About half of Americans will experience at least one traumatic event in their lives. Of those, a percentage will go on to develop post-traumatic stress disorder (PTSD).
3.6% of adults experience PTSD in any given year, according to the National Institute of Mental Health. Women are nearly three times more likely than men to be affected.
PTSD is very difficult for affected individuals to live with. It doesn’t help that so many misconceptions persist about the disorder, leading many to live with shame or feel that others do not understand what they are going through.
Various forms of psychotherapy, often combined with medications like SSRIs, are the primary form of treatment for PTSD. However, a growing body of evidence suggests that cannabinoids (CBD) may also be helpful in treating PTSD, particularly the anxiety and sleep-related symptoms of the disorder.
What are the benefits of using CBD to treat PTSD? How does CBD affect the brain and body, and is it safe to use? In this guide, we answer these questions and more.
Overview of PTSD: Symptoms, diagnosis and treatment
PTSD is especially common in veterans of war and sexual assault survivors, but it can affect anyone who has experienced a traumatic event. Traumatic events may include abuse, domestic violence, car or workplace accidents, physical or sexual assault, natural disasters, military combat, natural disasters, or the death of a loved one. Trauma can be physical or psychological, and it’s often both.
After a trauma occurs, it is common for the affected individual to become disoriented or anxious, or to experience mood swings or nightmares. When these symptoms persist and worsen over a period of months, it can develop into PTSD.
To be officially diagnosed with PTSD, the individual must experience all four of the below criteria for a period of at least one month:
- Re-experiencing events, where the individual re-experiences the trauma, as through a flashback or nightmare. These can be so realistic and disturbing as to disrupt the person’s daily quality of life. Re-experiencing events may be triggered by particular words, sounds, images or something else.
- Avoidance symptoms, where the individual begins to avoid certain people, places, or activities that remind them of the trauma—even if they had no problem with these situations before. Like re-experiencing events, avoidance symptoms can also interfere with their daily life. For example, a person who experienced a workplace shooting may refuse to go back to work.
- Two or more arousal and activity symptoms, which persist outside of any triggers or re-experiencing events. On a more general basis, the individual may have trouble sleeping, or be more irritable or on edge.
- Two or more mood and cognition symptoms, which persist outside of any triggers or re-experiencing events. The individual may have trouble remembering the event, or they may develop feelings of guilt, self-directed negativity, or detachment from things they previously enjoyed.
In addition to the above symptoms, individuals with PTSD may develop depression, substance abuse, sleep issues, and other mental health disorders.
Treatment for PTSD often combines psychotherapy with antidepressant medications. Specific psychotherapeutic approaches for PTSD fall in the broader category of cognitive behavioral therapy (CBT). In CBT, the therapist works with the patient to help them recognize the counterproductive thought patterns and behaviors that are hurting their psyche, and develop ways to counteract them with healthier thoughts and behaviors. PTSD therapies include:
- Prolonged exposure therapy (PET), where the individual works with their therapist to encounter the places, people, or things they’ve been avoiding.
- Cognitive processing therapy (CPT), where the individual talks through the trauma with their therapist, and writes down their thoughts about it to uncover patterns.
- Eye movement desensitization and reprocessing (EMDR), where the individual mentally focuses on the trauma while watching or listening to another neutral trigger, like music or light.
- Stress inoculation training (SIT), where the individual learns stress management techniques to cope with triggers and negative events, like breathing exercises.
Treating PTSD with CBD: A review of the research
Increasingly, recent research suggests CBD may be another way to treat PTSD and other anxiety disorders. In particular, CBD appears to have a positive effect on several of the core symptoms of PTSD, including the re-experiencing events, avoidance symptoms, and arousal symptoms.
What is CBD?
CBD, short for cannabidiol, is the non-psychotomimetic component of Cannabis sativa. CBD is distinct from tetrahydrocannabinol (THC), which produces the psychoactive “high” effects of cannabis. CBD alone does not have these psychoactive effects.
CBD can significantly affect how we retain memories, which is why researchers have looked into it as a potential treatment for PTSD and other disorders that center around negative memories.
The body’s endocannabinoid (eCB) system plays a critical role in emotional regulation, as well as memory consolidation and retrieval. Due to the way CBD interacts with the eCB system, researchers have discovered that CBD can affect our emotions around memories, and how we form and remember them, in such a way that’s uniquely beneficial for those living with PTSD.
