Set and setting of psychedelics for therapeutic use in psychiatry: A systematic review
Clémentine Estric, Thomas Duron, Sarah Kabani, Jorge Lopez-Castroman
Journal of Psychopharmacology May 12, 2025 DOI: 10.1177/02698811251338214 via OpenAlex
Summary
AI-generated from the abstractPsychedelics show promise for treating psychiatric disorders, but how participants are prepared (set) and the environment where the drug is taken (setting) vary widely across studies. This systematic review examined 27 articles covering 25 clinical trials with 763 participants. Participant selection and creating a safe environment were consistently reported, but other elements like monitor training (52% of studies), controlling visual distractions (64%), and ensuring a pleasant environment (68%) were less consistently described. Psilocybin was the most studied psychedelic (47% of trials). The lack of standardization in set and setting limits comparability and reproducibility, and harmonizing these aspects would improve future research.
Study at a glance
| Characteristics | Systematic review Randomized Open-label Peer reviewed |
|---|---|
| Sample size | 763 |
| Population | Participants in clinical trials of psychedelics for psychiatric disorders |
| Topics | Ayahuasca DMT LSD Psilocybin Psychedelic-assisted therapy |
| Keywords | Context |
| Citations | 10 |
| Key finding | Participant selection and safe environment creation were consistently reported across psychedelic clinical trials, but other aspects of set and setting like monitor training, visual distractors, and pleasant environment were not standardized, limiting comparability and reproducibility. |
Abstract
Psychedelics offer promising outcomes in psychiatry. However, the preparation of participants (set) and the environmental conditions of taking a psychedelic (setting) are not standardized. We describe the set and setting for therapeutic use of psychedelic drugs in people with psychiatric disorders. In this systematic review, articles were identified in the PubMed and Web of Science databases until 12 December 2023. Only clinical trials published in English or French were eligible, and studies using psychedelics for withdrawal were excluded. Sixteen domains of set and setting were assessed covering participant selection, pre- and post-session interventions, monitor presence, environmental management, and end-of-session procedure. Of 4912 articles screened, 27 articles were retained reporting on 25 studies. Thirteen of the included studies reported randomized trials, while 12 were open-label studies, on a total of 763 participants. Studies considered features of set and setting to different extents. Participant selection and the creation of a safe environment were consistently present, but articles were more heterogeneous about reporting monitor training (52%), controlling visual distractors (64%) and creating a pleasant environment (68%). Psilocybin was over-represented (47%). Many key elements were described in each study, but differences in set and setting limit comparability and reproducibility. Harmonizing these aspects would aid the interpretation of future studies and help understand the effect of psychedelics in psychiatry.