BRIEF RESEARCH REPORT article
Sec. Psychology for Clinical Settings
Music programming for psilocybin-assisted therapy: Guided Imagery and Music-informed perspectives
- 1Neurobiology Research Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- 2Anna Maria College, Institute for Music and Consciousness, Paxton, MA, United States
- 3Center for Research in Music and Health, The Norwegian Academy of Music, Oslo, Norway
- 4Institute for Communication and Psychology, Aalborg University, Copenhagen, Denmark
- 5Department of Psychology, University of Copenhagen, Copenhagen, Denmark
The psychedelic drug psilocybin has been successfully explored as a novel treatment for a range of psychiatric disorders. Administration of psilocybin requires careful attention to psychological support and the setting in which the drug is administered. The use of music to support the acute psychoactive effects of psilocybin is recommended in current guidelines, but descriptions of how to compile music programs for the 4–6 h long sessions are still scarce. This article describes the procedural steps and considerations behind the curation of a new music program, the Copenhagen Music Program, tailored to the intensity profile of a medium/high dose psilocybin. The method of Guided Imagery and Music is presented as a music therapeutic framework for choosing and sequencing music in music programming and the Taxonomi of Therapeutic Music is presented as a rating tool to evaluate the music-psychological intensity of music pieces. Practical examples of how to organize the process of music programming are provided along with a full description of the Copenhagen Music Program and its structure. The aim of the article is to inspire others in their endeavours to create music programs for psychedelic interventions, while proposing that an informed music choice may support the therapeutic dynamics during acute effects of psilocybin.
Music has been used in rituals across the world to achieve changes in consciousness throughout history, at times in combination with plants containing psychedelic compounds (Nettl, 2013). Literally translated from ancient Greek, psychedelic means “mind-revealing” (ψυχή = soul; δηλοῦν = to reveal) which is a name that hints to the therapeutic potential of these compounds if administered with careful deliberation. The classic psychedelics include primarily compounds that stimulate the brain’s serotonin system such as lysergic acid diethylamide (LSD), psilocybin, N,N-dimethyltryptamine and mescaline (Nichols, 2016). Of these, psilocybin, the prodrug of psilocin, is structurally similar to serotonin and produces its psychedelic effects through serotonin 2A receptor agonism (Kometer et al., 2012; Madsen et al., 2019). Psilocybin has been successfully explored as a novel therapeutic for a range of psychiatric disorders (Andersen et al., 2021) and is now tested in larger phase II studies of depression (e.g., ClinicalTrials.gov identifier: NCT03775200, C. G. I, 2022 2). COMPASS Pathways is currently preparing a phase III trial testing psilocybin for treatment resistant depression. Recent clinical trials show promising results of treatment with psilocybin for patients with depression (Carhart-Harris et al., 2016, 2018a, 2021; Davis et al., 2021), addiction (Johnson et al., 2014; Bogenschutz et al., 2018, 2022), end-of-life anxiety (Grob et al., 2011; Griffiths et al., 2016; Ross et al., 2016) and obsessive–compulsive disorder (Moreno et al., 2006). Although psilocybin is the drug under investigation in these trials, it is widely assumed that the external environment (“setting”) and mind-set of participants (“set”) modulates the acute and long-lasting effects (Carhart-Harris et al., 2018b).
