The Use, Role, and Function of Music During Psychedelic-Assisted Therapy (PAT) with Ayahuasca: A Scoping Review Protocol

Abstract

Objective: To provide a state of the art on the use, role, and function of music during psychedelic-assisted therapy (PAT) with ayahuasca. Introduction: Ayahuasca is a medicinal brew with psychoactive qualities used by indigenous communities throughout the Amazon region, and music is deemed crucial during ayahuasca experiences. In PAT, music forms part of the set and setting, but it lacks systematization and is poorly explored in the scientific literature. Inclusion criteria: Published literature in English, Spanish, and Portuguese, focusing on conceptualizing, defining, or describing the use, role, and/or function of music in PAT sessions with ayahuasca. Methods: This review follows the JBI methodology for scoping reviews. We will search Web of Science, Scopus, Google Scholar, and PubMed databases without year restrictions, and a hand search of articles will be performed. Two reviewers will assess titles/abstracts, followed by independent reviews of included full texts. An Excel data extraction sheet will be used to tabulate the information. The findings will be presented narratively, including respective tables or figures. If feasible, a potential theoretical framework for the use, role, and function of music during PAT with ayahuasca will be outlined, including implications for future research and clinical practice.

1. Introduction

Psychedelics are one of the oldest known pharmacological agents used by humans and have been utilized by many cultures for thousands of years [1]. Modern psychedelic therapy emerged in the 1950s with the discovery of lysergic acid diethylamide (LSD) in 1938 and psilocybin in 1955 to treat mental health conditions [2]. However, in the early 1970s, several countries implemented policies that prohibited, restricted, or regulated the use of psychedelics [3]. Over the last decade, psychedelic-assisted therapy (PAT) has experienced a resurgence, particularly by demonstrating its potential for individuals with treatment-resistant depression, anxiety, and addiction disorders [4,5,6,7]. PAT is described as “an emerging therapeutic approach that combines the use of psychedelics (a subclass of hallucinogenic drugs) and psychotherapy…” ([8], p. 1). In PAT, the use of psychedelics is usually embedded in preparatory and integration sessions and accompanied by trained therapists [9]. While different (psycho-)therapeutic models exist within PAT settings, common core elements include a focus on individual and contextual factors (i.e., set and setting), the beforementioned structure of preparation, intake, and integration, and a focus on the inward-directed experience during the psychedelic intake [10].

Ayahuasca, a medicinal brew with psychedelic qualities from the Amazon region, is currently used in PAT studies. Ayahuasca is primarily made from two plants: one is Psychotria viridis (also known as ‘chacruna’), or Diplopterys cabrerana (also known as ‘chagropanga’). Both contain the psychoactive compound dimethyltryptamine (DMT). The second plant is Banisteriopsis caapi, commonly known as ‘ayahuasca’, which contains monoamine oxidase (MAO) inhibitors that prevent the degradation of DMT when orally ingested and allow for 5-HT2A receptor agonism in the central nervous system [11]. The effects of ayahuasca last approximately 4 to 6 h depending on the dosage, and participants can experience altered sensory perception, visions, and a physical purgative effect that may include nausea, vomiting, or diarrhea [12,13].

Ayahuasca has a deep and complex spiritual meaning for indigenous communities and forms part of their cultural heritage for hundreds, if not thousands, of years [14,15]. The first written records of ayahuasca date back to the mid-19th century, when British botanist Richard Spruce observed Tukano indigenous people in Brazil consuming ayahuasca, and Ecuadorian geographer Manuel Villavicencio wrote about its use in the Napo River region [16,17]. In the 1920s, Brazilian churches began using ayahuasca as part of their religious ceremonies, and currently, three of them use ayahuasca as their main sacrament: Santo Daime, União do Vegetal, and Barquinha. At the end of the 1980s, these churches were established internationally, including in Germany, Spain, the Netherlands, Canada, Mexico, and the USA, as well as countries in Africa, Asia, and Central America [18]. Today, ayahuasca is globally consumed in a variety of contexts and settings. A recent report by the International Center for Ethnobotanical Education, Research, and Service (ICEERS) estimates that around 800,000 people consumed ayahuasca in 2019 across the Americas, Europe, Australia, and New Zealand [19].

