Shaping the Space: Why Setting Matters in Psychedelic Therapy

This article recaps the Psychedelic Support webinar “Exploring Setting Within and Beyond Psychedelic-Assisted Therapy,” presented by psychologist and researcher Lisa (Ilsa) Jerome, PhD. In this session, Dr Jerome invites us to slow down and look closely at a factor that is often acknowledged but rarely examined in depth: setting.

While “set and setting” are frequently cited as cornerstones of psychedelic experiences, Dr Jerome challenges us to ask a more rigorous question: What do we actually mean by setting—and how do we study, measure, and refine it in ways that improve care?

Drawing on over a decade of work in clinical psychedelic research, including her time with the Multidisciplinary Association for Psychedelic Studies (MAPS) and MAPS Public Benefit Corporation (now Lykos Therapeutics), Jerome offers a grounded, research-informed exploration of how environments shape experience—and why this matters far beyond aesthetics.

🎥 Watch the Webinar Replay: Exploring Setting Within and Beyond Psychedelic-Assisted Therapy with Lisa Jerome, PhD

Beyond a Backdrop: What “Setting” Really Includes

People often reduce setting in psychedelic discourse to atmosphere: a comfortable room, soft lighting, and thoughtful music. While these elements matter, Dr Jerome emphasizes that setting is far more expansive.

Setting includes:

• the physical environment (room layout, lighting, visual stimuli),
• sensory inputs (music, sound, temperature),
• social and relational factors (who is present, their roles, identities, and interactions),
• and the cultural and institutional context in which therapy takes place.

Importantly, setting is not static. It is dynamic, interactive, and each participant experiences it differently. A room that feels calming to one person may feel alienating or unsafe to another.

This variability is precisely what makes setting both powerful—and difficult to study.

Why Studying Setting Is So Hard (and So Necessary)

Despite decades of psychedelic research, Dr Jerome notes that surprisingly few controlled trials have isolated or systematically examined elements of setting. One reason is methodological: environments are complex, multi-layered, and difficult to standardize without stripping away their meaning.

Another challenge is historical. Early psychedelic research focused primarily on pharmacology and outcomes, often treating setting as an uncontrolled background variable rather than a core component of the intervention.

Yet emerging evidence suggests this is a mistake.

“Setting isn’t just context,” Jerome explains during the webinar. “It’s an active ingredient.”

“Importantly, setting is not static. It is dynamic, interactive, and each participant experiences it differently.”

— Lisa Jerome, PhD

What the Research Is Beginning to Show

Dr Jerome walks participants through several recent studies that illustrate how specific environmental factors influence both subjective experience and physiological outcomes:

• Nature-themed visual environments have been associated with improved cardiovascular safety during psilocybin-assisted therapy for alcohol use disorder [2].
  
• Musical structure and genre can meaningfully shape emotional trajectories during psychedelic sessions, influencing depth, challenge, and resolution [4].
  
• Visual and auditory stimulation have measurable effects on psychedelic state neurodynamics, highlighting how external inputs interact with brain activity during altered states [3].

At the same time, Jerome is careful not to overstate conclusions. Many of these studies are small, exploratory, or limited in scope. Their value lies not in definitive answers, but in demonstrating that we can study setting—and that it matters enough to try.

Measuring the Unmeasurable?

 A central portion of the webinar focuses on emerging tools and models for assessing setting. Rather than asking whether a room is “good” or “bad,” researchers are beginning to break setting into components that they can observe, report on, and refine.

These include:

• participant perceptions of safety and comfort,
• emotional resonance with music or imagery,
• sense of relational support,
• and alignment between environment and therapeutic intention.

Such tools don’t aim to eliminate subjectivity. Instead, they help researchers and clinicians understand patterns—how different elements interact with different people, diagnoses, and therapeutic goals.

Setting Beyond the Clinic

While much of the research discussed centers on clinical trials, Dr Jerome repeatedly emphasizes that setting extends beyond formal therapy rooms.

Community spaces, preparation sessions, integration environments, and even post-session support systems all contribute to how psychedelic experiences are processed and remembered.

This understanding has important implications for accessibility. As psychedelic services expand into real-world contexts, understanding how to create supportive, ethical, and culturally responsive settings becomes not just a research concern—but a public health one.

Music as a Case Study in Setting

Music receives special attention throughout the webinar—not as decoration, but as a structuring force that shapes emotional flow, containment, and return. 

