The secret of the care of the patient is in caring for the patient. - Francis Peabody
Psychedelics: a group retreat - lessons: playlists, nature & integration
“If I were not a physicist, I would probably be a musician. I often think in music. I live my daydreams in music. I see my life in terms of music.” Albert Einstein
“After silence, that which comes nearest to expressing the inexpressible is music.” Aldous Huxley
This is the fifth and last post about a recent group retreat I went on with the UK Psychedelic Society Experience Retreats. The previous four posts are 'Psychedelics: a group retreat - initial thoughts', 'Psychedelics: a group retreat - meeting up, orientation & the ceremony', 'Psychedelics: a group retreat - the ceremony, integration & follow-up' and 'Psychedelics: a group retreat - lessons: ceremonies, duration & organisation'. In this post I want to look at the use of playlists, encouraging connection with nature, and ways of supporting integration of what we experience.
There are lots of pluses of using a music playlist especially during high dose psychedelic trips. It obviously isn't the only option - see, for example, the addendum further down this earlier post where I discuss experiences walking out into nature, dancing and meditating while tripping. However, both practically (keeping everyone safe) and to link more directly with most recent research, it makes good sense to use playlists during group psychedelic ceremonies (although using a meditation retreat format is an interesting alternative to consider). If one is using playlists during a retreat, is it sensible to get everyone to listen to the same list (with all the advantages of this more straightforward approach) or is it worth the potential headache of providing participants with more than one playlist option? Despite the challenge of catering for differing musical playlists across different group members, I think this is likely to be worth the effort. Mendel Kaelen & colleagues' qualitative study - 'The hidden therapist: evidence for a central role of music in psychedelic therapy' - highlights that " ... when the music was experienced as dissonant with the unfolding experience, disliked, and rejected (resistance), therapeutic outcomes suffered. In contrast, when the music was in resonance with the patient’s experience, liked, and accepted (openness), therapeutic outcomes were most positive. These music experience variables in this study (resonance, liking, and openness) correlated with each other, suggesting that they represent a single construct within the music experience that is associated with positive therapy outcomes."
And the authors go on to note "This hypothetical framework holds that an optimal music experience (style liking, music’s resonance, and openness to music) creates an optimal climate for the expression of meaningful therapeutic content, characterised by the sensation of being on a personal journey, with a spontaneous and often intense emergence of personally meaningful imagery, thoughts, and emotionality. This optimal music experience construct may be a critical pre-requisite, and when it is not met adequately, is likely to result in the patient to distance from the music experience (resistance), characterised by feelings of discomfort, and a diminishment of personally meaningful imagery, thoughts, and emotionality (i.e. the absence of the sense of being on a journey). Given the patient’s experience is highly individual and dynamic, this finding suggests that the adaptation of the music during psychedelic therapy sessions may be critical at times, in order to provide adequate therapeutic support conditions, or prevent possible counter-therapeutic experiences ..." So one size definitely doesn't fit all!
It has been suggested that there may be advantages if the participant is unfamiliar with the music being used, so that it's relatively free of personal associations. I don't think there's any hard evidence for this suggestion, even if it has become a bit of an urban myth. Since it seems central for better therapeutic outcomes that the participant likes the musical style of the playlist, resonates with & feels open to it, an obvious way forward is to encourage participants to listen to the planned playlist beforehand (or at least enough to get an overall sense of it). If they feel OK with it, this is fine. If not, then offering another off-the-shelf option seems sensible. Three obvious sources are the major psychedelic research centres at John Hopkins, Imperial College and the Usona Institute. Their playlists are just a quick internet search away - for example look for 'Psilocybin research John Hopkins' in Apple Music or on Spotify; and also on Spotify searching for 'Psychedelic therapy playlist' brings up three offerings from Imperial College's Mendel Kaelen and also Wavepaths provides a playlist there from Usona as well.
Especially for more experienced participants, there may well be advantages in constructing one's own playlist. I've used playlists from John Hopkins, from Imperial and one I put together myself. I went deepest on the Mystical Experiences Questionnaire using the one I'd designed for myself (which by the way was the one where I was most familiar with the music being used). I valued having peaceful tracks mostly in the first hour of so of ascent into the trip, and on the descent I've experimented with having some vocal music in the list and some music I enjoy dancing to. During the high plateau of the trip ... likely to start from 30-90 minutes in and last for roughly 2-4 hours (see this diagram) ... it may be worth selecting from the kind of tracks suggested in Table 2 of Fred Barrett et al's paper 'Qualitative and quantitative features of music reported to support peak mystical experiences during psychedelic therapy sessions.' I tend to put in some tracks that may be quite emotionally challenging (for example movements from Gorecki's Symphony of sorrowful songs & Coltrane's Love supreme) as well as some that are more serene.
