilocybin, LSD, or ayahuasca where participants provided self‑reports about music experiences (through interviews or questionnaires). The review accepted qualitative, quantitative, or mixed methods designs and studies conducted with healthy volunteers or clinical populations. Excluded were nonclinical/recreational uses, ethnographic ritual studies, therapist‑only reports of music, non‑peer‑reviewed materials (letters, commentaries, theses, conference abstracts), and studies without participant music reports. Screening and data extraction were performed by multiple independent reviewers: initial title/abstract screening and subsequent full‑text screening involved pairs of reviewers with disagreements resolved through discussion. C. O'Callaghan led the narrative synthesis. Extracted data included study descriptors, methods, samples, and music‑related findings. Analysis used narrative synthesis techniques with inductive thematic coding informed by grounded theory methods; qualitative data management software supported coding. The synthesis comprised developing a preliminary thematic coding of study findings, translating findings across studies, and a critical reflection on robustness. The reviewers note they limited quality appraisal to consideration of how well participant music experiences were reported rather than a full risk‑of‑bias assessment.
Searches retrieved 406 records, of which 80 were duplicates. After screening 326 titles/abstracts, 319 were excluded and seven full texts were reviewed; five met inclusion criteria. Reference checks of included papers led to the review of an additional 16 full texts and five further papers were included, yielding a final set of 10 studies contributing participant music reports (data abstraction for 10 studies is in the supplementary material according to the extracted text). Across the included studies there were a total of 180 participants aged 18–69 years; sex was reported for 121 participants of whom 53 were female, and one study did not state sex. Studies were conducted in the United States (6), United Kingdom (3), and Switzerland (1). Sample sizes ranged from 10 to 59. Seven studies examined psilocybin with music (populations included religious/spiritually active participants, people with cancer, depressed patients, smokers attempting cessation, and healthy volunteers) and the remainder examined LSD with music (including alcoholism, existential anxiety, and healthy volunteers). Participant prior psychedelic experience was variably reported: three studies did not report it, one enrolled psychedelic‑naïve people, and others included some or all experienced participants. Designs and measures were heterogeneous: qualitative thematic analyses and mixed‑methods studies predominated, alongside a cross‑sectional single‑exposure trial manipulating five music conditions and paired/dosage studies. Data collection included semi‑structured interviews, visual analogue scales, the Quick Inventory of Depressive Symptoms (pre–post), a music preference survey, the Objective Checklist for LSD Experience, Geneva Emotion Music Scales (GEMS‑9), and subjective effects/state questionnaires. Timing of data collection ranged from during the session to follow‑ups at 1 week, 3–6 months, up to 30 months. Descriptions of the music used varied widely and were often incomplete. Only two studies fully detailed music selections or playlists; others referred vaguely to "a program of classical and world music", "a specific music playlist", or simply "music". Some studies used participant music‑preference information to create experimental music conditions (including no‑music, familiar/liked, unfamiliar/disliked, headphone/speaker variations). Instructions to participants commonly included closing eyes, reclining, and prompts to relax and focus inward, but these also varied. Thematic analysis across studies yielded four principal themes. Theme 1: music was experienced as central to supportive, emotionally intense, imagery‑rich, and meaningful experiences and was linked to therapeutic outcomes. Qualitative quotes described music as the "whole script" or as enabling surrender to emotion; quantitative results included an LSD study reporting greater emotion with music versus saline (difference 0.51, p = .006) and increases in feelings such as wonder, power, tenderness, and transcendence (p = .027 for each). One study found that higher psilocybin doses were associated with stronger absorption in music and greater sense of music's significance (both p < .05). Theme 2: participants described transformational qualities of music, often anthropomorphising it (a "guide" or "ally"), reporting transportive experiences, synesthetic sensations, and episodes of self‑dissolution that merged music with emotion and imagery. Theme 3: liking, openness to, and contextual features of music and listening (e.g., unfamiliar vs familiar, headphone use, choice) moderated therapeutic impact. Liking (r = 0.61, p = .006), resonance (r = 0.67, p = .002), and openness (r = 0.70, p = .0008) to music predicted mystical experience in one study; resonance (r = 0.53, p = .016) and openness (r = 0.59, p = .007) predicted insightfulness. In a depression study, reductions in depressive symptoms one week after psilocybin were predicted by music variables liking (r = 0.60, p = .006), resonance (r = 0.59, p = .008), and openness (r = 0.57, p = .001), whereas drug intensity did not predict improvement (r = 0.004, p = .98). Headphone presentation of familiar music was reported as more effective in one study (n = 59; p < .05), though some participants found mandatory use of headphones or blindfolds restrictive. Theme 4: music experiences were linked to longer‑term changes in participants' relationship to music and to life, including renewed enjoyment of music and lifestyle changes such as taking up musical practice; several participants continued to experience strong positive emotions in response to pieces heard during sessions months later. Reported study limitations included frequent absence of detailed reporting on the specific music used (eight studies did not detail music), limited or few music‑focused interview questions, sparse description of analytic approaches to textual data, lack of baseline emotion measures before music, and incomplete participant‑level reporting of quotes (e.g., lack of identifiers).
