Psychedelic Therapy: Definition, Types, Therapeutic Potential and Music
Advancements in Psychedelic Therapy
Given the large number of different variables present in this approach, much more research is needed to define exactly how this approach works. Yet, important clues are emerging from increasing numbers of independent research groups, giving rise to a growing consensus in the field: it is not the drug, but the particular experience that the drug can facilitate, that relates to the positive therapeutic outcomes reported by an increasing numbers of studies.
To view psychedelic therapy as yet another psychiatric drug intervention, would be a grave mistake.
The distinctness of the method amongst modern practices is where its significance lies. The unprecedented outcomes possible give us hope that this renaissance marks a breakthrough in the way we understand and treat mental health.
Mental health care is in dire need of innovation: for depression alone treatment efficacy has not improved for 70 years, only 30% respond to first-line treatments, 30% do not respond to any treatment at all, and the global economic burden runs into the trillions — let alone the immense amount of chronic human suffering that remains unresolved.
It is not the drug, but the particular experience that the drug can facilitate, that relates to the positive therapy outcomes reported by increasing numbers of studies.
Going one step further, it is possible that consistent observation in psychedelic therapies — experience as the foundation for personal transformation — may not in fact be so mysterious. Despite being novel in terms of modern mental health care, it may well be aligned with our current understanding of the neuroscience of human development.
This new approach has the potential to not only be more effective, but more humane, more evidence-based, and –yes- much more rewarding.
What is Psychedelic Therapy?
The word psychedelic is derived from the Greek words psychḗ meaning “mind” or “soul”, and dêlos, meaning “to manifest” or “make visible”.
Common Psychedelic Drugs
Compounds considered “classic” psychedelics include:
- Psilocybin (the psychoactive constituent of magic mushrooms),
- LSD, mescaline (the psychoactive constituent of peyote and san pedro cacti) and,
- DMT (a major psychoactive ingredient in the Amazonian brew ayahuasca).
All these drugs share the property of activating the serotonin 2A receptor and have phenomenological similarities.
Different Psychedelic Therapeutic Approaches
Broadly speaking, by the 1960’s two distinct therapeutic approaches with psychedelics had evolved:
- the “psycholytic” method, mainly practiced in Europe, and
- the “psychedelic” method, mainly practiced in the United States.
These approaches differed in the dosages administered, the amount of sessions conducted, the theoretical frameworks used, and the structure of the sessions themselves.
Psycholytic therapy was characterised by lower dosages, with the intention to preserve sufficient “ego-functioning” for the patient in order to actively engage with the therapist during the sessions.
Generally speaking, the primary goal here was to use the drug as an adjunct to psychotherapy. Typically, patients underwent multiple sessions to reach the therapeutic objectives. Music was used in psycholytic approaches, but more frequently intermitted by conversations or periods of silence.
Psychedelic therapy was characterised by higher dosages, with the intention to dissolve “ego-functioning”, and for the individual to “immerse” fully in the unfolding experience. The primary goal here was to facilitate a “peak experience” that would result in enduring changes in personality, mood and behaviour. Typically, patients underwent one or a small number of sessions, and would listen to music for the majority of the time during these sessions.
All modern studies today so far have implemented a psychedelic therapy approach.
The Therapeutic Potential of Psychedelic Therapy
A consensus amongst independent research groups is that therapy outcomes are attributable to the occurrence of personally meaningful experiences during psychedelic therapy sessions.
Profoundly meaningful experiences change how an individual relates to themselves and with the world around them. Psychedelic therapy typically involves a small number of sessions whereby individuals are administered a high dose of a psychedelic substance that can facilitate profoundly personally meaningful experiences. It has been shown that treatment success is linked with the occurrence of such experiences, which support growth and learning and lead to enduring positive changes in mood and behaviour.
Safe and Successful Psychedelic Sessions
A combination of factors influence the outcome of psychedelic therapy, including but not limited to:
- Psychological preparation and integration,
- Pharmacological intervention, and
- The presence of a therapist or facilitator
All of the variables above are capable of impacting the quality of subjective experience during a session, and its long-term therapeutic effects.