How CBD affects PTSD-related memories
When cannabidiol (CBD) gets introduced into the body—through inhalation, oral ingestion, or transdermally (through the skin)—it activates CB1 and CB2, two cannabinoid receptors in the endocannabinoid system. This has ripple effects throughout the central nervous system, such as increasing pleasure and altering memory processing. Meanwhile, the cannabinoids block the retrieval of the traumatic memory.
In other words, the body experiences a pleasure boost while the traumatic memory is blocked, enabling the person to feel less anxiety about the trauma during a re-experiencing event. Since they have less of a negative emotional experience with the memory, this in turn helps reduce their avoidance and arousal symptoms.
Over time, eCB enhancers like CBD work together to block the continuous retrieval of the memory, enabling the memory to lessen in intensity and detail, while also reducing the anxiety associated with it. In this way, CBD may be especially effective as a treatment for PTSD because it addresses both the cognitive and emotional aspects of the disorder.
Plus, CBD boasts the additional benefit of having fewer side effects than the medications typically used to treat PTSD. SSRIs and antidepressants can affect libido, cause nausea or headaches, and create sleep problems like insomnia. In rare cases, they can even increase risk of depression or suicide. CBD offers similar therapeutic benefits as these drugs, but with fewer side effects, which is why many are touting CBD as a suitable replacement for treating PTSD.
How CBD affects PTSD-related anxiety
With repeated dosing, CBD may reduce the long-lasting anxiety caused by PTSD. For many individuals living with PTSD, the originating trauma exposed them to a predator, such as the person committing the assault, a workplace shooter, or a combat enemy.
In one 2012 study, researchers studied how CBD affects predator threat stress, and its possible implications for PTSD. In the study, rats were exposed to a cat (the predator). One hour later, they were given single or repeated doses of CBD. The rats who received repeated doses of CBD had less anxiety over the 7 days following the predator exposure. Researchers hypothesized that this was due to the CBD’s activating effect on 5HT1A receptors in the hippocampus and frontal cortex. They also concluded that CBD’s anti-anxiety benefits could significantly benefit those living with PTSD.
CBD and PTSD-related substance abuse
Several studies suggest CBD’s treatment potential for PTSD extends beyond the immediate symptoms of the disorder. For example, CBD may be a particularly effective treatment for individuals with PTSD and comorbid substance abuse disorder (SUD).
Substance abuse often co-occurs with PTSD. To cope with the symptoms of the disorder, individuals with PTSD often turn to substances like alcohol and become addicted. People with PTSD are two to four times as likely to suffer from SUD, a trend which persists among veterans. About one-third of veterans with substance abuse also have PTSD.
In a 2017 meta-analysis, researchers reviewed the effects of CBD on fear memories, expanding upon the research we cited above about CBD’s effects on memory consolidation. With fear memory processing, as with other memories, CBD disrupts the memory reconsolidation process (thereby encouraging extinction of the fear memory), and reduces the acute fear response. More importantly, however, CBD also reduces the learned fear individuals experience towards the memory.
This is relevant to individuals with PTSD because part of what makes the disorder so challenging to cope with is the re-experiencing events, and the association of those re-experiencing events with fear—creating a conditioned fear response which can intensify each subsequent re-experiencing event. As a result, the individual ends up in a negative feedback loop that reinforces their PTSD symptoms and reliance on substance abuse, resulting in relapse rather than relief.
If CBD can help break that cycle by changing their fear memory response, individuals with PTSD and SUD may experience higher success at treating both disorders.
CBD vs. Marijuana for PTSD
Besides alcohol, it’s not uncommon for individuals with PTSD to self-cope using marijuana (which includes THC and CBD), and to experience relief as a result of their use. In fact, the more severe the symptoms over time, the more likely individuals are to use cannabis to relieve them, according to a 2011 study of veterans with PTSD.
CBD produces the same medical benefits of cannabis without the high of THC. Because it doesn’t provide an intoxicating effect, individuals can take CBD without worrying about a potential disruption to their daily lives.
CBD and PTSD-related sleep issues
Individuals with PTSD are more likely to use CBD to cope in two scenarios: when they have more severe PTSD and when they develop sleep problems as a result of PTSD. In a study of medical cannabis users with PTSD, the individuals with higher PTSD scores were more likely to use PTSD, both generally and specifically to improve sleep, than those who had lower PTSD scores.
Sleep is such a problem and aggravating factor for those with PTSD that researchers have called it a “primary motivator” for coping-related cannabis use.