Drawing from her research and curation work in MDMA- and psilocybin-assisted therapy, Dr Jerome emphasizes intentionality over prescription: musical arc, tempo, cultural familiarity, and emotional tone all influence how participants move through inner landscapes.

Rather than prescribing a single “right” playlist, Jerome encourages choosing music that supports the phase of the journey, the nervous system, and the person in the room.

From Optimization to Responsibility

One of the most resonant themes of the webinar is restraint.

Dr Jerome cautions against the urge to over-optimize—adding more stimuli, more complexity, more control. Sometimes, the most ethical setting choice is simplicity.

This perspective reframes setting not as a tool for engineering experiences, but as a practice of care. How we shape environments reflects what we value: autonomy, dignity, safety, and respect for individual differences.

Closing Reflection: Setting as Relationship

Rather than offering a checklist, Dr Jerome leaves us with a question:

What kind of relationship are we creating between a person, a substance, and the space that holds them?

In psychedelic work, the setting is not neutral. It communicates expectations, power, and possibility. As research evolves and access expands, carefully attending to setting may be one of the most impactful—and humane—ways to improve outcomes.

About Lisa Jerome, PhD

Lisa (Ilsa) Jerome, PhD, earned her doctorate in psychology from the University of Maryland. She has spent over a decade working in psychedelic research, including roles at MAPS and MAPS Public Benefit Corporation (now Lykos Therapeutics). Her interests span social cognition, neuroscience, and the role of music in human experience. Dr Jerome is the author and co-author of multiple peer-reviewed publications on MDMA-assisted therapy and regularly presents on research methodology in psychedelic science.

Resources from the Webinar

🌐 Connect with Lisa Jerome

• Connect with Lisa on LinkedIn
• Listen to her playlists on Spotify
• PDF of slides shared in the presentation
• PDF of references and music playlists listed in this article
• Article by Dr Jerome: A Journey in Sound: Music in Psychedelic Assisted Psychotherapy
• Jump to the full list of playlists shared by Dr Jermone 🎵

See the full list of playlists.

🎓 Courses & Continuing Education

• Free Harm Reduction Course: Principles of Psychedelic Harm Reduction
• Recordings of Online Speaker Events: Past Monthly Speaker and Professional Networking Series
• Accredited CE/CME Courses: Psychedelic Therapy Education & Training Programs
• Earn CE for Webinar Events: Psychedelic Therapy Continuing Education Series (CE) – $120 for the entire series!

👀 Further Reading on Setting, Music, and Integration

• The Psychedelic DJ: How Music Guides Healing in Psilocybin Therapy
• Grounding a Psychedelic Experience
• Integrating Nature into Psychedelic Treatments
• What Makes a Good Psychedelic Therapist? Questions to Ask When Looking for One

References

1. Okano, L., Jones, G., Deyo, B., Brandenburg, A., & Hale, W. (2022). Therapeutic Setting as an Essential Component of Psychedelic Research Methodology: Reporting Recommendations Emerging From Clinical Trials of 3,4-Methylenedioxymethamphetamine for Post-Traumatic Stress Disorder. Frontiers in Psychiatry, 13, 965641. https://doi.org/10.3389/fpsyt.2022.965641
2. Heinzerling, K. G., Sergi, K., Linton, M., Rich, R., Youssef, B., Bentancourt, I., Bramen, J., Siddarth, P., Schwartzberg, L., & Kelly, D. F. (2023). Nature-Themed Video Intervention May Improve Cardiovascular Safety of Psilocybin-Assisted Therapy for Alcohol Use Disorder. Frontiers in Psychiatry, 14, 1215972. https://doi.org/10.3389/fpsyt.2023.1215972
3. Mediano, P. a. M., Rosas, F. E., Timmermann, C., Roseman, L., Nutt, D. J., Feilding, A., Kaelen, M., Kringelbach, M. L., Barrett, A. B., Seth, A. K., Muthukumaraswamy, S., Bor, D., & Carhart-Harris, R. L. (2024). Effects of External Stimulation on Psychedelic State Neurodynamics. ACS Chemical Neuroscience, 15(3), 462–471. https://doi.org/10.1021/acschemneuro.3c00289
4. Strickland, J. C., Garcia-Romeu, A., & Johnson, M. W. (2021). Correction to Set and Setting: A Randomized Study of Different Musical Genres in Supporting Psychedelic Therapy. ACSs Pharmacology & Translational Science, 4(3), 1248. https://doi.org/10.1021/acsptsci.1c00119