Music accompanies almost every modern psilocybin, MDMA, or ketamine-assisted therapy session. The practice is inherited from 1950s–70s LSD research and carried, largely unexamined, into today's live Phase 3 drug-development programs. It has been called “the hidden therapist”, capable of deepening the psychedelic state, conjuring emotions and ideas.
Who makes the playlists? Can we take music for granted? Should we avoid cluttering the ‘set and setting’ with elements we might not need?
COMPASS Pathways, in the lead with its Phase-3 trials of psilocybin, offers deliberately minimal support. Roughly four-fifths of its PTSD session time is spent in silence. It provides neither music nor therapeutic guidance.
The inclusion of music in psychedelic sessions came hand-in-hand with the refinements of ‘set and setting’. In early research with psilocybin, volunteers were often left to themselves – producing dysphoria, panic, and psychotic reactions.
A psychedelic pioneer named Walter Pahnke sought to produce better trips.
Pahnke included compositions like Brahms’ German Requiem and Bach’s Fantasia and Fugue in G Minor. “Music appears to be involved significantly in the crucial extra-drug variables of both set and setting”, he and a colleague wrote.
“As I allowed my body to move with the music I could feel myself joining force, having a feeling of an elemental animal force”, one patient described. “...When the earphones were put on, the music seemed to take over the entire inner field and I exclaimed, ‘“I'm inside the music now.’”
They found that choreographing a parabolic arc in the session, from preparation to peak and release, could induce the state of death and rebirth.
Music in Psychedelic Therapy
Still, we may suppose that synergies of music and drugs have a very long history. We have fragments of ivory flutes in prehistoric Germany from 35,000 years ago, which predates the development of agriculture. Fossilised peyote buttons were discovered in caves in Texas, dating to nearly 6,000 years ago. DMT was extracted from a 4,000-year-old pipe excavated in Argentina. The use of hypnotic drumming circles and choirs is an established shamanic technique in many traditional communities, often in combination with mind-altering drugs.
Dr Mendel Kaelen, CEO of Wavepaths, argues that several compositions included in psychedelic playlists today are too familiar. He highlights ‘Adagio for Strings’ and Beethoven’s Fifth Piano Concerto, to which patients’ prior exposure may “reduce the opportunity… to have a new experience”. Johns Hopkins’ playlist contains The Beatles' ‘Here Comes the Sun’, Louis Armstrong's ‘What a Wonderful World,’ and ‘Swing Low, Sweet Chariot’. We also see Latin liturgical choral music like Bach, Vivaldi, Gounod and Górecki. In Pahnke and Bonny’s playlist, patients heard Bach’s “St. Matthew Passion”, Brahms’s “German Requiem,” and Mozart’s “Laudate Dominum.” All three are directly drawn from the New Testament.
Bill Richards, a senior member of the Hopkins’ team and former collaborator with Pahnke, concedes that the earlier playlists reflected the Christian backgrounds of many participants and his own personal preferences. Today, he argues that Bach’s Kyrie, Barber’s Adagio for Strings, Brahms, Mozart, Beethoven, and Elgar “reliably work well” or speak to deep “universal tendencies”, despite all having similarly Occidental personalities. That said, a small study by Richards’ colleagues at Johns Hopkins found no difference between Western classical music and overtones in their therapeutic benefits. If anything, the latter was more associated with inducing mystical experiences.
Sughra Ahmed, a Muslim participant in a Hopkins psilocybin study, found the supplied music overwhelmingly Euro-Christian and asked whether qawwali or Punjabi music could be substituted. The answer was no. Bill Richards, who has long overseen Hopkins's musical protocol, later said he agreed with her “a hundred percent”. His usual response to a participant's acute dislike of a track is to encourage them to “hate it with passion,” since the aversion may signal meaningful material. That may be true, but this does not license an unqualified inclusion of aversive material.
