The hidden therapist: evidence for a central role of music in psychedelic therapy
Carhart-Harris, R. L., Evans, J., Feilding, A., Giribaldi, B., Kaelen, M., Nutt, D. J., Raine, J., Rodrigues, N. B., Roseman, L., Timmermann, C.
This open-label qualitative interview study (n=19) assessed the role of music during psychedelic therapy with psilocybin (25mg) for treatment-resistant depression (TRD). It identified several ways in which music influenced their experience, most frequently related to the intensification of emotions and mental imagery, and the music appeared to be a significant source of guidance, creating a sense of grounding, as well as a sense of carrying the listener into different psychological places.
Abstract
Rationale: Recent studies have supported the safety and efficacy of psychedelic therapy for mood disorders and addiction. Music is considered an important component in the treatment model, but little empirical research has been done to examine the magnitude and nature of its therapeutic role.Objectives: The present study assessed the influence of music on the acute experience and clinical outcomes of psychedelic therapy.Methods: Semi-structured interviews inquired about the different ways in which music influenced the experience of 19 patients undergoing psychedelic therapy with psilocybin for treatment-resistant depression. Interpretative phenomenological analysis was applied to the interview data to identify salient themes. In addition, ratings were given for each patient for the extent to which they expressed “liking,” “resonance” (the music being experienced as “harmonious” with the emotional state of the listener), and “openness” (acceptance of the music-evoked experience).Results: Analyses of the interviews revealed that the music had both “welcome” and “unwelcome” influences on patients’ subjective experiences. Welcome influences included the evocation of personally meaningful and therapeutically useful emotion and mental imagery, a sense of guidance, openness, and the promotion of calm and a sense of safety. Conversely, unwelcome influences included the evocation of unpleasant emotion and imagery, a sense of being misguided and resistance. Correlation analyses showed that patients’ experience of the music was associated with the occurrence of “mystical experiences” and “insightfulness.” Crucially, the nature of the music experience was significantly predictive of reductions in depression 1 week after psilocybin, whereas general drug intensity was not.Conclusions: This study indicates that music plays a central therapeutic function in psychedelic therapy.