If you’ve ever sat with a client in a ketamine or psilocybin session and quietly wondered whether you chose the right songs for your playlist, you’re not alone, and you’re already asking the right question.
Music is not just for creating a nice atmosphere in psychedelic-assisted therapy. It is, as researcher Mendel Kaelen put it after studying psilocybin sessions at Imperial College London, “It’s the music which is really driving what kind of experience patients have in the therapy, and what kind of experience they have predicts the outcome of the therapy.” And the kind of experience they have, he found, predicts the outcome. ¹
This means that in a well-designed psychedelic therapy session, the music may be shaping therapeutic results as meaningfully as the medicine itself. Some have suggested that the playlist and music are the “hidden therapist” in the room.
This piece is a practical introduction to why that’s true, what the science says, and what it means for you as a practitioner. This article will cover the basics of music theory as it applies to psychedelic sessions, how to think about curating a playlist, and why this is a skill worth investing in, regardless of whether you’ve ever played an instrument in your life or understand music theory.
Why is Music Important? What the Research Says
The therapeutic use of music in psychedelic settings isn’t new. It dates back to the first wave of LSD research in the 1950s and ’60s, where music was already understood to be a key component of the session environment. Music therapist Helen Bonny, who worked at the Maryland Psychiatric Research Center during that period, developed some of the earliest formalized playlists for psychedelic therapy, and her work continues to influence practitioners today. ²
What’s new is the quality of our scientific understanding of why it works.
A 2024 study published in Frontiers in Psychiatry analyzed 494 ketamine/esketamine sessions across 37 patients with treatment-resistant depression. Patients who listened to music during treatment reported significantly lower anxiety, tolerated higher administered doses on average, and showed lower peak blood pressure responses compared to patients who did not listen to music. Anxiety scores averaged approximately 0.4 in the music group versus 1.4 in the no-music group during sessions. The study did not examine specific genres or playlist types but only whether music was present during treatment.
A 2025 study published in Frontiers in Psychiatry went further. Researchers at St. Vincent’s Hospital in Melbourne conducted phenomenological interviews with patients following psilocybin-assisted therapy sessions and found that music undergoes a profound transformation during psychedelic-assisted psychotherapy. Music shifted from externally heard recorded music into internally generated, multisensory, and deeply personal experiences. The music, in other words, is no longer experienced merely as background sound. It becomes woven into the experience itself. The music becomes something participants feel immersed in rather than simply listening to from the outside.
Kaelen’s research at Imperial College took this further still. He found that the quality of a patient’s experience of music during a psilocybin session was directly associated with mystical and therapeutic insights and that this musical experience, rather than the intensity of the drug alone, seemed to predict improvements in depression a week later. ¹
A 2024 review in Psychedelic Medicine concluded that music plays a central role in both therapeutic and ceremonial psychedelic experiences, influencing emotion, memory, meaning-making, and the overall trajectory of the experience itself. At the same time, the authors noted that the field still lacks a nuanced understanding of how specific musical elements, cultural contexts, and individual differences shape therapeutic outcomes. Rather than functioning as simple background ambiance, music may operate as an active component of the psychedelic process itself. ⁵
The Oldest Curriculum We Have
Long before clinical trials and controlled conditions, indigenous communities across the globe had already developed sophisticated musical frameworks for navigating psychedelic states.
Across many Amazonian healing traditions, icaros, the ceremonial healing songs sung during ayahuasca rituals, are understood as an essential part of the medicine itself. A recent phenomenological study of participant experiences at the Takiwasi Center in Peru found that these songs were often experienced not simply as music, but as active guiding forces within the ceremony, shaping visions, emotional processing, bodily sensations, and the overall trajectory of the experience. Participants frequently described the songs as calming, protective, emotionally evocative, and even physically embodied, with some reporting that the songs felt as though they were moving through the body or carrying the intention of the healer. Rather than functioning as background sound, the icaros were experienced as relational and immersive aspects of the healing process itself. ⁶
In West Africa, Bwiti practitioners using ibogaine play drums, rattles, sing, and strum continuously for twelve to fifteen hours across multi-day ceremonies. The music does not stop because stopping would mean abandoning the journeyer mid-voyage.