Music has been recommended as an integral part of psychedelic sessions since the early psychedelic studies (Gaston and Eagle, 1970). Today music is still recommended as part of the psychedelic setting (Johnson et al., 2008) and the role of music is becoming more salient in psychedelic research (Barrett et al., 2018). It is currently unknown, whether alternative approaches, e.g., silence or nature surroundings can be used interchangeably with music, but since most psychedelic studies use music as part of the intervention setting, gaining more insight into the facilitating potential of music is important. A recent meta-analysis including ten studies concluded that music which resonates with the patient’s experience supports self-exploration during the psychedelic experience (O’Callaghan et al., 2020). For example, liking the presented music is reported to promote safety and companionship (Belser et al., 2017; Noorani et al., 2018) and induce a sense of being on a personal journey (Gasser et al., 2014; Belser et al., 2017; Kaelen et al., 2018). Openness to and liking the presented music also correlate with the intensity of acute psychoactive effects of psilocybin and with better antidepressant treatment outcome (Kaelen et al., 2018), perhaps by enabling depressed patients to surrender and accept repressed emotions (Watts et al., 2017). These effects are likely compounded by the fact that psychedelic drugs themselves enhance the emotional and meaning-making response to music (Kaelen et al., 2015; Preller et al., 2017). Although music appears to be widely accepted as a central component in the psychedelic setting, the literature regarding appropriate choice of music for music programming in psychedelic therapy is surprisingly scarce. To gain a qualified perspective on the matter, researchers may look to the field of music therapy, which holds a wide body of knowledge regarding the therapeutic qualities of music and altered consciousness states.
As part of the early psychedelic research in the 1950’s and 60’s, music therapist Helen Bonny conducted research on the role of music in LSD sessions at Maryland Psychiatric Hospital (Bonny and Pahnke, 1972). In these sessions, she viewed the music as the primary mover of the therapeutic process, always present and actively influencing the patient (Summer, 1998). She and others found that music which matches the intensity of the drug effect could act as a non-verbal support with the capacity to facilitate relinquishment of control, emotional release, mystical experiences, and autobiographical insights (Eisner and Cohen, 1958; Gaston and Eagle, 1970; Bonny and Pahnke, 1972). Inspired by these early psychedelic studies, Bonny later developed the method of Guided Imagery and Music (GIM) (Bonny, 2002) after the prohibition of psychedelic drugs in 1970 (Oram, 2018). GIM is a receptive music psychotherapeutic method in which the patient listens to selected programs of classical music lasting 30–45 min, while exploring inner imagery with verbal guiding from the therapist (Bonny, 2002; Grocke, 2019). By use of relaxation techniques, the patient, who is laying down with eyes closed, is guided into a music-induced altered state of consciousness and invited to let the music “take you where you need to go” (Grocke, 2019, p.114). In GIM the music is understood to act as a co-therapist within the therapeutic triad of patient, therapist and music (Skaggs, 1992; Bonde, 2007, 43–74). Akin to the skilled therapist, music in GIM is understood to be a holding environment in which the music can regulate arousal and emotions (Grocke and Wigram, 2006; Koelsch, 2009), convey a sensed presence of an empathic ‘other’ (Summer, 1998; Levinge, 2015), facilitate embodiment (Beck, 2012; Bonde, 2017) and provide a sense of continuity and overall structure for experiences in altered states of consciousness (Lawes, 2017). We suggest that GIM may be a particularly relevant approach to consider when compiling a music program for use in psychedelic interventions. Based on the knowledge gained in GIM practice and from psychedelic research, we here describe our considerations and procedural steps for curating a novel music program for interventions with psilocybin.
With the intention of creating a novel music program for use in psilocybin sessions, i.e., the Copenhagen Music Program, which would accommodate a variety of cultural backgrounds, though primarily those of Northern Europe, we agreed on some overall criteria for the music program which were: (1) the music should reflect the intensity profile of a medium/high dose psilocybin, (2) the music should present cultural diversity of styles and genres, (3) vocal music pieces should avoid familiar languages, and (4) the music should avoid direct religious connotations. The procedural steps for creating the music program were inspired by (Bruscia, 2019) and will serve as the overall organisation of the article in four steps: (1) Setting up a structure for the music program, (2) Search and selection of music pieces, (3) Sequencing of music pieces for the music program, and (4) Indexing the intensity of music pieces in the music program. We hope that this format will provide a practical outline and inspire others in their endeavours to create music programs for psychedelic intervention.