One option on a group retreat is to 'broadcast' a standard playlist through speakers, while encouraging participants (who would prefer to) to bring their own headphones and personal choice of playlist. If any technical problems emerge with individuals' sound equipment, they can just drop back into listening to the broadcast group playlist. Of course, it would be sensible if all playlists being used were of about the same length. On a high-dose trip in the summer, I used headphones that allowed me to increase/decrease volume, stop the music, and jump forward or backwards with the tracks. This felt helpful, on balance - but when really dissolved on the high plateau of the trip, choice can become an interesting issue and I found myself just going with the flow, rather than being bothered with choices during that phase of the journey.
A second point I'd like to mention more briefly is the value of encouraging connection with nature & the wider environment both during and also after the retreat. This sense of increased connection with nature is one of the most commonly described benefits experienced even a couple of years after taking a psychedelic trip. It is associated with increased wellbeing levels for the individuals concerned and also increased commitment to ecological action. The 'nature mandalas' we were encouraged to gather treasures for (natural objects we were drawn to, while walking around the house garden & grounds), construct and then bring to the group room altar, were a lovely aspect of our recent retreat. It was good too that one of the facilitators offered to take all who wanted outside for a while after the main ceremony. I do wonder though about other ways of encouraging connection with nature during the trip itself.
The recent research paper - "From egoism to ecoism: psychedelics increase nature relatedness in a state-mediated and context-dependent manner" - highlights the potential value of this with its comments that "There appears to be a growing disconnection between humans and their natural environments which has been linked to poor mental health and ecological destruction. Previous research suggests that individual levels of nature relatedness can be increased through the use of classical psychedelic compounds ... Individuals planning to use a psychedelic received questionnaires 2 weeks before (N = 654), plus one day, 2 weeks, 4 weeks, and 2 years after a psychedelic experience. (3) Results: The frequency of lifetime psychedelic use was positively correlated with nature relatedness at baseline. Nature relatedness was significantly increased 2 weeks, 4 weeks and 2 years after the psychedelic experience. This increase was positively correlated with concomitant increases in psychological well-being and was dependent on the extent of ego-dissolution and the perceived influence of natural surroundings during the acute psychedelic state. (4) Conclusions: The here presented evidence for a context- and state-dependent causal effect of psychedelic use on nature relatedness bears relevance for psychedelic treatment models in mental health and, in the face of the current ecological crisis, planetary health."
Here's a downloadable copy of the short-form Nature relatedness questionnaire (NR-6) that was used in the research - as a Word doc & as a PDF file - and here are abstracts of some linked research. In this "From egoism to ecoism" study, in addition to repeated use of the NR-6 over follow-up, they also asked if the ceremony took place with access to nature or not. If the response was yes, then the participants were asked to what extent access to nature seemed to influence the overall quality of their experience, rated on a visual analogue scale (VAS) with values ranging from 0 to 100. The link they identified between higher scores on this VAS scale and increased NR-6 scores over follow-up is a good reason for looking at how one can encourage stronger nature access than usually seems available in the current classic trip environment - typically held inside, blindfolded & listening to a playlist.
I think it would have been better - and this would be even more true for longer two-ceremony retreats - if participants had been encouraged to get out for walks more often over the several days of our retreat (and if it had been clarified where there were good paths we could use). It might have been helpful too if we had not only gathered nature treasures for the central group room altar, but had also been encouraged to bring some (relatively small) object/connection with nature with us to have by our couch on the trip itself. And deepening this link to & care for the wider world in the longer term too, leads us into the last section of this post - how to encourage integration of psychedelic experiences into people's lives after the retreat has ended.