O'Callaghan and colleagues interpret the synthesis as showing that music is often central to participants' psychedelic therapy experiences but that reporting about music in the literature is inconsistent and frequently inadequate. When participants liked and were open to the music, it was integrally related to intense multisensorial, imagery‑laden, and transformative experiences; conversely, music perceived as discordant with a participant's unfolding experience could diminish benefit or provoke distress. The authors note that negative or challenging music experiences sometimes promoted therapeutic processing, but distinguishing therapeutically useful challenge from genuinely adverse, unwanted effects creates a practical dilemma for clinicians and researchers. The review situates its findings alongside historical practice (e.g., Browne, Bonny) and contemporary playlist builders (e.g., Richards, Kaelen), highlighting that prior guidance has often relied on clinician intuition rather than systematic music analysis. The authors suggest that structural analyses of music (examining formal features, harmonic sequences, rhythmic motifs, pitch elements) used in other music therapy research could inform identification of musical features associated with pivotal therapeutic moments. They propose that playlists might be matched to phases of the psychedelic session (preparation, ascent/lead‑in, peak, return) and that both unfamiliar but liked music and opportunities for silence have roles. Key limitations acknowledged by the reviewers include the rapid review design with a restricted search scope, heterogeneity across the included studies (clinical populations, drugs, music, outcome measures), and the small number of studies reporting participant music experiences. They also note historical studies often lacked contemporary statistical controls (e.g., adjustments for multiple comparisons) and that cultural background of researchers and therapists likely influenced music selection in ways not explored by the reviewed literature. The authors therefore caution that conclusions must be tentative and context‑bound. Implications for practice and research that the authors discuss include adopting patient‑centred approaches to music selection (sampling playlists in preparatory sessions, inviting participants to identify music to include or exclude, allowing choice over headphones/blindfolds), equipping therapists to adapt music in session, and studying therapists' decision‑making around music changes. They recommend further empirical work to map musical structures associated with pivotal moments, to compare BMGIM techniques and playlists, and to explore whether music therapists could contribute to playlist design, session delivery, and future controlled trials. The authors emphasise that while music appears pivotal, systematic investigation and better reporting are needed to develop evidence‑based guidelines.
The reviewers conclude that liked music is integral to meaningful and transformative psychedelic therapy experiences and can amplify multisensory, synesthetic, and emotionally embodied effects. Music may simultaneously anchor and propel participants through intense emotions and imagery; it can also be associated with negative affect that either facilitates psychological processing or undermines the experience. Given music's centrality, the authors argue for patient‑centred planning of music in psychedelic sessions, greater involvement of music therapists in research and clinical teams, and targeted research (including structural music analysis and comparisons with BMGIM) to inform future playlist design and clinical guidance should psychedelics gain broader regulatory approval.
Psychedelic drugs are psychoactive compounds that primarily act on neural serotonin 5HT2A/2C receptors and cause altered emotion, cognition, and perception. The synthesis of lysergic acid diethylamide (LSD) in 1938, the subsequent discovery of its psychoactive effects in 1943, and discovery of psilocybin (active agent in the so-called "magic mushrooms") in 1955 spawned the use of psychedelics in psychotherapy from the 1950s. LSD was distributed by a drug company from 1949 for patient research; however, psychiatrists also "often tested the drug with any patient group that intrigued them".permitted distribution of drug samples for investigational use by qualified experts prior to "new drug application" approval.] Psychedelics were widely considered "miracle drugs" for many psychiatric disorders, including anxiety, depression, and alcoholism, although psilocybin and other plant-based psychedelics, including ayahuasca, have been used by indigenous communities for centuries. Early research and clinical practice demonstrated the therapeutic potential of LSD for alleviating depression, anxiety, existential distress, and pain in patients with cancer. Sensationalized recreational use of psychedelic compounds eventually drew political and cultural backlash, resulting in the placement of psychedelic drugs in the most restrictive Schedule I category of the U.S. Controlled Substances Act in 1970. This scheduling banned many psychedelics for medical use and discouraged associated research. Around this time, international psychedelic drug control treaties and efforts also emerged. Psychedelic research then dwindledbut resurged in the 1990s, with follow-on findings indicating therapeutic benefits for depression, smoking addiction, alcohol dependence, and obsessive-compulsive disorder. Studies examining psychedelic therapy administered to patients with life-threatening conditions also revealed positive benefits, including on anxiety, depression, demoralization, hopelessness, spiritual well-being, quality of life, and life meaning. Psilocybin is widely used in contemporary psychedelic therapy research. Primary advantages of psilocybin are its very low toxicity and benign side-effect profile, and the relatively short duration of its psychoactive effects, with sessions generally lasting 8 hr.
Although psychedelic therapy sessions do not follow one psychotherapeutic model, music-listening has remained a vital component, including in contemporary psychedelic therapy studies. A 1965 review claimed that music in psychedelic therapy could be Downloaded fromby University of Birmingham user on 10 April 2020 used to alleviate psychotomimetic response and alter mood; however, music could also distract from fully experiencing drug effects. In 1972, researchers (including music therapist, Helen Bonny) asserted that music complements therapeutic aims of psychedelic therapy through providing continuity within an experience of timelessness and structure as patients relinquish usual controls and further enter inner worlds: this enables emotional release and "peak experience," characterized by a sense of unity, transcendence, reverence, wonder, meaningfulness, and ineffability. Recent psychedelic, music, and neuroimaging studies support these assertions. A review highlights: (a) partial overlap of brain regions involved in music processing and those affected by psychedelics; (b) psychedelic enhancements to auditory perception and tonal tracking of music; and (c) facilitation between psychedelics and music in the activation of neural areas involved in emotion, autobiographical memory, mental imagery, and self-referential processing. Psychedelics are conceptualized as effecting a "relinquishment" of filters that people normally use to regulate internal milieu. This letting go of psychological control allows less inhibited emotional expression. Usual regulatory processes of music-evoked emotion are potentially diminished, allowing more extensive processing of music and elicitation of related emotion. Choice of music appears important as music psychology studies demonstrate that, "Emotions influence what music listeners choose to hear, and music influences how they feel". Further, music therapy reduces anxiety; hence, music may reduce emotional arousal, potentially helping patients to find solutions to struggles, as commonly reported in psychedelic therapy. Music's potential to connect patients with deeply meaningful and therapeutic experiencescould also be enhanced through its interaction with the drug.
