Music Pilots the River: How music tracks frame and transform psychedelic therapeutic experiences, Part 2

This is the second of a two-part newsletter about music in psychedelic therapy.

While a standardized one-size-fits-all psychedelic playlist may be necessary for the requirements of modern scientific research, the same is not always true for people who are hoping to benefit from psychedelic therapy sessions.

“The track is supposed to follow the trajectory of the experience. At the beginning, there’s a somewhat rapid tempo, relatively short tracks, then towards peak, the tempo is slower, the music more somber, then the pieces become longer, then there are no tracks with lyrics,” said Fred Reinholdt, Clinical Social Worker, who was my guide at Johns Hopkins in 2012. Towards the end of the session, the music becomes lighter, the tempo accelerates, minor key becomes major. In the Hopkins playlist: “Here Comes the Sun” pipes through the headphones as one of the final pieces.

Mr Reinholdt has conducted over 130 psychedelic sessions at Johns Hopkins and Imperial College, as well as having now trained numerous guides to conduct sessions for clinical trials taking place around Europe.

People, he said – that includes myself – spend a lot of time complaining about playlists. I personally disliked the vocal and ecclesiastical tracks.

“They are so subjective,” said Mr Reinholdt. “One participant found it transcendent, it lead them to evaporate to the core, for you it was torturous, others entirely neutral. You can plan a playlist but you have to let go of trying to be too cute with the music,” he said. “Then, there’s the problem of purposely interfering with someone’s experience by obviously playing music that is syntonic.”

As an example, Mr Reinholdt called to mind the facilitators – guides – for sessions during the 1960s and 1970s.

“Back then, guides played disc jockey. Stacks of vinyl records that had to be changed every few minutes. They’d keep guessing. Their ideas can be pure projection. ‘I know what he needs, he needs Sinatra.’”

Those who developed the playlist at the Maryland Psychiatric Research Center tinkered with the playlist, as did designers of the Johns Hopkins clinical trials but they’ve maintained basic structure of beginning, middle and end. Standardization has been the idea over the decades.

“Playlists will may be more individualized as time goes on,” said Mr Reinholdt. “If psilocybin therapy rolls out to the NHS, there has to be standardization. At the periphery, more and different work has to be done.”

The complexity around music is born out by the observations of Drs Bonny and Pahnke. In my experience, and in the experience of subjects in other studies with whom I’ve spoken, melody and euphony is often not the magic carpet that can take you where you need to go. You may need to go other places.

“At times during the session, a patient may struggle very hard to maintain defenses by resisting the powerful emotionally-revealing effects of the drug. Resistance may take the form of objection to the music...Voiced objections to the music, therefore, may indicate to the therapist that problem areas are being encountered.1

These are the times when a skilled guide steps in, and suggests the subject focus on some of what is troubling to her or him about the music.

Some subjects in clinical trials intuit this themselves, and embrace the message of the dissonance to growth-enhancing effect.

Nigel McCourry, Iraq war veteran, and a subject in an MDMA trial to treat his combat related PTSD, was one such subject. Because he was in a clinical trial that allowed for additional active-dose sessions, he was able to have additional MDMA sessions. He asked the investigators, Michael and Annie Mithoefer, if he could include some of his own music in a subsequent session. They agreed.

“Music played huge part during the deployment. It was how the guys connected with home, their culture, their past. Everyone had a music collection.” They’d listen to music out on patrols. Most of the collections had a lot of heavy, aggressive metal music, with a lot of anger and intensity. “Lets-go-out-and-start-some-shit music.”

They included a track he’d brought from his personal collection, the industrial metal band “Ministry.” It was unlike any of the music tracks they used for sessions.

The Ministry tracks reminded Nigel of the brutal harshness of the Iraq war. “It was symbolic for what was going on inside,” he said.

Nigel listened to a few Ministry tracks. It didn’t take long. After a few minutes, he knew he’d arrived where he needed to be emotionally. The feelings emerged:

“Hatred towards people I was with, hatred toward people in Iraq. Hatred I’d had for myself, hating having to feel good about it.” He couldn’t stand when people thanked him for doing service when he felt like “a piece of shit.”

For twenty minutes, he focused on his feelings, breathing into them, paying attention to what was happening inside.

Within a few minutes, the hatred dissipated. He stopped running from his Iraq experiences. He just embraced whatever was going on. He thought about the guys he’d served with who got killed, and how senseless their deaths were. He really couldn’t stand what had happened. The Mithoefers encouraged him to focus on the pain, letting him know they were there for support. They asked him to consider how all the people who had died would feel now, and what they would want him to be doing. How would they want him to be living in the world? Would they want him to be overcome with grief, or or enjoying life as much as he could?

“I realized then I should be focused on living versus dying,” said Nigel. “I think I’d been dying. I felt guilty about living because they couldn’t. I understood that not dealing with the situation was not making anybody happy. I wasn’t doing what the people who had been killed would want me to be doing. And I think that was sort of left off,” he said. “The relationship with the guys who were killed was put to rest, on some level.”

1

Bonny, Helen L, RMT, MME, and Pahnke, Walter N, MD, PhD. The Use of Music in Psychedelic (LSD) Psychotherapy. Journal of Music Therapy, Vol IX, Summer, 1972 pp 64-87.