Selecting Music for Psychedelic Therapy

By Pierre Bouchard, LPC

As a professional DJ and full-time psychotherapist offering ketamine-assisted psychotherapy sessions, I love selecting music for people. Almost universally, clients report a heightened sense of significance and interest in music while on psychedelics. How you select music for your client’s experience can have a profound impact on what they experience and the depth of experience they have.

There are numerous approaches to selecting and playing music for psychedelic work. While the Holotropic Breathwork people have a sophisticated method of making playlists and supporting the arc of a session, they have the added burden of having to play music that is going to work for everyone in a group experience. As a psychedelic therapist, your task is to assist a client in having a powerful non-ordinary experience, and you’ll likely be working with one client at a time. As such, there is room to get more specific and tailored in the approach that will offer a deeper and more powerful session.

Music Selection – Recreational vs. Therapeutic 

One of the large differences between recreational and therapeutic psychedelic use is the focus of the experience. While psychedelics can be used in a wide variety of ways that we might consider recreational, using them in a therapeutic context has one key feature- namely that the psychedelic journeyer has the full attention and attuned nervous system of the therapist with them through the experience. This situation allows the psychonaut to go to places internally that they may not have gone without the benefit and psychological safety of being held in another’s mind. As such, people are coming to know their own depth of being in a new way. I would encourage you, dear therapist, to play things for them that will help them go deeper into their experience. You are helping someone have an experience of themselves within a psychedelic-assisted psychotherapy session. 

Is the song beautiful or are you beautiful in the presence of the song?

A critical question at the heart of psychedelic music selection that was put to me by a mentor of mine: “Is the song beautiful or are you beautiful in the presence of the song?” A well-curated playlist can be used not only to have a beautiful experience, but to come to know your own depth and beauty and emotional range more fully. One thing that will help your clients go into their experience is to select pieces that are less beat-driven. Here’s a rule of thumb: if you can bob your head to it, don’t play it. This rule breaks down in working with anger/rage. In that situation, the right kind of beat can be very helpful. Generally though, find pieces that are more open and moving than a beat-driven song.

When someone is having a psychedelic experience, they are feeling their sense of self being stretched to new dimensions. Having one’s awareness bent and moved emotionally by instruments and sounds that are less known is akin to being stretched in new ways emotionally. You’ll deny your clients this gift by playing music for them that is within their musical wheelhouse. The point isn’t to have a “good” experience, but a meaningful one. You can play music that will add to that sense by picking pieces they are unfamiliar with and therefore have fewer associations to. Examples include ambient or neo-classical composers. Another critical way of accomplishing this is to play music for them from other cultures, and luckily there is no shortage of absolutely beautiful, deep, emotional world music to choose from out there that is still quite accessible to most North American ears. Middle Eastern, Asian, and African string instruments, chants, and flutes from all over the world bring out an otherworldly quality that can help your client to stretch into new ways of knowing themselves.

How to select 

Aside from what to play, let’s talk about how you should select music for psychedelic sessions. I’m of the opinion that a good place to start is with something that is soothing yet stimulating and emotionally neutral. This is a great way to do no harm, musically speaking. There are many playlists out there to give you the inspiration to start. Try searching “psychedelic therapy” on Spotify or any streaming service you use. If you never do more than this, your clients will have a worthwhile experience. However, in this emerging field, I think we can do better.

Here are some guidelines that help me select during a session. When emotions or emotional needs emerge, try matching them musically in tone, or leading with music that has a slightly stronger affective tone. This can also be great for people who are by nature less in touch with their emotions or have less access to certain emotional ranges like anger or sadness. Begin building playlists and finding albums that have consistent emotional tones you can call on- sorrow, sadness, playfulness, anger, confusion, or pensive, heroic or childlike feelings, etc. This way, you’ll have them at hand when you need them. Your collection of playlists can go on and on and get more and more refined as you build your library. For me, the joy of this kind of collecting is to find new pieces that open me up to different emotional tones, and over time, they get more and more nuanced. Then try them with clients and see if they support their experience. You might have a sense a certain song will work, only to find that it falls a little flat when you try it with clients. That’s no problem at all- just as in every other aspect of therapy, you make an informed guess, you try something, and you see how it lands. Put simply, your job in session is to sonically attune to your clients. Keep an eye out for their affect and consider playing something that matches that tone. It’ll help your clients go deeper into their experience and get more out of their session with you because the music offers them permission to keep going where normally they might hold back and where a stock playlist may totally miss them.