Although psychedelic therapy and music listening interactions facilitate profound responses in emotion, mental imagery, and meaning, limited attention Downloaded fromby University of Birmingham user on 10 April 2020 has focused on understanding views about the music used. Its examination is encouraged to promote the development of empirical guidelines for music used in sessions and optimization of therapeutic outcomes. In 1963, music therapist, Hermina Browne, commenced supervising music presented with LSD to patients with alcoholism at the New Jersey Neuropsychiatric Institute and reported on patients' responses. Throughout the 5-hr LSD sessions, music and silence alternated for 30 min each, and staff believed that familiar, religious, and romantic music helped and guided patients. From 1968, Helen Bonny developed a music program for researchers using psychedelic drugs to treat patients at Maryland Psychiatric Research Centre (MPRC) Baltimore, drawing from about 100 music recordings of varied genres that staff had collected. Bonny and others also used patient-completed music preference questionnaires to inform music used in experimental conditions. After the LSD research program ceased, Bonny explored the use of music and imagery without LSD because she believed that music alone could stimulate imagery). Bonny's work confirmed her belief and also demonstrated that, when music alone was used, recollections of imagery and feelings were "far greater" than when LSD was also ingested. Consequently, Bonny developed the Bonny Method of Guided Imagery and Music (BMGIM) for "exploring consciousness for personal growth and transformation". [The evolution of BMGIM is further described in, which includes]. This evidence-based method involves 1.5-2 hr sessions including: (a) Pre Talk (Preliminary therapist-client conversation); (b) Induction (Therapist suggestions for body relaxation and focusing the mind as clients transition into deeper altered states of consciousness); (c) The Music and Imagery Experience (30-50 min of a Bonny Method music program selected by the therapist during which time the client describes spontaneously experienced imagery and the therapist helps the client to explore it); and (d) Return and Post-Talk (Processing of imagery through discussion, mandala creation, or other artmaking). Music selection is informed by therapists' experience and described as: "carefully selected pieces of music from the Western classical genre, the elements of which combine in a way that has Downloaded fromby University of Birmingham user on 10 April 2020 been found to optimally support and sustain the client's imagery experiences.". Although many recent psychedelic studies only brieflyor do notmention the nature of music used, music playlists prepared by two researchers are available.Their creators largely relied on "intuition" and experience when designing the standardized playlists: Bill Richards (Baltimore) used much classical music and avoided English lyrics except in the final phase of the drug therapy session, asserting that classical and non-lyrical music minimize usual and rational thinking. Mendel Kaelen (London) used classical, neoclassical, ambient, jazz, and ethnic music. Highly familiar music was avoided because, Kaelen believed, the music impeded opportunity for a new experience. When selecting music, Kaelen asked whether each piece included something intrinsic, likely to evoke emotion in most listeners. His playlist was also informed bydescription of different drug therapy phases and work byand. Two studies, separated by 45 years, examined psychedelic therapists' views about musical features which support positive experiences in psychedelic therapy.reviewed the most frequently played music by seven MPRC therapists who had conducted over 600 LSD drug sessions and examined their views about optimal music for each phase of drug action, including psychedelic peak experience.examined 10 therapists' views about optimal musical features which support peak mystical experiences in psilocybin therapy, that is, the feeling of oneness or unity with the world or universe. Findings from these two studies are summarized in Tablesand. Another important area is participants' experience of music, especially given its association with treatment effect. This article presents a rapid review of participants' experiences of music in psychedelic therapy research. The research question is: What are participants' experiences of music in psychedelic therapy research using psilocybin, LSD, or ayahuasca?" The review was conducted to inform a research team's decisions about the music used in a study examining psilocybin-assisted psychotherapy for the treatment of depression and anxiety associated with life-threatening illness. The team includes a music therapist and is inspired byhope that information about music in psychedelic therapy may advance understanding of "the hypothesis that music is therapeutic at deeper levels of the psyche" (p. 83). While psychedelic therapy remains under clinical investigation as a therapeutic modality, the Food and Drug Administration has recently granted "breakthrough therapy" status to psilocybin in the context of Major Depressive Disorderwhich will potentially expedite governmental approval of this intervention. It is, therefore, possible that psychedelics will become approved medicines in the United States, UK, and other Western countries within the next 3-5 years. As music is pivotal in psychedelic therapy, music therapists can potentially make important contributions to ongoing psychedelic research and in psychedelic therapy delivery if psychedelics become approved medicines.
