Music and non-music approaches in psilocybin-assisted psychotherapy: The sound of silence

Abstract Music is integral to Psilocybin-assisted psychotherapy (PAP), believed to enhance therapeutic outcomes by structuring experiences and facilitating emotional expression. However, the effects of conducting PAP without music are underexplored. This study examines the experiences of two breast cancer patients undergoing psilocybin therapy under Canada's compassionate access program, specifically focusing on sessions that incorporated intentional periods without music. Patients had previously experienced psychedelics in therapeutic contexts but only with continuous music, as is common practice. Here, each patient participated in a 30-min silent period involving mindfulness exercises and therapist discussions. These periods of relative silence resulted in both challenges and benefits. One patient found that the absence of music was difficult initially, but that the relative silence allowed for engagement with mindfulness exercises that were experienced as highly meaningful. The other patient reported that music had evoked challenging past memories early in the dosing session, which were then productively explored with her guides during the subsequent period without music. These findings suggest that integrating silent intervals in PAP can enhance mindfulness practices and therapist-patient interactions, potentially offering distinct therapeutic benefits. Further research is necessary to delineate the differential impacts of music, silence, and guided activities in PAP, given that these three common treatment activities can be understood as both complementary and competing. Finally, we emphasize the importance of more detailed reporting on session components in psychedelic research publications, particularly regarding the balance between patients listening to music and interacting with their guides, which is often not clearly detailed in existing studies.