In Native American traditions that use peyote and San Pedro, they play drums, chant, and use rattles in a clear wave structure: gentler at the opening, building toward intensity, then returning to softness at the close.
Every culture that developed a sustained relationship with plant medicines discovered the same shape independently. The wave. The arc. A beginning that opens, a middle that intensifies and releases, and an ending that brings the traveler home.
Meanwhile, the Johns Hopkins psilocybin playlist, developed by researcher William Richards, drawing partly on Helen Bonny’s earlier tapes, is divided into distinct segments: background music as the participant arrives; music as the drug begins to take effect; the ascent; the peak; the post-peak; and the “welcome back” music. ² While modern clinical psychedelic therapy approaches music differently than Indigenous ceremonial traditions, both frameworks recognize that music can shape emotional tone, guide attention, and influence the unfolding trajectory of the experience itself.
A Beginner’s Guide to Music Theory for Psychedelic Sessions
You do not need to read sheet music or understand chord progressions to become an effective music facilitator. But a few foundational concepts will immediately improve how you think about playlist design.
Major Key vs. Minor Key
Within psychedelic therapy, the musical key can play an important role in shaping the emotional tone and psychological movement of a session. While every participant responds differently to music, many facilitators intentionally use shifts between major and minor tonalities to support different phases of the journey.
Major keys sound bright, open, and resolved. Think of morning light, a sense of arriving somewhere safe. Major key music communicates to the nervous system: you are okay, there is ground beneath you, and you can open.
Minor keys sound inward, deep, and emotionally complex. They create a sense of interiority — the feeling of going somewhere, of moving through something. Minor key music communicates: we are traveling, stay with it.
When creating playlists for participants, you can think of using the major and minor keys as follows:
- Open with major key music as it establishes safety and readiness before the medicine takes hold
- Shift to a minor key as the journey deepens, as it supports and mirrors the inward movement of the experience
- Return to the major key during the descent and landing, as it signals to the nervous system that the traveler is coming home
Rather than rigid rules, these shifts can be understood as emotional and relational cues that help support orientation, surrender, emotional processing, and eventual re-grounding throughout the psychedelic experience.
Tempo and BPM
BPM stands for beats per minute, the speed of a track. For psychedelic sessions, tempo functions like a pacemaker for the journey.
- Slow BPM (60–80): Grounding, meditative, receptive. Appropriate for opening and closing phases when the client needs to settle into or return from the experience.
- Medium BPM (80–110): Moving, building, emotionally propulsive. Useful during the onset and deepening phases.
- Higher BPM (110+): Driving, intense, peak-associated. The music of the session’s climax — what carries the client through the most charged territory of the experience.
David Starfire, who has designed playlists for sessions with Gabor Maté, Bessel van der Kolk, and Richard Schwartz, stressed one point specific to ketamine: for high-dose ketamine sessions, beats are not optional. Without rhythmic forward momentum, clients can fall into loops, which can lead to cycling through the same material without being able to move through it. “With ketamine, especially high-dose ketamine, it’s important to have beats and to have different music changing over time,” he says. “Because that’s how the journey is.”
For low-dose ketamine sessions in a talk therapy context, the opposite applies: no beats, ambient only, and major keys. The music must stay soft enough to support conversation. Research on music during esketamine infusions supports this distinction, finding that musical context meaningfully shapes the character of the dissociative experience rather than merely accompanying it. ³
Key-Based Playlist Sequencing: The Circle of Fifths
The Circle of Fifths is a diagram that arranges all twelve musical keys so that adjacent keys are harmonically compatible, they share chord tones, and sound smooth when played one after another.
The practical implication for practitioners: sequence your playlist so that each song’s key neighbors the previous song’s key on the circle. Going from a C major song directly to a C# major song creates subconscious dissonance. Clients in altered states are particularly sensitive to this, and it can feel like something is going wrong without knowing why.
Free Circle of Fifths charts are widely available online. Combined with free key-detection software like Mixed in Key Live, which identifies the key and BPM of any track playing on your computer in real time, this gives any practitioner, regardless of musical training, the ability to build playlists that flow harmonically from beginning to end.
