Music Makes or Breaks the Patient Experience

A uniquely dynamic and and powerful therapeutic stimulus, the application of music can shape the substrate of someone’s experience in a number of important ways

Music and sound has long played a prominent role in psychedelic ceremonies (1) - ayahuasca shamans sing icaros and shake chakapas, peyoteros sing songs accompanied by a rattle and water drum, Bwiti iboga shamans pluck mungongo musical bows and ngombi harps. Shamans have also long been using sound and music as a means for altering consciousness, with the ritual use of drumming being perhaps one of the most ancient techniques for altering consciousness employed by humankind. This near ubiquitous ceremonial application of music and sound suggests it has a profound underlying importance that is tied to altered state experiences, with modern neuroscientific findings beginning to reveal the mechanisms that underpin this effect.

Key takeaways
  • Music and sound have historically played an important role in psychedelic ceremonies.

  • Modern psychedelic research results show that it is not necessarily the drug, but the experience that the drug can facilitate which is therapeutic.

  • The types of experiences classified as most therapeutic are (1) emotionally-evocative experiences, (2) autobiographical experiences, and (3) peak experiences, and music has the capacity to evoke all of these.

  • Subjective effects of the music can be predictive of therapeutic outcomes, and this has implications for using music in psychedelic therapy.

  • Person-centered music may positively influence the patient experience and therapy outcomes.

The power of both psychedelics and music lies in their capacity to affect the substrate of our conscious and emotional experience in deep and dynamic ways. The two also powerfully synergise, with the pivotal role music plays in psychedelic therapy having long been recognised, it having been referred to as “the hidden therapist” (2). By shaping the psychedelic experience in a fundamental way, music plays a central role in catalysing the long-term outcomes people may experience. Studies on both psilocybin (2) and LSD (3) have revealed that the power of music during the psychedelic experience extends to helping catalyse positive changes post session (in depression scores and openness, respectively), in contrast to intensity of drug effect, which by itself was not found to be predictive of such change in either case.

Music can be viewed as having a two-fold function, one being directive/suggestive (activating) and the other being non-direct/non-suggestive (calming). In a directive context, music can facilitate an immersive journey, rich with meaningful thoughts, emotionality and imagery. In a non-directive context, music can play a calming, soothing role, facilitating feelings of safety, which can in turn enhance feelings of openness to the experience (4). These capacities have a number of important implications for psychedelic therapy. The calming effect of music is important, as anxiety is known to be a predictor of adverse reactions to psychedelics (5,6). Music can also stimulate the recollection of autobiographical memories and evoke mental imagery under a psychedelic (7), while enhancing meaningfulness (8) and emotions such as wonder and transcendence (9). Such emotions are considered to be core aspects of the mystical-type psychedelic experiences, which are strongly associated with the enduring benefits and therapeutic gains (10,11,12). Three factors - liking, openness and resonance - tied to the experience of music have been found to positively predict beneficial responses to psilocybin therapy. ‘Liking’ refers to the degree to which the music was liked, ‘resonance’ the extent to which the music was harmonious with the emotional state of the patients, and ‘openness’ refers to the degree to which the patients were open to or accepting of the music-evoked experience. The latter two factors were notably tied to experiencing insightfulness during the session, a key component of the therapeutic psychedelic effect, while drug intensity was not (2). Different types of music may vary in their capacity to elicit mystical-type experiences. One small study noted that overtone-based music (emphasising instruments with a particularly strong overtone signature, such as Tibetan singing bowls, gongs, didgeridoo, chimes, bells, sitar, human voice overtone singing) was associated with greater mystical experience scores than playlists dominated by Western classical music compositions. However, follow up research is needed here - the results were not significant, with a small sample size of 10. Certainly this study highlights the need for deeper and more rigorous research into the therapeutic potential of different types of music, especially as until very recently, psychedelic therapy has almost exclusively utilised Western classical musical selections (13). Wavepaths is actively working to evolve the application of music used in psychedelic therapy, while developing technology to empower therapists in their practice and researching aspects of music that may heighten its therapeutic potential.

Another study investigated the musical selections used by a number of experienced psychedelic therapists in their sessions. From this, a consensus of music supporting peak experiences was found to be characterised by a regular, predictable, formulaic phrase structure, and orchestration, a feeling of continuous movement and forward motion that slowly builds over time. (14) The latter quality is important during the peak effects of a psychedelic, as the music can provide an important sense of guidance. (4)

Musical selection in the acute psychedelic may even have the potential to affect personality change in an enduring sense post session, this having important therapeutic implications. Music can help facilitate mystical-type experiences, which have been associated with enduring increases in personality trait openness (15), this being associated with creativity and qualities such as appreciation for new experiences, aesthetics, imagination, and hunger for knowledge. In addition, music can help catalyse experiences of insight in a psychedelic session which has been associated with decreased neuroticism and increased extraversion. (16) This may have profound implications for health and well-being, with high levels of neuroticism being an important predictor of different mental and physical disorders, while being an important factor determining the quality and longevity of our lives. (17) High levels of extraversion are associated with a number of wellness behaviours such as exercise and healthy eating (18), in addition to sociability (19).

