Music in Psychedelic-Assisted Therapy: How Playlists, Eye-Masks, and Sound Shape the Experience

Music in psychedelic-assisted therapy is not background. In the modern clinical literature, the playlist is treated as a therapeutic variable in its own right — engineered, sequenced, and selected with the same care as any other element of the dosing session. The Imperial College London group has gone so far as to call music "the hidden therapist" (Kaelen et al. 2018, Psychopharmacology, PMID 29396616). This article is a Canadian clinical guide to what the evidence on music in psychedelic therapy actually shows, where the framework comes from, how standardized and personalized playlists differ, why eye-masks and headphones are part of the apparatus, what cultural considerations are real, and how ATMA CENA constructs the audio environment for ketamine, psilocybin and MDMA-AT.

Key takeaways

• Music is one of the most-studied set/setting variables in psychedelic-assisted therapy. Kaelen et al. 2018 (PMID 29396616) showed measurable contributions of music to subjective experience — emotional response, sense of meaningfulness, and mystical-type experience — in psilocybin sessions.
• The framework predates modern clinical trials. Helen Bonny's Bonny Method of Guided Imagery and Music (GIM), developed during LSD-era psychedelic research at the Maryland Psychiatric Research Center, is the foundational music-therapy model that informs current practice.
• Standardized playlists dominate Phase 2 and 3 trials. MAPP1/MAPP2 (Mitchell 2021/2023) and COMP001 (Goodwin 2022) use structured playlists with limited personalization.
• Music has structural arc. Pre-session calming, onset building, peak emotional or transcendent, descent integrative — designed to scaffold the pharmacology.
• Eye-masks and high-fidelity headphones are standard for psilocybin and MDMA dosing; sometimes used in ketamine. They support the inward-directed posture.
• Cultural, linguistic, religious, and identity considerations are clinically real — vocals in a familiar language, sacred music, or culturally loaded selections can land differently for different patients.
• The evidence is real but the literature is small. Sample sizes are modest, the standardized-vs-personalized question is open, and clinical judgment still does substantial work.
• Necessary, not sufficient. Music supports the work; it does not predict response and does not replace screening, preparation, or integration.

Where the framework comes from: Bonny, Eisner, and "music as therapist"

The use of music in psychedelic therapy did not begin with the modern Phase 2 and 3 trials. It begins with Helen Bonny, a music therapist who worked in the 1960s and 1970s at the Maryland Psychiatric Research Center alongside Stanislav Grof and others, conducting some of the most rigorous LSD-assisted psychotherapy research of that era. Bonny's clinical observation — that carefully selected and sequenced music seemed to do therapeutic work alongside the medicine — became the foundation for what she developed into the Bonny Method of Guided Imagery and Music (GIM), a music-psychotherapy model that has since been used in non-psychedelic contexts but originated in psychedelic research.

Bonny's framing is preserved in contemporary practice through phrases like "music as therapist": the playlist is not entertainment, not ambience, not distraction, but a structured presence that holds the arc of the session. Bruce Eisner's writing in the same tradition extended this framing through the late twentieth century. Many of the music-selection principles in current MAPS, COMPASS, and Imperial College protocols are recognizably descended from Bonny's GIM-era work.

The modern clinical literature picks up the thread. The Imperial College London group's Kaelen et al. 2018 paper, The hidden therapist: evidence for a central role of music in psychedelic therapy (Psychopharmacology, PMID 29396616), used qualitative and quantitative analysis of patient reports following psilocybin-assisted therapy for treatment-resistant depression and demonstrated that music made measurable contributions to the therapeutic process, including emotional response, sense of meaningfulness, and the degree of mystical-type experience reported. Mendel Kaelen's earlier 2017 work — including journal articles examining music as a non-pharmacological component of psychedelic therapy — laid the groundwork for the 2018 paper and is part of the same line of research.

More recent reviews (Strickland and Garcia-Romeu, ongoing literature) have continued to map the parameters: which musical features matter, how playlist arcs interact with substance-specific timecourses, and where the standardized-vs-personalized question stands. The literature is real; it is also small, and clinical judgment still does substantial work.

