The 19 interview transcriptions were on average 1048 words long each
(standard error = 133). Coding analyses identified a total of four separate groups,
each including different clusters with related themes. These four different groups
were (1) “welcome influences,” including all influences of music on subjective
experience that were described as welcome, wanted, accepted, or appreciated (see
Fig. 1, identified in 18 out of 19
patients, i.e. 95% of total); (2) “unwelcome influences,” including all experienced
influences of music that were described as unwelcome, unwanted, rejected, or
unappreciated (see Fig. 1, identified in ten
out of 19 patients, i.e. 53% of total); (3) “appreciated music styles and playlist
features,” including all themes related to the liking and appreciating of music
genres, styles, and playlist design (see Fig. 2, identified in all 19 patients, i.e. 100% of total); and (4)
“unappreciated music styles and playlist design,” including all themes related to
the disliking and not appreciating of music genres, styles, and playlist design (see
Fig. 2, identified in 11 out of 19
patients, i.e. 58% of total). Here, the term “music styles” refers broadly to the
instrumentation, compositional, genre, and acoustic features of the music. The term
“playlist design” refers to all aspects related to the selection and structuring of
the music into the full music playlist.
The figures displaying the four groups (Figs. 1 and 2) include the
clusters present in more than 30% of the respective groupand the themes present in
more than 30% of the respective cluster. This threshold was chosen for display
purposes and emphasisesthe most dominant themes. However, all themes are discussed,
and all associated patient quotes are presented in separate tables in Supplementary
materials (Tables 1–11). It is important to emphasise that the identification of a
theme in a patient’s experience, and subsequently the including of that theme in
counting its presence in the total population, does not enable to make any
statements on the duration that this theme was present in the patient’s total
experience. For example, one patient may have experienced a sense of irritation in
response to one particular song, and therefore the theme “irritation” under the
cluster “intensification” in the group unwelcomed influences is present. But this
does not imply that the patient experienced persistent feelings of irritation during
his or her experience: it may simply refer to one short but memorable moment. In
addition, the measure also only allows the capturing of spontaneous mentioning and
elaborations on the subjective experience of the music in response to the open
questions, as opposed to the questions targeting (and biasing) specific facets of
the experience. The only bias present within the interview that is important to
acknowledge was the inquiry of both “positive” and “negative” influences of the
music, leading to the subsequent “welcome” and “unwelcome” groups.
Welcome influences: intensification
The most prominent cluster in the group welcome influences,
including 17 out of 19 patients (89% of total), refers to themes that describe
an intensification of the subjective experience by the music. Within this
cluster, themes that describe an “intensification of emotion” were identified in
15 out of 17 (82% of cluster), including descriptions of music enhancing or
changing emotions. Importantly, the emotion-evoking effects that were welcomed
showed diverse emotional valence and included descriptions of the music
facilitating “happiness” or strong “ecstatic” experiences, as well experiences
of the music intensifying “tearfulness.”
Themes describing an “intensification of imagination” were
identified in nine out of 17 (53% of cluster). This included statements of the
music-evoking vivid and complex mental imagery and of the concrete imagery
relating to specific characteristics of the music, such as ethnic “Indian” style
of the music being associated with “seeing an Indian temple.”Eight out of 17
patients (47% of cluster) mentioned a “general intensification” effect of the
music, without specifically referring to this being an intensification of
emotionality, imagery, or others. Other themes, present below 30% in the cluster
intensification, include effects of music on “personal thoughts or memories”
(2/17, 12% of cluster), music facilitating a “sense of transcendence” (2/17, 12%
of cluster), and music enhancing “ego dissolution” (2/17, 12% of cluster)
(Fig. 1). See Table 1 (Supplementary materials) for a listing of
all themes present in the cluster intensification.
Welcome influences of the music: guidance
The second most prominent cluster of welcome influences includes
themes that depict the music as a source of “guidance.” This cluster was
mentioned by 15 out of 19 patients (79% of total). Within this cluster,
statements that the music provided a “sense of being on a journey” were
identified in 11 out of 15 (73% of cluster). This included descriptions of the
music being experienced as a “vehicle” that “transports” or “carries” the
listener forward, providing a sensation of “travelling” to different
psychological “places.”
