Beyond the Diagnostic Binary: A Translational Use of the Research Domain Criteria to Improve the Measurement of Anxiety in the Context of Cannabis Use
Nicole Ennis, Katie Kloss, Alyssa Flores
Healthcare August 1, 2026 DOI: 10.3390/healthcare14152333 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Mixed methods study Qualitative Peer reviewed |
|---|---|
| Sample size | 30 |
| Population | Adult cannabis consumers, including medical (n=19) and recreational (n=11) consumers |
| Measures | State-Trait Anxiety Inventory |
| Topics | Anxiety Cannabis |
| Key points | Medical cannabis consumers reported more frequent use (28.95 days per month) than recreational consumers (23.55 days per month), and both groups showed clinically significant anxiety symptoms on the State-Trait Anxiety Inventory (39.95 and 38.55, respectively), with medical consumers more likely to report elevated anxiety. The authors argue that the Research Domain Criteria framework offers a transdiagnostic way to study when and for whom cannabis induces or reduces anxiety. |
Abstract
Introduction: Epidemiological data indicate that over half of people who consume cannabis report anxiety reduction as a reason for use. Anxiety is frequently cited as a primary motivation for cannabis use among both medical and recreational consumers. The lifetime prevalence of anxiety disorders in the United States is approximately 34% with more recent data suggesting that the figure may be as high as 43%.
Methods: Using a mixed methods design, we collected quantitative data through psychosocial assessment tools and demographic questionnaires from a sample of adult cannabis consumers (n = 30). These data were integrated with qualitative findings from semi structured interviews to contextualize consumers’ experiences and perceptions related to anxiety and cannabis use.
Results: Medical cannabis consumers (n = 19) reported significantly more frequent consumption, averaging 28.95 days per month, as compared to recreational consumers (n = 11), averaging 23.55 days per month. Scores on the State-Trait Anxiety Inventory indicated clinically significant anxiety symptoms in both groups (39.95 for medical; 38.55 for recreational), with medical consumers more likely to endorse elevated anxiety. Qualitative analyses revealed nuanced and individualized interpretations of anxiety that extended beyond traditional binary diagnostic criteria revealing the Research Domain Criteria (RDoC) as a framework to better understand the relationship between anxiety and cannabis use.
Discussion: The value of this work is its use of the RDoC framework to provide a new way to examine the relationship between anxiety and cannabis consumption. Currently the diagnosis of anxiety is binary based on DSM-5-TR criteria. This limitation makes it challenging to study the complex range of outcomes that occur when examining anxiety and cannabis use. Therefore, the opportunity to understand anxiety from a transdiagnostic framework such as RDoC enables researchers to study for whom and under what circumstances cannabis induces and/or reduces anxiety.
In the evidence
This study is part of the evidence base for a synthesis in the library. Here is how each one recorded it.
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Both medical and recreational consumers showed clinically significant anxiety symptoms, and the authors argue for a transdiagnostic framework to study when cannabis induces or reduces anxiety.
Synthesized
Comparable studies
Other qualitative studies on cannabis for anxiety, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Patterns, Trends, and Meanings of Drug Use by Dance-drug Users in Edinburgh, Scotland Clubbers in clubs and pre-club bars | 2004 | Cross-sectional survey with focus groups | n = 124 |
| Mapping the pathways between recreational cannabis use and mood disorders: A Behaviour Sequence Analysis approach Participants who wrote autobiographical accounts online about cannabis use and mental... | 2019 | Qualitative study using behavior sequence analysis | n = 61 |
| Predictive impact of different acute cannabis intoxication effects with regard to abstinence motivation and cessation of use Current and past cannabis users | 2023 | Mixed methods online survey | n = 441 |
| Beyond symptom change: a qualitative descriptive study of reported quality of life experiences among adults prescribed medicinal cannabis for anxiety disorders Adults with a diagnosed anxiety disorder who had initiated medicinal cannabis within... | 2026 | Qualitative descriptive study | n = 9 |