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

Abstract

RationaleRecent 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.ObjectivesThe present study assessed the influence of music on the acute experience and clinical outcomes of psychedelic therapy.MethodsSemi-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).ResultsAnalyses 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.ConclusionsThis study indicates that music plays a central therapeutic function in psychedelic therapy.Electronic supplementary materialThe online version of this article (10.1007/s00213-017-4820-5) contains supplementary material, which is available to authorized users.

Effects of psilocybin therapy on personality structure

“…The second session was the focus of the therapeutic process, as only this dose was predicted to induce lasting therapeutic effects. After capsule ingestion, patients laid with their eyes closed while listening to a music playlist . Two therapists adopted a non‐directive, supportive approach, allowing the patient to experience a mostly uninterrupted introspection.…”

“…Typically, psychedelic‐assisted therapy involves only one or two sessions in which a moderate to high dose of a psychedelic compound is given in a supportive environment with the intention of evoking ‘peak’ or ‘mystical‐type’ experiences, characterized by disintegration of ego boundaries and an accompanying sense of connectedness , oneness, or unity . This treatment paradigm differs from the approach of long‐term daily pharmacological intervention associated with conventional antidepressant medication.…”

“…The mechanisms underlying the long‐lasting therapeutic effects of psychedelic therapy remain unknown. There appears to be a relationship between the therapeutic outcome and the subjective experiences during the psychedelic sessions . Moreover, psilocybin and LSD may increase the NEO‐PI‐R personality trait Openness to Experience (or simply ‘ Openness’ ) in healthy volunteers after a single dose .…”

Culturally informed research design issues in a study for MDMA-assisted psychotherapy for posttraumatic stress disorder

“…In addition, music and song are the integral part of many indigenous psychedelic traditions (e.g., the icaros sung by shamanic healers during the traditional ayahuasca ceremony; Labate & Pacheco, 2010;Tafur, 2017). In one study of 19 patients undergoing psychedelic therapy with psilocybin for depression, analyses revealed that the music had both "welcome" (desirable) and "unwelcome" (aversive) influences on the patient's experience (Kaelen, Giribaldi, Raine, & Evans, 2018). In many cases, it evoked deeply meaningful, emotional, and therapeutically valuable emotions and imagery.…”

“…In many cases, it evoked deeply meaningful, emotional, and therapeutically valuable emotions and imagery. In some cases, however, this was not the case; 6 out of 19 patients referred to "misguidance" and 9 out of 19 spoke to "resistance" as being a part of their experience at some point (Kaelen et al, 2018). However, to date, no empirical research has been conducted to examine the role of music in psychedelic-assisted therapy with people of color.…”