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

Introduction

Contemporary clinical research has renewed interest in classic psychedelics (agents acting at the serotonin 2A receptor such as psilocybin, LSD, and DMT) for a range of psychiatric indications including depression, anxiety related to life‑threatening illness, and substance use disorders. Psychedelic therapy historically emphasises the importance of "set" (the individual's psychological state) and "setting" (the environmental context), and music has been a near‑universal element of clinical sessions. Despite these long‑standing recommendations, there has been little experimental work isolating how specific session components such as musical selection influence subjective drug effects or therapeutic outcomes, and prior studies have had methodological limitations (for example, between‑subject designs, quasi‑randomisation, or absence of objective clinical endpoints). Strickland and colleagues set out to experimentally evaluate whether musical genre played during psilocybin sessions affects acute subjective experiences and a clinical outcome in an open‑label smoking cessation study. Using a within‑subject, counterbalanced design, participants received psilocybin sessions accompanied either by a Western classical playlist (commonly used in psychedelic therapy) or by an overtone‑based playlist emphasising instruments with strong overtone signatures (e.g. Tibetan singing bowls, gongs, didgeridoo, sitar, overtone singing). After sampling both playlists, participants chose the playlist for a third, higher‑dose session; subjective experiences (MEQ30, CEQ) and biologically verified smoking abstinence were analysed by musical condition. The study aims to inform whether standardised Western classical music is uniquely beneficial or whether alternate or individualised musical approaches might be appropriate in psychedelic therapy.