Types of Psychedelic Experiences
During the 60s, a general consensus arose among researchers studying psychedelics that it was not the drug, but the experience that the drug can facilitate, which is therapeutic.
By the mid 1960s, the types of experiences that were considered most therapeutic were identified, and these were roughly classified into two main categories: peak experiences, and autobiographical experiences.
A “mystical-type experience” is an experience that differs from ordinary states of consciousness and is associated with feelings of awe, unity, and joy. Peak-experiences are characterised by moments of transcendence and are often associated with a sense of absence or resolution of inner conflict, and a sense of serenity, confidence and purpose in one’s life.
An “autobiographical experience” is characterised by vivid, emotionally charged memories and insights into one’s personal life, associated with an emotional release or catharsis. These experiences were often interpreted within a psychodynamic framework. While the breadth of psychedelic experience extends beyond these definitions, they serve as valuable markers when studying psychedelic therapy – enabling researchers to test the specifics of the relationship between mystical-type experiences and therapeutic outcomes.
Personally meaningful experiences as predictors of therapeutic outcomes
The direct relationship between subjective experiences and therapy outcomes has been established by early psychedelic researchers and continues to be supported by current research.
Early studies experimenting with classic psychedelics examined the treatment of drug and alcohol dependence; their findings suggested that the occurrence of a mystical-type (i.e. peak) experience contributed towards a positive therapeutic outcome. When studying psychological distress associated with advanced cancer patients, researchers similarly reported a decrease in symptoms mediated by the occurrence of meaningful experience.
More recently, a clinical trial using psilocybin therapy for treatment-resistant depression (TRD) investigated reports of ‘oceanic boundlessness’ (OBN), as one of the principal factors in assessing altered states of consciousness. In this study, psilocybin-induced high OBN scores (sharing features with mystical-type experience) predicted positive long-term clinical outcomes in a clinical trial of psilocybin for TRD.
Across the board, research finds that certain experiences evoked during psychedelic therapy act as an predictor of therapy success – such as reduced symptoms of depression and anxiety, reduction in addiction-related behaviour, as well as increases in well-being.
Music and Psychedelic Therapy
Music can make or break the psychedelic experience.
It has been shown that with proper setting, preparation, support and dosage, meaningful experiences can be occasioned with a high probability during psychedelic therapy.
Therefore, both patient experiences and therapy outcomes can be optimised with a deeper understanding of context.
As a primary setting variable in psychedelic therapy, music plays an influential role in mediating patient experience.
Music holds a unique capacity to facilitate a range of therapeutically-relevant states, including emotional processing, the occurrence of mental imagery, autobiographical insight, peak experience, and providing a sense of guidance, direction and support.
In a study assessing the role of music in psychedelic experiences, researchers found that the individuals’ acute experience of the music (defined as “resonance”, i.e. openness, liking, the music being harmonious with one’s inner state) played during the session correlated with therapy outcomes. These experiences selectively correlated with the occurrence of peak experiences and insightfulness, a finding that points to the value of a person-centred approach.
Playlists for Psychedelic Therapy
Despite best efforts, pre-curated playlists usually do not meet the best practice standards identified by research to provide adaptive music experiences responsive to the unique needs of the client, moment to moment during psychedelic therapy. Set playlists are not suited to the highly dynamic and subjective experience of an individual during psychedelic therapy and can increase the likelihood of unwelcome effects.
Studies demonstrate that the degree to which music resonates with an individual drives core therapeutic mechanisms: insight, meaning-making, emotionality and peak experience. Music that does not resonate can be counter-therapeutic.
Journeys are as unique as the individuals undertaking them. There is no one size fits all approach when it comes to curating music for psychedelic therapy.
The best music for psychedelic therapy is person-centred and composed for clients in the moment – this is why Wavepaths was born: to create personalised, unique music experiences every time.