The review was conducted from February to May 2019, with a limited project timeline. A rapid review is a timely, streamlined approach to synthesizing evidence used to inform healthcare decisions. The search is less comprehensive and enables a cautious interpretation of findings, compared with evidence-based findings derived from a systematic review. Numerous rapid review approaches existand this review was informed byapproach as follows: development of keyword search strategy, undertaking the literature search, screening of literature, data abstraction, quality appraisal (limitations), and narrative synthesis of data. Reporting followed the Systematic Reviews, Integrative Reviews, and Meta-Analyses checklist (PRISMA)where applicable.
The research team discussed and agreed on the review's aim, literature search criteria, and strategy. A librarian helped with the development of search terms. Initial literature screening of article titles and abstracts was informed by the question, "1. Does this paper include research findings about participant reported experiences of psychedelic therapy using psilocybin, LSD, or ayahuasca, which may include music?" Screening of full-text articles was informed by the question "2. Does this paper include research findings about participants' experience of music in psychedelic therapy using psilocybin, LSD, or ayahuasca?" Inclusion Criteria. The study included primary research published in refereed journals with the following characteristics: participants ≥ 18-year-old; healthy or any diagnosis; qualitative, quantitative, or mixed methods studies; includes a psychedelic therapy intervention involving psilocybin, LSD, or ayahuasca with music involved; includes participants' self-reports of music experiences in Downloaded fromby University of Birmingham user on 10 April 2020 psychedelic therapy, that is, subjective narrative and/or numerical accounts about exposure to music in psychedelic therapy acquired through interviews and/or questionnaires; questionnaire measures of emotional reactions associated with music and psychedelic therapy experience; studies published in the St Vincent's Hospital Melbourne, Australia, searched databases; and in English. Exclusion Criteria. The study excluded: studies of psychedelic use in nonclinical settings (e.g., recreational psychedelic use, ethnographic fieldwork examining psychedelic rituals); psychedelic therapy research without mention of participants' music experience or music; studies examining therapists' perception of participants' music experiences; letters, commentaries, review articles, conference abstracts, book reviews, theses, and corrections. The review searched the following electronic databases: Medline, Embase,. Search terms were (hallucinogens or "lysergic acid diethylamide" or psilocybin or ayahuasca or LSD or psychedelic) and (music or "music therapy" [MESH, Ti, Abstract]). To expedite the timeframe, we searched a limited number of databases and only examined included articles' quality (limitations) in relation to reporting of participants' music experiences. Each step was conducted by two independent reviewers. Articles that passed initial screening (Question 1) were determined by first (C. O'Callaghan), second (D. J. Hubik), and final (M. Ross) authors based on title and abstract. C. O'Callaghan and D. J. Hubik separately reviewed half of the abstracts, and C. O'Callaghan and M. Ross separately reviewed half of the abstracts. There was no disagreement about final studies included for full-text review. There was occasional disagreement on the reason for exclusion of articles, which were resolved via discussion. For example, one author reported that "Segida, L. (). I-migrations in cultures and languages. Dissertation Abstracts International Section A: Humanities and Social Sciences, 75(7-A(E)), No Pagination Specified" was a "discussion paper/commentary/letter" whereas another reported it as a thesis. After discussion of the meaning of dissertation (a term not widely used in Australia), it was excluded with the reason that it was a thesis. All full text included articles were read by C. O'Callaghan and one other author, who jointly decided and agreed on all article inclusions and exclusions (Question 2). Information extracted from included studies is presented in descriptive summaries (Authors/date/location, Purpose of Study, Methods, Sample, Limitations), and as a narrative synthesis (Music Related Findings and Interpretations). A narrative synthesis narratively synthesizes evidence from multiple studies (as distinguished from statistical meta-analysis), including studies with wide-ranging designs, to explore relationships in findings in an attempt to generate new insights. Steps and techniques used in this synthesis were derived fromguidance on conducting narrative syntheses and included: (a) Developing a preliminary synthesis of findings focused on patterns across the studies (Technique: Inductive thematic analysis); (b) Explorations of relationships in the data, including differences across studies (Technique: Multiple study findings translated into one another, i.e., findings compared and contrasted); and (c) assessing robustness of the synthesis (Technique: Critical reflection on the synthesis process in the Discussion). [Another element which can be used in narrative syntheses, i.e., developing a theory of how the intervention works to inform the review question, was not necessary in this exploratory rapid review.] The first two steps of the synthesis were conducted together as follows: (a) coding of study findings/interpretations using researcher created descriptive labels; (b) grouping of comparable codes across study findings/interpretations into researcher created categories; (c) grouping of comparable categories into researcher created themes; and (d) statements clarifying each theme, which illuminate comparisons across studies. This thematic analysis was informed by grounded theory methods. Qualitative data management software also supported the analysis. C. O'Callaghan led the narrative synthesis of the Music Related Findings and Interpretations, and a strategy of the level of agreement between reviewerswas integrated whereby remaining authors examined all the Music Related Findings and Interpretations data listed in the abstraction Table, then read C. O'Callaghan's narrative synthesis, and discussed it until reaching an agreement. All authors agreed with the narrative synthesis after two items were added: (a) saline was the placebo used in one study and (b) only one study described associations between music pitch elements and imagery.