1.1. The Role of Music

In addition to scientific advances regarding the psycho-pharmacological effects of psychedelics, growing attention is now given to individual and contextual factors that are being considered fundamental in shaping and integrating psychedelic experiences, often referred to as set and setting [20]. In PAT, music forms part of such factors, and the importance of music’s therapeutic function in this context is regularly highlighted [21]. A common ground is the belief that music plays a significant role in enriching and enhancing the psychedelic experience, creates meaning, and facilitates emotionality and mental imagery, contributing in this way to a better therapeutic utilization of psychedelic substances [22,23]. Particularly music’s role and effectiveness in emotion regulation have been discussed in many studies [24,25], with neuronal correlates being found in both cortical and subcortical systems and networks [26]. In PAT, facilitating and regulating emotional states is an important feature in which music can play a crucial role (for an overview, see [23,24]). Such potential benefits of music during psychedelic experiences are certainly not exclusive to PAT. In the case of ayahuasca, singing icaros (i.e., medicine songs) is for example essential for the healing process in traditional ayahuasca ceremonies led by curanderos (i.e., healers) [27], and music is used for enhancing religious ecstasy and facilitating spiritual transcendence in the Santo Daime religion [28,29].

Recent review articles emphasize the interplay of music and psychedelics from a neuroscientific point of view, taking ayahuasca in ceremonial or entheogenic settings as examples [30,31]. Individual studies report on the general role of music during ayahuasca experiences [32], on the relation between musical structures and the religious aspects of ayahuasca rituals in the beforementioned Brazilian churches [33], or on specific aspects such as the time perception of ayahuasca participants when listening to different types of music and sounds [34]. The experiences of listening to icaros have been investigated in both healthy adults [35] and in therapeutic settings, for example, in addiction rehabilitation patients [36].

While there is a breadth of literature on music and ayahuasca in ceremonial and entheogenic contexts, its role in PAT is still poorly explored. This scoping review aims to fill this knowledge gap by specifically looking into the use, role, and function of music during PAT with ayahuasca. Conducting a preliminary database search in MEDLINE, Scopus, the Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis, no scoping reviews were identified on the use, role, and/or function of music during psychedelic therapy with ayahuasca. We consider a scoping review most suitable for the exploration of this topic due to the complex and interdisciplinary nature of the subject. This type of review allows for a broad and inclusive examination of the existing literature, enabling the mapping of various aspects of the music itself. This review will be conducted in an inductive, data-driven manner, in which the conclusions will be primarily informed by the analysis and interpretation of the extracted data of the included studies [37,38].

The main objective of this scoping review is to understand and systematize how, why, and for what goals music is used during PAT with ayahuasca. Based on the results, this review aims to further expand the understanding of the role of music during psychedelic experiences and, if feasible, to provide an initial theoretical framework for the use of music in this context.

1.2. Review Question(s)

What is the use, role, and function of music in the context of PAT with ayahuasca?

1.3. Inclusion Criteria

1.3.1. Participants

Participants of PAT with ayahuasca. Our scope will not be limited to a specific population (i.e., there will be no restrictions based on age, gender, reason for assisting PAT, etc.). However, participant inclusion will be limited to those engaging in PAT sessions with ayahuasca in which music is used. Furthermore, we will only consider the literature in which participants orally ingested ayahuasca as a plant-based brew and will not consider synthetically extracted DMT that might be used vaporized or injected.

1.3.2. Concept

This review will consider studies that describe the use, role, and/or function of music in psychedelic therapy with ayahuasca. Music may include all types of musical genres, instruments, or chants, either presented live or recorded. Articles will be considered if they describe at least one of the following: the use (when, how, what) and/or the role (why, with what purpose) and/or the function (for what, directed towards what goal) of the music applied. An example hereof could be playing ethnic instrumental music at the beginning of the experience (use) as a facilitator for evoking imagery (role) to enhance openness or creativity in participants (function).

1.3.3. Context

This review will consider PAT studies with ayahuasca across all geographical regions. The overall scope of our study is global and will not be limited by time periods. While ayahuasca is used in different and, at times, overlapping contexts (e.g., ceremonial, entheogenic, therapeutic, etc.) and for many different reasons (e.g., for spiritual and personal growth, due to a medical condition, etc.), this scoping review will focus on ayahuasca during PAT and on contexts that are defined as ‘therapy’.

1.3.4. Types of Sources

This scoping review will consider quantitative, qualitative, and mixed-method study designs for inclusion. In addition, all types of literature reviews (i.e., narrative, systematic, etc.) will be considered for inclusion.

