Cannabis containing equivalent concentrations of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) induces less state anxiety than THC-dominant cannabis
Nadia R. P. W. Hutten, Thomas R. Arkell, Frederick Vinckenbosch, Jan Schepers, Richard C. Kevin, Eef L. Theunissen, Kim P. C. Kuypers, Iain S. Mcgregor, Johannes G. Ramaekers
Psychopharmacology October 13, 2022 DOI: 10.1007/s00213-022-06248-9 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial, within-subjects Placebo-controlled Peer reviewed |
|---|---|
| Sample size | 26 |
| Population | Healthy recreational cannabis users |
| Interventions | THC-dominant cannabis CBD-dominant cannabis THC/CBD-equivalent cannabis placebo cannabis |
| Dose | 13.75 mg THC, 13.75 mg CBD, 13.75 mg THC/13.75 mg CBD |
| Topics | Anxiety Cannabis CBD |
| Keywords | Anxiolytic Placebo Cannabinoid Pharmacology |
| Citations | 36 |
| Key findings | THC/CBD-equivalent cannabis induces less state anxiety than THC-dominant cannabis, but CBD's anxiety-counteracting effect is absent in individuals with high baseline anxiety. |
Abstract
Rationale: Delta-9-tetrahydrocannabinol (THC), an active component of cannabis, can cause anxiety in some users during intoxication. Cannabidiol (CBD), another constituent of cannabis, has anxiolytic properties suggesting that cannabis products containing CBD in addition to THC may produce less anxiety than THC-only products. Findings to date around this issue have been inconclusive and could conceivably depend on moderating factors such as baseline anxiety levels in users.
Objective: The present study examined whether anxiety following single doses of vaporised THC, CBD and THC/CBD might be explained by state and trait anxiety levels at baseline.
Methods: A placebo-controlled, randomised, within-subjects study including 26 healthy recreational cannabis users tested the effects of vaporised THC-dominant cannabis (13.75 mg THC), CBD-dominant cannabis (13.75 mg CBD), THC/CBD-equivalent cannabis (13.75 mg THC/13.75 mg CBD) and placebo cannabis on anxiety. Self-rated trait anxiety was assessed with the State-Trait Anxiety Inventory (STAI). State levels of anxiety were objectively assessed with a computer-based emotional Stroop task (EST) and subjectively rated with the STAI-state questionnaire and a visual analogue scale.
Results: Both THC and THC/CBD significantly increased self-rated state anxiety compared to placebo. State anxiety after THC/CBD was significantly lower than after THC alone. THC-induced anxiety was independent of anxiety at baseline. When baseline anxiety was low, CBD completely counteracted THC-induced anxiety; however, when baseline anxiety was high, CBD did not counteract THC-induced anxiety. There were no effects of any treatment condition on the EST.
Conclusion: Overall, the study demonstrated that the THC/CBD-equivalent cannabis induces less state anxiety than THC-dominant cannabis.
In the evidence
This study is part of the evidence base for a synthesis in the library. Here is how each one recorded it.
-
THC and THC/CBD both increased state anxiety versus placebo, but THC/CBD produced less anxiety than THC alone; CBD's counteracting effect was absent in those with high baseline anxiety.
Synthesized
Comparable studies
Other randomized controlled trials on cannabis for anxiety, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Distinct Effects of Δ9-Tetrahydrocannabinol and Cannabidiol on Neural Activation During Emotional Processing Healthy, English-native, right-handed men who had used cannabis 15 times or less in... | 2009 | Double-blind, randomized, placebo-controlled crossover trial | n = 15 |
| Modulation of Mediotemporal and Ventrostriatal Function in Humans by Δ9-Tetrahydrocannabinol Healthy, native English-speaking, right-handed men of white race/ethnicity who had used... | 2009 | Randomized controlled trial | n = 15 |
| Modulation of effective connectivity during emotional processing by Δ9-tetrahydrocannabinol and cannabidiol Healthy subjects | 2009 | Randomized controlled trial | n = 15 |
| Psychedelic symptoms of cannabis and cocaine use as a function of trait impulsivity Regular drug users | 2015 | Three-way crossover study | n = 122 |
| Effects of Cannabinoids on Emotional States and Alcohol Use Among Underrepresented Groups: Moderation by Perceived Discrimination. Participants who identify with a racial, ethnic, gender, or sexual identity that is... | 2025 | Randomized controlled trial | n = 172 |