A total of 406 articles were retrieved with 80 duplicates. Following the review of the remaining 326 titles/abstracts, 319 articles were excluded because they included at least one exclusion criteria, as reported in the study selection flow diagram (Figure). Seven full-text papers were reviewed and five included in the review. Two were excluded because music was not mentionedor it was an ethnographic rather than clinical study. References in the five included articles were examined, leading to an additional 16 full-text articles being reviewed. Five of these were also included in the synthesis). The 11 not included studies described researchers' reports of music's effect on patients in psychedelic therapy, did not present research on participants' music experiences Downloaded fromby University of Birmingham user on 10 April 2020, nor state that music was used (Garcia-Romeu,. Data abstraction for the 10 reviewed studies is in the Supplementary Material.
There were 180 participants in included studies, aged 18-69 years, and 53 of 121 participants were female (sex unstated in one study). In two sets of two articles,and, andand, participants were sourced from the same primary studies, that is,and, respectively. Studies were undertaken in the United States (6), UK (3), and Switzerland. Sample sizes ranged from 10 to 59. Previous psychedelic experience of participants was not reported in three studies, one study included psychedelically naïve participants, and remaining studies included some-to-all psychedelically experienced participants. Seven studies examined effects of psilocybin with music, on: people regularly involved in religious/spiritual activities; meaning-making and experience of death with cancer; depression; smoking cessation; and healthy volunteers. Other studies examined the effects of LSD with music on: people with alcoholism; existential anxiety related to life-threatening illness; and healthy volunteers.
Two studies each specifically examined how the music was associated with altered states and remembered experiences, whether music supported the psychedelic therapy experience, and music preferences during the therapy. Individual studies also examined views about how music was administered, and whether music was associated with clinical outcome. Three studies examined whether music-evoked emotions were enhanced while under the drug. In a study examining smoking cessation, an extensive interview framework included the question, "Did the music play a role?". Otherwise, studies aimed to examine nonmusic-related effects but reported on incidental comments made about the music.
Research designs included mixed methods, qualitative thematic analyses, a cross-sectional single exposure trial with five music conditions, a paired study using quantitative measures, and a paired longitudinal dosage study. Data collection tools included: semi-structured interviews examining psychedelic experiences; researcher visual analog scale ratings (VAS) informed by participant interview content; the Quick Inventory of Depressive Symptoms pre-post the session, to examine the association between music and clinical outcome; a music preference survey with closed-ended questions, including about music examples presented administered pre-post LSD; the Objective Checklist for LSD Experience); an openended question with VAS response ("How emotionally affected were you by the music?"); Geneva Emotion Music Scales (GEMS)-9 which asked about music tracks played during LSD therapy; and Subjective Effects and States of Consciousness Questionnaires, which contained one music item each. Studies were mostly conducted using therapists, although trained "monitors"or "guides"were used in four studies. Data were collected during the psychedelic therapyor a week, 4 months, 3 months, 6 months, 1-52 weeks, or 30 monthslater.
Approaches to music played during psychedelic sessions varied. Only two studies detailed specific music used. InLSD study, 10 tracks were used, based on participants' ratings for highest liking and lowest familiarity. The 10 tracks were Downloaded fromby University of Birmingham user on 10 April 2020 from 16 researcher-selected tracks presented to the participants and are listed in the article. The music playlist used instudy is completely detailed in the Supplementary Material included in that study. The playlist order was arranged by study staff to complement psilocybin effect phases. In this study, participants also received an opportunity of listening to the playlist in a preparation session; one participant, who strongly disliked this playlist, used the Richards' playlist, mentioned earlier.used participants' music preferences, spanning nine categories, to inform music presented but the information was used to inform five treatment conditions, that is, no music; miscellaneous music, familiar and liked music free-field, familiar and liked music with headphones, and unfamiliar and disliked music. Music from all categories was randomly used in the miscellaneous condition. Music categories, not actual music used, were listed in the article. In the remaining seven studies, the nature of music presented was only alluded to, with phrases including: (a) "with music", (b) "a program of classical music", (c) "a program of classical and world music", (d) "a program of music", and (e) "a specific music playlist".andboth used participants sourced from Carhart-Harris et al.'s () study, so it can be inferred that Watt's used theplaylist. Likely,study, who had Richards on the team, used the psychedelic playlist that Richard's designed. Instructions given to participants when listening to music varied widely. Headphone use was one of the experimental conditions in two studiesand also reported in three others. Participants were requested to cover or close their eyes in all except one studyand in four studies participants reclined on a bed/couch. Instructions across the studies included, "relax as completely as possible," "Let the music take you where you need to go", focus attention inwards, "relax", lie comfortably (Belser Downloaded fromby University of Birmingham user on 10 April 2020, and "trust, let go, and be open". Inpsilocybin study, both headphones and speakers presented music during sessions to allow deep immersion, continuity if headphones were disrupted, and for therapists to empathize with participants' states.