Themes describing the music as a source for psychological “support”
were identified in 11 out of 15 (73% of cluster). This includes various
statements of the music providing a sense of “grounding,” “help,” and
“reassurance.”Descriptions of the music being in tune with, or in resonance with
the person’s intrinsic emotional state, were identified in six out of 15 (40% of
cluster). Rather than describing the music as evoking emotion, this theme is
defined by statements of the music being experienced as “fitting,” “following,”
or “matching” present emotional states.
Finally, five out of 15 of patients (33% of cluster) referred to
the music as providing a “sense of continuity and direction,” this included
statements of music providing a sense of connection between different parts in
the experience, making the experience feel “driven” by the music and “flowing”
into a certain direction (Fig. 1). See
Table 2(Supplementary materials) for a
listing of all themes present in the cluster guidance.
Welcome influence of the music: calming
Ten out of 19 patients (53% of total) described calming effects of
the music. From this cluster, nine out ten(90% of cluster) described “general
calming” effects, whereas five out of ten patients (50% of cluster) described
the music as providing “mental calming” effects, including sensations of
peacefulness and of the music calming and “slowing the mind.” One out of ten
(10% of cluster) described that the music helped them to feel more physically
relaxed. Calming effects of music often referred to ambient music by Brian Eno,
Harold Budd, and Stars of the lid. See Table 3 (Supplementary materials) for a listing of all themes
present in the cluster “calming.”
Welcome influences of the music: openness to music-evoked
experience
Seven out of 19 patients (37% of total) made statements about their
own attitude of openness towards the influences of the music and in addition,
about the effects of music on their attitude of openness. From this cluster, six
out of seven (86% of cluster) referred to the “importance” and the “purpose” of
being open to “challenging experience” evoked by the music, and that this felt
like an important part of the therapeutic process. This included statements of
accepting being deeply emotionally moved by the music and the music helping to
“face” or “connect with” the listener’s “unresolved” inner conflicts. Four out
of seven (57% of cluster) described that some music specifically helped to
enhance their attitude of openness, such as statements that “the music opened
(him/her) up” or that because of the music was “well-chosen,” the listener “felt
open to it all” (Fig. 1). See Table
4 (Supplementary materials) for a
listing of all themes present in the cluster “openness to music-evoked
experience.”
Unwelcome influences of the music: intensification
The most prominent cluster, including five out of ten patients (50%
of cluster), described music to “intensify” emotions they did not want to feel,
such as increased “fearfulness,” “sadness,” or “fear.” In addition, five out of
ten (50% of cluster) made statements about the music creating a sense of
“discomfort,” including “unpleasant” or “uncomfortable” experiences, and four
out of ten (40% of cluster) described irritation as a consequence of the music.
In less than 30% of the cluster, the music was described as bringing mental
imagery, thoughts or memories that were unwelcome, a sense of puzzlement, inner
conflict, tension, or a “dark atmosphere.” This cluster of unwelcome
intensification influences forms a contrast with the cluster of themes
describing intensification as a welcomed influence (Fig. 1 and Table 1 (Supplementary materials)). See Table 5 (Supplementary materials) for a listing of
all themes present in the cluster unwelcomed intensification.
Unwelcome influences of the music: resistance to music-evoked
experience
Nine out of 19 patients (47% of total) described feelings of
“resistance to the music-evoked experience.” This includes statements of “not
liking” or “not wanting” the subjective effects of the music. This cluster of
unwelcomed influences contrasts the cluster of themes describing an openness to
music-evoked experience, as a welcomed influence (see Table 4 (Supplementary materials) and
Fig. 1). See Table 6 (Supplementary materials) for a full list of
all themes in the cluster intensification.