I regularly see clients go further and deeper into the range of emotions than they ever have before. And once something that a client didn’t even know was possible becomes an option, their life starts to change. New neural networks emerge to support that experience, and that deep, new experience they had with me in the office becomes something they have access to in other areas of their lives. 

Since so much of what I encounter with my clients is relational wounds and developmental trauma, it can be helpful to play music that has the voices of the same gender as the parent they have a particular wound with. If Mom was cold or unavailable, it can be incredibly powerful for a client to hear warm, soothing (non-English speaking) women singing. It offers a missing experience. The same is true with fathers and masculine wounds. I have specific playlists built out of women and/or men singing or music that for me has a particularly gendered expression. I call them “limbic feminine” and “limbic masculine.” With transference, those limbic tones can be a crucial part of healing. 

Here are a few examples of different songs:

Reflective:

Emerging:

Pensive:

Heroic:

Limbic Femininity:

Limbic Masculinity:

Stimulating Neutral:

Mendel Kaelen is also doing beautiful work creating playlists that support people going through psychedelic sessions with gorgeous general arcs.


So to you, dear therapist, I have some suggestions on how you can integrate this into your psychedelic practice. 

  • Engage in your own work: First and most importantly, you have to keep doing your own work. As is true in ordinary psychotherapy, you won’t be able to take your clients beyond where you yourself have gone. Continue exploring your own depth of being through ongoing work with the medicines you are working with. 
  • Widen your Music Selection: Listen to lots of things! Search out sorrowful songs, find what instruments produce those best, listen to movie soundtracks for passionate or suspenseful elements, and find music from other countries and cultures that have different instruments and scales. This can go as deep as you want. 
  • Use Spotify to find new music: If you’re using Spotify, let their algorithms suggest things! I can’t tell you how often I find new stuff through their suggestions based on my playlists. 

The collection and selection of music for psychedelic work is an ongoing venture. You’ll get better as you go, and you’ll fall in and out of love with songs or albums. And you’ll get more masterful in your own approach.

At the end of the day, what we’re offering our clients is an education into their own depth and beauty. By selecting music well, we’re saying, “You’re more than you thought you were, and what you actually are is totally welcome here. In fact, it’s fantastic”.

I hope you enjoy the endeavor. 


About the Author

Pierre Bouchard is a Licensed Professional Counselor with a private practice in Boulder and Denver CO and professional vinyl DJ. He specializes in blending somatics, embodiment, attachment theory, and trauma therapy with ketamine assisted psychotherapy. He offers supervision around ketamine assisted psychotherapy and training on music selection. He’ll be opening a clinic soon to expand ketamine access and to further prepare for the psychedelic revolution.
You can find out more here pierrebouchardcounseling.com and on Instagram @pierre.bouchard.lpc

The Second Pandemic: Is Psychedelic-Assisted Therapy the Answer to the Mental Health Crisis Caused by COVID-19?

By Jeff Kronenfeld

Mental health has become one of the central themes of 2020 thanks to COVID-19 and the resulting societal shutdown. In fact, the psychological spillover from coronavirus is projected to evolve into an entirely separate pandemic, according to the Journal of the American Psychiatric Nurses Association (JAPNA). Like the virus itself, the “second pandemic” is nothing to ignore. The United Nations, World Health Organization and other academic sources such as the Journal of the American Medical Association have also sounded the alarm about a potential mental health crisis coming down the pipeline.