Without making a hard-and-fast rule, the MAPS manual suggests that instrumental songs are “preferred” to those with lyrics. Music should provide a field of therapeutic exploration, without narrowing to certain culturally narrow sources of meaning. Five tracks in their A Playlist, however, are Christian worship songs with plain English lyrics: “Better to Believe,” “Every Prayer,” “I Receive,” “Sing Redemption's Song,” “My Name Iz.” Artists from other religious traditions like Islam, Hinduism, Buddhism, and Native American religions are included. But the inclusion of religious material at all, as we’ve seen, may be aversive. Researchers in another control trial took a lifespan music history, including likes and dislikes, as part of assessment. Participants were offered three playlists during orientation, including an eight-hour locally designed playlist.
When interviewed, trial participants report that music can adopt a form of sentience – whether benign or coercive, even Lovecraftian. “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”, one respondent said. “The music was its own entity, and it was trying to kill me.” It was a feeling akin to a “big brother controlling thing.”
“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”, another said. “I feel the music in large part drove a lot of the experience... 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... It wasn't particularly pleasant in any way, but extraordinarily powerful.”
Around ninety per cent of participants found the music intensifying, four-fifths a guiding presence, and just over half found the music calming. Among those who felt the music unwelcome, half believed the intensity was overwhelming.
The music may obstruct the healing process. “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.” One song that participants specifically disliked was Buffy Sainte-Marie's ‘Up Where We Belong,’ which patients called “cheesy.” Indeed, in How To Change Your Mind, journalist Michael Pollan is often disappointed by the sheer low quality of the playlists on offer: he had “a lot of boring yoga music,” and one “truly insipid” track propelled him to total loss of “control of my body”. A stellar performance of Bach’s cello suites, which he specifically requested, was effective in producing total ecstasy.
Accounts from Reddit illustrate the mixed effects music can have. One Redditor described music as having “carried” them through the experience. Another recalled becoming so entranced by the beauty of the music that they and their wife never addressed the difficulties they had planned to explore. After five sessions with the MAPS playlist, one contributor reported that particular sounds and chord progressions had become bound up with traumatic memories, so that hearing similar music during a sports class triggered flashbacks. Another person deliberately replayed their session music because it could bring back the feelings of the experience. One or two tracks came to “haunt” them in both positive and negative ways.
Music as an Instrument of Control
The power of music and psychedelics has been put to malignant ends. Salvador Roquet ran a Mexican clinic combining LSD, ketamine, psilocybin, and peyote until his arrest in 1975. He built sessions around a mish-mash of tapes, amplified to patients wearing blindfolds. He layered rock and meditation music, Hitler speeches, and chattering gunfire. The MK-Ultra programme used a similar approach to “destroy and control human minds”.
Charles Manson played The Beatles’ music to his followers – many of them normal suburban teenagers – while they tripped on LSD. Manson convinced the Family that the band were sending him secret messages, including an injunction to commit mass murder. Mel Lyman, known as the ‘East Coast Charles Manson’, held court with would-be disciples and gave them 1,500 micrograms of LSD. Once they were flying, Lyman would begin “filming and recording them. And playing really weird soundtracks for them like pure noise – machine gun fire, screams. And then when they were absolutely out of their minds, he would plug them into this Lyman Family group sing – love, togetherness, you know. He was playing with these people, programming them”, one contemporary observed.
Reviewing the history of psychedelic therapy, critics have detected overtones of abusive practice. David Nickels and Lily Kay-Ross, formerly linked with Psymposia, have drawn extensive links between the protocols of MAPS therapy and Salvador Roquet, the abovementioned Mexican guide. Yet no thinker has shaped the MAPS approach more than Stanislav Grof.
Grof taught patients to embrace discomfort. It is perennial wisdom, found in Stoicism, Buddhism, and the Abrahamic faiths. A tolerance for discomfort overlaps with exposure therapies, used to treat phobias and OCD. But Grof believed that discomfort, when held to a certain breaking point, could crack and reveal a paranormal world, one hidden from view, but pregnant with birth trauma, angels, demons, perhaps UFOs.