Unwelcome influences of the music: misguidance
Six out of 19 (32% of total) made statements about the music
providing a sense of “misguidance”; this cluster primarily includes descriptions
of the music being a “mismatch” or being incongruent with the unfolding
subjective experience. This cluster, named “dissonance,” was present in four out
of six (67% of cluster) and forms a contrast with the welcome influence
resonance, when the music was experienced as harmonious, or a good match, with
the subjective experience. Other themes of misguidance, present in less than
30%, include descriptions of the “music feeling intrusive,” the music being
“unable to positively influence a challenging experience,” the music giving a
“sense of being manipulated,” the music giving a “sense of unmet potential,” or
the music giving a sense of “foreboding,” as if something “bad” was going to
happen. This cluster of unwelcome influence contrasts the cluster of themes
describing a sense of “supportive” and “helpful” guidance, as a welcome
influence (see Table 2 (Supplementary
materials) and Fig. 1). See Table
7 (Supplementary materials) for a
full list of all themes in the cluster misguidance.
Appreciated music styles and playlist features: music styles
All 19 patients referred to some music styles within the music
playlist that they especially appreciated (Fig. 2). Most frequent were positive statements about “ethnic
music,” present in eight out of 19 patients (42% of cluster), such as Indian,
“Spanish,” or “African” music styles (e.g. Jon Hassel, Ry Cooder, and Ronu
majumdar). Positive statements about music with human voice were mentioned by
seven out of 19 patients (37% of cluster). Importantly, this refers to vocal
music either without lyrics or music with lyrics in a foreign language (e.g.
The Journey by Ludovico Enaudi and Enya’s
sumiregusa). One other music style that
was frequently appreciated by seven out of 19 (37% of cluster) was neo-classical
music (e.g. Max Richter or Olafur Arnalds) or classical music (e.g. Henryk
Gorecki or Arvo Part). Apart from these styles, the appreciated music styles
showed a noticeable diversity. In less than 30%, positive statements were
directed to “music with crescendo” (five out of 19, 26% of total), “powerful
music” (four out of 19, 21% of total), and only one to two out of 19 made
explicit statements about their appreciation for specific instruments, such as
violin, guitar, piano, or “music with a solid drone.” See Table 8 (Supplementary materials) for a full listing
of all themes referring to music styles that were explicitly appreciated.
Appreciated music styles and playlist features: playlist design
Seventeen out of 19 patients (89% of total) made statements
reflecting appreciation for the design of the playlist (Fig. 2). Most prominent were positive descriptions of
the “music selection,” described by 12 out of 17 patients (71% of cluster),
including descriptions of the music “working well” or being “well-selected.”
Secondly, nine out of 17 patients (53% of cluster) provided positive
descriptions on the way the music was structured into the full playlist. This
theme, named “music order,” is defined by statements of the “structure” and the
“ordering” of the music playlist, “aligned” well with the drug effects. The
third most prominent theme, present in six out of 17 (35%), corresponds to the
“music presence,” meaning the mere presence of the music itself. This includes
descriptions from the music being present as helpful, to statements that it
could not be imaginable doing the sessions without it and that the music
presence felt “necessary.” Finally, other themes include appreciation for
“calming music” to be played mainly during onset, ascent, and return phases,
whereas more emotive music (i.e. “sentimental” or “cinematic” music) to be
better reserved for late in the ascent phase and during peak phase. See Table
9 (Supplementary materials) for a
full listing of all themes describing playlist design features that were
appreciated.
Unappreciated music styles and playlist features: music styles
Eleven out of 19 patients (58% of total) referred to musical styles
that were not appreciated. These responses reflected different degrees of the
individual’s disliking of the music and were highly diverse, making no theme
present in more than 30% of this cluster (Fig. 2). Some examples of themes in this cluster refer to “music
with lyrics,” “vocal music,” “piano music,” “classical or neo-classical music,”
and “cheesy music.”Often, vocal music and cheesy music referred to one
particular song played during the final return phase by Buffy Saint Mary,
up where we belong. See Table
10 (Supplementary materials) for a
list of all themes present in the cluster of un-appreciated music styles.
Unappreciated music styles and playlist features: playlist design
Six out of 19 patients (32% of total) referred to aspects of the
playlist design that were not appreciated. In 2 out of 6 (33% of cluster), a
clear disliking of the music selection was present, and a preference for “own
music selection” was expressed (Fig. 2).
See Table 11 for a complete list of
all themes present in the cluster of un-appreciated playlist design
features.