The JAPNA study, however, calls for the implementation of “new mental health interventions” and “collaboration among health leaders” in order to prepare for mobilization when the masses are seeking psychological assistance. While psychedelic medicines were not explicitly cited in the study, these drugs offer an array of treatments that just so happen to address many of the mental health issues brought on by the COVID-19 pandemic, including depression, anxiety, PTSD, and paranoia. Specifically, psychedelic-assisted psychotherapy, which is on the brink of legalization in Oregon, may serve as one such model to assuage the psychological fallout from COVID-19.

Causes of the Mental Health Pandemic

So, how can COVID trigger a mental health crisis? That answer is: Easily. At the time of writing, over 121,000 Americans have died from COVID-19 and more than 2.3 million have been infected, according to data from John Hopkins University. The authors of the JAPNA article note that survivors of ICU treatment face an elevated risk for depression, posttraumatic stress disorder (PTSD), sleep disturbance, poor quality of life, and cognitive dysfunction. 

Those who contract COVID are not the only ones facing psychological trauma from the pandemic, however. Healthcare workers on the frontlines are at a heightened risk of experiencing severe trauma, PTSD, anxiety, and depression from COVID. Family members of coronavirus patients also face heightened distress, fear, and anxiety, all of which are likely aggravated by the restrictions on hospital visits and lack of testing. The rapid influx of COVID-19 cases also has the potential to decrease capacity for treating other patients, such as those experiencing psychological issues. 

Moreover, even people who have not directly dealt with COVID may experience mental health troubles. A lot of anxiety exists around virus exposure, which is triggered when having to leave the house for basic reasons, such as going to the grocery store or bank. The media’s inconsistent, doomsday coverage of the pandemic adds to the confusion around what’s going on, resulting in extreme fear, information overwhelm, and hysteria.

The unintended consequences of a nationwide shut down is also proving to have a negative impact on mental health, according to a study published in European Psychiatry (EP). Lack of social interaction, specifically, is a well-known risk factor for depression, anxiety disorders and other mental health conditions. Further, the study warns that the longer such policies are in effect, the more risk they pose to those with preexisting mental health issues. 

“Most probably we will face an increase of mental health problems, behavioral disturbances, and substance-use disorders, as extreme stressors may exacerbate or induce psychiatric problems,” the EP authors write. 

News from the economic front is also concerning. The IMF projects global GDP will contract by 3 percent this year—the most severe decline since the Great Depression—with the US GDP predicted to drop by a whopping 5.9 percent. Data from the Bureau of Labor Statistics show more than 40 million Americans have filed for unemployment benefits since mid-March, a number that will likely increase. For many, job security means financial stability, which generally ties into one’s mental wellness. 

Research published in Clinical Psychological Science found that people who lost their job, income and housing during the Great Recession were at a higher risk of depression, anxiety and substance abuse. This is particularly troubling considering the Great Recession only caused a .1 percent drop in global GDP, a decline 30 times less severe than the financial crisis caused by COVID-19. Moreover, suicide rates in the US are directly related to unemployment. In fact, for every unemployment rate percentage increase, the suicide rate rises 1.6 percent in the US, according to a study in the Social Science and Medicine journal.

Looking at all of these factors combined, a mental health crisis seems imminent. A report from the Well Being Trust predicts that COVID-19 and its associated stressors will cause anywhere from 27,644 to 154,000 deaths from alcohol, drugs and suicide. The results of a recent poll by the Kaiser Family Foundation suggest our trajectory could already be trending towards the worst-case scenario. The poll shows that 56 percent of Americans surveyed believe the outbreak has negatively impacted their mental health. But that number rose to 64 percent for those who experienced income loss.

How Can Psychedelics Help?

Psilocybin, MDMA and ketamine combined with psychotherapy show promise for treating an array of mental health conditions— many of which happen to be brought on by the pandemic. 