Wavepaths is designed to complement the duration of action of psychedelic medicines while optimising for resonance. Sessions can be customised based on drug dose and route and administration. Care providers can co-create sessions live with their clients or create several sessions ahead of time and run them live, in-person or remotely through a user-friendly link.
Music as Psychedelic Therapy
The therapeutic use of music spans far and wide, with a myriad of studies reporting positive results in areas of medicine such as neurological disorders and chronic pain, to name a few.
For example, music therapy interventions (e.g. using patient-preferred live music) offered within a therapeutic relationship have been shown to favourably affect pain perceptions in patients recovering from spine surgery, with researchers suggesting that individualised treatment was at the core of music therapy’s efficacy, through which patients are supported in their recovery of “self.”
Similarly, in a study investigating the benefits of music therapy in cancer care in the form of an improvisational music therapy program found a variety of social and psychological benefits that related to the patients’ experience of music therapy, such as facilitating peer support and group interaction, increasing self-confidence, relaxation, and generation of positive feelings such as stress relief and feelings of enhanced communication through music.
Music as psychedelic therapy can be practised as deep listening: a way of reconnecting with yourself through music. It is active listening – an attitude of listening without judgement, with curiosity and intention.
Psychedelic medicines are a promising new locus of research in the field of mental health, capable of catalysing powerful therapeutic processes.
In addition, it has been shown that subjective experiences, in particular experiences of personal meaning and spiritual significance, are predictive of positive outcomes. Seeing the experience itself as the therapeutic agent reveals a captivating insight, one that turns existing pharmaceutical treatment paradigms on their head – experiential therapy is an internally driven, essentially creative healing process.
1. The word psychedelic is derived from the Greek words psychḗ meaning “mind” or “soul”, and dêlos, meaning “to manifest” or “make visible”. Compounds considered “classic” psychedelics include psilocybin (the psychoactive constituent of magic mushrooms), LSD, mescaline (the psychoactive constituent of peyote and san pedro cacti) and DMT (a major psychoactive ingredient in the Amazonian brew ayahuasca). All these drugs share the property of activating the serotonin 2A receptor and have phenomenological similarities.
2. Broadly speaking, by the 1960’s two distinct therapeutic approaches with psychedelics had evolved: the “psycholytic” method, mainly practiced in Europe, and the “psychedelic” method, mainly practiced in the United States. These approaches differed in the dosages administered, the amount of sessions conducted, the theoretical frameworks used, and the structure of the sessions themselves. Psycholytic therapy was characterised by lower dosages, with the intention to preserve sufficient “ego-functioning” for the patient in order to actively engage with the therapist during the sessions. Generally speaking, the primary goal here was to use the drug as an adjunct to psychotherapy. Typically, patients underwent multiple sessions to reach the therapeutic objectives. Music was used in psycholytic approaches, but more frequently intermitted by conversations or periods of silence. Psychedelic therapy was characterised by higher dosages, with the intention to dissolve “ego-functioning”, and for the individual to “immerse” fully in the unfolding experience. The primary goal here was to facilitate a “peak experience” that would result in enduring changes in personality, mood and behaviour. Typically, patients underwent one or a small number of sessions, and would listen to music for the majority of the time during these sessions. All modern studies today so far have implemented a psychedelic therapy approach.
3. Johnson, M. W., Garcia-Romeu, A., Cosimano, M. P. & Griffiths, R. R. Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction. J. Psychopharmacol. (Oxf.) 28, 983–992 (2014).
4. Bogenschutz, M. P. et al. Psilocybin-assisted treatment for alcohol dependence: A proof-of-concept study. J. Psychopharmacol. (Oxf.)0269881114565144 (2015). doi:10.1177/0269881114565144
5. Krebs, T. S. & Johansen, P.-Ø. Lysergic acid diethylamide (LSD) for alcoholism: meta-analysis of randomized controlled trials. J. Psychopharmacol. Oxf. Engl. 26, 994–1002 (2012).