Predictors in music experience for psilocybin experience and therapy
outcomes
PCA reduced the dimensions of the 11-ASC to five factors,
explaining more than 95% of total variance. These PCs are (1) “mystical
experience” (loadings from “experiences of unity,” “spiritual experience,” and
“blissful state”), (2) “impaired cognition” (loadings from
“disembodiment,”impaired cognition, and “new meanings”), (3) “audiovisual
perception” (loadings from “audio/visual synaesthesia” and “elementary
imagery”), (4)” anxiety” (primarily loaded by anxiety), and (5) “insightfulness”
(loadings from insightfulness and “complex imagery”) (see Fig. 3). Subsequently, music experience (liking,
resonance, and openness) and drug intensity scores were correlated with these
five factors and ratings for reductions in depression (1 week after psilocybin,
defined by % reduction in QIDS score).
Reductions in depression 1 week after psilocybin were significantly
predicted by the musicexperience variables,liking (r = 0.60, p = .006),
resonance (r = 0.59, p = .008), and openness (r = 0.57, p = .001), but not by
drug intensity (r = 0.004, p = 0.98). Mystical experience during the
psilocybin sessions was significantly predicted by music variables, liking
(r = 0.61, p = .006), resonance (r = 0.67, p = .002), openness
(r = 0.70, p = .0008), and by drug intensity (r = 0.58, p = 0.009).
Insightfulness was predicted by music variables resonance (r = 0.53, p = .016) and openness (r = 0.59,
p = .007), as well as by drug intensity
(r = 0.65, p = 0.002), but not by music liking (r = 0.44, p = .06). Impaired
cognition (r = 0.55,p = 0.01) and audiovisual perception changes (r = 0.71, p = 0.0006) were only predicted by drug intensity and not by any of
the music variables. Anxiety was not predicted by any of the variables. All
reported significant pvalues refer to
FDR-adjusted threshold for significance of 0.016. See Fig. 4.
Inter-rating reliability and discriminative validity of musicexperience
variables
Pearson correlation tests between the scores of all researchers
(n = 4), who rated the three
musicexperience variables (liking, resonance, and openness), demonstrated good
inter-rater reliability (average r = 0.6 ± 0.1, from total of 18 correlations). Pearson correlation
tests between the three music experience variables showed significant
correlations (r = 0.9, r = 0.96, and r = 0.91). Drug intensity did not correlate with any of the music
experience variables.
Discussion
Via an analysis of patient interviews, this study identified a
number of ways in which music influenced the subjective experiences of patients
receiving psilocybin with psychological support for treatment-resistant
depression. The most frequently reported themes relate to an intensification of
emotions and mental imagery by music under psilocybin, complementing previous
studies that demonstrated modulatory effects of LSD on music-evoked emotion
(Kaelen et al. 2015, 2017) and music-evoked mental imagery
(Kaelen et al. 2016) in healthy
volunteers. By focussing on the phenomenology of the acute experience, the
present study provided new insights into the role and importance of music in the
context of psychedelic therapy. For example, the music appeared to be a
significant source of guidance, creating a sense of grounding, as well as a
sense of carrying the listener into different psychological places. Specific
examples of this can be found in the following two excerpts:
The sad songs would bring painful memories on, more happy
songs would make me think of a really good period in my life. Every new
song could bring a different image. (#4)
I feel the music in large part drove a lot of the
experience. Under the influence of psilocybin, the music absolutely
takes over. Normally when I hear a piece of sad music, or happy music I
respond through choice… but under psilocybin I felt almost that I had no
choice but to go with the music. […] I did feel I was being held. And it
did feel like the music opened [me] up to grief, and I just was very
happy for that to happen. It wasn’t particularly pleasant in any way,
but extraordinarily powerful. It took my thinking and my experience to
uncomfortable places, but I was kind of reassured in the experience.
There was something there that meant “I’m going
to take you on a ride here, but I promise I won’t abandon you. It’s
just going to be tough, and you know, you’re going through the
grinder here, but you won’t be left in pieces.” That
seemed to be… what the music was saying to me. (#14).
