Set and setting in psilocybin-assisted therapy: A qualitative study of patients with cancer and depression
This qualitative study (n=28 interviews) of participants in a psilocybin-assisted therapy trial for cancer-related depression found that therapeutic benefits were closely tied to participants' ability to surrender (accepting and remaining open to the experience's intensity and unpredictability), with a safe, supportive, and ethical environment critical to fostering trust and engagement, and preparation and integration key to maximizing benefit, whilst music played a significant but variable role and ceremonial elements added meaning for many despite the clinical setting providing safety.
Authors
- Manish Agrawal
- Yvan Beaussant
Published
Abstract
Background
Psilocybin-assisted therapy (PAT) shows promise for cancer-related depression, yet little research has examined how therapeutic context shapes patient experiences. While set (mindset) and setting (environment) are considered central to psychedelic treatment, empirical evidence on their role in PAT acceptability remains limited. This study explores factors influencing the acceptability of PAT from the perspective of patients with cancer and depression.
Methods
We conducted semi-structured interviews with participants in a clinical trial of psilocybin-assisted therapy. Using template analysis, we examined themes related to the acceptability of the experience and the surrounding therapeutic environment.
Results
Participants (n = 28) described the psilocybin experience as intense and demanding, with therapeutic benefits closely tied to their ability to “surrender”-a term used to describe accepting and remaining open to the experience's intensity and unpredictability. A safe, supportive, and ethical environment was critical in fostering trust and engagement. Preparation and integration were key to maximizing benefit. Music played a significant but variable role, sometimes enhancing and other times distracting. While the clinical setting provided safety, ceremonial elements added meaning for many.
Conclusions
Findings highlight how therapeutic structure, preparation, and setting shape PAT acceptability, supporting the need for patient-centered approaches to optimize care and outcomes.
Research Summary of 'Set and setting in psilocybin-assisted therapy: A qualitative study of patients with cancer and depression'
Introduction
Interest in psychedelic-assisted therapy (PAT) has renewed attention to the non‑pharmacological elements that accompany drug administration, commonly framed as "set" (patients' mindset) and "setting" (the treatment environment). Earlier research and contemporary models suggest these contextual factors shape subjective experiences and hence therapeutic outcomes, but empirical, especially qualitative, investigations of how set and setting influence acceptability and patient experience in PAT are scarce. Debates persist about whether preparatory work, therapist presence, music, ritualised elements and integration practices are merely safety scaffolds or active contributors to efficacy. Beaussant and colleagues set out to explore how elements of therapeutic context shaped acceptability, perceived safety and therapeutic benefit among patients with cancer and major depressive disorder who participated in a Phase II open‑label psilocybin trial. Using semi‑structured exit interviews, the study examined participants' perspectives on preparation, dosing‑day environment, music, therapist support, and integration practices, aiming to generate empirical insights into the interplay between the psilocybin experience and its therapeutic container to inform optimisation of PAT delivery.
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Study Details
- Study Typeindividual
- Journal
- Compound
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- APA Citation
Beaussant, Y., Tarbi, E., Nigam, K., Miner, S., Sager, Z., Sanders, J., Ljuslin, M., Guérin, B., Sholevar, R., Roddy, K., Tulsky, J. A., & Agrawal, M. (2025). Set and setting in psilocybin-assisted therapy: A qualitative study of patients with cancer and depression. General Hospital Psychiatry, 97, 175-184. https://doi.org/10.1016/j.genhosppsych.2025.10.010
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