Four themes emerged from the analysis related to music experienced during psychedelic therapy as follows. Where available, participant numbers from the original studies are signified by "#." Theme 1. Music Is Central for Supportive and Meaningful Emotional and Imagery Experiences and Therapeutic Outcomes. Music was widely considered "central"or "integral"to participants' "phenomenal"experiences during psychedelic therapy: a vehicle for "making things happen". Music was supportive, calming, and associated with intensified and meaningful emotions, thoughts, and mental imagery which carried participants into different realms: "The music was melding with what I was feeling, and it was all mixing up to create images in my mind… the music was the whole script, the whole movie, the whole everything" (#427). In two studies, many participants said that music enabled them to surrender to emotions. In one of these, music also provoked participants' repressed emotions and acceptance of those which were painful. In another, researchers observed that negative music-evoked emotions often helped to elicit and address participants' psychological issues.found that music with LSD was associated with participants' significantly higher experience of emotion (diff 0.51, p = .006); and wonder, power, tenderness, and transcendence (all p = .027; see figureofarticle for effect size) compared with when participants experienced music with placebo (saline).also found that as psilocybin dosages increased, participants also reported experiencing stronger absorption in music listening (p < .05) and sense of music's significance (p < .05). Elsewhere, musically elicited spiritual connections were also evident through music's association with "heaven"and the Downloaded fromby University of Birmingham user on 10 April 2020 aesthetic: "To "let go" & become enveloped in the beauty of -in this case -music -was enormously spiritual" (#27). Theme 2. Transformation via Music's Anthropomorphic, Transportive, Material, and Dichotomous Elicitations. Participants described how music experienced during therapy was transformational through its elicitation of anthropomorphic, transportive, and material sensations. Individuals described music as "alive", a "coauthor," "ally", and lover: "I was in love with the music. But I felt like it was [also] in love with me. That's a great feeling" (#405). Music was also something "real" to "hold" onto, a "conveyor" of experience, "tour guide"/"guide", and a carrier, which took people to different places. One participant said it was "gorgeous" being "carried" with the music "from dark to light, from tension to total relaxation" (#3). Some "lived" in the music, said that their experience matched the music, or that it enabled richer self-exploration. Music was also experienced by some in visual-, somatic-, and/or gustatory-auditory synesthesia. One tasted the music and another felt: "My entire body was musical instrument for every sound, which was coming through my head and it eviscerated from top to bottom . . . I know what a grand piano feels like when it is played".stated that, "Nine participants described a loosening or even dissolving sense of self, often merging with different elements of their experience such as the music, emotions, or images" (p. 497). Similarly, most participants instudy felt that music was touching or a part of them and, as mentioned earlier, music melded with #427's feelings. Music's therapeutic influence was also especially evident in how the music elicited dichotomous emotional and imagery effects. Music enhanced participants' experience of both power and tendernessand enabled a participant to simultaneously "let go" and be "enveloped" in music. Others stated, "The music was wonderful because it anchors you and yet it propels you", and "Incredibly Downloaded fromby University of Birmingham user on 10 April 2020 funny and tears of joy, then crying because of the poignancy of the music". Theme 3. Openness and Liked Music and Listening Contexts Support Therapeutic Outcomes. Participants' liking of music heard during psychedelic therapy was associated with therapeutic impact. Most positive outcomes were evident when the music was liked, accepted, and resonated. Rare dislike of music (n = 2) inpsilocybin study was associated with reduced subjective effects. These participants preferred their own music. A "few" participants in Watts et al.'s study also wanted freedom to change the music and one added that listening to the music blindfolded and with headphones, as required, was "sickening and nauseating" when she wanted to open her eyes and "do things under the effect of the drug" (p. 550). At one point, the "trippy" music inmade #10 think, "I'm going crazy" (Kaelen et al.'s Supplementary file, p. 9). Also in this study, liking (r = 0.61, p = .006), resonance (r = 0.67, p = .002), and openness (r = 0.70, p = .0008) to music predicted mystical experience, and resonance (r = 0.53, p = .016), and openness (r = 0.59, p = .007) to music predicted insightfulness. Researchers asserted that music in psychedelic therapy should, therefore, be "patient centered," including through adapting music during sessions when needed. They also stated that participants need an open and curious attitude and preparedness to engage in emergent therapeutic content. Two other participants also recommended that music should be tailored to each participant.findings also informed their recommendations that the music should reflect participants' music preferences and "unique responses" in psychedelic therapy, but that while the music needs to be liked the music does not need to be familiar. Studies which examined participants' liking of music in psychedelic therapy sessions indicated that most affirmed the music experienced. This includesfinding that most liked the music in four music intervention arms, although the music conditions were informed by all participants' completion of an LSD Music Preference Questionnaire. All except the no-music condition (n = 10/59) stated that music should be in sessions, yet in this no-music group, four participants also requested music during sessions. There were exceptions in studies, however, where individuals wanted the music changedor said that the music was "manipulative". Instudy, 3 out of 20 participants found the music restrictive and too dark, sometimes unbearable. Instudy (which used the same participants as Watts), 10 out of 19 participants stated that the music had unwelcome influences on subjective experiences, although 18 out of 19 participants also stated music had welcome influences. Only a few studies reported on participants' views about various genres experienced during psychedelic therapy. Love ballads were most preferred inLSD study. Inlater psilocybin study, the most preferred music was ethnic, vocal, and (neo-) classical music.also reported that music most liked by participants through drug therapy phases included: (a) calming (ambient) music, particularly at early and final (return) phases, and sometimes during the peak phase and (b) more emotionally evocative music, also during peak phase. These researchers surmised that optimal playlist design needs to include music genre selection structured to match different phases of drug experience (and added that this supported other authors' views). Individuals instudy also recommended more periods of silence (#417) and "repetitive harmonics" (#422). Elsewhere, a few wanted the "spooky" Holocaust Gorecki track removed, which "is about a young Jewish woman being prepared for death; it evokes deep sorrow". Onlyspeculated