Music Playlist Use in Clinical Trials of Psychedelic Assisted Psychotherapy: A Hidden Code

In a quiet room, a person lies on a couch, eyes closed, breathing slowly as a playlist plays in the background. The music is familiar, maybe even comforting — but in that moment, it’s doing something more than just filling the silence. It’s helping them navigate a trip that could change their life. Yet, in the world of psychedelic-assisted psychotherapy, the role of music is still a mystery — and the science is only beginning to uncover its secrets.

Bottom line: Music is a critical, yet underexplored, element in psychedelic-assisted psychotherapy (PAP), with wide variation in how it’s used across studies. Understanding its role could shape the future of treatment.

The Soundtrack of Transformation

In the field of psychedelic-assisted psychotherapy (PAP), music is more than a backdrop. It’s a tool, a guide, and sometimes a collaborator in the therapeutic process. A recent systematic review of 36 studies found that 25 of them specifically addressed the use of music in PAP, with the majority focusing on treating depressive disorders and post-traumatic stress disorder (PTSD) using psilocybin and MDMA. These studies reveal a striking diversity in how music is selected, integrated, and experienced — from carefully curated playlists to spontaneous, emotionally resonant tracks.

The variation is not just in the music itself, but in the purpose it serves. Some studies suggest that music helps regulate emotional states, while others argue it enhances the depth of insight or supports the therapeutic relationship. What remains consistent, however, is the idea that music plays a role in shaping the psychedelic experience — and that its impact is far from predictable.

One study, for example, explored how music is used in sessions with MDMA-assisted psychotherapy for PTSD. Researchers found that playlists were often created with specific therapeutic goals in mind, such as grounding the patient or evoking memories. Yet, the same study also noted that the music’s effect was not always linear: sometimes it would deepen the emotional experience, while at other times it would shift the participant’s focus entirely. This unpredictability highlights a key challenge in the field: how do we measure the impact of music when its influence is so variable?

From Playlist to Personal Revelation

The role of music in PAP goes beyond what many might expect. A separate study, published in Europe PMC, re-evaluated the nature of music during psychedelic-assisted psychotherapy and found that it undergoes a profound transformation. In the context of a randomized controlled trial involving end-of-life care, participants described how music evolved from a familiar recording into a deeply personal, multisensory experience. These experiences were not just emotional — they became “actors” that collaborated with the participant and the therapist in their ongoing healing journey.

This finding is both surprising and significant. It suggests that music in PAP is not merely a passive element but an active, evolving presence that can shape the therapeutic process in ways that are both internal and interpersonal. The study also noted that this transformation was not observed in the placebo group, implying that the psychedelic state may be uniquely capable of recontextualizing music in a way that fosters introspection and connection.

The implications of this are vast. If music can become a collaborative force in the therapeutic process, then its selection and use may need to be more nuanced. Instead of relying on pre-curated playlists, therapists might need to consider how music interacts with the individual’s psyche in real time. This could mean tailoring the musical environment to the participant’s emotional state, cultural background, and even the specific goals of the session.

The Science of Sound and Silence

Despite the growing body of research, the role of music in PAP remains poorly standardized. The systematic review found that there was no consensus on how music should be used — whether it should be played continuously, paused, or left to the participant’s discretion. Some studies even reported that music was not used at all, raising questions about its necessity in certain therapeutic contexts.

This lack of standardization is both a limitation and an opportunity. On one hand, it makes it difficult to compare findings across studies or draw definitive conclusions about music’s impact. On the other hand, it opens the door for more personalized, adaptive approaches to music use in PAP. For instance, some researchers are exploring how real-time feedback from participants could be used to adjust the musical environment dynamically, ensuring that it supports the therapeutic goals of the session.

Another area of interest is the role of silence. While music is often emphasized in PAP, some studies suggest that silence can be just as powerful — especially in moments of deep introspection or emotional release. This challenges the assumption that music is always necessary and highlights the importance of context in shaping the therapeutic experience.

Frequently Asked Questions

Q: Can music help with PTSD or depression in psychedelic-assisted therapy?
A: Some studies suggest that music can enhance the therapeutic experience by regulating emotions, supporting introspection, and fostering connection. However, the exact mechanisms and long-term benefits are still being explored.

Q: Is there a standard way to use music in PAP?
A: No. There is significant variation in how music is selected and used across studies, with no consensus on best practices. This reflects both the diversity of therapeutic goals and the lack of standardized protocols.

Q: Can music become a “collaborative actor” in therapy?
A: Some research suggests that music can transform from a recorded track into a deeply personal and multisensory experience that interacts with the participant’s psyche. This idea challenges traditional views of music as a passive element.

Q: Is music always necessary in PAP?
A: Not necessarily. Some studies report that music is not used at all, and silence or other environmental factors may play a role in shaping the therapeutic experience.

Q: What are the limitations of the current research?
A: Many studies are small in scale, lack long-term follow-up, and do not address the potential risks or limitations of using music in PAP. This means that while there are promising correlations, causation remains unclear.

Sources

• ¶Music Playlist Use in Clinical Trials of Psychedelic Assisted Psychotherapy: A Systematic Review
• ¶Concomitant use of antidepressants and classic psychedelics: A scoping review
• ¶Music as a collaborating actor: new insights into the nature and role of music in psychedelic-assisted psychotherapy

Educational Disclaimer

This article is for informational and educational purposes only. It is not medical advice, mental health advice, diagnosis, treatment guidance, or a recommendation to use any substance, supplement, therapy, or protocol.

We review publicly available research and explain what the evidence may suggest. Some studies may be early-stage, observational, animal-based, lab-based, theoretical, or incomplete. Always consult a qualified professional before making health-related decisions.

If you or someone you know is struggling, you are not alone. In the US, call or text 988 (Suicide & Crisis Lifeline). Elsewhere, contact your local emergency or crisis service.

Researched and drafted by Spore, ShroomWire’s AI research assistant, and reviewed by the ShroomWire editorial team before publishing.