The Hidden Therapist—evidence for the central role of music in psychedelic therapy

A summary of the 2018 research paper The hidden therapist: evidence for a central role of music in psychedelic therapy. Psychopharmacology vol. 235, 2 (2018): 505-519. Kaelen, Mendel et al.

The Hidden Therapist—evidence for the central role of music in psychedelic therapy

A summary of the 2018 research paper The hidden therapist: evidence for a central role of music in psychedelic therapyPsychopharmacology vol. 235, 2 (2018): 505-519. Kaelen, Mendel et al.

Since the latter half of the 20th century psychedelics have been used as a therapeutic tool to facilitate the deepening of patients’ self-understanding through experiences of ‘autobiographical insight’ and also to evoke ‘mystical experiences’, related to feelings of ego-dissolution and self-transcendence.

Both of these kinds of experiences have been linked to long-term improvements in mental health and recent successful clinical trials have rekindled interest in psychedelic therapies as a treatment for addiction, depression and post-traumatic stress disorder. Music-listening has been a consistent feature of psychedelic therapies and has been linked in its own right to peak, or mystical experiences, but a detailed investigation of the interaction between music and psychedelics has so far been missing.

In this study, Kaelen et al. investigate the effects of music on the experiences of patients undergoing psychedelic therapy for treatment-resistant depression with psilocybin.

The 19 patients in this study were given psilocybin in a specially designed therapy room with two therapists present, before listening to a standardised playlist of contemporary music. The playlist was curated to follow a trajectory of rising, peaking and then falling musical intensity, intended to follow the cadence of the drug effects. After two therapy sessions the patients were interviewed and researchers analysed their transcripts seeking to understand how the patients’ responses to the music affected key outcomes of the therapy; whether they had a mystical experience, whether they had experiences of autobiographical insight and whether their depression was reduced a week later.

Their analysis showed that all three of these positive therapeutic outcomes were more likely when the patient responded positively to the music.

Significantly, they found that while the likelihood of a reduction in depression depended on a positive response to the music, it did not depend on the intensity of the drug effects, demonstrating that it was the interaction between the music and the psychedelics which was critical in this study, and not the drug alone.

The researchers also uncovered three common features of the patients’ subjective experiences that characterised a positive response to the music; the patients had to like the music (‘liking’), the patient had to feel the music resonated with their emotional state (‘resonance’) and the patient had to feel open to the experiences and imagery evoked by the music (‘openness’). This analysis has important implications for the use of music in psychedelic therapy. First, the authors note that liking the music at an aesthetic level may be a prerequisite for experiencing resonance and openness - personalised playlists to suit individual tastes may therefore be important. Secondly, given that a patient’s experience during a session can be highly dynamic, it may also be important that playlists are adaptive over time to maximise resonance. Interestingly, patients who reported experiencing resonance described the music as a guiding force or a ‘vehicle’ carrying them forward on an inner journey. One patient described how,

‘under the influence of psilocybin the music absolutely takes over… the music opened [me] up to grief and I just was very happy for that to happen… It took my thinking and my experience to uncomfortable places, but I was kind of reassured in the experience.’

This account hints at the interdependence between experiences of resonance and experiences of openness - if the music resonates with a patient in a way that makes them feel safe and supported, they can allow themselves to be more open to challenging emotions, a process which is central to many therapeutic practices. Finally, the authors acknowledge that a patient’s ‘openness’ is not determined solely by the music but by the attitude the patient brings to the therapy, highlighting a key role for the therapist in identifying and overcoming sources of resistance in the patient before and during the therapy process.

Overall, this study demonstrates that music has a significant influence on psychedelic therapy with psilocybin for patients with treatment-resistant depression. The authors conclude that with further research into how music interacts with an individual patient’s personality traits and psychological states, it should be possible to maximise its positive effects.