Track Length and Scene Changes
Aim for tracks of five to seven minutes. Each track functions like a scene in a film. When the music shifts, the client moves to the next scene. That micro-transition, a small opening, a moment of reorientation, is what prevents looping and keeps the experience moving forward.
Tracks that are too short can be jarring. Tracks that are too long can trap a client in a particular emotional space past the point of productive engagement. Five to seven minutes is the practical sweet spot.
Transitions between tracks matter as much as the tracks themselves. If you use Spotify, you can use Spotify’s crossfade feature, but there are limitations. For example, if you want to switch a track early and hit the “next” button, the transition doesn’t do a crossfade and can be jarring with the abrupt change. It is better to own the audio files and use a DJ software like Mixxx, where the crossfade feature works better. If the music program doesn’t offer a crossfade and there are silent gaps between tracks, use a rain stick, a shaker, or a set of chimes so the silence between songs is held rather than dropped.
The Question of Lyrics
The rule of thumb is to avoid tracks with lyrics from native and familiar languages. This is one of the most consistent pieces of guidance across practitioners. In a non-ordinary state, words can have an impact. A familiar lyric, even from a song the client loves, can redirect the journey, trigger associations, or impose a narrative that belongs to the song rather than to the client’s process.
A 2024 review in Psychedelic Medicine noted that music selection guidelines consistently recommend avoiding music with lyrics for this reason, as semantic content competes with the client’s inner narrative during the session. ⁵ Vocal music in non-native languages can be valuable; the human voice carries something that no instrument can replicate, but wordless musing, chanting, and vocalization allow that quality through without the semantic freight of language.
Curating a Playlist: A Framework for Beginners
The session arc, drawn from both indigenous traditions and contemporary clinical practice, looks like this:
Phase 1: Preparation (before the medicine)
This is the arrival. The music should help the person settle into the space and slowly let go of the outside world. Soft ambient music, gentle major key tones, guided meditations, or even subtle theta-oriented binaural beats can work well here. Avoid anything too rhythmic or emotionally demanding. The feeling is less “we are starting” and more “something is beginning to open.” It’s about grounding and getting ready.
Phase 2: Onset
As the medicine starts coming on, the music begins to shift with it. The energy becomes a little more inward. Minor keys often start to appear here, along with subtle percussion, flutes, drones, or world instruments. The music is still supportive and spacious, but there’s now a sense of movement and a feeling that the journey is beginning to deepen.
Phase 3: Deepening
This is where the music starts carrying more momentum. Rhythm becomes more noticeable, and layers build. Tracks may feel emotionally richer, with more texture, and feel more alive/dynamic. Ideally, the music evolves gradually enough that the participant can continue moving with it rather than feeling pushed by it. The goal is to support immersion as the medicine begins to take effect.
Phase 4: Peak
This is often the most emotionally charged part of the experience. The music may become bigger, more rhythmic, more intense, or more cinematic. Drums, strong melodies, layered instrumentation, and emotionally evocative pieces are often used here to help support depth, surrender, and emotional breakthrough. As Peruvian ceremonialist Claudia Cuentas says, “Whatever it is, it always has to have some heart.”
Phase 5: Descent
Eventually, the intensity of the journey begins to soften. The music follows that movement. Rhythms slow down, spaciousness returns, and major key elements often begin reappearing. The feeling here is less about pushing deeper and more about helping the participant reconnect with themselves, their body, and the room around them.
Phase 6: Landing
This phase is gentle, warm, and grounding. Soft melodies, light vocals, acoustic textures, and calming ambient pieces can help create a sense of safety and return. The nervous system is settling. The experience is still present, but the music now feels more like reassurance than exploration.
Phase 7: Integration
As the session transitions into conversation and reflection, the music moves into the background. Quiet ambient tracks without strong beats, dramatic emotional shifts, or distracting vocals tend to work best. The music is no longer leading the experience. It’s simply holding the space while the person begins making sense of what emerged.
What Playlist Curation Actually Requires
Crafting a playlist can seem like a daunting task. Where and how do you start? Most practitioners can understand the framework, but they don’t know how to find music that fits within each phase. Also, music can feel subjective. Certain tracks can fit into multiple phases.
Try not to think of creating a playlist as a “task” but rather as a practice. It develops over time through intentional listening. And with intentional listening, listen to as much diverse music as possible.