It seems likely that this is very important and I would have welcomed more attention being paid to this during our retreat itself. I know there was a good deal of free time we could have used to think about 'integration', but I would have liked more 'formal' group exercises to help us dig into this as well. I find this quite tricky territory. We don't have a lot of good research that throws much light on what promotes better integration of psychedelic experiences. There is a good deal of evidence that depth of mystical experience & ego dissolution during the trip itself promote better long-term outcomes at follow-up, but I don't think we really know why this is. I suspect that, at least in part, benefits are because we develop a different sense of ourselves & the world - see for example "Psychedelics and connectedness" - and more recently there is reason to think that higher scores on a new scale - the Psychological Insights Questionnaire - seem linked with decreases in depression/anxiety via improvements in Psychological Flexibility. I think we do know a good deal about how we can encourage trips to be more helpful - as we prepare, go into and experience them - see, for example, the recent papers "Replication and extension of a model predicting response to psilocybin", "States and traits related to the quality and consequences of psychedelic experiences" and particularly it seems if one's baseline wellbeing levels are low "Emotional breakthrough and psychedelics: validation of the Emotional Breakthrough Inventory". Set & setting do matter ... our intention and the degree of openness & surrender we allow as we go into the trip & how well we're supported make a difference to both trip experience & to long-term outcome. Does the way we think about & work with our experiences after the trip make a difference to long-term outcomes too? And does how we're supported to do this matter? Almost certainly the answer is 'yes' to both these questions ... but how to do this well?
Briefly I'd like to look at three areas here. One is what kind of integration & follow-up have been provided in the main psychedelic research trials? A second is what have experienced people in this field written about integration? And a third is what do we know more generally about how we can best integrate any major life experience? So first, what have research trials typically provided?
One caveat is that becoming too verbal & analytic may sometimes be unhelpful.
More to follow ...
Good paragraph on preparation/integration in the overview of depression research methodology article ... comment too on using feedback including the SRS during the retreat (put into small group time rather than full??) ... and stuff on the importance of FIS ... there's the Irvin Yalom findings about optimal facilitator style too ... and stuff on embedding in longer structure as in the John Hopkins spiritual practice study or the Zen retreat study or the stopping smoking study ... mention recent Enhance results and query embedding in How to live well ...
"Now and then it's good to pause in our pursuit of happiness and just be happy." Guillaume Apollinaire
Psychological support section in O'Donnell et al's recent paper "Psilocybin for depression: Considerations for clinical trial design" with
"In psychedelic clinical research, the standard practice is for drug-administration sessions to be conducted by a mixed-gender team of two therapists, interventionists, or guides. The therapists provide at least several hours of preparatory sessions in addition to any indication-specific therapy. They perform careful monitoring and provide non-directive support during the medication session itself. They also meet with the participant (often several times) after the medication session to allow the opportunity to process or integrate the experience, and to monitor for any negative sequelae of the sessions (Johnson, Richards, & Griffiths, 2008). Although the components of this psychosocial platform are based on tradition and experience, studies conducted with such a supportive framework have successfully minimized the occurrence of adverse psychological events during and after the dosing session. It may also be integral to the therapeutic effect, particularly if that effect depends on psychological experiences that require context and integration. The specific number and content of preparatory and debriefing sessions will likely vary across studies, as will the dosing schedules. The qualifications, training, and gender combinations of the therapists will also likely vary across studies. Although an attempt to unify approaches at this point would be premature, some limits on heterogeneity are necessary, in order to highlight the drug-specific effect and maximize the extent to which outcomes can be compared across studies. For example, a depression-focused psychotherapy platform might obscure the drug-specific effect, and would not be preferred in a drug efficacy study. However, combining psilocybin with a depression-focused psychotherapy platform might be highly relevant in the treatment optimization studies that would follow if efficacy studies have positive results. It is unclear whether the antidepressant effect of psilocybin might allow for its use as monotherapy, or whether an optimal effect can be achieved only when it is used as an adjunct to psychotherapy. In their open-label study of psilocybin for TRD, Carhart-Harris et al. (2016, 2017) provided comparatively little psychological preparation and debriefing. Despite a robust short-term antidepressant effect, by 3 months, 7 of 12 patients had relapsed, reporting mild-moderate or severe depressive symptoms. Different treatment protocols (e.g., a higher number of debriefing/integration sessions) might be associated with significant differences in short- and long-term clinical effects, which could guide future studies designed to optimize the treatment."
The next day
... by linking to the research finding - see 'Psychedelics and connectedness' - that psychedelics can be seen to act by connecting us more fully to self, others and the world. I would be interested to see how helpful it seemed to be using these ideas more in the orientation & integration phases of the retreat.
Note ... more focus on integration (recordings, 'focusing', dialogue, drawing, gratitude work, intentions, etc) ...
More to follow ...