Context Matters in Psychedelic-Assisted Therapy

If you have ever read or heard anything about psychedelics, you have most likely heard about “set and setting.” This term refers to internal and external elements that can impact a psychedelic experience. It was popularized by Timothy Leary in the 1960s, but the concept has been observed in indigenous and spiritual practices with psychedelics since the pre-Columbian era (Hartogsohn, 2017).

In the context of psychedelic-assisted therapy, set and setting play a major role in the therapeutic effect of the treatment, as experts believe these two factors have the potential to make or break a psychedelic experience. While there is little research on exactly how set and setting impact patients’ experiences, new research is now attempting to measure with data what indigenous practitioners have understood for centuries.

What are Set and Setting?

Set, shortened from “mindset,” describes the mental state that a person brings to a psychedelic experience. This may include their feelings, personality, mood, and the expectations or intentions they have going into the experience. Setting refers to the physical and social environment in which a person has a psychedelic experience. This includes the physical location they are in when they take a psychedelic medication, who they are with, and if they feel secure and comfortable in that location and in the company of others who are present.

Current Research on Set and Setting

Evidence suggests that set and setting have a significant impact on not only the psychedelic experience, but the therapeutic outcome of the psychedelic-assisted therapy.

In a research article on psychedelics and the important of context, Dr. Robin Carhart-Harris and colleagues claim that “the therapeutic action of psychedelics is fundamentally reliant on context – both in the psychological and environmental sense” (2018). They also argue that a lack of emphasis on context in psychedelic-assisted therapy can be clinically ineffective, and at worst, psychologically harmful. The authors suggest that cases of harm are quite uncommon. However rare they may be, these harms can cause real suffering, which is why it is critical that supportive set and setting are prioritized in any psychedelic treatment model.

By convention, current psychedelic research trials support patients by creating a comfortable atmosphere and preparing patients to ideally arrive at their psychedelic medication session feeling calm and reflective. However, no one knows for sure what the “optimal” set and setting are or how these might differ for each individual.

The Future of Set and Setting

Moving the concept of set and setting from the lab to the real world requires research that accurately represents the American public. So far, most psychedelic-assisted therapy research participants have been white, college educated persons. It is paramount that researchers investigate how set and setting impact people from other populations, especially marginalized communities, which is the goal of researcher Dr. Cody Wenthur from of the University of Wisconsin. In his study, Psychedelic Outcomes: Interactions of Environment, Self-Identity, and Success (POIESIS), Wenthur aims to understand how different identity groups might choose to customize the study rooms (where medication sessions take place) and whether an individual’s selection of aesthetic elements in the space could affect treatment outcomes.

It is proactive research like this that will set the tone for the development and application of psychedelic-assisted therapy in real world contexts.

References

Carhart-Harris RL, Roseman L, Haijen E, et al. Psychedelics and the essential importance of context. Journal of Psychopharmacology. 2018;32(7):725-731. doi:10.1177/0269881118754710

Hartogsohn I. Constructing drug effects: A history of set and setting. Drug Science, Policy and Law. 2017;3. doi:10.1177/0269881118754710

Psychedelic outcomes: Interaction of environment, self-identity, and success (poiesis). Wenthur Lab. (2021, June 3). Retrieved November 15, 2022, from https://pharmacy.wisc.edu/faculty/wenthur-lab/research-project/psychedelic-outcomes-interaction-of-environment-self-identity-and-success-poiesis/