Experience of Music Used With Psychedelic Therapy: A Rapid Review and Implications

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.