Psychedelic Minimalism: The Case Against Music in Psychedelic Therapy SettingsIn response to: Kaelen et al. (2018), "The Hidden Therapist: Evidence for a Central Role ofMusic in Psychedelic Therapy."Introduction: Reframing the Role of SettingIn recent years, renewed attention has been given to the centrality of set and setting inpsychedelic-assisted therapy. The Reporting of Setting in Psychedelic Clinical Trials (ReSPCT)guidelines reflect an evolving consensus: therapeutic outcomes are not solely pharmacologicallydetermined but are heavily shaped by both the environment and the psychological state of theparticipant (Pronovost-Morgan et al. 2025). Within this evolving paradigm, music has assumed aprivileged role, framed as a therapeutic constant, typically curated to be emotionally supportiveor evocative, and especially emphasized during peak psychedelic states (Barrett et al. 2017).The prevailing assumption is that music facilitates safety, emotional access, and therapeuticalignment (Kaelen et al. 2018). However, this assumption has not been subjected to the samedegree of empirical or philosophical scrutiny that other elements of the setting have receivedIn this opinion, I offer a contrarian view: that the inclusion of music in psychedelic therapy maynot be benign or beneficial but could instead function as a confounding variable, altering,distorting, or displacing the very psychological material that therapy seeks to access. I arguethat music introduces external emotional content that may obscure the patient's naturalpsychological flow, their set, thereby undermining the core objective of psychedelic therapy:unmediated engagement with the self. This perspective, which I call psychedelic minimalism,challenges the default assumption that additive features of the setting, particularly music, areinherently therapeutic. Rather than continuing to ask what kind of music, or how it's played, bestsupports the psychedelic experience, I suggest we ask a more foundational question: whymusic at all? If the therapeutic goal is to access internal, unfiltered psychological material, thenany emotionally potent stimulus, no matter how well-curated, may interfere with that process. Ialso call for further research to fill this gap, exploring whether a minimalist setting, free ofemotional modulation, offers deeper, more authentic access to the self.Setting, Set, and the Risk of Emotional InterferenceIn psychedelic therapy, set refers to the totality of a patient's internal state, their beliefs,thoughts, personality, and emotional tendencies, while setting denotes the external environmentwith its sensory, and interpersonal dimensions (Eisner 1997). Together, set and setting shapethe content, tone, and trajectory of the psychedelic experience (Hartogsohn 2016).Psychedelics generate non-ordinary states of consciousness (NOSCs) not inherentlytherapeutic in themselves but filled with potential emerging from lowered psychologicaldefenses, allowing dissociated material to surface (Grof 2000). When this material is engagedwith, the therapeutic action of psychedelics obtains; the role of the setting should not be to guidethe patient away from this material, but to allow its unfolding with as little interference aspossible allowing for direct engagement.To that end, the ideal therapeutic setting is emotionally neutral, a vessel that supports theemergence of unfiltered psychological content without adding its own emotional coloration. Iargue that psychedelic therapeutic efficacy hinges most critically on preserving the primacy ofthe set, enabling the individual to encounter their psyche without distortion or displacement fromexternal stimuli; namely, that the goal of what I refer to as the pure set encounter is a settingdesigned to unconfound the set, where every additive feature of the setting is evaluated for howit alters the natural flow of cognition and introspection.Music as a Modulator of Emotion and MeaningAmong all components of the therapeutic setting, music stands out as a uniquely potentpsychological force. It is not ambient noise or passive background, rather, it is emotionallyloaded, temporally structured, and rich with meaning (Bonny and Pahnke 1972). Music inpsychedelic therapy is often justified for its ability to guide, ground, or emotionally stabilize thepatient during challenging experiences (Kaelen et al. 2018). Yet it is this very power thatwarrants caution.I propose that music operates as a phenomenological modulating influence, shaping thepatient's emotional and cognitive flow during psychedelic sessions. Clinical data and emergingtheories in affective neuroscience and music therapy suggest two primary axes by which musicmay exert its effects: emotional provocativeness, or the ability to evoke strong affective stateslike awe, nostalgia, grief, or anxiety, and personal meaning, referring to the autobiographicalassociations embedded within particular songs (Barrett, Preller, et al. 2017; Barrett, Preller, andKaelen 2018; Strickland, Garcia-Romeu, and Johnson 2020). Music scoring high on eitherdimension, let alone both, I argue, risks overpowering the patient's natural stream of thoughtand redirecting attention to emotionally charged content that may not have otherwise emergedThe influence