Studies show that psilocybin-assisted therapy decreases depression and anxiety in patients with life-threatening diseases, such as cancer. Participants reported reduced feelings of hopelessness, demoralization, and fear of death. Even 4.5 years after the treatment, 60 to 80 percent of participants still demonstrated clinically significant antidepressant and anti-anxiety responses. While we do not advocate for those sick with coronavirus to eat mushrooms, these studies suggest that psilocybin may be effective in treating the extreme fear, anxiety and depression activated by the virus and global shutdown. 

MDMA-assisted psychotherapy also promises major relief from pandemic-related trauma. Multiple studies show that it is a profound tool in the treatment of PTSD for military veterans, firefighters and police officers with no adverse effects post-treatment. MDMA therapy could be particularly beneficial to healthcare workers, survivors of extreme COVID cases or those who lost a loved one to the disease— all of which can inflict significant trauma, and therefore, PTSD. 

“We found that over 60 percent of the participants no longer had PTSD after just three sessions of MDMA-assisted psychotherapy,” says Brad Burge, the director of strategic communications at MAPS. “We also found that those benefits persisted and people actually tended to continue getting better over the next year without any further treatments.” 

Ketamine (and the esketamine nasal spray) treatment, on the other hand, is already available in North America. It’s especially effective in assuaging the tension of treatment resistant depression, bipolar disorder, chronic pain, and PTSD —all of which could be exacerbated by pandemic-related stressors.

Keep in mind, however, that using psychedelics at home is different than receiving psychedelic-assisted psychotherapy. Catherine Auman, a licensed family and marriage therapist with experience in psychedelic integration, warns that now may not be the best time to use psychedelics, especially in a non-clinical setting. She worries that pandemic-related stressors could impact a patient’s psychological state. 

“Psychedelics are powerful substances and are best to do at a time in a person’s life when they’re feeling more stable, not less,” Auman explains. “This is good advice whether someone is using them recreationally or therapeutically.”

Will COVID-19 Impede Psychedelic Research and Delay Public Access?

The pandemic has impeded both psychedelic research efforts and access to currently available therapies. We’re essentially at a standstill until COVID is controlled. MAPS is among few—if not the only—organization with FDA permission to carry on research, but at a reduced scale. When we first spoke with Burge for this story, MAPS was on its first session of Phase 3 MDMA clinical trials. More recently, however, the FDA allowed MAPS to end the first round of Phase 3 early with only 90 out of 100 of the planned participants enrolled. Burge confirmed MAPS is already preparing for their second and last Phase 3 clinical trial. He predicts the DEA could reschedule MDMA by as early as 2022. 

Usona Institute temporarily paused all in-person activities related to its Phase 2 clinical trials looking at psilocybin for major depressive disorder, according to its April newsletter. Usona is still recruiting participants for clinical trials at five sites, however.

Compass Pathways is not currently accepting any new patients in its clinical trials looking into the impact of psilocybin on treatment-resistant depression, according to a statement. They continue to support already enrolled patients remotely, when possible within the protocol. Pre-screening of potential study participants continues where possible, too.

Field Trip Health is a recently formed network of clinics offering ketamine-assisted psychotherapy. The facility opened its first clinic in Toronto in March. But, after seeing one patient, it promptly shut down due to the accelerating spread of COVID-19. 

The decision for Field Trip Health to close its clinic was relatively easy, according to Ronan Levy, the company’s executive chairman. They didn’t have large numbers of patients actively receiving treatment yet. But, the pandemic has forced the organization to quickly adapt. “We launched a digital online therapy program, so patients can self-refer or have referrals to our psychotherapists, who are trained in psychedelic-assisted psychotherapy, with specific protocols and behavioral therapies,” says Verbora, Field Trip Health’s medical director. “Long term, as these clinics start to open up again, we’ll have dual streams. We’ll be able to sort patients in the clinic for ketamine-assisted psychotherapy, but some of their care may be able to be done from home.”

While the COVID-19 pandemic has hampered research efforts in the short term and, the movement around the healing properties of psychedelic medicine is still going strong. 