Setting up a structure for the music program
To meet the first criteria for the music program, we wanted it to reflect the experience of a medium/high dose of psilocybin, as this dose is commonly used in psychedelic research. Ingestion of a medium/high dose psilocybin elicits profound changes in consciousness, which lasts around 4–6 h and unfolds through a dynamic process in several phases (Leuner, 1962; Preller and Vollenweider, 2016). Recently, this process was modelled empirically in a study of healthy volunteers, which revealed three overall experiential phases: (1) the Ascent phase; (2) the Peak phase and (3) the Descent phase (Stenbæk et al., 2021). These Ascent, Peak and Descent contours were also observed in physiological responses to psilocybin such as blood pressure and hormonal secretion (Hasler et al., 2004; Holze et al., 2022). The phenomenology of the experience is described to change through these phases as a gradual build-up of effects, including perceptual, autobiographical and psychodynamic effects at lower intensities, over symbolic existential effects with transient ego-dissolution to deep integral levels of transcendent states at higher intensities. (Leuner, 1962; Preller and Vollenweider, 2016). We therefore created a working template of the music program, organized it in these three overall phases and applied the average time period of each phase, as measured by Stenbæk et al. (2021). Based on the phenomenology described above, we then created sub-phases with specific music-psychological opportunities for progress through the overall phase. Sub-phases of the Ascent phase were named: Opening, Onset, Build to peak and Going inside, sub-phases of the Peak phase were named: Confrontation & Surrender, Plateau and Transcendence, and sub-phases of the Descent phase were named: Emotional release, Reflection & Integration, Acceptance & Relief, Celebration and Landing & Return. Inspired by Hevners Mood Wheel (Hevner, 1936), which is often used in GIM to evaluate the emotional expression of a piece of music, adjectives referring to the music-psychological qualities of each sub-phase were noted; for example, music pieces for the sub-phase Confrontation & Surrender were noted with the adjectives: expansive, challenging, intense, mystical, sacred and cosmic, and music pieces for the sub-phase Acceptance & Relief were noted with the adjectives: lyrical, tender, holding, affectionate, and heartfelt. The creation of sub-phases and descriptions of the music-psychological qualities were inspired by the work of Bonny and Pahnke (1972) and Preller and Vollenweider (2016). However, due to the scarce available data regarding the temporal unfolding of experiential content during a medium/high dose of psilocybin, the authors have partly based the descriptions of sub-phases on their own clinical experience. These descriptions should therefore be seen as propositions, which need to be empirically validated in future studies. For an overview of our description of sub-phases and their corresponding music-psychological themes together with exemplary music pieces for each sub-phase see Table 1.
Search and selection of music pieces
Based on our working template, we began the process of searching for music by focusing on the few playlists for psychedelic research, that are currently available. One playlist was created for psilocybin therapy at Imperial College, London (Kaelen et al., 2018; Kaelin, n.d. 3) and consists of primarily neo-classical and ambient music with elements of jazz, classical and ethnic music. Two playlists were made for psilocybin therapy at Johns Hopkins University (Richards, 2003; Richards, 2015 4; Strickland et al., 2020; Strickland, n.d. 5) of which one consists of primarily Western classical music and the other primarily of overtone music. A last playlist that was made for psilocybin research at the Chacruna Institute included more indie, new wave and post-rock (Thomas, n.d. 6). Apart from playlists for research, we listened to a variety of playlists made for psychedelic ceremonial work at retreat centres or within the psychedelic underground communities (i.e., Watts, n.d. 7; Rasa, n.d. 8), as well as a range of music programs made for GIM (Grocke, 2019; Bruscia and McShane (2014)). In our search for music, we primarily used music platforms like Spotify, ITunes and SoundCloud. Author 1 and 4 undertook the first selection of music pieces, of which each was categorized into one of the sub-phases. Each music piece that was deemed suitable according to the music-psychological qualities, underwent extensive critical listening for a range of specific details, such as the quality of sound in the specific recording and the musical performance, especially regarding presence, nerve, sensitivity, soulfulness and a general authenticity. In this respect qualities of singing voices and instruments were understood as important for the music to be engaging (Kaelen et al., 2018) and to embed qualities of an empathetic ‘other’ as described above (Summer, 1998; Levinge, 2015). We generally avoided well-known music- and vocal pieces with familiar language in order to offer a novel and curiosity-evoking, open experience with the music. Within the field of GIM, familiar languages are often avoided, as it may be experienced as too directive and thus distract the listener from experiencing the broader suggestions of the music’s inherent qualities (Bonny, 2002).
