Trial PaperTreatment-Resistant Depression (TRD)Depressive DisordersSubstance Use Disorders (SUD)Set & SettingPersonality & Trait FactorsPsilocybin

The hidden therapist: evidence for a central role of music in psychedelic therapy

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.

Authors

  • Robin Carhart-Harris
  • David Nutt
  • Christopher Timmermann

Published

Psychopharmacology
individual Study

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.

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Research Summary of 'The hidden therapist: evidence for a central role of music in psychedelic therapy'

Introduction

Psychedelic-assisted psychotherapy has been associated with emotional release, peak or mystical experiences, and autobiographical insight, and music has long been an integral component of historical and contemporary treatment models. Previous experimental work shows that psychedelics amplify music-evoked emotion, imagery and perceived meaningfulness, and patients commonly report that music strongly influences their session; however, empirical study of music's specific therapeutic functions within psychedelic therapy is scarce. Kaelen and colleagues set out to characterise how music is experienced during psilocybin-assisted therapy for treatment-resistant depression and to test whether aspects of the music experience are associated with acute subjective effects (including mystical-type experiences and insightfulness) and with short-term clinical outcome. The study combined semi-structured interviews analysed with interpretative phenomenological analysis with quantitative ratings of three music-experience variables (liking, resonance and openness), and related these to standard psychometric measures collected around two psilocybin sessions.

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Study Details

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