How Music May Influence Psychedelic Therapy: A Review of Measured and Reported Effects

Psychedelic compounds, such as ketamine, 3,4‐methylenedioxymethamphetamine (MDMA), psilocybin, lysergic acid (LSD), and other classic hallucinogens, have seen renewed scientific and clinical interest in recent years. These agents have re‐emerged as potential therapeutic tools whereby preliminary efficacy data exist for a range of psychiatric disorders including depression (Carhart‐Harris et al. 2021), end of life anxiety (Griffiths et al. 2016), post‐traumatic stress disorder (Mitchell et al. 2023), and substance use disorders (Bogenschutz et al. 2022; M. W. Johnson et al. 2014). It has been well documented among pioneering researchers that drug effects can be strongly influenced by the “mindset” of an individual and the environment in which the psychedelic compound is administered, referred to as “set” and “setting” (Leary et al. 1963). Over time, the application of psychedelics evolved from an isolated pharmacological administration toward a more structured therapeutic process with careful consideration of: (i) preparation: supporting participants to develop therapeutic alliance and trust with therapist and psychological readiness prior to dosing; (ii) dosing: guiding participants during the psychedelic dosing session, often with the use of music; and (iii) integration: helping participants during the process of meaning‐making from their experience to maximize therapeutic potential.

Music has long been regarded as a key contextual feature within many Indigenous and ceremonial uses of psychedelics. For example, musical features such as rhythm, tempo, and vocalization are employed within ayahuasca ceremonies observed in the Santo Daime religion to guide emotional experience, evoke autobiographical memory, and shape visual imagery (Efthimiou et al. 2024; Jerotic et al. 2024). Recognition of music's use within ceremonial contexts as a powerful means of shaping the psychedelic experience helped inform early therapeutic uses of psychedelics (Lett and Dyck 2022), where music was increasingly viewed as a means of potentiating drug action (Hoffer 1965), accelerating the release of emotions, and facilitating peak therapeutic experiences (Bonny and Pahnke 1972). Contemporary protocols developed for psychedelic‐assisted therapy (PAT) used across clinical trials have largely inherited this model whereby music remains a near universal component during dosing sessions (Barrett, Preller, and Kaelen 2018; M. Johnson et al. 2008). Despite this, there are currently no formal guidelines to inform optimal music selection for PAT, and music's selection has largely relied on playlists developed by psychedelic therapists using structured approaches corresponding to distinct phases of the unfolding experience (Barrett et al. 2017; Bonny and Pahnke 1972; Messell et al. 2022).

Importantly, a growing body of empirical research examining the role of music in PAT is emerging, explored within recently published narrative (Barrett, Preller, and Kaelen 2018; Efthimiou et al. 2024; Jerotic et al. 2024) and critical reviews (Moskovitz 2025). To date, the only paper to systematically synthesize research on music's use in PAT is O'Callaghan et al. (2020), primarily focusing on qualitative data. Music was found to elicit meaningful emotions and imagery experiences under psychedelics, which participants reported as integral for self‐exploration. However, given the review aimed to understand subjective and qualitative aspects of music during PAT, controlled experimental studies using objective measures (e.g., neuroimaging) were largely omitted. Subsequent research has been published, contributing to a growing body of quantitative research yet to be systematically reviewed.

Research from neuroscience and psychology of music provides a context for understanding how music may shape the psychedelic experience. Indeed, music listening reliably evokes emotion (Juslin 2013) and autobiographical memory (Janata et al. 2007) and modulates large‐scale brain network dynamics (Koelsch 2014). Further, recent models of psychedelic action (see Carhart‐Harris et al. 2014) implicate increased sensitivity to contextual and environmental input; thus, music's effects may be intensified under psychedelics. Currently, no unified theory of music's role in therapeutic uses of psychedelics exists; however, early clinical observations (Bonny and Pahnke 1972) and more recent reviews (Kaelen and Barrett 2018; Vuust et al. 2024) suggest music may play a central role in shaping emotional and perceptual aspects of the psychedelic experience. Despite near universal recognition of music's importance during psychedelic sessions across both Indigenous ceremonial and contemporary clinical settings, understanding music's role during psychedelic experiences and mechanism of action remains poorly understood (Golden et al. 2022), and further efforts are needed to clarify whether it is best conceptualized as acting to scaffold, guide, or contain the experience.

