Psychedelic therapy can work better if this element is in the mix — study

Psychedelic drugs aren’t the only unusual thing you’ll find in a session of psychedelic-assisted therapy.

You’ll also find a blindfold, headphones, and a carefully curated playlist.

That may be surprising: perhaps you think of music as more consistent with recreational psychedelic use (think Woodstock). But researchers believe music is an essential component of psilocybin-assisted therapy.

Music is so important to this kind of therapy that Mendel Kaelen, a neuroscientist, refers to music as “the hidden therapist” of psilocybin-assisted therapy. In fact, the psilocybin researchers at Johns Hopkins University have their own specific psilocybin playlist they use in clinical trials. (Psilocybin is the primary hallucinogenic compound found in “magic mushrooms.”)

Research supports the powerful combination. A 2020 review of the literature found music was “integral for meaningful emotional and imagery experiences and self-exploration during psychedelic therapy” and participants’ openness to music resulted in more immediate and more long-term outcomes.

But how does being on psilocybin change how we experience music? Researchers from the University of Copenhagen recently investigated this inquiry — and not just because it would be interesting to know. Instead, they argue this insight can further explain why combining psilocybin and music can effectively treat depression.

The study team presented their initial results at the ECNP Congress in Lisbon on Monday, a conference focusing on applied and translational neuroscience. These have not yet been peer-reviewed or published.

But they do present a promising path forward. Psilocybin was found to enhance the emotional response to music, and the scientists suggest this can leverage the clinical potential of psilocybin-assisted therapy.

Lead author Dea Siggaard Stenbæk, an associate professor at the University of Copenhagen, tells Inverse that while music is widely assumed to be an important part of the psychedelic setting, there’s been a lack of scientific research supporting and probing its role.

“Knowing more about the different roles that music may play can help us put together music programs that are optimally designed for psychedelic treatments,” she says.

How the discovery was made — Stenbæk and colleagues asked 20 participants to listen to ten minutes of music (tracks 8 and 9 off Edward Elgar’s “Enigma Variations” and Wolfgang Amadeus Mozart’s “Laudate Dominum”) and rate their emotional response on the Geneva Emotional Music Scale.

Next, the participants were given 0.3 mg/kg of psilocybin. At the peak of the drug’s effect, participants listened to the same pieces of music as before and again rated the emotion associated with the music on the Geneva Emotional Music Scale.

Fourteen of the participants were also given ketanserin. Ketanserin is an anti-hypertension drug that’s often used in studies involving psychedelics. Like psychedelics, ketanserin binds to the HT-2A serotonin receptors.

When someone takes a psychedelic drug that binds to those receptors, ketanserin will lessen the effect of the psychedelic. Similarly, if ketanserin is taken prior to a drug like psilocybin or LSD, it will either totally or partially block the effect of the psychedelic drug.

Stenbaek says her team randomized participants to receive psilocybin or ketanserin on separate days. If a participant received psilocybin one day, they would receive ketanserin on the second.

What they found— The study team found emotional responses to music, while participants were on psilocybin, increased by 60 percent compared to baseline measurements before taking the drug.

The difference was even higher when compared to the participants’ responses after taking ketanserin. The researchers found that ketanserin decreased the participants’ emotional responses from their baseline emotional response — when they weren’t on anything.

“We saw that ketanserin attenuated the emotional response to music compared to baseline, suggesting a modulating role of the serotonin 2a receptor itself — not just psilocybin — on emotional response to music,” Stenbæk explains. “These results are preliminary, but could suggest that serotonin is involved in music perception.”

While more research needs to be done to confirm this initial finding and further understand what’s happening, the results suggest the stimulation of the serotonin 2a receptor is “important for the emotional enhancement,” Stenbæk says.

But she notes it’s possible other effects play a role, including synesthesia.

“For example, you may taste a color or see a sound,” she says. “This could give rise to a whole new way of perceiving music in a multisensory manner.”

What’s next — Now that the researchers have confirmed that psilocybin heightens our emotional response to music, they want to look at the effect of music on the brain while participants are on psilocybin.

The resulting MRI scan should give researchers a clearer picture of the neural mechanisms at play when someone is listening to music on psilocybin.

“I would like to study the effects of music on the acute psychedelic experience and lasting effects,” Stenbæk says.

What’s clear is that music should be considered an essential part of psilocybin-assisted therapy.

David Nutt, director of the Neuropsychopharmacology Unit in the Division of Brain Sciences at the Imperial College of London, was not involved in the study but says the researcher’s findings are consistent with his knowledge.

“This is further evidence of the potential of using music to facilitate treatment efficacy with psychedelics. What we need to do now is optimize this approach probably through individualizing and personalizing music tracks in therapy,” he said in a statement.

In other words, the hippies were on to something.

Partial abstract: We found that psilocybin markedly enhanced the emotional response to music in healthy individuals, both as compared to baseline and ketanserin. Interestingly, ketanserin decreased the emotional response to music as compared to baseline, suggesting a modulating role of 5-HT2AR in music-evoked emotions. These findings add to our empirical knowledge about the interplay between psilocybin and music in shaping the intense emotional states typical of psychedelic phenomenology. Insights such as these are critical for more effectively leveraging the clinical potential of music, e.g., prepare and integrate psychedelic sessions through music listening aimed at increasing emotional awareness. Understanding the contribution of enhanced music-evoked emotions to other prototypical psychedelic phenomena, e.g., mystical-type experiences, will also be important for establishing music as a key element in psychedelic therapy.