Start with your own resonance. Byron Metcalf’s foundational advice: explore music experientially before you use it in sessions. Listen to it in a quiet, receptive state. Breathe with it. Notice what happens in your body. If a track creates even a flicker of dissonance or aversion in you, that response will be part of the field you bring into the session.
Work from elimination as much as selection. Notice what doesn’t work for you, and be honest about why. The playlist you would want to journey to yourself is the best starting point you have.
Consider the instrument. For live sound in sessions, David Starfire recommends beginning with instruments that don’t require years of training: Koshi chimes for opening and closing rituals, rattles for peak phases, Tibetan or crystal singing bowls for harmonic resonance (noting that every bowl must be tuned to match the key of whatever recorded track is playing — dissonance is counterproductive). Free software can identify the key of any track in real time, eliminating the guesswork.
Avoid lyrics. This bears repeating. Default to wordless music. If you use vocal tracks, ensure the vocals are musing rather than semantic. ⁵
Categorize the Music: As you develop an intentional listening practice and track the feeling that the music fosters, categorize the music into different playlists. You cna use cateogorize the music with the phases above. For example, if you listen to a track that “feels” like a “Peak” track, add that to a playlist called “Peak.” This will help you stay organized and also have an easier time putting a playlist together.
Download everything before the session. If you can, try not to stream live over Wi-Fi. A dropped connection mid-session can disrupt the journey – from a journeyer’s perspective, the music has stopped, and they might be asking, “What’s going on?” From the practitioner’s perspective, you might be scrambling to troubleshoot, and your focus turns away from the participant and more towards technical problem-solving. It is an event in the session itself, and it can be a destabilizing one. The best option is to purchase albums or tracks through a website like Bandcamp and use local files.
Why Every Practitioner Needs Training in Music
There is broad agreement across psychedelic research that music is not simply background ambiance during psychedelic-assisted therapy, but it is an active part of the therapeutic environment itself. Multiple papers suggest that music can shape emotional tone, influence meaning-making, support emotional breakthrough, regulate difficult states, and affect the overall trajectory of a psychedelic experience.
At the same time, the field still knows surprisingly little about how music should actually be used in practice. A 2025 review on music selection in psychedelic-assisted therapy noted that only three empirical studies had directly examined which types of music best support psychedelic therapy, while also highlighting substantial disagreement among experts around issues such as playlist structure, percussion, familiarity, vocals, emotional intensity, and cultural context. ⁸ A separate critique of the Copenhagen Music Program argued that psychedelic playlists are not neutral therapeutic tools, but may actively guide, constrain, and shape participants’ experiences in ways practitioners may not fully appreciate. ⁹
A 2025 phenomenological study on music in psilocybin-assisted therapy found that participants often stopped experiencing music as external sound altogether, instead describing it as immersive, relational, emotionally intelligent, and woven directly into the therapeutic process itself. ⁴ Similarly, research on Amazonian icaros at the Takiwasi Center in Peru found that participants experienced ceremonial healing songs not merely as music, but as active guiding forces that shaped visions, emotional processing, bodily sensations, and the unfolding movement of the ceremony. ⁶
Taken together, these findings suggest that music may function less like “background support” and more like a co-facilitator within psychedelic work.
Music can help regulate fear, support surrender, deepen introspection, evoke memory, create emotional safety, and help participants navigate difficult psychological terrain. But music can also overwhelm, distract, over-direct, rupture emotional flow, or subtly impose therapeutic assumptions onto the experience. In altered states where perception, suggestibility, and emotional sensitivity are heightened, these choices matter.
This does not mean there is one perfect playlist or one universally correct approach. In fact, the recent literature increasingly argues the opposite: that music selection is relational, culturally situated, participant-dependent, and far more complex than many early psychedelic therapy models assumed. ⁸
The emerging field of psychedelic-assisted therapy needs practitioners who understand this complexity. Practitioners who can think critically about music rather than simply inheriting playlists from existing protocols. Practitioners who understand pacing, emotional arc, nervous system regulation, cultural context, symbolism, silence, and the ways sound interacts with altered states of consciousness.
That relationship with music takes time to develop. Like therapy itself, it is part intuition, part attunement, part experimentation, and part practice.