of provocative music has been observed clinically and acknowledged even in theReSPCT Guidelines (Item 11), which call for careful reporting of the music used, given itsevident impact on the therapeutic setting ("The ReSPCT Guidelines" 2025). One case studyparticipant described her psilocybin session as uncomfortable when accompanied by music, butcalming and insightful during silent periods that involved therapist-guided mindfulness andinterpersonal discussion. She ultimately chose to move to a quiet room, preferring a music-freesetting (Gloeckler et al. 2024). Another participant stated that "under psilocybin I felt almost thatI had no choice but to go with the music" (Kaelen et al. 2018), implying a surrender of agency tothe external structure of sound. These accounts suggest that music, far from universallysupportive, can inhibit introspection and redirect the therapeutic process away from self-generated insight.Proponents of music often argue that it enhances the psychedelic experience and supportspatients through difficult terrain (Kaelen et al. 2015). But this assumption is worth challenging. Inmany cases, meaningful breakthroughs occur not through comfort but through productivediscomfort: the slow processing of unstructured inner chaos, the confrontation with long-avoidedemotions, or the resurfacing of deeply repressed memory. One psilocybin trial participantdescribed her musical experience as overwhelming, reporting that she felt she was"suffocating," and that the music was "too much" (Gloeckler et al. 2024). Only during a music-free period did she experience release from resistance and begin productive introspection.Even music that holds personal significance may be counterproductive. A song tied to thememory of a lost loved one may elicit genuine sadness, but that sadness is structured by themusic's associative framework, not by the patient's internal emotional terrain. While some mayargue that such triggers can facilitate emotional processing, especially when linked to trauma,the ability to identify and select such music in advance is clinically uncertain and not scalable.Many patients are unaware of how particular songs will affect them until they are in the alteredstate. Furthermore, music that appears helpful in one moment may overwhelm or displace morerelevant material that would otherwise emerge in silence. The risk here is not just distraction,but displacement: the substitution of an externally prompted emotional script for an internallydriven exploration.Gaps in Research, Future Directions, and Analysis of Conflicts of InterestDespite the central role music plays in most psychedelic-assisted therapy protocols, there is astriking lack of controlled research examining its specific effects. Music is often treated as adefault or essential component, not as a testable variable. This has left a significant gap in ourunderstanding of how therapeutic outcomes differ between music-enriched and minimalist(silent) settings. The assumption of music's benefit remains largely unchallenged, limiting insightinto which aspects of the psychedelic experience are truly intrinsic and which are shaped byexternal influences.This oversight presents a valuable opportunity for future research. Clinically testable questions,such as whether music fosters emotional insight or deflects it, and whether insights gained insilence are more enduring, could inform more effective, scalable treatment models. Randomizedtrials, qualitative and neurophenomenological studies, and long-term follow-ups comparingdifferent settings could clarify whether music enhances or interferes with therapeutic goals.Rather than accepting tradition, researchers must begin to treat music as an active variablewhose inclusion requires empirical justification.It is also not without mention, notable to consider the potential conflict between author MendelKaelen, PhD, the first author of the dissented paper, and his role as CEO of Wavepaths, a"startup providing music both for and as psychedelic therapy" (ICPR by OPEN Foundation 2024;Wavepaths 2024). If Dr. Kaelen has a financial stake in the use of music in the setting ofpsychedelic assisted therapy, this invites scrutiny of potential influence over confirmation bias inhis research, especially given the nascent, subjective nature of current psychedelic medicineresearch.DiscussionPsychedelic therapy is most powerful when it enables unmediated access to the self. Yet music,widely assumed to be therapeutic, may disrupt this process by directing attention and shapingemotional response. As a modulating force, it risks overshadowing the very psychologicalmaterial therapy aims to access. Emotional experiences prompted by music may feelmeaningful but are often structured by the music itself, not by the patient's own psyche. Aminimalist setting that is quiet, neutral, and non-directive, offers an alternative. Rather thanguiding or soothing, it allows internal content to emerge undisturbed. If the goal is authenticintrospection and lasting transformation, then silence may be more supportive than sound.Future research should directly test this, shifting the burden of proof onto any setting feature,especially music, that claims therapeutic value.
S. Nader (Tue,) studied this question.