Critics have charged that Grofian psychotherapy underpinned the eventual abuses in the MAPS MDMA trial for PTSD. Against this background, the musical policies of MAPS and Grof may be read differently. If a patient expresses that a music choice is unsavoury, the MAPS guide “encourage[s] you to first reflect on whether this desire is motivated by wanting to move away from an uncomfortable feeling”. The therapist’s role is “to follow, rather than guide”, but the latter is free to judge “when it is desirable to allow the participant to explore… without any interaction and when it is more appropriate to interact… in order to facilitate a particular avenue of experience.” In Psychology of the Future, Grof draws on the case of “Norbert,” who “could not tolerate the music, which he felt was 'killing' him,” and records that “it took great effort to persuade him to stay with the process” rather than let him leave.
“He finally agreed and, for almost three hours, he experienced severe pains in his breast and shoulder, which intensified to the point of becoming unbearable. He struggled violently as if his life were seriously threatened, choked and coughed, and let out a variety of loud screams. Following this stormy episode, he quieted down and was relaxed and peaceful. With great surprise, he realized that the experience had released the tension in his shoulder and muscles and that he was free from pain.”
Norbert’s shoulder pain was reportedly healed for twenty years. It is unknown what Norbert’s worldview was before commencing therapy with Dr Grof. It is notable, however, that Norbert’s experience would confirm the particular transpersonal psychology of his psychiatrist. Norbert’s shoulder pain was cured by reliving his birth trauma, as well as a past life as a soldier in Cromwell’s England, during which his shoulder was “pierced by a lance”.
Grof believed that the patient must “surrender completely to the flow of music” – so much so that they should risk embarrassment with “loud screaming or laughing, babytalk, animal noises, shamanic chanting, or talking in tongues”. Patients were encouraged to “suspend any intellectual activity”, placing total priority on the songs’ emotional and bodily impact. Musical selections were made to choreograph particular psychodramas, including “aggression, emotional or physical pain, sexual and sensual feelings”, and the experience of pregnancy and birth. In group work, music has the additional function of concealing the sounds made by participants, including groans of pain and cries for help, in order to induce a group consciousness, or “unified artistic form”.
Perhaps the most pertinent risk of Grofian psychotherapy is its belief in repressed memories. The concern has been discussed at length in the writings of Kayla Greenstein, a PhD student at the University of Melbourne. There is little to no high-quality evidence that recovered memories are genuine. But a majority of therapists believe in the concept.
Many ‘remembered’ having been abused in Satanic rituals, fuelling the well-known Satanic Panic of the 1980s. One technique for ‘recalling’ such memories is Guided Imagery and Music Therapy (GIM), developed by Helen Bonny, who pioneered the effect of music on psychedelic sessions with both Grof, Bill Richards, and Walter Pahnke. GIM conceives of music as a therapeutic ‘Other’ that fosters meaningful images, which are channelled to the therapist, who calibrates their immersion with questions and instructions. A clinical case article explicitly describes “recalled memories of physical/sexual trauma elicited by the imagery,” while the literature on the related Directed Imagery and Music (DIM) describes a process combining “facilitated re-calling and re-experiencing of traumatic memories” with GIM.
It is possible that music distorts memory in general. In one experiment, around 150 participants who received misleading information after hearing a musical excerpt were significantly more likely to misremember an instrument that had not been present. Other experiments found that emotional music played during recall increased the later incorporation of emotion-congruent false details into previously neutral fictional events. The role of music and acoustic architecture in fostering religious experiences, including those with high-control worldviews, is well known.
Does Music Work?
Mendel Kaelen has said that “I'm confident that we can view music as a psychedelic,” and marketing for Wavepaths, his company, describes his work as “the first to demonstrate music's central role in psychedelic therapies.” Eric Sienknecht, co-founder of Polaris Insight ketamine clinic, put it like this: “Without music, psychedelic therapy... is impossible”.
