From the beginning of therapeutic research with psychedelics, music listening has been consistently used as a method to guide or support therapeutic experiences during the acute effects of psychedelic drugs. Recent findings point to the potential of music to support meaning-making, emotionality, and mental imagery after the administration of psychedelics, and suggest that music plays an important role in facilitating positive clinical outcomes of psychedelic therapy. This review explores the history of contemporary research on, and future directions regarding the use of music in psychedelic research and therapy and argues for more detailed and rigorous investigation of the contribution of music to the treatment of psychiatric disorders within the novel framework of psychedelic therapy.
Today, we will explore the history of, contemporary research on, and future directions regarding the use of music in psychedelic research and therapy and argue for a more detailed and rigorous investigation of the contribution of music to the treatment of psychiatric disorders within the novel framework of psychedelic therapy.
Classic psychedelic drugs are being investigated for the treatment of psychiatric disorders, such as addiction, end-of-life distress, and depression. Although mood and substance use disorders have a long time-course and uncertain prognosis when treated with currently available methods, psychedelic therapies are showing great promise. Recent studies demonstrate positive behavioral outcomes, including clinically relevant reduction in self-report and clinician-rated disorder severity, physiological outcomes, including breath carbon monoxide and urine cotinine and, in one case, modulation of potential neurobiological correlates of mood disorders.
- Given that only one or a small number (i.e., 2) of psychedelic therapy sessions can bring acute and sustained symptom improvements, psychedelic therapies represent a strong departure from the common medical model of chronic, daily pharmacotherapy and/or counselling as treatment.
- A central principle in psychedelic therapy is that the quality of subjective experiences during acute drug effects predict and mediate clinical outcomes. Music listening during acute drug effects has been a consistent feature of both research and therapeutic administration of psychedelics, as a method to guide or support experiences. Although music delivery during psychedelic therapy is not standardized, and methods used to select music for psychedelic therapy are largely untested, there may be some consistency in the features of music that are used to support therapeutic experiences.
Recent findings point to the potential of psychedelics to support meaning making, emotion, and mental imagery during music listening, and suggest that music plays an important role in facilitating positive clinical outcomes of psychedelic therapy.
Contemporary Research on the of Music and Psychedelics
Music listening has been shown to engage a wide range of domain-general brain areas, including those associated with reward, emotion, and memory processing. Brain regions recruited during music listening overlap at least partially with brain regions where activity and connectivity are altered after the administration of psychedelics.
- Psychedelic drugs have notable effects on auditory perception. This follows from the neurobiology of both psychedelic drugs (serotonin 2A, or 5-HT2A, receptor agonists) and the neurobiology of auditory processing.
- Brainstem serotonergic neurons have been implicated in selective neuronal responses to auditory stimuli, and 5-HT2A signaling has specifically been shown to alter neuronal responses to auditory stimuli from the cochlear nucleus through the pre-cortical primary auditory sensory pathway, through to the primary auditory cortex and auditory cortical neurons.
The synthesis of LSD spurred a large wave of psychiatric and neuroscience research with psychedelics in the 1950s and 1960s. The therapeutic potential of psychedelics was heavily explored, and music was early on identified as a factor that can potentiate and influence drug experiences significantly. Soon, music was recognized as an important element of the setting to support the therapeutic process. Emphasis was given to view music as a therapeutic aid, and that, due to music’s ‘profound’ influence, great care and responsibility must be practiced in selecting the music for a patient’s individual therapeutic needs.
- Studies reported profound alterations in a patient’s perception of and response to music and suggested this underlies the usefulness of music as an adjunct to psychedelic therapy. For example, very often, sounds which normally have no aesthetic appeal, were heard in a most unusual manner.
The use of music to support specific experiences during psychedelic therapy has been typically framed and characterized in terms of supporting specific emotional experiences, such as peak or mystical experiences or emotional catharsis.
How Do Music and Psychedelics Interact to Promote Healing?
A prime motivation for many people to listen to music is to modulate emotion, and the emotion-arousing properties of music arguably comprise one important motivation for the application of music therapy in the treatment of various psychiatric and neurological diseases. Emotionally intense ‘chill-inducing’ effects of music are common and empirically studied. However, the mechanisms through which music can modulate emotional experience are many and varied.
- Different classes of determinants, from acoustic and musical features of individual stimuli to personal associations people have made with music, to more abstract concepts such as preference traits and personality, have been shown to influence the emotions that are experienced during music listening.
- ‘Liking’, in particular (e.g., a person’s affinity for a particular piece of music), is shown to influence the emotions experienced with music significantly and it may be the case that liking moderates the effect of musical features and familiarity on music-evoked emotions. This is consistent with previous theoretical perspectives, in that liking may act as an index for the emotional utility of a musical stimulus, thus functioning as a ‘gatekeeper’ or filter for the subsequent effects of the music on the listener’s emotional state.
The effects of psychedelics, however, are conceptualized as a relinquishment of the normal filters the ‘self’ utilizes to regulate its internal milieu. Thereby, psychedelics may diminish the usual regulatory processes of music-evoked emotion and allow a fuller processing of music and the features of the music that evoke emotion. Support for this hypothesis can be found in both psychopharmacological and neuroimaging investigations.
- Psychedelics indeed have been shown to not only alter the processing of acoustic properties of music, but also the psychological and emotional reaction to it. Intensification of emotion and mental imagery by music was a primary motivation for the use of music in psychedelic therapy in the 1950’s and 1960’s and has been most frequently reported by patient’s undergoing psychedelic therapy.
Implications for Psychedelic Therapy
The capacity of psychedelic therapy to facilitate acute and sustained therapeutic changes represents a promising direction in mental healthcare, and a significant deviation from conventional treatments, both in terms of administration of the drug and in the underlying theoretical frameworks.
Studies reviewed previously indicate an enhanced emotional and psychological responsivity to music under psychedelics. While evidence exists for potential therapeutic effects of psychedelic drugs absent of music listening, patients often emphasize the significant influence of music on their experience in psychedelic therapy.
- It has been demonstrated that the music-experience during psychedelic therapy correlates with the occurrence of mystical experiences and insightfulness during psychedelic therapy, and with reductions in clinical symptoms one week after the session, and that calming effects of music are welcome and potentially beneficial during onset, ascent, and return phases of the psychedelic experience.
These findings provide a body of evidence that music can be a potent medium to modulate emotion and meaning making, to facilitate experiences that have strong therapeutic significance. As the quality of the music experience has been associated with therapy outcomes, and, more specifically, a music-experience characterized by personal ‘resonance’, the music-selection requires a thoughtful optimization to the individual patient.
Psychedelics and music listening interact to produce profound alterations in emotion, mental imagery, and personal meaning. Research is beginning to unveil underlying brain mechanisms, and to support a central role of music in psychedelic therapy. Music appears to influence the efficacy of therapy significantly, through modulating emotion, including the facilitating of mystical experiences, and through supporting autobiographical processes.
Acknowledging the significance of music and the importance of rigorous future empirical investigations in this young field of research is key to improving our understanding of psychedelic therapies, and key to improving the efficacy of psychedelic therapies.