about associations between musical pitch elements and imagery, reporting that low pitches were noticed more than high pitches, but high pitches were associated with brighter colors, smaller geometric designs, and more real past experiences. Most participants preferred high pitches due to associations with virtues and heaven. These authors also reported that no distortion of music experienced was evident. Two studies reported on the experience of wearing headphones. In one, familiar music heard through headphones was the most effective presentation method (n = 59; p < .05); however, a participant elsewhere found the expectation of using headphones, eyeshades, and lying down restrictive. Downloaded fromby University of Birmingham user on 10 April 2020 Theme 4. Music Is Associated With Positive, Longer-Term Effects. Some findings revealed how the music in psychedelic therapy changed participants' lives, namely through how they related to music. Those who experienced familiar music through headphones instudy changed their music preferences after the LSD experience. Following involvement instudy, a participant listened to music more consciously. Certain musical pieces from sessions continued to overwhelm 6 out of 12 of this study's participants with positive emotions. Elsewhere, two participants also considered taking up musical instrument playing after sessions, and 2.5 years after psilocybin therapy #413 was "so into music now". In the depression studies (which used the same participants), many who had stopped enjoying music were able to listen to it again.also reported: Reductions in depression 1 week after psilocybin were significantly predicted by the music experience variables, liking (r = 0.60, p = 0.006), resonance (r = 0.59, p = 0.008), and openness (r = 0.57, p = 0.001), but not by drug intensity (r = 0.004, p = 0.98). (p. 513)
In eight studies, the specific music used was not reported. Interview schedules in qualitative studies also included oneor nomusic experience questions. In individual studies, no details were provided about the analytic approach to textual data, instructions about music engagement, the data collector/person accompanying sessions, baseline emotion checking before music was played, nor participant code identifiers to signify quotes, which is necessary to ensure that the illustrative quotes are not all from one person. Downloaded fromby University of Birmingham user on 10 April 2020
In psychedelic therapy research, details about music offered by researchers and used by participants are needed to assist with the development of guidelines for music provision into the future; however, such details are often absent in study reporting. Similarly, music's role in psychedelic therapy research is seldom examined. Participant reports of music-related experiences were evident in only 10 studies in this rapid review, 5 of which just reported incidental statements in research focused on nonmusic-related effects. Yet, when participants liked and were open to music used, music was integrally linked with positive multisensorial and transformational outcomes. Music experienced as "negative" may lead to therapeutic outcomes through eliciting and helping to address psychological concerns; however, therapeutic outcomes may alternatively diminish when the music is "dissonant with the (individual's) unfolding experience". Some of those with depression also developed enhanced appreciation of music following psychedelic therapy, as found in psychedelic therapy outcomes in the 1960s. Lack of detail about the music used and experienced in psychedelic research is striking given its profound effect. This may be due to lack of awareness about how music analysis could assist researchers to examine the efficacy of music in psychedelic therapy.
Future research could examine associations between music structures heard when participants experience significant altered effects, evident via participant reporting or (possibly) therapist observation. Researchers could examine whether there are similar musical features in psychedelic therapy associated with peak experiences, or with lead-up and follow-on reintegration phases. Study designs with comparable aims already used in music psychology and BMGIM research could be helpful for future psychedelic therapy research. For example, a structural analysis of music passages associated with participants' reports of physical responses found that tears were most reliably elicited by passages with sequences and appoggiaturas, and shivers most commonly elicited by passages with new or unexpected harmonies.also used a Structural Model of Music Analysis to examine whether Downloaded fromby University of Birmingham user on 10 April 2020 the music being played when participants experienced pivotal moments during BMGIM had similar structural components. Pivotal moments were defined as intense embodied experiences when clients experience life-changing resolution after confronting distressing imagery. Common features included formal structures (e.g., ternary) with repetitive themes and rhythmic motifs, consistent rhythmic structures, slow tempi, diatonic tonal structural progressions with predictable harmonies, predominantly legato (with perhaps pizzicato in accompaniment), and instrumental dialog. Participants' views about optimal music for different phases of drug effects during psychedelic therapy may also inform guidelines for developing psychedelic therapy playlists, including genres, familiar/unfamiliar, or vocally comprehendible/ non-comprehendible music.
Guideline development for music in psychedelic therapy would need flexibility due to the widely varied, idiosyncratic ways that individuals respond to music. Participants' music backgrounds and preferences can affect the quality of their psychedelic experience, and unwelcome music can be associated with participants feeling spookedand manipulated. Hence, participants should have the opportunity to sample researcher-offered music before drug ingestion, as described inpsilocybin study, and to choose music used in sessions. Inviting participants to reflect on their musical backgrounds and whether there is specific music that they want included or excluded should also occur. Therapist adaptation of music presented during psychedelic therapy sessions may also be needed to reduce adverse experiences, as recommended throughout the history of psychedelic therapy. Therapists and researchers inevitably face a challenge when endeavoring to distinguish between negative music-evoked emotions, which can help to address participants' psychological issues, and unwelcome music associated with adverse outcomes and need for playlist changes. Further research on therapists' decision-making related to music changes in psychedelic therapy, and participants' reactions to these changes, would help to inform this area. Bonny developed 18 music programs for use in BMGIM with titles describing either Downloaded fromby University of Birmingham user on 10 April 2020 the program's intent (e.g., transitions) or music's affective quality (e.g., serenity). Research on BMGIM therapists' reasons for using different music playlists across sessions may also illuminate future planning for music use in psychedelic therapy. Overall, findings from the rapid review support other authors' recommendations for "patient-centered" or "patient-specific" musicfor optimal participant experience and therapy outcomes. This includes both the music played and how it is presented, as participants need a choice over using headphones, blindfolds, or lying down to listen.