The broad range of positive effects music can impart on the psychedelic experience clearly show it to be a uniquely powerful, dynamic and multidimensional therapeutic variable which can be individually tailored to suit every person’s needs. It can soothe, deepen emotional states, aid in autobiographical memory recall and mental imagery generation, provide a sense of guidance, and also allow space for reflection and contemplation. It can also play a role in catalysing peak experiences and generating psychological insight, which in turn can help instigate shifts in personality. Certain musical styles and their associated properties may be more predictive of peak experiences than others, and individual preferences for certain musical styles may also predict the synergistic effect between the psychedelic and musical experience. As research advances, there may be greater potential for providing individually optimised musical experience likely to maximise long-term beneficial outcomes.

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References

  1. Barrett, F. S., Preller, K. H., and Kaelen, M. (2018) Psychedelics and music: neuroscience and therapeutic implications. International Review of Psychiatry 30, 350-362.

  2. Kaelen M, Giribaldi B, Raine J, Evans L, Timmerman C, Rodriguez N, et al. (2018) The hidden therapist: evidence for a central role of music in psychedelic therapy. Psychopharmacology (Berl) [Internet]. 235(2): 505–519. Available from: http://dx.doi.org/10.1007/s00213-017-4820-5

  3. Lebedev, AV, Kaelen, M, Lövdén, M, et al. (2016) LSD-induced entropic brain activity predicts subsequent personality change. Human Brain Mapping 37(9): 3203–3213.

  4. Kaelen M, Barrett FS, Roseman L, Lorenz R, Family N, Bolstridge M, Curran HV, Feilding A, Nutt DJ, Carhart-Harris RL. (2015) LSD enhances the emotional response to music. Psychopharmacology (Berl) 232(19): 3607-3614. doi: 10.1007/s00213-015-4014-y

  5. Studerus, E, Gamma, A, Kometer, M, et al. (2012) Prediction of psilocybin response in healthy volunteers. PLoS ONE 7(2): e30800.

  6. Russ, SL, Carhart-Harris, RL, Maruyama, G, et al. (2019) States and traits related to the quality and consequences of psychedelic experiences. Psychology of Consciousness: Theory, Research, and Practice 6(1): 1–21.

  7. Kaelen M, Roseman L, Kahan J, Santos-Ribeiro A, Orban C, Lorenz R, Barrett FS, Bolstridge M, Williams T, Williams L, Wall MB, Feilding A, Muthukumaraswamy S, Nutt DJ, Carhart-Harris R. (2016) LSD modulates music-induced imagery via changes in parahippocampal connectivity. European Neuropsychopharmacology 26(7): 1099-1109.

  8. O’Callaghan C, Hubik DJ, Dwyer J, Williams M, Ross M (2020) Experience of Music Used With Psychedelic Therapy: A Rapid Review and Implications. Journal of Music Therapy 57(3): 282–314.

  9. Kaelen, M (2017) The psychological and human brain effects of music in combination with psychedelic drugs. PhD Thesis, Imperial College London. Available from: https://spiral.imperial.ac.uk/handle/10044/1/55900

  10. Haijen, ECHM, Kaelen, M, Roseman, L, et al. (2018) Predicting responses to psychedelics: A prospective study. Frontiers in Pharmacology 9: 897.

  11. MacLean KA, Johnson MW, Griffiths RR (2011) Mystical experiences occasioned by the hallucinogen psilocybin lead to increases in the personality domain of openness. Journal of Psychopharmacology 25: 1453-1461.

  12. Garcia-Romeu A, Griffith RR, Johnson MW (2014) Psilocybin-Occasioned Mystical Experiences in the Treatment of Tobacco Addiction. Current Drug Abuse Reviews 7: 157-164.

  13. Strickland, JC, Garcia-Romeu A, Johnson, MW (2021) Set and Setting: A Randomized Study of Different Musical Genres in Supporting Psychedelic Therapy. ACS Pharmacology & Translational Science 4(2): 472–478. DOI: 10.1021/acsptsci.0c00187

  14. MacLean KA, Johnson MW, Griffiths RR (2011) Mystical experiences occasioned by the hallucinogen psilocybin lead to increases in the personality domain of openness. Journal of Psychopharmacology 25: 1453-1461.

  15. Erritzoe, D, Roseman, L, Nour, M, et al. (2018) Effects of psilocybin therapy on personality structure. Acta Psychiatrica Scandinavica 138: 368–378.

  16. Lahey, B. B. (2009). Public health significance of neuroticism. American Psychologist 64(4): 241–256.

  17. Williams, P. G., O'Brien, C. D., & Colder, C. R. (2004). The effects of neuroticism and extraversion on self-assessed health and health-relevant cognition. Personality and Individual Differences 37(1): 83–94.

  18. Verduyn, P., & Brans, K. (2012). The relationship between extraversion, neuroticism and aspects of trait affect. Personality and Individual Differences 52(6): 664–669.