Patients ask me all the time whether they can journal during a Spravato® session. Or listen to a podcast. Or an audiobook. Or a guided meditation with a narrator. The question makes sense — these are things we reach for when we want to feel grounded, intentional, or productive.

The answer is no. And the reason isn't arbitrary. It comes down to one of the most important concepts in modern neuroscience: the default mode network.

What Is the Default Mode Network?

The default mode network (DMN) is a set of interconnected brain regions that becomes active when you are not focused on the outside world. It lights up during self-referential thinking — when you are remembering the past, imagining the future, worrying, ruminating, or constructing a narrative about yourself.

In plain terms: the DMN is the part of your brain that talks to you about you. It is the inner monologue. The self-critic. The storyteller who keeps replaying what happened last Tuesday and rehearsing what might happen next month.

In people with treatment-resistant depression — the population Spravato® is designed for — the DMN is often hyperactive. It runs on a loop. The same painful narratives, the same self-defeating patterns, the same grooves worn deep by years of rumination. This is not a character flaw. It is a neurological pattern, and it is one of the things Spravato® is specifically positioned to interrupt.

How Spravato® Quiets the DMN

Esketamine — the active compound in Spravato® — works in part by temporarily disrupting the default mode network. It loosens the grip of habitual self-referential thought, creating a window of neuroplasticity in which new patterns can form. This is why patients often describe a sense of distance from their usual mental chatter, a feeling of openness, or an experience of seeing their life from outside the familiar story.

Researchers studying ketamine and psilocybin have found that the therapeutic benefit of these medicines correlates strongly with the degree of DMN disruption during the session. The more the medicine can quiet that self-referential loop, the more room there is for something new.

This is not a side effect. It is the mechanism.

"The more the medicine can quiet that self-referential loop, the more room there is for something new."

Why Language Re-Engages the DMN

Here is the problem with journaling, podcasts, audiobooks, and spoken-word content during a session: language is the primary medium of the default mode network.

When you hear words — especially words that carry meaning, narrative, or instruction — your brain's language-processing regions activate. Wernicke's area, Broca's area, the angular gyrus. These regions are deeply integrated with the DMN. Processing language pulls you back into the self-referential network that the medicine is working to quiet.

Journaling is even more direct. Writing about your experience requires you to construct a narrative, evaluate your thoughts, and translate inner states into language. All of this is DMN activity. You are, in effect, asking the medicine to open a door while simultaneously pulling it shut.

Guided meditations with narrators present the same problem. Even if the content is calming, the act of following verbal instructions keeps the language network — and by extension the DMN — engaged. The voice becomes an anchor to the ordinary mind, exactly when the medicine is trying to help you let go of it.

What About Lyrics in Music?

The same principle applies to music with lyrics. Lyrics are language. When you hear a song with words, your brain processes those words — even if you are not consciously paying attention to them. The language network activates. The DMN is pulled back online.

This is why the research on music-assisted psychedelic therapy consistently recommends instrumental music. It is not aesthetic preference. It is neuroscience. Instrumental music can carry emotional weight, create a sense of journey, and support the therapeutic process without triggering the language-processing circuitry that works against the medicine.

There is a meaningful difference between music that moves you and music that talks to you. During a Spravato® session, you want the former.

The Integration Window Is Different

It is worth being precise about timing. The concern about language applies primarily during the active session — the period when the medicine is working and the DMN is most disrupted.

After the session, during the integration period, language becomes valuable again. Journaling after a session can be a powerful tool for capturing insights, processing what arose, and beginning to weave new understanding into your life. Many therapists and clinicians actively encourage post-session journaling as part of the integration process.

The distinction matters: language after the session supports integration. Language during the session competes with the medicine.

What to Use Instead

The alternative to language is not silence — though silence has its place. The alternative is non-verbal sound that supports the therapeutic arc without engaging the language network.

Instrumental music — particularly music with a clear emotional arc, harmonic openness, and appropriate dynamic range — can guide the session experience without triggering the DMN. It provides structure and emotional support while leaving the self-referential network quiet.

Ambient and drone-based music works well for the onset phase, when the medicine is beginning to take effect and the mind is still somewhat active. More emotionally expressive music — classical, jazz, world music — can support the peak. Gentle, grounding music helps with the return.

The goal is to give the medicine room to work. Non-verbal music does that. Language, in almost any form, does not.

The Session Is Not the Time to Process

There is a cultural assumption that we should be doing something during altered states — capturing insights, working through problems, making meaning in real time. This impulse is understandable, but it misunderstands how Spravato® works.

The session is not the time to process. It is the time to allow. The medicine does its best work when the analytical, narrative, self-referential mind steps back. Language — in any form — keeps that mind in the room.

Give the medicine the quiet it needs. The words can come later.