What music does in a psychedelic session

The mechanistic claims in the literature converge on several functions music appears to perform in dosing sessions:

• Emotional scaffolding. Music structures emotional arc. Rising harmonies during onset, sustained energy or stillness at peak, returning structure during descent — these supply a temporal frame the medicine can attach to.
• Inward focus. Combined with the eye-mask, headphones direct attention inward and reduce orientation to the external room. The combination is deliberate.
• Affect regulation. Music can support a patient through difficult material — not by distracting from it, but by providing a steady emotional container that the patient can lean on while staying with what is surfacing.
• Meaning-making. Kaelen 2018 specifically documents the link between music and reported meaningfulness of the experience.
• Co-presence. The team listens with the patient, even at quiet volume. The shared audio environment is part of the relational frame.

Music is not doing therapy on its own. It is doing structural work that the team and the medicine work through.

The structural arc of a psychedelic playlist

Across protocols, the dominant playlist structure follows a four-phase arc keyed to the pharmacokinetics of the substance.

Pre-session: calming and engagement. Before the medicine is administered, music is soft, slow, and emotionally neutral — designed to support the patient settling in, lying back, putting on the eye-mask, and orienting toward the work. Silence is also a defensible choice here.

Onset: building, gentle. As the medicine takes hold (psilocybin onset typically 20–40 minutes; MDMA 30–60 minutes; ketamine more rapid), the music builds gradually — gentle, harmonically rich, often instrumental, often acoustic or orchestral, without sudden transitions. The aim is to support the patient as the non-ordinary state arrives without forcing emotional content too early.

Peak: emotional, transcendent, or sustained. During the peak phase, the music depends on substance and protocol. Psilocybin peaks in many protocols use selections with greater emotional intensity, harmonic complexity, sometimes choral or vocal-non-linguistic textures, sometimes silence. MDMA peaks tend toward sustained warmth and emotional accessibility rather than ascending intensity. Ketamine peaks are shorter and the music structure is calibrated accordingly. The peak is where the playlist's emotional contour matters most clinically.

Descent: returning, integrative. As the medicine wanes, the music returns to gentler, more structured forms — familiar harmonic patterns, sometimes returning to selections heard during onset, supporting the patient's re-emergence into ordinary consciousness. Some protocols add a quieter "landing" segment at the very end, before the eye-mask comes off and conversation resumes.

Different protocol playlists implement this arc differently. The MAPS MDMA-AT playlist and the COMPASS psilocybin playlist are not the same; they share the four-phase logic.

Standardized vs personalized playlists — the open question

The most contested clinical question on music in psychedelic therapy is how much personalization is wise.

Standardized playlists are the dominant choice in Phase 2 and 3 controlled trials. The MAPS-developed MDMA-AT manual used in Mitchell 2021 MAPP1 (PMID 33972795) and Mitchell 2023 MAPP2 (PMID 37640273) specifies a structured playlist with deliberate emotional arc and limited personalization options. The Compass Pathways COMP001 psilocybin protocol (Goodwin 2022, PMID 36322843) similarly uses a Compass-developed structured playlist. The Imperial College psilocybin trials used playlists designed by their team. The rationale is consistent across protocols:

• The emotional arc is predictable for the team, who can anticipate what the patient is hearing at any moment
• Selections are clinically vetted — no unanticipated lyrical content, no destabilizing associations, no genre choices that might undermine the inward-directed posture
• Standardization supports research comparability across patients and across sites
• The team is trained on the playlist — they know its arc, its peaks, its landings

Personalized playlists appear more in ketamine-assisted psychotherapy practice and in some psilocybin and MDMA protocols outside the controlled-trial mainstream. The argument for personalization is that musically meaningful selections — songs the patient has loved, that mark life events, that connect to their cultural or spiritual frame — can deepen the experience and make it personally legible. The clinical concern is that personal meaning cuts both ways. A song that means one thing to the patient on an ordinary day can mean something quite different at the peak of a psilocybin or MDMA experience. Associations the patient has not anticipated — to a former relationship, a deceased family member, a difficult period — can surface unexpectedly and require the team to navigate them in real time.

The current consensus in mainstream clinical-trial protocols is standardized or semi-standardized playlists with bounded patient input on exclusions — vocals or no vocals, language exclusions, specific genres or instruments to avoid, particular religious or sacred music to include or exclude. Patients are not handed full playlist authority because the team's clinical judgment about emotional pacing remains in play. Patients are not denied input because their cultural frame, language, and history are clinically real.