The best time to begin developing it is now.
Learn More About Music for Psychedelic-Assisted Therapy
If you’ve read this far and are thinking, “But I’m not a musician,” here is the important thing to understand: You do not need to be a trained musician to work skillfully with music in psychedelic therapy.
You do not need to understand music theory (although it can be helpful), compose songs, or build perfect playlists from scratch. What you do need is curiosity, attention, and a willingness to listen closely and not just to the music itself, but to what happens in the room, in the participant, and in your own nervous system when certain sounds enter the space.
Over time, experienced facilitators begin developing a felt sense for music. They notice when a track creates spaciousness, when rhythm increases tension, when vocals become distracting, when silence is needed, or when a participant seems supported, overwhelmed, softened, opened, grounded, or emotionally activated by what is playing.
The goal is not to control the experience through sound. It is to become more attuned to how music interacts with emotion, memory, embodiment, symbolism, safety, and altered states of consciousness.
Like therapy itself, this is ultimately relational work.
And like all relational work, it deepens through practice, reflection, humility, and careful attention over time.
If you want to deepen your understanding of how music functions within psychedelic-assisted therapy, including playlist design, emotional arc, nervous system regulation, ceremonial and clinical approaches, major and minor tonalities, rhythm, silence, and the emerging research in the field, we invite you to join Polaris Insight Center’s new course, Advanced Music Module for Psychedelic Therapy.
Whether you are brand new to working with music or already building playlists for clients, this training is designed to help you develop a more intentional, ethical, and therapeutically informed relationship with sound.
References
- Kaelen, M. et al. (Imperial College London). Music and the psychedelic experience. Cited in: The Third Wave. The Psychedelic Score: How Music Magnifies Meaning. https://thethirdwave.co/the-psychedelic-score-how-music-magnifies-meaning
- Johns Hopkins Medicine. (2020). Inside the Johns Hopkins psilocybin playlist. https://www.hopkinsmedicine.org/news/articles/2020/10/inside-the-johns-hopkins-psilocybin-playlist
- Hauser, J., Sarlon, J., Liwinski, T., Brühl, A.B., & Lang, U.E. (2024). Listening to music during intranasal (es)ketamine therapy in patients with treatment-resistant depression correlates with better tolerability and reduced anxiety. Frontiers in Psychiatry, 15, 1327598. https://doi.org/10.3389/fpsyt.2024.1327598
- Dwyer, J., Johnston, R.B., O’Callaghan, C., Kallianis, V., & Ross, M.L. (2025). Music as a collaborating actor: new insights into the nature and role of music in psychedelic-assisted psychotherapy. Frontiers in Psychiatry, 16, 1541528. https://doi.org/10.3389/fpsyt.2025.1541528
- Efthimiou, A.A., Cardinale, A.M., & Kepa, A. (2024). The role of music in psychedelic-assisted therapy: A comparative analysis of neuroscientific research, indigenous entheogenic ritual, and contemporary care models. Psychedelic Medicine, 2(4), 221–233. https://doi.org/10.1089/psymed.2023.0058
- Sherwin, M., Friso, F., Fachner, J., & Politi, M. (2025). Participant experiences of icaros (Amazonian curative songs) during a traditional medicine ceremony at the Takiwasi Center, Peru. Journal of Psychedelic Studies, 9(2), 149-168. https://doi.org/10.1556/2054.2024.00370
- Moskovitz M. (2025). The Research Deficit and Expert Disagreement Regarding Music Selection for Psychedelic-Assisted Therapy. ACS pharmacology & translational science, 8(10), 3684–3690. https://doi.org/10.1021/acsptsci.5c00583
- Ratkovic G, Sosteric M, and Sosteric T (2023) A case-study evaluation of the “Copenhagen Music Program” for psilocybin-assisted therapy. Front. Psychol. 14:1156852. doi: 10.3389/fpsyg.2023.1156852
- Weiss, B., Roseman, L., Giribaldi, B. et al. Unique Psychological Mechanisms Underlying Psilocybin Therapy Versus Escitalopram Treatment in the Treatment of Major Depressive Disorder. Int J Ment Health Addiction 22, 806–841 (2024). https://doi.org/10.1007/s11469-024-01253-9
