Psychedelics and music: neuroscience and therapeutic implications

Barrett and colleagues frame the review within renewed interest in classic psychedelics (for example LSD, psilocybin, DMT, mescaline) as treatments for conditions such as addiction, end-of-life distress and depression. They note that psychedelic-assisted therapies are distinctive because clinically meaningful improvements can follow only one or a small number of sessions, and that a central premise of this therapeutic model is that the phenomenology of the acute drug experience predicts and mediates longer-term clinical outcomes. Music listening has been a pervasive element of psychedelic therapy since mid-20th century practice, but methods for selecting and delivering music are not standardised and have received little systematic empirical evaluation. This paper sets out to review the historical use of music in psychedelic contexts, and to synthesise contemporary neurobiological, psychopharmacological and clinical findings about how music and psychedelics interact. The authors aim to identify mechanisms by which music may support therapeutic effects (notably emotion modulation, imagery and autobiographical meaning-making), and to highlight gaps and future research directions needed to develop evidence-based guidelines for music use in psychedelic therapy.

The extracted text presents this work as a narrative, integrative review rather than a systematic review or meta-analysis. The authors draw on historical accounts, psychopharmacology, neuroimaging and clinical studies to synthesise current understanding of how music interacts with psychedelic experiences. The paper summarises early clinical and ethnographic observations, experimental human studies (EEG, MEG, fMRI), psychopharmacological comparisons and contemporary clinical trials of psychedelic-assisted therapy where music listening was used as part of the therapeutic setting. The extracted text does not report a formal methods section describing a systematic search strategy, databases searched, explicit inclusion or exclusion criteria, or methods for risk-of-bias assessment. Consequently, the review appears to be selective and narrative: it integrates diverse lines of evidence but does not present reproducible search or study-selection procedures. Where specific experimental paradigms are discussed (for example EEG/ERP measures, MEG, or fMRI studies under LSD or psilocybin), the review summarises key outcome measures and neural targets reported in those individual studies, rather than pooling data quantitatively.

Historically, music and psychedelics have co-occurred in many cultural and ritual contexts; ethnographic evidence and archaeological findings suggest longstanding ritualised use of both music and psychoactive plants, and mid-20th century psychiatric practice incorporated music as a core element of the therapeutic setting. Early clinical reports described profound alterations in patients' perception and responsiveness to music under psychedelics and advocated careful selection of music to support distinct phases of the drug experience (onset, peak, return). Contemporary neurobiological and psychopharmacological findings indicate substantive interactions between music processing and the actions of classic psychedelics. Music listening engages distributed brain networks involved in reward, emotion and memory, and several of these regions overlap with areas where activity and connectivity change after psychedelic administration. At the level of sensory processing, psilocybin has been associated with a reduced N1 auditory ERP (suggesting altered intensity processing), and MEG studies under LSD have shown altered auditory sensitivity. Functional MRI studies under LSD revealed increased BOLD responses to timbral complexity in auditory cortices and in regions implicated in emotion and music perception, including inferior frontal gyrus, insula, precuneus, striatum and supplementary motor area. LSD altered coupling of the precuneus with frontal and auditory regions when processing timbral complexity, and enhanced tracking of tonal structure (tonality) in temporal, frontal and medial prefrontal areas as well as the angular gyrus and amygdala. One set of findings linked greater perceived meaningfulness of music under LSD with increased activation in regions associated with emotion and autobiographical memory (for example SMA, putamen, insula, posterior cingulate cortex). Another reported increased effective connectivity from the parahippocampal cortex to visual cortex during LSD-plus-music conditions, with the magnitude of that effect correlating with enhanced visual imagery and reports of autobiographical scenes. Behavioural and subjective studies reviewed show that psychedelics intensify music-evoked emotion, absorption and perceived beauty or significance of music. Comparative psychopharmacology found greater absorption and appreciation of music during acute psilocybin than during placebo or dextromethorphan. Clinical reports and patient narratives commonly describe a sensation of ‘‘surrendering to the music’’ and intensified emotional and imagery-rich experiences. The review notes associations between the quality of the music experience during sessions and therapeutic outcomes: music-experience metrics have been correlated with the occurrence of mystical-type experiences and with reductions in clinical symptoms measured one week after sessions in some studies. Practical implications emerging from the synthesis include the proposition that music can both evoke intense emotion and reduce anxiety or provide a sense of safety, thereby supporting therapeutic processing. The authors contrast standardised playlist approaches (commonly used in classic psychedelic trials) with tailored, patient-specific music selection (more typical in MDMA-assisted psychotherapy), arguing that tailoring may better support personal resonance and therapeutic outcomes. The review also identifies limitations of the evidence base: many historical studies lacked modern experimental controls; a substantial portion of recent clinical work is open-label; some controlled studies exist but the literature remains nascent and at times draws repeatedly on the same small samples. These constraints limit the ability to perform a formal systematic review or meta-analysis at present. Finally, the authors list concrete research gaps reported in the extracted text: the need for replication and independent studies separating drug and music effects (including controlled trials with and without music), investigations of how music genres and specific acoustic or compositional features contribute to outcomes, exploration of time-phase tailoring of music during sessions, study of how individual music history and psychological context moderate music-experience under psychedelics, and development of scalable, empirical music-selection protocols linked to therapeutic processes.

The authors interpret the assembled evidence as indicating that music is a central, active component of the psychedelic-therapy setting. They argue that music interacts with psychedelics to modulate emotion, intensify mental imagery and increase perceived personal meaning, and that these processes plausibly contribute to therapeutic mechanisms such as mystical-type experiences and autobiographical processing that have been associated with clinical benefit. In addition to amplifying emotional reactivity, music may also provide calming, supportive effects that help patients navigate challenging phases of acute drug action. Positioning their synthesis relative to earlier research, the review highlights continuity with mid-20th century clinical practice that emphasised careful music selection, while noting that modern neuroimaging and psychopharmacology provide mechanistic insights not previously available. The authors stress that while a promising mechanistic picture is emerging—5-HT2A receptor-mediated modulation of auditory and higher-level associative networks, altered connectivity supporting imagery and autobiographical recall—evidence remains preliminary and often uncontrolled. Key limitations acknowledged include the narrative (non-systematic) nature of the review, the weak experimental rigour of many historical reports, the prevalence of open-label clinical studies, and instances where multiple analyses derive from the same datasets. These factors constrain inferences about causal contributions of music to therapeutic outcomes and limit generalisability. For practice and research, the authors recommend prioritising rigorous empirical work to separate and quantify the contribution of music in psychedelic-assisted therapies. Proposed next steps include randomised comparisons with and without music, systematic testing of music genres and acoustic features, studies of phase-specific and individually tailored playlists, and investigations into interactions between patient psychological context and the music-experience. Developing evidence-based, scalable guidelines for playlist design and music selection is emphasised as necessary to harmonise research reproducibility with person-centred clinical practice.

The review concludes that psychedelics and music interact to produce marked changes in emotion, imagery and personal meaning, and that early neurobiological and clinical findings support a central role for music in psychedelic therapy. Music appears to influence therapeutic efficacy by modulating emotional processes, facilitating mystical-type experiences, and supporting autobiographical processing. The authors call for rigorous future empirical investigations to better characterise and optimise the contribution of music to psychedelic-assisted treatments.