In ketamine-assisted psychotherapy, the picture is more variable. Some clinics use standardized playlists analogous to the psilocybin model; others let the patient bring selections; others use shorter playlists matched to the shorter ketamine timecourse. The Dore 2019 KAP literature (PMID 30917760) documents the variability. The ATMA CENA approach is structured-with-input and is explained to the patient in preparation.

Eye-masks: inward focus as a setting choice

Eye-masks are nearly universal in psilocybin and MDMA-AT dosing protocols and are sometimes used in ketamine protocols depending on dose, route, and patient preference.

• Reduce visual stimulation. With the eye-mask on, the room recedes. Visual content — geometry, imagery, fields of colour, sometimes detailed visions in the case of psilocybin — is internally generated rather than externally stimulated.
• Support inward direction. The dominant clinical posture in MAPS, COMPASS, and Imperial protocols is inward-directed: the patient attends to internal experience rather than the room. The eye-mask materially supports that posture.
• Cue the structure. Putting on the eye-mask is part of the ritual that marks the transition from preparation conversation to dosing. Taking it off is part of the ritual that marks the transition back.
• Patient autonomy. The eye-mask is invited, never imposed. Patients can remove it at any time, and the team is trained to respond to that without shame or interruption.

Some patients find eye-masks anxiety-inducing in preparation (claustrophobia, trauma-related associations with darkness or facial covering). These are addressed in preparation rather than discovered during dosing.

In ketamine-assisted psychotherapy, eye-mask use is more variable. Lower-dose, dialogic ketamine sessions sometimes proceed with eyes closed but without an eye-mask. Higher-dose, inward-directed ketamine sessions may use one. The decision is clinical and patient-specific.

Headphones: high-fidelity, closed-back, over-ear

The audio delivery system matters. Across modern psychedelic-assisted therapy protocols, the standard is high-quality, closed-back, over-ear headphones.

• Closed-back isolates external sound — the team's quiet movements, equipment, the room — and allows volume to be set lower than would otherwise be necessary. Lower volume reduces fatigue across long (6–8 hour) sessions.
• Over-ear is more comfortable across long durations than in-ear, particularly when the patient is reclining, lying back, and possibly moving.
• High-fidelity is not audiophile self-indulgence; it matters because compressed, low-fidelity audio loses the harmonic and dynamic detail that the playlist's emotional arc depends on.
• Wired, not wireless, in many clinical setups — to avoid Bluetooth dropouts during the most clinically sensitive parts of the session, and to avoid the patient receiving notifications or interruptions through the audio path.

The patient does not need to know the brand. The patient does need to know the headphones will be comfortable, will be cleaned, and will not interrupt the session.

Cultural, linguistic, and identity considerations

Music carries cultural, religious, and personal meaning. Treating playlist selection as if it were neutral is a clinical failure mode. Modern protocols and ATMA CENA's practice incorporate the following considerations explicitly.

• Language and lyrics. Vocals in a language the patient understands carry semantic content that can be surprisingly powerful at peak. Many patients prefer instrumental selections, or vocals in a language they do not understand, for that reason. Others specifically want to hear lyrics in their own language. This is a preparation conversation.
• Cultural background. Patients from particular cultural traditions may want music from those traditions — and may want music from outside those traditions to be excluded if it carries religious or appropriative associations. Patients may also specifically want to exclude music from their tradition if they are working with material related to it.
• Religious and spiritual considerations. Sacred music, hymns, devotional traditions, and religiously charged selections can land powerfully — sometimes therapeutically, sometimes not. Patients with active religious lives often have clear preferences. Patients with complex relationships to a religion of origin may need careful conversation about what to include or exclude.
• Indigenous patients. Indigenous patients in Canada may want Indigenous-led music, may want to exclude appropriative or pseudo-Indigenous selections sometimes found in psychedelic playlists, and may want ceremony-related music handled with appropriate cultural care. ATMA CENA works with patient leadership on these choices.
• LGBTQ+ patients. LGBTQ+ patients, particularly those with religious-trauma history, may have specific exclusions around devotional or hymn-style selections. The conversation is patient-led.
• Personal associations. Beyond category, individual associations — songs connected to specific people, places, or periods — are worth surfacing in preparation if the patient is using a personalized playlist.