Yet for all the bioethical risks that music may encourage, it is not clear that music produces clear therapeutic benefits. Existing studies show an association between music that participants experience as resonant or supportive, stronger mystical-type experiences, and better short-term outcomes after psychedelic therapy. This neither shows that music causes mystical experiences nor that mystical experience is the causal route to clinical improvement. Most evidence comes from retrospective ratings among small samples. What’s more, the music may be deliberately sequenced alongside the drug’s peak effect, which makes determining the drug effect more difficult.
The MUSIK trial randomised curated music against matched support without music. While music made the experience more tolerable, it produced no significant difference in the pre-specified four-week depression outcome. Of 36 clinical studies, 25 reported using music, but only 13 gave meaningful playlist detail and just seven linked to the actual playlist. The durations ranged from 90 minutes to over seven hours, six to 98 tracks, without a standardised protocol. Three studies used no music at all and still reported positive outcomes. That doesn't prove music is unnecessary, since none were head-to-head component tests, but it shows benefit can occur without it. A separate scoping review found only 19 quantitative papers examining music within psychedelic therapy, and no music-specific studies of MDMA at all.
A 2025 Frontiers in Psychiatry paper argued in favour of ‘psychedelic minimalism’: the notion that psychedelic therapy should consist solely of elements supported by high-quality evidence. Rather than assuming that music is good – or receiving it as a convention from earlier therapists – the burden of proof should sit with any addition to the ‘setting’. It is clear that music shapes experiences, the author says, and it’s not clear that it’s for good or in what sorts of ways. If we wish to understand what the psychedelics are doing, perhaps we ought to apply moratoria to the continued use of music, or fund more studies without it.
Why Music?
It may seem arbitrary that a therapy should include a standardised media diet for its clients. Music is one medium among many. Had DVDs and VHS tapes been available in the ‘60s and ‘70s, when the pillars of psychedelic therapy were first being laid, we might regard the right to movies as inalienable, sharing a special synergy with tripping, such that dosing without the medium was weird or depriving for a patient. A special list of films may be compiled by researchers today. Patients may be randomly assigned to watch one during the come-up: The Wizard of Oz, Easy Rider, Yellow Submarine, The Matrix, Soul and Inside Out, perhaps. Had the practice of psychedelic therapy taken off in the 19th century, the media of choice may have been anthologies of poetry or books of paintings.
Many accounts of psychedelic successes with videos may be found online. One contributor said that watching videos about “existence, consciousness, death” while on ketamine had erased decades of suicidal ideation. Another watched The Worst Witch, which “made me cry and healed my inner child”. Another reported watching troubling news stories and documentaries during ketamine treatment. It caused them to “shed my prejudices and anxieties I've carried my entire life about humanity and the violence, pain, and trauma”.
So, what is so special about music? Why would it raise eyebrows if patients were “strongly encouraged” to watch a certain film, or read a particular set of poems?
Music has special experiential features that facilitate introspection. It moves and travels; it grounds a tripper in sensation. It provides a pole to hold onto amid the whirlwind. The music played in trials has largely forsworn lyrics to avoid being too “directive”: media like a film, book, or poem would be far too instructional. This is a therapeutic hypothesis. We do not, in fact, know whether music is less directive – at least in terms of real outcomes. Directiveness is also a multifactorial quality. It may consist of direct statements, as well as moments of greater salience and seizure of attention. We are directed by the swells and tones of emotion. We are nudged by cultural and religious signs. Indeed, the researcher-selected playlist is directive in itself: it favours the therapists’ authority. From there, the playlist seeks explicitly to move the patients in a predictable arc.
It strikes me as odd that music in psychedelic trials should take a standardised form. Choice over one’s music during a psychedelic session could be deeply valuable.
Instead of a ‘nice to have’, we may regard patient autonomy – including over music – as a core value for psychedelic work.