How It Works: ‘Setting’
Welcome to How It Works, a series that looks inside what really happens at a psychedelic clinical research organisation – and hears from some of the brightest minds in it.
In this issue, Laure Nolet, our Clinical Research Scientist, talks about the importance of setting and how we are planning to set the standards for clinical practice. Interested becoming a therapist on a psychedelic clinical trial? Click here to read about our training programmes.
I love music. I’ve always loved music.
In my free time, you can find me clubbing, and trawling the archives of my favourite DJs on Soundcloud. As I neared the end of my time at Imperial College London, I began to see how my academic and personal interests could combine. I jumped with joy when my supervisor told me that I could write my thesis on music and the psychedelic experience.
I started analysing interviews in which participants described their experience of taking a 25mg dose of psilocybin, and got even more excited when I came to realise how important music was throughout their trip. They described the music as ‘dictating’ and ‘guiding’ their psychedelic journey. This was when I first became interested in the concept of ‘setting’.
Since music played such a big role in a person’s psychedelic experience, how did other elements in the environment contribute? Besides the music, how could changing other aspects of the environment such as coloured lights or artworks control the experience?
When I look around my house, I feel this sensation of pleasure and fulfilment. I have an emotional connection to the way my home is decorated, and it makes me feel safe. It is only natural that setting plays such a big role in a psychedelic experience. Psychedelics enhance our emotions, and in turn, they enhance how we feel in an environment and how that environment affects our mood.
Maggie’s Leeds Centre combines biophilic design with curves.
‘Setting’ was a term first coined by the psychologist Timothy Leary, who quickly realised how much it affected the psychedelic experience. It was not uncommon to see the early LSD experiments of the 1950s testing participants in hospital rooms with fluorescent lighting and no furniture to lie down on. It was concluded that, among other aspects, such unwelcoming setting contributed to negative experiences and adverse effects.
In modern clinical trials, the setting in which the psychedelic experience takes place is often described as “a dimly lit room, with a bed or a couch placed in the corner”. While this is an improvement from the experiments in the 1950s, still not much attention is given to the rest of the room. Is there art on the walls? What type of lighting is there? Are there any plants?
Increasingly more healthcare facilities, from mental health to cancer treatment centres, recognise the importance of setting for positive patient outcomes. For example, a hospital is currently being constructed in Cairo, in the middle of a desert oasis offering patients the best natural setting to recover in. Large windows overlook a landscape filled with palm trees, and a soft colour scheme is used throughout the building to speed up patient recovery time.
Magdi Yacoup Global Heart Centre in Cairo maximises natural light.
A psychiatric clinic in Greenland is also being built in the middle of a fjordic landscape. Tall windows and a rooftop terrace provide hospitalised patients with soothing views of surrounding icebergs, icy waters and snowy cliff peaks.
Although such unique settings might not always be feasible, other options exist to make patients feel like they are part of the natural world. The Maggie Centre for cancer patients in Leeds uses biophilic design by incorporating plants native to the Yorkshire landscape throughout the building. The entire facility is made of wood and a curved design is used to create a comfortable, pod-like environment.
Whilst setting is hardly described in the psychedelic literature, private psychedelic facilities place great emphasis on appealing locations and designs. Synthesis, a Dutch retreat centre is nestled in a nature reserve providing sensations of peacefulness and healing: the centre has massive windows overlooking the greenery, and every time you step outside you are surrounded by trees and plants.
Novamind, a network of psychedelic clinics around the United States, recently revealed the design of their new facility, which uses biophilic design, curved treatment spaces, and light interplay with neutral colours.
These private facilities are leading the way in optimising setting in order to increase the therapeutic outcomes of psychedelics. Although not much is known about how such designs contribute to a psychedelic experience, there is evidence showing their positive effects on our wellbeing. Understanding how we can incorporate these good practices into clinical settings is essential, and at Clerkenwell Health, this is what we are keen on exploring.
Synthesis’s psychedelic retreat centre uses biophilic design.
Biophilic design
Nature has soothing effects on the mind and can help reduce anxiety and stress. When we are surrounded by nature, it becomes easier to focus on the present moment and to silence our thoughts. Being surrounded by elements of nature can decrease the chances of having a challenging experience on psychedelics and increase moments of insightfulness.
One way to incorporate nature in a clinical setting is through biophilic design. This can be achieved in many ways. For example, plants can simply be placed throughout a building, hung from ceilings or shelves, or be incorporated into vertical gardens and moss panels. Using natural materials can also help achieve a biophilic environment, such as the use of wooden furniture, walls and floors.
Lighting
Natural light is important in relieving anxiety and can enhance emotional well-being. Therefore, large windows are preferable as they let in tons of natural light, but when this is structurally not possible mirrors can be used to give an illusion of openness.
Research shows artificial lighting that is soft and resembles natural light has also a place to facilitate communication between therapists and patients. Feelings of privacy have been suggested to increase when a source of diffused light, such as a lamp, is placed near the participant.
Novamind’s facility makes good use of light and curves.
Colours
Colours can contribute to a psychedelic experience by inducing certain moods. Soothing effects can be achieved by using earth-toned colours such as vegetative green, while accent colours associated with pleasantness include pale blue/green and warm purple/orange. Accordingly, treatment facilities can make more informed decisions about the colour of their walls, furniture and lights.
Furnishing
Both the texture and the shape of furniture can contribute to how you feel in a space. Since sensations of touch are heightened under the influence of psychedelic drugs, soft furniture can aid in feelings of comfort. Round furniture is also preferred over cornered furniture because it adds softness to the room and makes it feel more nurturing.
Our approach
We are soon opening the first commercial research facility for psychedelic drugs in Europe, based just off Harley Street in London. Although the clinic is built for clinical purposes, we are planning on incorporating these design elements to create a setting that is more conducive to a therapeutic psychedelic experience.
The first trial we are holding there will be to treat patients who are suffering from adjustment disorder due to an incurable cancer diagnosis with a dose of psilocybin. We are curious to see how a carefully curated setting will contribute to the outcomes of our trial.
By informing our design decisions for this upcoming research facility with evidence from academic literature, we hope to set the standard for future psychedelic research and treatment facilities.
Further reading:
Metzner, R, Leary, T (1967) On programming psychedelic experiences. Psychedelic Review 9: 5–19.
Hartogsohn, I. (2017). Constructing drug effects: A history of set and setting. Drug Science, Policy and Law.
Johnson, M., Richards, W., & Griffiths, R. (2008). Human hallucinogen research: guidelines for safety. Journal of psychopharmacology (Oxford, England), 22(6), 603–620.
Gandy, S., Forstmann, M., Carhart-Harris, R. L., Timmermann, C., Luke, D., & Watts, R. (2020). The potential synergistic effects between psychedelic administration and nature contact for the improvement of mental health. Health Psychology Open.
DeAngelis, T. (2017). Healing by design. Monitor on Psychology, 48(3).
Pressly, P. K., & Heesacker, M. (2001). The physical environment and counselling: A review of theory and research. Journal of Counseling & Development, 79(2), 148–160.