“The path to acceptance might be slowed down a little bit due to COVID,” Verbora says. “But the current path that’s being undertaken by a number of different groups and institutions is one that’s going to lead to profound changes in the way we approach mental health.”

The timing couldn’t be more perfect.


About the Author

Jeff Kronenfeld is an independent journalist and fiction writer based out of Phoenix, Arizona. His articles have been published in Vice, Overture Global Magazine and other outlets. His fiction has been published by the Kurt Vonnegut Memorial Library, Four Chambers Press and other presses.

For more info, go to www.jeff-k.com

Socials
Facebook: @JeffKron
Twitter: @jeffthereporter
Instagram: jeff.the.scrivener 

Not All Ayahuasca is Made Equal

By Jasmine Virdi

As the use of ayahuasca becomes increasingly widespread, the Amazonian vine has extended its roots beyond the traditional indigenous and religious contexts of South America, lending itself to a newly evolving field of practice. However, the economic viability of ayahuasca ceremonies combined with the vine’s complicated legal status opens the field to a plurality of malpractice, particularly when it comes to what practitioners actually serve in the cup. 

A Closer Look at the Chemical Composition of Ayahuasca

Ayahuasca, otherwise known as yagé, is perhaps one of the most curious hallucinogenic plants of the Amazon, known for its powerful psychoactive effects and healing capacities. Generally, when we refer to ayahuasca, we refer not only to the woody liana Banisteriopsis caapi, but the visionary decoction made by pounding its stems and boiling them together with various plant admixtures. 

Typically, ayahuasca, as prepared by the syncretic ayahuasca churches of Brazil, the Santo Daime, União do Vegetal, and Barquinha, only contains B. caapi and P. viridis (Psychotria viridis). However, it is increasingly common to encounter additional plants in brews made by the indigenous groups in Peru, Ecuador, and Colombia. For example, Colombian yagé is made with an entirely different DMT-containing admixture plant, Diplopterys cabrerana, which produces mild qualitative differences in terms of effect.

The psychoactive compound DMT is inactive when ingested orally, as it is the enzyme monoamine oxidase (MAO) in the gut that breaks down the vision-inducing ingredient before it is able to cross the blood-brain barrier and make its way into the central nervous system. However, the vine itself contains the beta-carboline alkaloids harmine, harmaline, and tetrahydroharmine (THH), of which harmine and harmaline are monoamine oxidase inhibitors (MAOIs). Chemically speaking, the alchemical essence of ayahuasca rests in the mixing of monoamine oxidase inhibitors (MAOIs) present in the alkaloids of the B. caapi vine with a DMT-containing admixture plant.

Determined to understand the diversity of ayahuasca brews, Helle Kaasik, a researcher from the University of Tartu, Estonia, in collaboration with researchers from the University of Campinas, Brazil, sought to illuminate the chemical differences in ayahuasca brews across traditions. 

Their study, yet to be published, analyzed changing distributions of DMT, harmine, harmaline, and tetrahydroharmine (THH) across 102 ayahuasca samples. These samples were taken from different locations in Europe and Brazil, spanning across different traditions including indigenous shamanic, Santo Daime, and neo-shamanic. 

Interesting tendencies emerged based on the traditions from which the samples came, with indigenous brews showing a balanced ratio between the concentrations of DMT, THH, and harmine. Samples that came from the ayahuasca religion, Santo Daime, also showed a similar balance between chemical compounds, although some brews tended towards increased concentrations of DMT.

However, when it came to brews received from neo-shamanic facilitators of different backgrounds, there was notably more variation between chemical constituents, and on average, they contained substantially greater concentrations of DMT than indigenous brews.

Of the 102 samples, 39 were further tested for additional additives and contaminants, with several brews from neoshamanic practitioners found to contain Peganum harmala (Syrian rue) and the DMT-containing Mimosa tenuiflora, otherwise known as jurema. Similar to the ayahuasca vine, Syrian rue contains the MAOI, harmaline. The combination of the MAOI in Syrian rue with the DMT-containing M. tenuiflora mimics the chemical composition of ayahuasca, being a well-known ayahuasca analog or “anahuasca.” The substitution of P. viridis with M. tenuiflora contributed to the higher concentrations of DMT found in neoshamanic brews. 