To the authors’ knowledge, there is currently no comprehensive and systematic synthesis of quantitative research investigating the role of music in PAT on influencing clinical outcomes and impacting both subjective (psychological) and objective (biological) processes. The aim of this review is therefore to conduct a comprehensive systematic scoping review with a focus on: (i) consolidating knowledge, identify gaps and characteristics across studies, and, if applicable, (ii) identifying effects of psychedelics and music on subjective (psychological) and objective (e.g., neurobiological) processes.

This systematic scoping review was conducted in accordance with the standardized guidelines for PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) guidelines (Liberati et al. 2009).

The initial literature search identified a total of 1457 papers. A total of 776 duplicates were removed along with a further 637 during abstract and title screening. Nineteen papers remained after full‐text screening (Figure 1), representing 10 unique studies (see Figure 2). For clarity, “studies” refer to any of the 10 unique studies, and “papers” refer to any of the 19 included publications. Several papers reported on a subset of participants from their original study dataset due to technical errors encountered during data collection, for example, head movement during functional magnetic resonance imaging (fMRI) acquisition or incomplete recordings. Summaries of characteristics, aims, measures, and outcomes across papers are in Table 1, whereas music listening conditions and music characteristics used across studies are in Table 2. Below, we outline the (i) study characteristics (population, design, intervention, outcomes) and (ii) a summary of the findings.

This comprehensive scoping review synthesized existing literature on music and psychedelics, aiming to map study characteristics (e.g., designs, incorporation of music), consolidate quantitative evidence across subjective (e.g., psychological) and objective (e.g., biological) outcomes, and identify gaps to guide future research. Overall, 19 papers from 10 studies were included, comprising following delivery of music during administration of LSD, psilocybin, and ayahuasca in therapeutic and controlled experimental contexts.

Evidence gathered across studies reporting on subjective response to music under psychedelics revealed alterations across multiple domains. The findings indicate enhanced music‐evoked emotions (Kaelen et al. 2015), increased absorption in and aesthetic appreciation of music (Carbonaro et al. 2018, 2020), intensified mood (Ditman et al. 1969), and modulations in temporal perception, with dose‐related changes in temporal estimation accuracy observed under increasing doses of ayahuasca (Campagnoli et al. 2020), although the implications of these specific effects remain unclear. Together, these findings are broadly consistent with early observations that music may act to shape and direct acute‐psychedelic experiences (Bonny and Pahnke 1972), highlighting the need to clarify how a participant's experience of music during PAT may influence clinical response.

To these aims, two papers contribute preliminary evidence (Kaelen et al. 2018; Weiss et al. 2024). However, it is important to note that given none of the studies included a no‐music condition and current findings rely on indirect associations between music experience and outcomes, direct causal inference regarding music's independent contribution to clinical response in PAT is limited. Nonetheless, the findings from Kaelen et al. (2018) and Weiss et al. (2024) indicate that the quality of a patient's music experience during psychedelic sessions plays a role in amplifying acute‐psychedelic states, exerting influence on treatment outcomes via moderation of acute psychedelic variables such as mystical experience and ego dissolution, both of which are known mediators of clinical response (Ko et al. 2022; Yaden and Griffiths 2021). Qualitative research offer convergent evidence with authors suggesting music's role was that of “hidden therapist” (Kaelen et al. 2018) or, more recently, “sentient actor” (Dwyer et al. 2025), implicated in processes that, on the one hand, serve to deepen and enrich psychedelic states conducive to peak or mystical‐type experiences and, on the other, contribute to distress by evoking unpleasant emotions and imagery that may well be counter therapeutic (Kaelen et al. 2018; O'Callaghan et al. 2020). Given music is positioned as central in guiding emotional processes within traditional and ceremonial entheogenic ritual practices, these findings highlight a pressing need to clarify whether the role of music in PAT is best understood as a guide and director of the experience or simply as a container through which the experience unfolds. Reported findings provide preliminary support for the influence of music in PAT; thus, understanding how music may be delivered to optimize therapeutic response is of importance to researchers and clinicians.