6. Mithoefer, M. C., Wagner, M. T., Mithoefer, A. T., Jerome, L. & Doblin, R. The safety and efficacy of ±3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study. J. Psychopharmacol. (Oxf.) 25, 439–452 (2011).
7. Mithoefer, M. C. et al. Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study. J. Psychopharmacol. (Oxf.) 27, 28–39 (2013).
8. Ot’alora G, M. et al. 3,4-Methylenedioxymethamphetamine-assisted psychotherapy for treatment of chronic posttraumatic stress disorder: A randomized phase 2 controlled trial. J. Psychopharmacol. (Oxf.) 32, 1295–1307 (2018).
9. Mithoefer, M. C. et al. 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder in military veterans, firefighters, and police officers: a randomised, double-blind, dose-response, phase 2 clinical trial. Lancet Psychiatry 5, 486–497 (2018).
10. Carhart-Harris, R. L. et al. Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. Lancet Psychiatry 3, 619–627 (2016).
11. Osório, F. de L. et al. Antidepressant effects of a single dose of ayahuasca in patients with recurrent depression: a preliminary report. Rev. Bras. Psiquiatr. 37, 13–20 (2015).
12. Grob CS, Danforth AL, Chopra GS & et al. PIlot study of psilocybin treatment for anxiety in patients with advanced-stage cancer. Arch. Gen. Psychiatry 68, 71–78 (2011).
13. Gasser, P. et al. Safety and Efficacy of Lysergic Acid Diethylamide-Assisted Psychotherapy for Anxiety Associated With Life-threatening Diseases. J. Nerv. Ment. Dis. 202, 513–520 (2014).
14. Ross, S. et al. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J. Psychopharmacol. (Oxf.)30, 1165–1180 (2016).
15. Griffiths, R. R. et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. J. Psychopharmacol. (Oxf.) 30, 1181–1197 (2016).
16. Bonny, H. L. & Pahnke, W. N. The Use of Music in Psychedelic (LSD) Psychotherapy. J. Music Ther. 9, 64–87 (1972).
17. Kaelen, M. et al. The hidden therapist: evidence for a central role of music in psychedelic therapy. Psychopharmacology (Berl.) 235, 505–519 (2018).
18. Johnson, M. W., Richards, W. A. & Griffiths, R. R. Human Hallucinogen Research: Guidelines for Safety. J. Psychopharmacol. Oxf. Engl. 22, 603–620 (2008).
19. Garcia-Romeu, A., R. Griffiths, R. & W. Johnson, M. Psilocybin-Occasioned Mystical Experiences in the Treatment of Tobacco Addiction. Curr. Drug Abuse Rev. 7, 157–164 (2014).
20. MacLean, K. A., Johnson, M. W. & Griffiths, R. R. Mystical experiences occasioned by the hallucinogen psilocybin lead to increases in the personality domain of openness. J. Psychopharmacol. (Oxf.) 25, 1453–1461 (2011).
21. Roseman, L., Nutt, D. J. & Carhart-Harris, R. L. Quality of Acute Psychedelic Experience Predicts Therapeutic Efficacy of Psilocybin for Treatment-Resistant Depression. Front. Pharmacol. 8, (2018).
22. Griffiths, R., Richards, W., Johnson, M., McCann, U. & Jesse, R. Mystical-type experiences occasioned by psilocybin mediate the attribution of personal meaning and spiritual significance 14 months later. J. Psychopharmacol. Oxf. Engl. 22, 621–632 (2008).
23. Holtzheimer, P. E. & Mayberg, H. S. Stuck in a Rut: Rethinking Depression and its Treatment. Trends Neurosci. 34, 1–9 (2011).
24. Trivedi, M. H. et al. Evaluation of Outcomes With Citalopram for Depression Using Measurement-Based Care in STAR*D: Implications for Clinical Practice. Am. J. Psychiatry 163, 28–40 (2006).
25. WHO | Global status report on noncommunicable diseases 2010. WHO(2011). doi:/entity/nmh/publications/ncd_report2010/en/index.html
26. WHO. WHO Depression fact sheet. WHO (2017)