These conversations happen in the preparation phase, not on the morning of dosing. They are clinical work, not box-ticking.

What the music research does and does not show

The strong claim in modern psychedelic medicine is that music makes a real contribution to subjective experience. The honest claim is more bounded.

What the evidence supports. Kaelen et al. 2018 demonstrated that music in psilocybin sessions made measurable contributions to subjective experience — emotional response, sense of meaningfulness, and degree of mystical-type experience — using mixed qualitative and quantitative methods. The MAPS and COMPASS controlled-trial protocols have run with structured playlists across hundreds of dosing sessions without playlist-related safety signals being identified. Music is treated as a clinical variable across the field for reasons consistent with the data.

What the evidence does not yet establish.

• Standardized vs personalized. The comparative evidence is limited. Most controlled trials have used standardized playlists; head-to-head comparison is sparse. Clinical judgment is doing more work than data here.
• Specific selection effects. Which pieces, which genres, which arcs work best — the literature is still descriptive rather than mechanistic.
• Transferability across substances. Most music research is in psilocybin. MDMA-AT music research is thinner. Ketamine music research is thinner still.
• Dose-response in music itself. The "more curated music = better outcome" claim is not empirically established.

The honest position is: music is a real clinical variable, the framework is well-established, the specifics are still being worked out, and clinical judgment in preparation is how the gap is bridged for any given patient.

Practical considerations for patients

• Talk about music in preparation. Bring it up early. Tell your team what you love, what you cannot bear, what you absolutely do not want to hear, and what you are unsure about. Specifics help.
• Bring favorite albums in advance, where the protocol allows. If your clinic supports any patient-curated additions, bring them in preparation rather than on the day of dosing — the team needs time to listen, vet, and integrate.
• Be honest about associations. A song you love in ordinary life can be unexpectedly heavy at peak. Tell your team about songs with strong associations.
• Be honest about exclusions. If a genre, language, or specific artist is off-limits for you — religious, traumatic, relational — say so.
• Trust the structure. If your protocol uses a standardized playlist, trust that the arc has been designed and tested across many sessions. The team knows where you are in the playlist throughout the day.
• Headphones and eye-mask in preparation. Try the headphones and the eye-mask in preparation, not for the first time on dosing day. Comfort and any anxiety responses are addressed before they become acute.
• Volume. Volume is set low — quieter than most patients expect. The medicine amplifies what is there. Tell your team if it is too loud or too quiet.
• Silence is allowed. Some patients prefer stretches of silence at peak. This is a valid choice and is worth discussing in preparation.

These are the levers patients actually have. Used in preparation, they make the audio environment of the session something the patient has co-constructed rather than received.

How ATMA CENA uses music

ATMA CENA's approach to music is structured-with-input, calibrated to substance and patient.

Standardized core, patient-input edges. For psilocybin and MDMA-AT under SAP, ATMA CENA defaults to structured playlists with arcs aligned to MAPP and COMPASS-style clinical models, with patient input on language, genre exclusions, religious or sacred-music considerations, and particular known triggers. The patient does not select the full playlist; the patient does meaningfully shape its boundaries.

Ketamine. ATMA CENA's KAP music approach is calibrated to dose, route, and clinical posture. Higher-dose, inward-directed ketamine sessions use a more structured playlist; lower-dose, dialogic sessions may use lighter background or none.

Equipment. High-quality closed-back over-ear headphones, vetted eye-masks, audio paths designed not to drop out mid-session.

Preparation conversation. Music is discussed in preparation. Patients try the headphones and eye-mask before dosing day. Specific exclusions and inclusions are documented and reviewed by the clinical team.

Cultural care. Indigenous, religious, LGBTQ+, and culturally specific considerations are surfaced in preparation. Patients lead; the team supports and screens for clinical concerns.

Integration. Music heard during dosing often re-emerges during integration — patients sometimes return to specific selections in the days and weeks after a session. The team can share the playlist on request after dosing.