In contrast to the sense of guidance by the music were descriptions
of the music providing a sense of misguidance. In these situations, the music
was most often described as being dissonant with the patient’s emotions and
thoughts. One example of the experience of misguidance and dissonance can be
found in the following excerpt:
The light music at one point took me to a place where I
thought I was safe, and it became unsafe, and the music was playing a
trick with me, you know, sort of giving me a false sense of security. I
can remember thinking “this is beautiful music,
why am I going to this dark place?” It didn’t line up
with what had gone on before. I just felt as I was being manipulated,
being duped almost. The music lured me to this beautiful place, and then
things started to become dark even with this beautiful music still
playing. (#16)
One important observation is that effects of the music that were
welcomed, included emotions such as increased grieving or tearfulness, and that
an attitude of openness towards negative music-evoked emotions was frequently
described as helpful in bringing to expression inner psychological conflicts
that might then be resolved (Watts et al. 2017). These experiences were grouped under the theme
“openness to challenging experience feels therapeutic” and show similarities
with recent qualitative research showing perceived therapeutic meaning in
transient psychological struggle during psychedelic therapy (Belser et al.
2017; Swift et al. 2017). One example of this attitude of
openness towards the music can be found in the following excerpt:
I can even view the negative moments as positive in a way
because they served a purpose. The purpose was to sort of let me face
the darkness, and my demons, I guess. It was beautiful at times, but
also… yeah, the darker moments really helped to reflect on and connect
with your unresolved shadows. (#19)
Contrasting such an attitude of openness to challenging experience
is an attitude of resistance to the intensification effects of the music. This
experience was characterised by not wanting the music or its effects and was
named “resistance to intensification.” An example of this can be found in the
following excerpt:
I worried that I let [the music] shape this sort of
melancholy. There was resistance, massively, to everything, every sort
of sensory input, I had a fearful response. I was afraid to open my
eyes, I was afraid to do anything, I was afraid that this sort of music
was the last thing I’d ever hear. (#5)
Music styles and playlist design
The study also shed light on how different musical styles and the
design of the music playlist were experienced. The choice of the music and the
design of the music playlist were overall well-appreciated, with the most
frequently appreciated musical genres being ethnic-, vocal-, and (neo-)
classical music. Appreciation was also expressed for the design of the playlist,
in particular for the calming (ambient) music, which was particularly present
during the early (pre-onset and early ascent) and the final (return) phases, and
at periods during peak, while more emotionally evocative music being reserved
for the peak phase. This indirectly supports the therapists’ views that that an
optimal playlist design is characterised by a music genre selection that is
structured to match the different phases of drug experience (Barrett et al.
2017; Bonny and Pahnke
1972; Grof 1980; Richards 2015).
Strong disliking of the music selection was rare, but when this did
occur it proved insightful about the possible functions of music selection:
Typically, disliking of the music seemed to be associated with either a
“diminishment” of psilocybin’s subjective effects, accompanied by unpleasant
feelings (such as discomfort and irritation), and with an attitude of
resistance, characterised by an attempt to psychologically reject and distance
oneself from the music, such as detailed in the following excerpt:
The music blocked my experience and feelings. A sense of
irritation, frustration, and sense of lowering mood. The majority of the
songs were not my kind of music, I can’t sit with that music … I have to
leave the room. I was sort of feeling bad, because I wanted to work with
it. I sensed the potential for a really profound experience. I couldn’t
meet that potential with music that I felt was quite mediocre. To me it
didn’t feel real, so I felt quite torn. (#6)
Music experience predicts experience and therapy outcomes
As outlined above, notable polarities were observed in the music
experience, such as the music being either liked or disliked, the music being
either resonant or dissonant with the patient’s experience, and the patient
being either open or resistant to the influence of the music. These variables
(liking, resonance, and openness) positively predicted the extent to which
patients reported having mystical experiences (a factor defined as the
experience of unity, blissful emotionality, and spirituality). In addition,
resonance and openness, but not liking, predicted the extent to which people
reported insightfulness (a factor defined by having inventive ideas, feelings of
profoundness, insights, and the experience of vivid personal memories or mental
images). Drug intensity, on the other hand, also correlated with other aspects
of the psilocybinexperience, such as impaired cognition and audio-visual
perception changes. It must be noted that liking, resonance, and openness were
highly correlated and thus likely represent one construct. The absence of a
significant correlation between music liking and reported insightfulness may
therefore be due to a lack of statistical power.
