As psychedelic-assisted therapy develops, researchers are investigating how music, visual imagery and treatment environments influence patients’ experiences, and whether these factors contribute to clinical outcomes.
Psychedelic medicine is often discussed in terms of the compound being administered, the dose and the condition being treated. However, researchers are also examining the role of the environment in which treatment takes place, including music, lighting, physical surroundings, therapist interactions and sensory stimulation.
These factors have long been associated with psychedelic experiences, but their contribution to therapeutic outcomes remains less understood. While the importance of the treatment environment is widely recognised, evidence that particular sensory interventions improve long-term clinical outcomes is still developing.
Researchers are now investigating how these elements interact with individual patients and whether different approaches to treatment design could improve safety, consistency and clinical effectiveness.
Beyond the Drug: The Science of Set and Setting
The concept of set and setting has long been associated with psychedelic research. Set broadly describes a person’s psychological state, expectations and intentions, while setting encompasses the physical and social environment in which the experience takes place.
In clinical research, the setting may include a comfortable room, trained therapists, music, eye shades and procedures designed to provide psychological support. Preparation and the therapeutic relationship also form part of the wider treatment context.
Psychedelic experiences can involve substantial changes in perception, emotional intensity and the way people engage with memories and thoughts. Researchers have therefore sought to understand how the surrounding environment interacts with the effects of psychedelic substances.
In June 2025, Nature Medicine published an international consensus study establishing the Reporting of Setting in Psychedelic Clinical Trials (ReSPCT) guidelines.
The researchers brought together experts from 17 countries, including psychedelic researchers, clinicians and former clinical trial participants. Their work identified 30 non-pharmacological variables that reached a predefined threshold of expert consensus for being important or very important to report in psychedelic clinical trials.
The variables covered four broad areas: the physical environment, dosing-session procedures, the therapeutic framework and protocol, and participants’ subjective experiences. Music, sensory-reduction devices, the people present during treatment and aspects of the therapeutic context were among the considerations addressed.
The guidelines were developed to address inconsistencies in how treatment environments are documented in clinical research. Without comparable reporting, it can be difficult to determine whether differences between trial outcomes reflect the drug, the therapeutic approach or the circumstances surrounding administration.
Although the ReSPCT guidelines do not establish that individual environmental factors improve treatment outcomes, they provide researchers with a more consistent framework for documenting and comparing these conditions.
Music: An Established Practice With Unanswered Questions
Music already plays a prominent role in many psychedelic-assisted therapy research protocols. In some studies, participants recline on a couch, wear headphones and eye shades, and listen to a carefully sequenced playlist while therapists remain available to provide support.
Music may evoke autobiographical memories, intensify emotions or provide a sense of continuity during an experience involving unfamiliar sensations and shifting perceptions. Its emotional character and structure may also influence how an experience is interpreted by the participant.
However, the relationship between music selection and therapeutic outcomes remains insufficiently understood.
A systematic review published in the Journal of Clinical Psychology in June 2026 examined how music is selected and used in psychedelic-assisted psychotherapy research. The review identified 36 relevant articles, of which 25 discussed music use.
The literature included studies involving different conditions and substances, particularly psilocybin and MDMA research addressing depression and post-traumatic stress disorder. The authors found substantial variation in how music was incorporated into treatment, with no standardised protocol across the literature they reviewed.
Researchers have yet to establish whether playlists should be tailored to patients’ musical preferences and cultural backgrounds or standardised across participants. Other considerations include the use of instrumental music versus music containing lyrics, the emotional characteristics of particular compositions and how transitions between pieces might influence the experience.
There is currently insufficient evidence to determine whether personalised playlists, particular musical genres or specific sequencing methods produce better clinical outcomes.
Further research will need to distinguish the immediate effects of music on the subjective psychedelic experience from any measurable contribution to symptom improvement over time.
Visual Imagery and the Inner Landscape
Psychedelic experiences can involve vivid imagery, unusual associations, autobiographical memories and powerful emotional responses. Some participants report elaborate landscapes or symbolic scenes, while others experience relatively little visual imagery. Experiences also vary according to the substance, the individual and the circumstances of treatment.
These experiences have attracted interest from filmmakers, visual artists and immersive-media designers exploring how altered states of consciousness might be represented through moving images, animation, photography and interactive environments.
Researchers are also beginning to examine whether externally presented visual material could influence the psychedelic experience itself.
Visual imagery might direct attention towards a particular scene, introduce a sense of familiarity or provide a focus for reflection. Equally, it could prove distracting, become overwhelming or interfere with the participant’s preferred way of engaging with the experience.
The therapeutic implications of these approaches remain uncertain, and there is limited evidence to guide the use of externally presented imagery during psychedelic treatment.
Clinical research will need to assess the safety, acceptability and potential benefits of different visual approaches, including how much control patients should have over the material presented to them during periods of heightened psychological vulnerability.
Visual Healing: Testing Nature-Based Video During Psilocybin Therapy
One of the more direct investigations of sensory intervention is a pilot randomised controlled trial of Visual Healing, a nature-themed video intervention studied in psilocybin-assisted therapy for alcohol use disorder.
Published in Frontiers in Psychiatry in 2023, the study enrolled 20 participants and compared Visual Healing with a standard treatment-setting approach.
Participants assigned to Visual Healing watched nature-themed videos during preparation and selected phases of their psilocybin dosing session. Participants in the standard-setting group completed a meditation during preparation and used eye shades and music throughout the dosing session.