Sequencing of music pieces for the music program
After critical listening to each music piece, we began the process of arranging the music pieces in meaningful sequences for the different sub-phases. Within the sequence of every sub-phase each piece of music would vary in regard to how its specific musical elements would serve the overall intent of the sub-phase; for example, the music could lead up to, prepare for, extend, give relief, add more variation or change direction from the overall music-psychological theme of a sub-phase (Bruscia, 2019, 401–12). The sequencing of music pieces involved a specification of the unique musical features and music-psychological quality of each selected piece in relation to the pieces surrounding it (Grocke, 1999; Bonde, 2007). To keep a record, the names of the music pieces and a description of their musical features and salient music-psychological qualities were noted in a table. To obtain a smooth transition between each of the music pieces, musical key, rhythm and sound in beginnings and endings were carefully examined and fitted together (Bruscia, 2019, 401–12), for example by connecting pieces in the same or related keys (according to the Circle of fifths) or by selecting pieces with the same basic note or one scale step up or down in modal music. Contrasts within and between music pieces and sections, such as instrumental/vocal, classical/electronic etc. were intentionally chosen to create a sense of opposing qualities, induce a sense of alertness or direct the listener in new directions (Bonny, 2002). In the same way that individual music pieces were carefully put together in sequences, sub-phases and overall phases were coordinated, until the program came together as a whole. To view the Copenhagen Music Program and the corresponding phases together with duration, tempo, key and genre of each music piece, see Table 2. The music program is available at: https://open.spotify.com/playlist/6QqL1JMtGAlw40kcMtBGDr?si=a47f1a017db74230 (Accessed January 15). After the first compilation of the music program by author 1 and author 4, all authors examined the music pieces and provided feedback both orally via online meetings and by commenting in the working template. During the process we repeatedly tested, revised and assessed the sequences to ensure that the original intention with the music program was met. This assessment also included approaching the music from a more affective-intuitive (Bonny, 1978) (as opposed to a cognitive, analytic) listening mode, by for example paying attention to subtle bodily and emotional reactions and by listening in an altered state of consciousness (Bonde, 2017, 269–277).
Indexing the intensity of music pieces in the music program
After the compilation of the music program, we applied a rating tool of music intensity developed in the field of GIM named the Taxonomy of Therapeutic Music (TTM) (Wärja and Bonde, 2014). The aim of applying this tool was to systematically explore whether the music program reflected the drug intensity profile of a medium/high dose of psilocybin (Stenbæk et al., 2021). The TTM consists of three prototypical music intensity profiles: (1) the Supportive, (2) the Mixed Supportive-Challenging, and (3) the Challenging. Each of these three main profiles is further divided into three sub-categories that express a continuum of intensity within the main profile. This makes it possible to rate a piece of music in one of nine sub-categories. The Supportive intensity profile consists of the following three sub-categories: (1) The supportive and safe field, (2) The supportive and opening field, and (3) The supportive and exploring field. The Mixed Supportive-Challenging intensity profile further consists of: (4) The explorative field with surprices and contrasts, (5) The explorative and deepening field, and (6) The explorative and challenging field, and the Challenging intensity profile consists of: (7) The rhapsodic field, (8) The field of metamorphosis and (9) The field of mystery and transformation (Wärja and Bonde, 2014). For a full description of music-psychological features of each of the three intensity profiles and their nine sub-categories with music examples, see Table 3.