Dependence on cannabis to cope with PTSD can become problematic because a) research has not been done as to the potential negative effects of long-term cannabis use, and b) some studies suggest it may intensify cannabis withdrawal. In a 2013 study of military veterans, researchers confirmed similar findings we’ve already reviewed, such as that individuals with PTSD are significantly more likely to use cannabis to cope with their PTSD. However, researchers also found that these individuals were more likely to experience increased withdrawal symptoms, and increased emotional cravings for cannabis. The more severe their PTSD, the more severe their cannabis withdrawal.
To prevent this outcome, researchers often propose that other, alternative methods are introduced to address the PTSD-related sleep problems—as a way to reduce the individual’s reliance on CBD. One such method is cognitive behavioral therapy for insomnia, or CBT-I. CBT-I is similar to the CBT approaches for PTSD, with a specific focus on insomnia. Over a period of weeks to months, individuals work with their therapist to identify the negative or disruptive thoughts and behaviors they have around sleep, and learn healthy sleep hygiene habits to replace them with.
Is it legal to use CBD to treat PTSD?
To date, much of the research surrounding CBD as a treatment for PTSD has focused on acute dosing, meaning that studies have looked at the effects of CBD over a short period in human or rat subjects. However, for many anxiety disorders like PTSD, the symptoms can persist for a number of years, although they lessen over time. Further research is warranted to see if CBD may be valuable as a long-term treatment solution for PTSD.
In the meantime, CBD has been approved as a treatment for PTSD in over half the country, including (at the time of writing): Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Maine, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, Washington, and West Virginia. Additionally, California, Massachusetts, and Washington, D.C. have special allowances for CBD as a treatment for various conditions with licensed physician approval.
New Mexico was the first state to approve medical cannabis as a treatment for CBD. In a 2014 study for the state, researchers found that individuals with PTSD who began using cannabis experienced at least a 75% reduction in symptoms.
Regardless of whether it is specifically approved as a treatment for PTSD in your state, CBD products can be purchased legally online in all 50 states as long as the THC amounts are below 0.3%. In states where recreational marijuana is legal, the allowable THC amount may be higher.
How to use CBD to treat PTSD
Before using CBD, you should check with your doctor to ensure it won’t create negative side effects with any other medication you may be taking for PTSD or other conditions. They may also be able to provide dosing recommendations and direct you toward a suitable form of CBD.
The research suggests that CBD is effective for PTSD when inhaled, taken orally, or transdermally. The best ingestion method for you is a matter of personal preference. CBD can be consumed in a variety of ways, including:
- Sublingual tinctures (which are placed under the tongue and swallowed)
- Food additives
- CBD edibles
- CBD topical gels or creams
- CBD oil
- CBD sprays
- CBD capsules
- CBD vape oil
CBD capsules and products can be purchased in various dose amounts. It’s best to start small and gradually increase, only if needed, until the desired symptom relief is achieved.
Once ingested, it can take 20 to 40 minutes for the CBD to begin its effects, depending on your tolerance level and method of ingestion.
Alternative methods to treat PTSD
If you want to explore alternatives for treating your PTSD, there are other natural methods you can try. Even if you do choose to use CBD, these additional methods may continue to alleviate your symptoms.
Psychotherapy is the most effective treatment for the majority of people with PTSD, enabling many to recover fully and others to enjoy a marked reduction in symptoms. Cognitive behavioral therapy is the most common form of psychotherapy used for PTSD, including prolonged exposure therapy (PET), cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR), and stress inoculation training (SIT). CBT can also be used to treat PTSD-related insomnia.
Exercise increases endorphins, the “happy” hormones that reduce stress. Exercise also helps one maintain good health, which makes it easier to cope with the emotional and mental duress of PTSD. Finally, a regular exercise program—when performed in the early morning and afternoon—promotes more restful sleep.
Yoga and meditation
Yoga can be one particularly helpful method of exercise for individuals with PTSD, as it promotes physical strength, flexibility, cardio and circulatory health—but it’s also a spiritual practice. Yoga focuses on staying in the moment, much like meditation. Either of these practices can complement other treatment methods for PTSD. They can also improve sleep, by helping the individual learn mindfulness and relaxation methods to relax into a restful state of mind. Yoga has been shown to positively improve symptoms of other anxiety disorders and depression, so it may be beneficial for PTSD as well.
Herbs like valerian root, lavender, and chamomile have all been shown to relieve anxiety and facilitate calm. By calming the nervous system, these herbs can both alleviate the arousal symptoms of PTSD as well as help induce sleep for those with comorbid insomnia. These can be taken in supplement form, as part of an aromatherapy practice, or in herbal teas.
Kava root has also been shown to be effective for treating generalized anxiety disorder, so it may help reduce the anxiety and panic attacks associated with PTSD.