Further suggestions informed by this study's findings for planning the music in psychedelic therapy follow. Participants need: • an invitation to be open-minded to music heard during psychedelic therapy because music is heard differently in a nonordinary state of consciousness, and the music one wants to hear may not have optimal therapeutic effects; • to ideally experience music which is unfamiliar, rather than familiar, which may already have positive or negative associations; • to be informed that music which is liked, even when unfamiliar, can have positive effects; • to be invited to choose the music for their psychedelic therapy session through listening to samplers of music playlist/s designed by psychedelic therapy researchers; • to feel empowered to attenuate the psychedelic effect of music through choosing to be in silence, which may also be helpful, or to listen to environmental sounds, such as bird song, the ocean, or wind; • to be advised that previous participants in psychedelic therapy find different playlists helpful, that some prefer music from the classical tradition, while others prefer more neoclassical and ethnic music, etc., and that some may need to avoid music with adverse associations. There is no one universally applicable playlist for psychedelic therapy. If the participant experiences heightened distress during drug ingestion, therapists should also consider including music the Downloaded fromby University of Birmingham user on 10 April 2020 participant identifies in preparatory sessions as having a positive mood association. Use of a "rescue genre" or "rescue songs" as a non-pharmacological support intervention may facilitate a soothing response, assist with reduction of severe anxiety or agitation, and avoid the need for "rescue medications." Therapists should also consider providing headphones and speakers to support participants' deep immersion in the music alongside therapists' awareness of music heard.
This is the first systematic review of participants' self-reported experiences of music in psychedelic therapy. Although it was a rapid approach with the search limited to refereed journal articles and major health databases, it was comprehensive, likely to have retrieved most (if not all) relevant articles, and independent reviewers were involved in all review phases. The entire data set which informed the development of themes is also available in the Supplementary Material. The findings illuminate music's integral role in psychedelic therapy and generate practical ideas for supporting participant-centered music selection procedures in sessions. Nonetheless, limitations related to reviewed studies, which spanned 1970 to 2018 across only three western countries (United States, England, and Switzerland), restrict the scope of application of the findings. Study designs and statistical procedures have evolved since thestudy: adjustment for multiple comparisons were historically not performed but, if they had been, statistical significance may not have been obtained. Limited conclusions can only be drawn from the findings because of the studies' heterogeneity regarding: clinical populations; research questions; and methods, including drug and music used, psychedelic therapy provided, and outcome measures. Specific music used in eight studies was also not detailed whereas contact with study authors may have improved this reporting. Researchers' cultural backgrounds would have likely affected decisions about the music used in psychedelic therapy (and participants' experience of sessions) similar to how music therapists' backgrounds can affect their "motivations as clinicians". Further reflection by researchers on motivations for decisions about the Downloaded fromby University of Birmingham user on 10 April 2020 music used in psychedelic therapy may inspire deeper insight into their work, and use of client-centered music. The review also did not examine psychedelic therapy outcomes when no music was used; however,findings would support music's availability in psychedelic therapy, as four participants in the no-music group condition requested music, and ethnographic fieldwork research also indicates that music amplifies and accentuates positive experiences following ingestion of psychedelic substances.
In psychedelic therapy research, liked music is considered integral for meaningful altered experiences and enriching selfexploration. Music can promote and extend helpful experiences of multi-sensorial and synesthetic sensations, safety and companionship, conveyance of love, and transportation to other realms. Music can also elicit a sense of deeply embodied transformation. Therapeutic influence is especially evident in the dichotomous physical and emotional ways that music can be experienced, as was also evident when music was used for self-care through cancer diagnoses: music can simultaneously anchor yet propel, and elicit tears of joy and poignancy. Music can also be associated with negative emotions, which could help with the processing of psychological issues, or they may be unwelcome, reinforcing the need for patient-centered planning of music in psychedelic therapy. Music therapists, Browne, Eagle, Gaston, and Bonny, helped the original psychedelic therapy researchers to understand music's import as a tailored accompaniment to drug ingestion. BMGIM, Helen Bonny's legacy spawned from her contribution, has since been embraced by international music therapists. Music therapists are well-placed to help with the psychedelic therapy research renaissance. First, music therapists can help to develop optimal approaches for offering music in psychedelic therapy research, through researching music associated with participant reports of significant reactions during drug therapy phases. This would include examining music genres, silences, micro-analysis of passages associated with significant outcomes, and the scope of shared and idiosyncratic reactions. Second, music therapists could help to explore whether integration of any of the Downloaded fromby University of Birmingham user on 10 April 2020 BMGIM techniques into psychedelic therapy has merit. Finally, music therapists can be involved in trials comparing BMGIM with psychedelic therapy outcomes. If psychedelics become approved medicines, music therapists may be involved in offering psychedelic therapy as part of therapeutic teams. Bonny's belief, that music alone is powerful enough to stimulate imagery without the need for psychedelics, is also well demonstrated. Further understanding about clinical indications for BMGIM, psychedelic therapy, or combination of both, is hopefully on the horizon.
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