In TTM, music intensity is understood as a compound feature of the music, including its degree of complexity, dissonance, mood and quality (Wärja and Bonde, 2014). The nature of the taxonomy is phenomenological, with each sub-category representing typical patterns of musical form, texture, dynamics and melodic-harmonic development, all elements strongly influencing the listening experience (Jacobsen et al., 2019). TTM merges music analysis with salient psychological features of the music, and thus relates to the music psychology of Kurth (1931). Intensity rating of the music pieces according to the TTM was undertaken by author 3, who noted the musical elements and psychological qualities of each piece of music in a table. Author 4 then examined the intensity ratings and in case of any discrepancies between author 3 and author 4, they would together with author 1 discuss the music piece in question in order to reach concensus. An overview of TTM intensity ratings of each music piece can be found in Table 2. Figure 1 shows the intensity profile of the music program upon a background of the three overall phases of psilocybin drug intensity.
Figure 1. Intensity profile of the Copenhagen Music Program. Illustration of each of the 60 music pieces in the music program with intensity indicated on the y-axis and duration in time on the x-axis. Intensity of the music is measured by the Taxonomy of Therapeutic Music. Average time of the Ascent, Peak and Descent phases for a medium/high dose of psilocybin is indicated by the vertical dotted lines. Numbers in the figure refer to the place of each music piece in the music program. These numbers can also be found in Table 2 which provides a full overview of all the music pieces.
In this article we have described the curation of the Copenhagen Music Program by laying out a series of procedural steps and considerations rooted in music-psychological perspectives from the field of GIM. Overall, we found that these perspectives in GIM provide a language that unifies psychological concepts and musical analysis coupled with an understanding of how music can be experienced in altered states (Bonny, 2002; Grocke, 2019). We also became aware of important differences between selecting music for GIM and for a psychedelic music program. In GIM, music serves as the primary mover of the process, whereas music in a psychedelic session also supports and facilitates the effects of the drug. Therefore, unlike in GIM, the interaction between music and the drug has to be taken into consideration when compiling a psychedelic music program (Kaelen et al., 2015; Preller et al., 2017). This became evident, when we used the TTM to rate music pieces for the music program, where certain new age music pieces would be rated with medium intensity even though we had placed them in the end of the Peak phase (see Figure 1). For example, we would select music with “trance inducing” features such as repetitive rhythms, overtones or drones to support the listeners’ experience of the intensity of peak psilocybin effects, by providing them with a musical “anchor” (the drone and rhythm) and a sense of spaciousness (the overtones) (Hall, 2015) (e.g., music no. 20: Sawhney (2015) 10). In this sense the music was intended as a container of the drug effects and not as the primary mover of the process in that particular music piece. Importantly, TTM was created to assess the intensity of musical structures of classical music without intake of any drugs (Wärja and Bonde, 2014), which makes it suitable for GIM music programming. We suggest it as a valuable tool, which can be developed further for use in music programming for psychedelic intervention.
The method by which we rated the music pieces with the TTM can be criticised for not incorporating interrater reliability to substantiate the consistency of the ratings. As such it must be considered a tentative rating, that needs to be validated by other studies.
The temporal unfolding of phenomenological content with a medium/high dose of psilocybin is not well described (Stenbæk et al., 2021). Most of the available research focuses on retrospective summaries of the total psychedelic experience completed at the end of the session (e.g., Griffiths et al., 2011; Carbonaro et al., 2020). This impeded our ability to make empirically based decisions about music pieces at the more detailed level of sub-phases where we had to rely on more general phenomenological descriptions (Leuner, 1962; Preller and Vollenweider, 2016). More research is needed to inform these choices of music and we suggest that a neurophenomenological approach (Berkovich-Ohana et al., 2020) may be a good candidate for this type of temporal exploration of the psychedelic experience in future studies. We also see a need for randomised controlled studies evaluating the effect of music compared to no music on the unfolding psychedelic experience. Such knowledge would inform us about the role of music in a manner that controls for the effects of the drug.