Only two studies (Gaston and Eagle 1970; Strickland et al. 2021) explicitly examined the influence of genre, mode of delivery, or familiarity on subjective experiences. Despite the relevance of this research agenda, the results were largely inconclusive and thus limit conclusions as to how music may best be delivered to optimize therapeutic efficacy in PAT, as discussed in Moskovitz (2025). That said, the findings across both papers indicate that specific characteristics of music (e.g., genre) may play a less prominent role in PAT than previously thought, opening the possibility for psychedelic practitioners working with music to deviate from music generally assumed to be necessary in processes deemed therapeutic (Barrett et al. 2017; Ratkovic et al. 2023). Importantly, the modest evidence gathered coupled with an absence of formal guidelines to inform music selection in PAT stands in contrast to evidence‐based practice guidelines (American Psychological Association Task Force on Evidence‐Based Practice 2006), emphasizing patient preferences, discussed within broader therapeutic literature (Swift et al. 2011) and literature on psychedelics and music (Barrett, Preller, and Kaelen 2018; Jerotic et al. 2024). Given the inherent subjectivity in music preference and variable nature of the psychedelic experience, this represents a significant challenge to PAT practitioners, particularly as group‐based protocols emerge where efforts to balance individual and collective needs in music have produced mixed responses (Lewis et al. 2023). Clearly, more research directly examining the delivery of music in PAT is required to guide these treatment protocols. Elucidating objective biological mechanisms through which music exerts influence under psychedelics could clarify aspects of music that may be important.

Collectively, the findings across papers reporting on objective (neural) outcomes suggest that music functions as a powerful contextual modulator, shaping both localized regional activity and broader large‐scale brain dynamics. At a global level, LSD was shown to increase brain entropy across both sensory and higher order networks, an effect which was deepened during close eyed and music conditions (Lebedev et al. 2016; Mediano et al. 2024). Further, music listening amplified the psychedelic‐associated expansion of brain state repertoire and transitions between different brain states, particularly those involving task positive networks (Adamska and Finc 2023; Atasoy et al. 2017), with computer modelling analysis demonstrating increased time taken to return to base‐level activation following in silico perturbation under LSD, pronounced during music conditions (Jobst et al. 2021). Consistent with theories implicating extrapharmacological or environmental (“setting”) conditions during psychedelic administration, the relationship between brain dynamics and subjective experience demonstrated sensitivity to external stimulation (video vs. music) and attention (eyes open versus closed), whereby visual stimulation reduced the measured entropy–experience relationship (Mediano et al. 2024). These results indicate conditions similar to those recommended in early (Blewett and Chwelos 1959) and contemporary protocols for PAT (M. Johnson et al. 2008), which foster internally focused attention with minimal environmental stimulation (e.g., music listening with eyes closed), may support the relationship between entropic brain states and subjective experience. However, the importance of maintaining the relationship between neural entropy and subjective experience in clinical outcomes requires further clarification, particularly given the role that environmental inputs beyond music may play such as those featured in traditional or group‐based settings and implicated in recently proposed mechanisms of PAT such as nature connectedness (Gandy et al. 2020) or communitas (Kettner et al. 2021).

At a regional level, LSD increased midline cortical and motor region activity, which was associated with heightened personal relevance and meaning‐attribution to music (Preller et al. 2017), as well as enhanced tonal tracking of music in frontal, temporal, limbic, and cerebellar regions (Barrett, Preller, Herdener, et al. 2018). During post‐treatment music, listening psychedelics decreased nucleus accumbens to DMN connectivity (Shukuroglou et al. 2023) and increased ALFFs in bilateral superior temporal and occipital regions (Wall et al. 2023). Finally, music listening under LSD strengthened coupling between the parahippocampus and bilateral visual cortex, as well as between visual and inferior frontal regions, reflecting enhanced emotionally driven visual‐perceptual processing (Kaelen et al. 2016). Thus, while studies directly examining the effect of music versus no music on clinical outcomes during PAT are lacking, objective data indicate that music under psychedelics modulates global brain functioning, affecting regions associated with emotion, meaning‐attribution, pleasure, and visual imagery.

Together, these findings offer preliminary empirical support for music's role in contributing greater flexibility within neurobiological processes and intensified subjective experience. Such effects are consistent with broader research on music in non‐psychedelic contexts (Janata et al. 2007; Juslin 2013; Koelsch 2014), suggesting these effects may be amplified in the presence of a psychedelic. Finally, the results align with mechanistic frameworks such as the entropic brain hypothesis (Carhart‐Harris et al. 2014) and related models such as relaxed beliefs under psychedelics (REBUS; Carhart‐Harris and Friston 2019), which propose that psychedelics relax high‐level predictive constraints and increase the influence of environmental and sensory inputs, such as music, on conscious experience.

T. Rowe: conceptualization, methodology, validation, writing – original draft. T. Hurzeler: methodology, validation, visualization, writing – review and editing, supervision. E. Towers: writing – review and editing, validation. E. Louie: validation, writing – review and editing, methodology. K. C. Morley: supervision, conceptualization, investigation, funding acquisition, writing – review and editing.

The authors have nothing to report.

No ethical was required for this review.

The authors declare no conflicts of interest.