Music in Psychedelic Therapy
Music has been a nearly universal component of psychedelic therapies since their first development in the mid-20th century. Music is also often a core aspect of the Montreal Model of Ketamine-Therapy and was studied in our recent Randomized Clinical Trial: The Music for Subanesthetic Infusions of Ketamine (MUSIK) Trial.
This trial compared carefully refined musical playlists to a matched form of non-music support centered on guided mindfulness and active dialogue. The MUSIK trial found that music was successfully in reducing the blood pressure increases associated with ketamine, but both approaches were similarly effective overall, in terms of psychiatric benefits and sorts of psychedelic experiences.
However, the music and non-music approaches developed in the MUSIK trial may have highly person-specific effects, each offering unique advantages and disadvantages as described and compared below.
Music in the Montreal Model
When music is incorporated into the model, it follows a specific structure:
- A 50-60 minute musical selection played through both headphones and speakers after the ketamine infusion is began or the intramuscular ketamine injection is given.
- Patients select from various curated playlists at the beginning of each treatment session
- The curated musical playlists follow a consistent format: beginning with soothing compositions, gradually increasing in intensity after 10-15 minutes, and concluding with calming music for the final 20 minutes.
- Generally there is little discussion with therapists while the music is playing, although it can always be stopped or removed from the headphones.
- After the treatment session, patients are provided with the playlist to re-listen during integration periods
Non-Music Approaches in the Montreal Model
The non-music variation of the Montreal Model maintains all other therapeutic elements while replacing music with alternative supportive interventions:
- Patients receive gentle encouragement to engage in mindfulness practices such as body-scanning and breath awareness
- Clinicians foster relaxation and curiosity about the ketamine experience through verbal guidance
- Patients may remain silent or discuss their experiences with clinical staff during treatments
Comparative Advantages and Disadvantages
Advantages of Music
- Hemodynamic benefits: The MUSIK trial found that music significantly reduces ketamine-induced increases in systolic blood pressure, improving cardiovascular tolerability
- Integration tool: Patients can revisit playlists after treatment to help recall and process emotional states experienced during sessions
- Temporal structure: Music provides a consistent framework that guides patients through different phases of the ketamine experience
Disadvantages of Music
- Potential for unwanted direction: Drawing from the psilocybin research, music can sometimes lead patients into challenging memories or experiences they weren’t prepared to address
- May limit interpersonal interaction: Headphones can create a barrier to direct engagement with clinicians during critical moments
- Possible interference with mindfulness: Music could potentially distract from mindfulness exercises that form part of the therapeutic approach
Advantages of Non-Music Approaches
- Enhanced mindfulness engagement: The relative silence facilitates deeper engagement with mindfulness practices like body scanning
- Increased therapist interaction: Without headphones, patients may interact more directly with clinicians during the experience
- Patient-directed experience: Without music’s directing influence, patients may have more agency in their internal experience
Disadvantages of Non-Music Approaches
- Initial discomfort: Some patients may find the relative silence uncomfortable or more challenging, especially if accustomed to music in previous sessions
- Less structured experience: Without music’s temporal framework, the experience may feel less guided
Summary
The Montreal Model represents a flexible approach to ketamine therapy that can effectively incorporate either music or non-music interventions based on individual patient needs and preferences. The research indicates that while music offers specific benefits for hemodynamic tolerability and experiential structure, non-music approaches provide alternative advantages through enhanced mindfulness engagement and therapist interaction. The comparable clinical outcomes between approaches suggest that practitioners can tailor the method to individual patients without compromising therapeutic efficacy.
Musical Playlists
Coming soon…
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