The researchers assessed feasibility, safety and tolerability, alongside exploratory measures relating to alcohol use, anxiety, stress and the psychedelic experience.
Nineteen of the 20 participants completed the 14-week study. The researchers reported that the video intervention was feasible and well tolerated, with no adverse events clearly attributed to the videos. The group assigned to Visual Healing also experienced a significantly smaller peak increase in blood pressure following psilocybin administration than the standard-setting group.
Alcohol use decreased across the study, but the researchers did not find a significant difference in alcohol-related outcomes between the Visual Healing and standard-setting groups.
The small sample size limits the conclusions that can be drawn from the trial, particularly regarding longer-term treatment outcomes. The cardiovascular finding is also preliminary and requires replication in larger studies.
The study nevertheless provides an early example of how a deliberately designed visual intervention can be evaluated within a clinical psychedelic protocol.
A subsequent study published in 2026 examined nature relatedness and social connectedness in the same 20-participant research context. It reported a greater increase in measured nature relatedness among participants assigned to the Visual Healing condition, compared with those receiving standard-setting procedures.
Although this finding suggests that visual interventions may influence particular aspects of the psychedelic experience, further research is needed to determine whether such changes translate into meaningful clinical benefits.
Could Virtual Reality Become Part of Psychedelic Therapy?
Virtual reality offers another potential direction for research, although its role in psychedelic-assisted therapy remains experimental.
VR technology could allow researchers to investigate controlled visual environments, including natural landscapes and simulated open spaces. These environments might be used during preparation, when patients become familiar with the treatment process, or during integration, when they reflect on their experiences with clinical support.
Its use during psychedelic dosing sessions presents additional practical and clinical challenges. Headsets can be uncomfortable, visual stimulation may become overwhelming, and immersive experiences may complicate communication between patients and therapists.
Researchers would also need to determine whether a virtual environment provides measurable therapeutic benefits beyond those associated with the psychedelic substance, therapeutic support and existing treatment protocols.
Although VR has been investigated for other mental health applications, those findings cannot automatically be applied to psychedelic-assisted therapy. Studies examining the combination will need to assess feasibility, safety, acceptability and clinical outcomes independently.
At present, VR remains an experimental approach rather than an established component of psychedelic treatment.
Why Do Some Patients Improve While Others Do Not?
One of the continuing challenges in psychedelic medicine is understanding why some patients experience sustained improvement while others report limited benefits, difficult psychological reactions or a return of symptoms.
Several factors may contribute to these differences, including the substance and dose, the condition being treated, patient characteristics, preparation, expectations, therapeutic support and follow-up care.
The influence of environmental and sensory factors is less well understood, particularly whether particular approaches are more appropriate for some patients than others.
The intensity of a psychedelic experience also needs to be considered separately from clinical outcomes. A profound or emotionally powerful session does not necessarily indicate that a patient’s symptoms will improve or that any improvements will persist.
Clinical trials therefore need to assess outcomes beyond the dosing session, including symptom severity, daily functioning, quality of life and adverse events over appropriate follow-up periods.
Future studies could compare different music protocols, visual interventions and environmental conditions while controlling for other treatment variables as far as possible. Larger trials would help researchers determine whether specific approaches produce reproducible benefits and identify the patients for whom they may be most appropriate.
The ReSPCT guidelines provide a useful foundation for this work by encouraging more consistent documentation of contextual factors across clinical trials.
The Emerging Intersection of Psychedelic Medicine and Multimedia Design
Research into sensory experiences during psychedelic therapy could create opportunities for collaboration between clinicians, neuroscientists, musicians, visual artists and immersive-media developers.
Music, film, visual art and immersive technologies could become subjects of more systematic clinical investigation, particularly as researchers seek to understand the influence of environmental conditions on psychedelic experiences.
However, developing media intended for use in a clinical setting introduces considerations that extend beyond artistic or technical design. Patient autonomy, informed consent, psychological vulnerability and the potential influence of externally directed sensory experiences would all need to be addressed.
Any proposed therapeutic application would also require evidence of safety and clinical benefit, rather than relying on the assumption that an engaging or immersive experience is necessarily beneficial.
The research published to date offers some early indications of how these questions might be investigated. The ReSPCT guidelines have introduced greater consistency to the reporting of treatment environments, systematic reviews have identified gaps in the evidence surrounding music protocols, and small clinical studies have begun evaluating visual interventions during psychedelic therapy.
Much remains unknown about whether particular sensory conditions can reliably improve mental health outcomes, and how their effects might differ between patients, substances and treatment protocols.
As psychedelic-assisted therapy continues to develop, understanding these influences may help researchers refine clinical protocols and determine whether music, imagery and immersive technologies have a useful role in treatment.
For now, the evidence supports continued investigation rather than the adoption of any particular sensory intervention as an established therapeutic practice.
Sources
- Pronovost-Morgan, C. et al. (2025). An international Delphi consensus for reporting of setting in psychedelic clinical trials. Nature Medicine. Research paper.
- Cruz, L. et al. (2026). Music Playlist Use in Clinical Trials of Psychedelic Assisted Psychotherapy: A Systematic Review. Journal of Clinical Psychology. Research paper.
- Heinzerling, K.G. et al. (2023). Nature-themed video intervention may improve cardiovascular safety of psilocybin-assisted therapy for alcohol use disorder. Frontiers in Psychiatry. Research paper.
- A Nature-Themed Video Intervention Increases Nature Relatedness in Psilocybin-Assisted Psychotherapy for Alcohol Use Disorder (2026). PubMed record.