Our approach to music programming for psychedelic interventions can be criticized for being too mechanistic and not taking the element of the therapeutic relationship and the patient’s choice of music into account (Read and Papaspyrou, 2021). In such a more music-centred approach (compared to a more patient-centred approach) the psychological-metaphorical structures of a piece of music are treated as having inherent causal potential for certain psychological processes (Schneck and Berger, 2005). However, we emphasize that the effect of music must always be considered in relation to the listener’s history, preferences and the cultural and social context of the listening experience (Summer, 2011; Bonde and Blom, 2016, 207–234). We do not understand the music effect as being causal in itself but view the role of the music as that of inviting the listener into a certain domain, which will be experienced in an individual manner by every listener (Bruscia, 2000). Importantly, a patient’s reactions to the music during a session can at times be an expression of a conflict that holds therapeutic significance [akin to the process of transference to a therapist (Bruscia, 1998)], in which case the therapist can support and encourage the patient to stay with the music and engage the conflict (Bonny, 2002; Beck, 2012; Grob and Grigsby, 2021).
When working with ethnic minorities or racial trauma, some authors have suggested that the music choice can amplify intercultural power dynamics in the therapeutic relationship (Michaels et al., 2018). Recent studies suggest that individualized music selections may hold some promise (Kaelen et al., 2018; Strickland et al., 2020), and within GIM, culturally adapted music programs have been shown to engage listeners in exploring and reconnecting to their cultural roots and identity (Swamy, 2018). However, the effect of using culturally adapted music programs in psychedelic-assisted therapy remains to be evaluated in future trials. If a therapist chooses to apply music from cultures foreign to them, it is advised that the therapist familiarize themselves with the function and cultural meaning of the music pieces, not to inflict unwanted associations in the listener (Short, 2005).
The Copenhagen Music Program was intended for possible use in psilocybin research, and although it was tailored to a medium-high dose of psilocybin, the procedures of curation can be modified and applied to music programming for other psychedelic substances, such as LSD, Ayahuasca or empathogens like MDMA.
The procedural steps and music psychological considerations behind the creation of a new music program, i.e., the Copenhagen Music Program, for psilocybin treatment was described in the current paper. Music selection was based on perspectives from GIM, and the TTM was presented and discussed as a possible assessment tool of music intensity. We found that GIM-perspectives provided a helpful framework for understanding the possible therapeutic role of music in psychedelic interventions. This approach may inspire others in curating music programs for psychedelic therapy and research. More music programs and theory developments are needed along with empirical testing of music programs to gain a better understanding of how music may complement and support psychedelic intervention.
The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.
CM, DS, and BB contributed to the conception of the work and wrote the first draft of the manuscript. CM and BB conducted the first working template of the music program. CM, LS, LB, BB, and DS contributed to the analysis and interpretation of the individual music pieces and the final compilation of the music program, critically reviewed the manuscript and approved the final submitted version. All authors contributed to the article and approved the submitted version.
The project was supported by The Independent Research Council Denmark (grant number 9058-00017A) and The Health Foundation (grant number 21-B-0358).
We gratefully acknowledge the assistance of assistant professor in biostatistics Brice Ozenne for technical and advisory support with the graphical representation of the music program.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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Keywords: music program, psilocybin, guided imagery and music, music therapy, psychedelic-assisted psychotherapy
Citation: Messell C, Summer L, Bonde LO, Beck BD and Stenbæk DS (2022) Music programming for psilocybin-assisted therapy: Guided Imagery and Music-informed perspectives. Front. Psychol. 13:873455. 10.3389/fpsyg.2022.873455
Edited by:Eric Vermetten, Leiden University, Netherlands
Reviewed by:Baruch Rael Cahn, University of Southern California, United States
Brian Barnett, Cleveland Clinic, United States
Daniela Flores Mosri, Universidad Intercontinental, Mexico
Copyright © 2022 Messell, Summer, Bonde, Beck and Stenbæk. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Dea Siggaard Stenbæk, firstname.lastname@example.org
†These authors have contributed equally to this work