Frequently asked questions

Why is music a clinical variable in psychedelic therapy? Because the evidence — including Kaelen et al. 2018 (PMID 29396616) — shows that music makes measurable contributions to subjective experience during psilocybin sessions, and the MAPS, COMPASS, and Imperial College protocols treat curated audio as part of the therapy. The framework descends from Helen Bonny's Bonny Method of Guided Imagery and Music (GIM) developed in LSD-era psychedelic research.

What is the Bonny Method of GIM? The Bonny Method of Guided Imagery and Music is a music-psychotherapy model developed by Helen Bonny, who worked at the Maryland Psychiatric Research Center during the LSD-era of psychedelic research. It is the foundational framework for the contemporary use of music in psychedelic-assisted therapy and continues to inform protocol design.

Can I bring my own music? Sometimes, with clinical review. Most modern controlled-trial protocols (MAPP1/MAPP2, COMP001) default to standardized playlists because their emotional arcs are predictable for the team. Personalized music can introduce associations a patient did not anticipate during dosing. Patient input on exclusions — language, vocals, genres, religious music — is built into preparation. Full patient-curated playlists are more common in some ketamine practices than in psilocybin or MDMA protocols.

Why an eye-mask? The eye-mask supports the inward-directed approach used in psilocybin and MDMA-AT protocols. It reduces visual stimulation and helps direct attention inward. Patients can remove it at any time, and any anxiety associated with eye-masks is addressed in preparation.

Are headphones required? In psilocybin and MDMA-AT dosing sessions, high-fidelity closed-back over-ear headphones are standard. They support the inward-directed posture, allow lower volumes, and isolate external sound. In ketamine sessions, headphone use is more variable.

What does a psychedelic therapy playlist sound like? Typically four phases: calming pre-session music, gentle building during onset, more emotionally complex or sustained selections at peak, and integrative returning music during descent. Most selections are instrumental, harmonically rich, and free of unexpected lyrical content — though specifics vary by protocol and substance.

What if I'm religious — or specifically not? Religious and spiritual considerations are clinically real. Patients with active religious lives often have clear preferences for or against sacred music. Patients with religious-trauma history may want specific exclusions. These are surfaced and documented in preparation.

Can Indigenous patients bring traditional music? Yes — patient-led. ATMA CENA works with patient leadership on Indigenous music selection and on excluding appropriative or pseudo-Indigenous music sometimes found in generic psychedelic playlists. Ceremony-related music is handled with appropriate cultural care.

Does music make a "bad trip" less likely? Music is one variable among many. Strong music in a strong protocol contributes to the overall set and setting that is associated with lower rates of acute panic and prolonged distress, but music alone does not prevent difficult experiences. See our article on difficult experiences for the broader framework.

Will my therapist talk to me during the playlist? In most psilocybin and MDMA-AT protocols, the dominant clinical posture during dosing is non-directive: the team is present, available, and supportive but does not steer content. Music plays under that posture. KAP can be more dialogic, particularly at lower doses. The structure is discussed in preparation.

How does music in psychedelic therapy compare with music therapy? Music therapy as a standalone discipline — including the Bonny Method of GIM in non-psychedelic contexts — uses music for clinical work in conscious states. Music in psychedelic-assisted therapy is one component of a multi-element protocol that also includes the substance, the team, the environment, and the integration work. The Bonny lineage connects them.

Compliance disclaimer

This article is educational. Psilocybin and MDMA are Schedule III and Schedule I controlled substances in Canada respectively; clinical access in Canada is via Health Canada's Special Access Program on a case-by-case basis. Ketamine is a Health Canada-approved anaesthetic; psychiatric use is off-label and within Canadian off-label prescribing principles. Esketamine (Spravato) is Health Canada-approved for treatment-resistant depression. Nothing in this article should be construed as a clinical recommendation for a specific individual; clinical decisions belong with a qualified prescribing physician.

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Related articles

• Set and Setting in Psychedelic-Assisted Therapy
• The Preparation Phase of Psychedelic-Assisted Therapy
• What to Expect at Your First Psychedelic-Assisted Therapy Session
• The Integration Phase of Psychedelic-Assisted Therapy
• Difficult Experiences and "Bad Trips" in Psychedelic-Assisted Therapy
• Psilocybin Therapy in Canada
• MDMA-Assisted Therapy in Canada

Last updated: 2026-05-06