As more states legalize cannabis, therapists and clients alike are asking the same question: can cannabis help with therapy?
In our Amarillo therapy office, we’ve noticed a growing curiosity about whether cannabis—or its components like THC and CBD—might enhance trauma processing, anxiety relief, or emotional openness. The research, however, paints a complex and often contradictory picture.
This article reviews what is (and isn’t) known about cannabis in psychotherapy — from neuroscience to ethical considerations — with a focus on the real-world implications for therapy clients in Texas and beyond.
The Science: Why Cannabis Is Being Studied in Psychotherapy
Cannabis affects the brain’s endocannabinoid system (ECS), which regulates stress, emotion, and memory (Volkow et al., 2017). Because the ECS overlaps with neural pathways involved in trauma, anxiety, and fear extinction, researchers have wondered whether cannabis could facilitate therapeutic processes (Hindocha et al., 2020).
For example, in trauma-focused work, clients may experience overwhelming physiological arousal or avoidance when confronting distressing memories. A mild cannabinoid effect could theoretically reduce anxiety and increase emotional accessibility, allowing therapy to move forward (Ona et al., 2023).
However, this idea remains largely theoretical. Few studies meet rigorous standards for controlled clinical trials.
Current Evidence: Hope and Hesitation
PTSD and Trauma
Some studies suggest cannabis may help people with PTSD by reducing nightmares, intrusive thoughts, or hyperarousal (Mitch Earleywine & Munsey, 2022). A systematic review found that some participants experienced symptom improvement, though the studies were small and often lacked control groups (Walsh et al., 2017).
A recent case report on cannabis-assisted psychotherapy for complex PTSD showed a 98.5% reduction in dissociative symptoms after 10 sessions (Ona et al., 2023). While striking, this result is anecdotal and cannot be generalized.
Other reviews caution that these benefits are often temporary and may rely on symptom suppression rather than trauma resolution (Bonn-Miller et al., 2019). The key takeaway: cannabis might ease distress, but it likely doesn’t replace the deep cognitive and emotional processing required for long-term recovery.
Anxiety, Depression, and Mood
Evidence for cannabis improving depression or anxiety is mixed.
Some small-scale studies found short-term anxiolytic (anxiety-reducing) effects (Crippa et al., 2011), while others showed increased anxiety and irritability with higher THC concentrations (Volkow et al., 2014).
Longitudinal studies even suggest that chronic or heavy cannabis use may increase the risk of depressive symptoms or worsen motivation over time (Lev-Ran et al., 2014).
Psychosis and Risk Factors
One of the clearest findings in cannabis research is its association with psychosis risk. People genetically predisposed to schizophrenia or bipolar disorder are more vulnerable to psychotic symptoms when exposed to high-THC cannabis (Di Forti et al., 2019).
For therapists, this means cannabis use—especially daily or heavy use—requires careful screening, psychoeducation, and collaboration with prescribers.
The Ethical and Clinical Landscape
Even in states where cannabis is legal, integrating it into psychotherapy is ethically complex. Therapists must maintain neutrality, avoid making medical recommendations, and focus on harm reduction and informed consent (Sessa, 2018).
Key points for clinicians:
- Ask, don’t assume. Many clients already use cannabis for anxiety, pain, or sleep; understanding their patterns helps shape treatment.
- Separate use from treatment. Cannabis can change symptoms but is not a stand-alone therapy.
- Clarify goals. Ask what the client wants cannabis to do — numb emotion, increase openness, or aid sleep — and explore those needs therapeutically.
- Address dependence. Cannabis Use Disorder (CUD) can subtly develop, especially when used for emotional avoidance (Budney et al., 2015).
Where the Research Is Headed
The next wave of studies aims to clarify whether specific cannabinoid ratios (THC:CBD) or delivery methods (oral vs. inhaled) can safely complement therapy for conditions like PTSD or chronic anxiety (Hindocha et al., 2020).
Until then, the most ethical stance is one of open curiosity and caution. Cannabis may have a place in psychotherapy’s future — but for now, the evidence suggests benefits are conditional and highly individualized.
For Clients in Amarillo
If you’re considering cannabis as part of your mental health journey, here’s what to remember:
- Therapy works best when your mind is clear. Cannabis may provide short-term relief but can also dull awareness and hinder insight.
- Be open with your therapist. We can support you best when we know what you’re using and why.
- Healing doesn’t come from a substance — it comes from relationship, reflection, and courage.
If you’re curious about therapy that honors both science and your lived experience, you can learn more about our services here or contact us directly here.
References
Bonn-Miller, M. O., Sisley, S., Riggs, P., Yazar-Klosinski, B., Wang, J. B., & Loflin, M. (2019). The emerging clinical importance of cannabis and cannabinoids in posttraumatic stress disorder. Psychology of Addictive Behaviors, 33(5), 563–575.
Budney, A. J., Borodovsky, J. T., & Lee, D. C. (2015). Epidemiologic trends in cannabis use and misuse: Implications for addiction risk. Substance Abuse, 36(1), 13–20.
Crippa, J. A., Zuardi, A. W., Garrido, G. E., Wichert-Ana, L., Guarnieri, R., Ferrari, L., Azevedo-Marques, P. M., Hallak, J. E., McGuire, P. K., & Busatto, G. F. (2011). Effects of cannabidiol (CBD) on regional cerebral blood flow. Journal of Psychopharmacology, 25(10), 1216–1223.
Di Forti, M., Quattrone, D., Freeman, T. P., Tripoli, G., Gayer-Anderson, C., Quigley, H., Rodriguez, V., Jongsma, H. E., Ferraro, L., & La Cascia, C. (2019). The contribution of cannabis use to variation in the incidence of psychotic disorder across Europe (EU-GEI). The Lancet Psychiatry, 6(5), 427–436.
Hindocha, C., Cousijn, J., Rall, M., Bloomfield, M. A. P., & Curran, H. V. (2020). The effectiveness of cannabinoids in the treatment of mental disorders: A systematic review. The Lancet Psychiatry, 7(4), 307–324.
Lev-Ran, S., Roerecke, M., Le Foll, B., George, T. P., McKenzie, K., & Rehm, J. (2014). The association between cannabis use and depression: A systematic review and meta-analysis of longitudinal studies. Psychological Medicine, 44(4), 797–810.
Mitch Earleywine, M., & Munsey, K. (2022). Cannabis and PTSD: A review of clinical and neurobiological findings. Current Addiction Reports, 9(2), 237–248.
Ona, G., Pellon, R., Feilding, A., & Dos Santos, R. G. (2023). Cannabis-assisted psychotherapy for complex PTSD: A case report. Frontiers in Psychiatry, 14, 1051542.
Sessa, B. (2018). The psychedelic renaissance: Reassessing the role of psychedelic drugs in 21st century psychiatry and society (2nd ed.). Muswell Hill Press.
Volkow, N. D., Hampson, A. J., & Baler, R. D. (2017). Don’t worry, be happy: Endocannabinoids and cannabis at the intersection of stress and reward. Annual Review of Pharmacology and Toxicology, 57, 285–308.
Walsh, Z., Gonzalez, R., Crosby, K., Thiessen, M. S., Carroll, C., & Bonn-Miller, M. O. (2017). Medical cannabis and mental health: A guided systematic review. Clinical Psychology Review, 51, 15–29.