More shockingly, two of the samples obtained from Europe were found to contain no caapi at all. Rather, this counterfeit ayahuasca was found to contain a combination of moclobemide (a pharmaceutical antidepressant and MAOI), psilocin (the active ingredient in magic mushrooms), and high concentrations of DMT from M. tenuiflora.

For years now, well-seasoned psychonauts have been imitating the active ingredients in a similar manner, creating ayahuasca analogs by combining other DMT and MAOI-containing plants. Combinations made of extracted or synthesized ingredients are referred to as “pharmahuasca.” However, there is a distinction to be made between testing anahuasca, pharmahuasca, and other psychonautic cocktails on oneself as opposed to falsely marketing brews as ayahuasca. Hence, using the term “counterfeit.” 

Comparatively, there was no counterfeit ayahuasca found among disciplined ayahuasca traditions such as the Santo Daime and among indigenous practitioners. In South America in general, the raw materials to make ayahuasca are both abundant and affordable, removing any incentive to replace them with other plants or pharmaceuticals.

Towards an Ethos of Transparency 

Within the psychedelic community, the pressing issue of counterfeit ayahuasca is either often neglected or largely unknown. Thus, without pointing fingers, it is important that we as a community work to develop self-regulating mechanisms that foster and encourage transparent practices.

According to ayahuasca researcher and co-author of this paper, Helle Kaasik, the complicated legal situation surrounding ayahuasca combined with its lucrative viability as a business “attracts risk-prone and overconfident people who often do not understand the level of responsibility of giving a strong psychedelic to people in need of healing.” As a result of these bad actors, disciplined ayahuasca traditions should not be persecuted or forced to go underground.

“What the community can do,” Kaasik explains, “is to expect clear information about [the] composition of whatever ‘medicine’ is offered to them and avoid drinking with facilitators who don’t tell the full truth about the constituents or act offended when asked.”

Ayahuasca religions such as Santo Daime have their own self-regulating mechanisms built into the tradition. For example, amongst Daimistas, the brewing of the sacrament is a ritual in which the whole community participates, making it almost impossible for contaminants to be added while cooking.

In line with Chacruna.net’s “Ayahuasca Community Guide for the Awareness of Sexual Abuse,” we should also seek to establish guidelines for transparency among ayahuasca practitioners when it comes to informing participants about a brew’s origin and composition. Practitioners should take it upon themselves to communicate truthfully and proactively to participants what is in the brew before they decide to participate in a ceremony.

Building a culture around transparency is especially important in the case of adverse reactions. “Imagine someone ‘enrich[es]’ your ayahuasca with dissociatives, mushrooms or synthetic chemicals without your knowledge?” Kaasik adds. “This would be ethically unacceptable and unsafe, but sadly, sometimes it happens.” In such cases, knowing what was in the brew could make adverse reactions more easily remedied and avoided. 

In many circles, ayahuasca is reverently referred to as “the medicine,” but would we ingest a medicine without first knowing what we were taking? To uphold the sanctity of this beautiful sacrament, it is critical that individuals keep themselves actively informed about what they are ingesting. Given the choice, people don’t want to take suspicious substances with questionable facilitators when they have access to safe communities. If we are to call ayahuasca a medicine, we should also treat it like one.


About the Author

Jasmine Virdi is a freelance writer, editor, and proofreader. Since 2018, she has been working as a writer, editor, and social media coordinator for the fiercely independent publishing company Synergetic Press, where her passions for ecology, ethnobotany and psychoactive substances converge. Jasmine’s goal as an advocate for psychoactive substances is to raise awareness of the socio-historical context in which these substances emerged in order to help integrate them into our modern-day lives in a safe, grounded and meaningful way.