2. Methods

This scoping review will be conducted in accordance with the JBI methodology for scoping reviews [39] and is registered with the Open Science Framework database [40] (registration date: 2 October 2024. URL: https://doi.org/10.17605/OSF.IO/7GWS3). The final publication will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) [41]. Any changes to this protocol will be recorded to guarantee transparency and reproducibility.

2.1. Search Strategy

The search strategy will aim to locate any published primary studies, reviews, theses, and text and opinion papers. An initial and limited literature search was performed without year restrictions in English, Spanish, and Portuguese in the Web of Science, Scopus, Google Scholar, PubMed, SciELO, Dialnet, and Redalyc. The following keywords will be used for the English search: “Music” (additionally: “Singing”, “Chanting”, “Icaro”) AND “Ayahuasca”, “Music” AND “Yagé”, “Music” AND “DMT”, “Psychedelic therapy” AND (“music” AND “ayahuasca”), “Psychedelic therapy” AND (“music” AND “yagé”), and “Psychedelic therapy” AND (“music” AND “DMT”). The same keywords will be used in Spanish and Portuguese. An example of the full search strategy can be seen in Appendix A. Additionally, handsearching of reference lists of the included articles will be performed.

2.2. Study/Source of Evidence Selection

Following the search, all identified records will be matched and uploaded to Zotero 6.0, and duplicates will be removed. After a pilot test, titles and abstracts will be reviewed by two independent reviewers and checked against the review inclusion criteria. Potentially relevant articles will be retrieved as full text, and their citation details imported into the JBI System for Unified Management, Assessment, and Review of Information [42]. The full texts will then be assessed in detail against the inclusion criteria by two independent reviewers. Reasons for excluding full-text articles that do not meet the inclusion criteria will be recorded and reported in the final scoping review. Any disagreements that arise between reviewers at each stage of the screening process will be resolved by discussion or with a third reviewer. The results of the search results will be reported in the final scoping review and presented as a PRISMA flow diagram [43].

2.3. Data Extraction

Data extraction will be performed by two or more independent reviewers using an Excel data sheet developed by the authors. The data extracted from the full-text articles will include information about the article (e.g., author, year), type of article (e.g., research, review), population data (e.g., age, gender, participants), information about the use, role, and function of music (e.g., genre, song, live or recorded, goals for music use), data collection (e.g., interviews, questionnaires), and outcomes (e.g., statistical results, qualitative analysis, etc.). The data extraction tool will be modified and revised as necessary during the review process, and any modifications will be detailed in the scoping review. Any disagreements that arise between the reviewers will be resolved through discussion or by consulting an additional reviewer. If appropriate or required, authors of articles will be contacted to request missing or additional data.

2.4. Data Analysis and Presentation

Data will be presented in tabular form and as a narrative summary and synthesis. If feasible, an initial theoretical framework on the role, use, and function of music during PAT with ayahuasca will be outlined based on the extracted data. Possible indications for future research and/or clinical practice will be discussed.

2.5. Timeline

The scoping review is planned to take place throughout 2025 and is aimed to be completed during the first trimester of 2026. A final updated database search will take place on 1 March 2025.

2.6. Ethical Considerations

Ethical approval was not required as this study is based on the analysis of publicly available data. All sources used are cited according to copyright rules. The authors fully recognize and honor the cultural and spiritual heritage of ayahuasca medicine, as well as the custodianship of this practice by indigenous communities, their elders, and leaders. This project aims to raise awareness within the scientific community about the significance of the context in which ayahuasca is used, particularly the integral role of music, songs, and sounds. The authors firmly reject any forms of social or cultural appropriation of ancestral knowledge.

2.7. PRISMA Flow Diagram

Figure 1 shows the flow diagram of the search strategy, study selection, and assessment.

3. Conclusions

The conclusions drawn from this scoping review will highlight the importance of music as an integral component of PAT with ayahuasca and describe in detail the role, use, and function of music in such a setting. This is important not only for understanding how music might facilitate meaning and insights for participants but is also necessary considering the potential replicability of study designs. It is expected that this review will help to gain a deeper understanding of how musical elements contribute to the effectiveness of psychedelic-assisted therapy, and it is hoped that this approach will provide valuable insights for future research and clinical practices when including ayahuasca for therapeutic purposes.