The selective association of the music experience with mystical
experience and insightfulness, and not with other subjective experiences,
supports the original motivations to include music in psychedelictherapy, i.e.
to promote the occurrence of therapeutically meaningful experiences. Modern
studies have confirmed that psilocybin can reliably facilitate mystical
experiences (Griffiths et al. 2011,
2016), and these experiences
have been associated with sustained positive changes in behaviour and
personality (MacLean et al. 2011)
and with positive therapy outcomes (Garcia-Romeu et al. 2014; Griffiths et al. 2016; Roseman et al. 2017; Ross et al. 2016). Although these studies incorporated
music-listening in combination with psilocybin, this study is the first to
demonstrate that the music experience during these sessions relates to the
occurrence of mystical experiences. A positive relationship was also found
between the music experience and reductions in depression 1 week after the
psilocybin experience. Importantly, reductions in depression were not related to
the intensity of the drug effects. This finding indicates that it is not merely
the drug effect in isolation, but an interaction between the drug and the music
on subjective experience that promotes positive therapeutic outcomes.
Possible therapeutic mechanisms of music in psychedelic therapy
A principal effect of psychedelics is that they temporarily
dysregulate brain mechanisms that normally regulate emotion(Carhart-Harris et
al. 2012a, 2016b; Muthukumaraswamy et al. 2013; Tagliazucchi et al. 2016), and this could underlie the enhanced
emotional responsiveness to emotionally evocative stimuli reported here as
elsewhere (Carhart-Harris et al. 2012b; Kaelen et al. 2015, 2017;
Quednow et al. 2012; Vollenweider
et al. 2007). The notion that
accepting and moving through challenging emotions are important for
psychotherapeutic change is central to many psychotherapeutic models (Greenberg
and Pascual-Leone 2006), has
empirical support (Whelton 2004),
and been noted by other psychedelic therapy studies (Belser et al. 2017; Swift et al. 2017; Watts et al. 2017). In psychedelic therapy, the function
of psychedelics may be to ease the relinquishment of psychological control (i.e.
ego dissolution and enhanced suggestibility (Carhart-Harris et al. 2014)), thereby allowing a fuller and freer
(i.e. less inhibited) expression of emotionality. The enhanced receptivity to
music, in turn, may play the important function of activating emotionality,
thoughts, and memories that are most personally salient. Thereby, music can
guide the patient’s experience into directions that are most therapeutically
significant. One key difference between psychedelic therapy and other forms of
psychotherapy (and conventional pharmacotherapy) may be the capacity of
psychedelics and music to rapidly facilitate deeply felt and personally
meaningful emotionality (Carhart-Harris et al. 2016a; Gasser et al. 2014; Griffiths et al. 2016; Grob et al. 2011; Johnson et al. 2014; Ross et al. 2016).
It is worth considering that these findings show a remarkable
congruency with the theoretical frameworks and patient experiences of
“introspective” forms of music therapy, where music is utilised as the means to
provide an experience that is thought to help the listener examine and change
his/her relationship with themselves (Abbott 2005; Albornoz 2013; Summer 1992, 2011).
This includes the use of music to evoke intense emotional experiences (Albornoz
2013), as well as a way to
provide a “holding environment,”which feels “safe and secure” to express and
experience new aspects of oneself (Carroll 2011; Schulberg 1999). Therapeutic effects of music are widely reported in
literature and utilised across different health care disciplines (Finch and
Moscovitch 2016; Mondanaro et al.
2017; Pavlov et al.
2017). The present findings
therefore engender the view that psychedelic therapy utilises therapeutic
effects of music that are enhanced via an interaction between the drug and the
music.
Implications for the use of music in psychedelic therapy
Due to the prominence of music-listening in psychedelic therapy,
increasing the knowledge of the appropriate therapeutic use of music in
psychedelic therapy is important. This becomes particularly critical when
psychedelic therapy is implemented on increasingly larger scales. The
therapeutic influence of music has been referred to as being of “profound significance”(Bonny and Pahnke
1972), and several authors
emphasised the care needed in selecting appropriate music, playing this music at
the right circumstances, and within a personalised patient-centred format (Grof
1980; Hoffer 1965). The present study provides support
for these views, by showing that when the music was experienced as dissonant
with the unfolding experience, disliked, and rejected (resistance), therapeutic
outcomes suffered. In contrast, when the music was in resonance with the
patient’s experience, liked, and accepted (openness), therapeutic outcomes were
most positive.
These music experience variables in this study (resonance, liking,
and openness) correlated with each other, suggesting that they represent a
single construct within the music experience that is associated with positive
therapy outcomes. Liking of music is usually characterised as a mixture of genre
appreciation and aesthetic judgements (Juslin 2013; Juslin and Västfjäll 2008; Juslin et al. 2016; North and Hargreaves 1997), and music liking may represent a basic pre-requisite
for music to evoke personally meaningful emotionality. In addition, some music
styles and acoustic properties may be more suitable for the conscious states
induced by psychedelics than others. The patient’s attitude, in turn, appears to
require a sufficient degree of openness to the music-evoked experience, and this
may imply not only a state of surrender but also a pro-active and curious
engagement with the therapeutic content that emerges.
This hypothetical framework holds that an optimal music experience
(style liking, music’s resonance, and openness to music) creates an optimal
climate for the expression of meaningful therapeutic content, characterised by
the sensation of being on a personal journey, with a spontaneous and often
intense emergence of personally meaningful imagery, thoughts, and emotionality.
This optimal music experience construct may be a critical pre-requisite, and
when it is not met adequately, is likely to result in the patient to distance
from the music experience (resistance), characterised by feelings of discomfort,
and a diminishment of personally meaningful imagery, thoughts, and emotionality
(i.e. the absence of the sense of being on a journey). Given the patient’s
experience is highly individual and dynamic, this finding suggests that the
adaptation of the music during psychedelic therapy sessions may be critical at
times, in order to provide adequate therapeutic support conditions, or prevent
possible counter-therapeutic experiences: an idea that was often emphasised by
early pioneers of psychedelic therapy (Bonny and Pahnke 1972; Grof 1980; Hoffer 1965).
In this framework, the experience of resistance and dislike by the
listener may be regarded as an important indicator for the therapist of music’s
failure to act therapeutically, and the type of intervention needed to restore
music’s therapeutic function may be determined by one central question the
therapists may need to clarify, i.e. what is the source
of the resistance or dislike? The therapists bear a
responsibility to ensure the music styles are sufficiently liked, via thoughtful
music selection, and that resonance is maximised by providing an attunement of
the music to the patient’s personal and dynamically unfolding experience, via
thoughtful playlistdesign and adaptation of the music when needed. However, in
addition, it may occur that the music-evoked experience is rich with
therapeutically meaningful content, yet the experience may be emotionally
challenging, resulting in similar expressions of resistance. In these scenarios,
the therapists may instead need to provide adequate therapeutic support for the
patient to feel safe and motivated to engage in exploring and expressing the
present challenging feeling states, of which the meanings may not always be
immediately clear.
Limitations and future directions
This study has a number of limitations. First of all, the data was
acquired without a placebocondition, making causal inferences about the nature
of the effects problematic. Secondly, the main body of data used for this study
was qualitative in nature. Therefore, the experiment did not allow studying the
magnitude of the observed themes in the music experience. It should therefore be
emphasised that the primary objective of this study was to provide a patient
perspective on the influence of music. We hope that this work inspires new
hypotheses for future studies, and that it assists therapists and researchers in
their use of music in psychedelic therapy. Examples of future directions include
testing whether maximization of resonance could improve therapy outcomes, and
whether the variables liking, resonance, and openness represent one single
factor or separate factors when larger sample sizes and more precise
measurements are employed.
A significant body of empirical work is required to advance the
therapeutic use of music in psychedelic therapy. One important focus of such
work will be the establishing of baseline measures that can reliably predict
individual music experiences during psychedelic therapy sessions. Such
predictive measures can range from personality traits (e.g. openness to
experience, absorption, or suggestibility) to measures of personal music
preferences. Furthermore, research that focuses on identifying reliable
indicators of positive (welcome/supportive) and negative
(unwelcome/unsupportive) influences of music on the therapeutic processes during
psychedelic therapy sessions may help therapists adapt music to individual
patients.