Post-traumatic stress disorder (PTSD) is a set of symptoms that develops in approximately 20% individuals following a traumatic experience. It is diagnosed in individuals whose symptoms persist for more than a month following the traumatic event. The mainstay of PTSD treatment is psychotherapy, often combined with pharmacotherapy (antidepressants and anti-anxiety medications). Cannabinoids, including CBD, may support the treatment of post-traumatic stress disorder.

What is trauma?

Trauma is an event that causes a person to experience extreme stress, fearing for their health and life. According to the American Psychological Association, a traumatic event results in significant levels of fear, helplessness, dissociation, confusion, or other emotions that disrupt normal functioning and are severe enough to have long-term consequences on a person's life, sense of security, and view of the world and self.

There are two types of trauma:

Type 1 trauma: a single, extremely stressful event that may result in post-traumatic stress disorder (PTSD).
Type Two Trauma – Relational Trauma: Repetitive, highly stressful events, most often occurring in close relationships or daily life. Type 2 traumas include long-term exposure to physical violence, psychological abuse, emotional abuse and neglect, or sexual harassment. People exposed to this type of trauma experience other consequences, for example, they may develop personality disorders, dissociative disorders, and so-called "complex PTSD," the diagnosis and treatment of which differs from PTSD.

Not everyone who experiences a traumatic event will develop PTSD. Immediately after an extreme event, 30% people experience an acute stress reaction (ASR). ASR symptoms typically resolve on their own within a few days of a single trauma if the person is in a safe, supportive environment. PTSD develops in approximately 20% people after a traumatic experience and may be diagnosed if symptoms persist for more than a month and significantly impact their daily functioning.

What experiences can cause PTSD?

Initially, PTSD was diagnosed only in soldiers returning from the front. The symptom complex was sometimes called "soldier's heart" during the Civil War or "veteran's fatigue" during World War I. As psychiatry, psychology, and diagnostic methods developed, the term PTSD began to be used in cases involving individuals who had experienced other, extremely stressful events.

Events that, according to current knowledge, can cause PTSD:

rape (49%),*
physical violence, assault (32%),
traffic accidents (16.8%),
threat to the child's life (10.4%).
witnessing the above / the above affected a close person (7.3%),
natural disasters (3.8%).

(*percentage of people who may experience post-traumatic stress after a given experience)

In each of these cases, we are dealing with an extreme experience that causes the person to feel that their life and physical integrity are threatened. The person experiences extreme stress that exceeds their emotional capacity to cope.

Diagnosing PTSD according to DSM-5

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) is the current classification of mental disorders by the American Psychiatric Association. According to it, post-traumatic stress disorder (PTSD) can be diagnosed when a person exhibits the following symptoms following a traumatic experience:

repeated experience of a traumatic situation (at least 1 of the following):

intrusive memories,
dreams related to the event,
flashbacks,
intense, prolonged stress reaction to factors reminding of the event (also physiological).

persistent, persistent avoidance of thoughts, feelings, places, conversations related to the event, situations and people associated with the event, difficulty in recalling the circumstances of the traumatic situation, isolation, alienation, feeling of no future,
hyperactivity (at least 2 symptoms from the list): high alertness, anxiety, sleep disorders, concentration disorders, irritability, outbursts of anger,
symptoms disrupt the person's functioning,
the symptoms are not related to the use of psychoactive substances,
optional: depersonalization, derealization.

Davidson Trauma Scale – Diagnosing PTSD

The Davidson Trauma Scale, developed in the late 1990s, is a questionnaire-based tool that helps psychiatrists and psychologists assess the severity of trauma in individuals who have experienced trauma. The scale is used for an initial assessment of mental health, which helps determine appropriate therapeutic interventions.

CBD as a support for PTSD treatment

Hemp cannabinoids, including CBD, exhibit a number of properties that can support therapy for people who have suffered a traumatic experience. These include:

regulation of the circadian rhythm, facilitating falling asleep,
mood regulation,
anti-anxiety and calming properties,
support for body regeneration,
improved appetite,
support for processes related to remembering and processing memories,
stress relief.

Cannabinoids are currently the subject of scientific research worldwide, and scientists recognize the enormous potential of cannabis medicine for somatic and mental health conditions. Medical cannabis is already being prescribed to patients experiencing post-traumatic stress disorder., anxiety states, depression or insomnia.

What is PTSD and what experiences can cause it?

PTSD – post-traumatic stress disorder – is a set of symptoms that develops in some people (approximately 20%) after experiencing trauma. It was originally observed in soldiers returning from the front. As diagnostic methods developed, PTSD began to be recognized in people who had experienced other traumas of similar intensity. These include situations in which a person experiences extremely severe stress that exceeds their coping abilities, and they feel their life and physical integrity are threatened.

Traumatic situations that can trigger PTSD currently include sexual violence, physical violence, assault, road accidents, natural disasters, threats to the life of a child or other loved one, and witnessing any of the aforementioned situations involving other people. PTSD most often develops in individuals who have experienced rape (49% of individuals with such experiences) and physical violence/assault (32%).

Importantly, PTSD is distinguished from acute stress reaction (ASR). Both syndromes share similar symptoms, but ASR persists for up to a month after the traumatic event and resolves spontaneously if the person experiencing it is in a safe environment. After this time, it is considered PTSD.

PTSD according to the American Psychiatric Association:

According to the DSM-5 diagnostic criteria, PTSD can be diagnosed if, after experiencing a traumatic event, a person experiences for more than one month:

re-experiencing the event:

intrusive memories,
dreams related to the event,
flashbacks,
intense stress reactions (psychological and physiological) to factors reminding of the event,

persistent avoidance of thoughts, feelings, places related to the event, avoidance of conversations about it and people and situations associated with it, isolation, alienation, feeling of no future,
sleep disorders, concentration disorders, outbursts of anger, anxiety, vigilance,

In PTSD, these symptoms disrupt a person's functioning, persist for more than a month, and are unrelated to psychoactive substance use. They may be accompanied by feelings of derealization and depersonalization.

Psychotherapy and pharmacotherapy – PTSD treatment

Psychotherapy is one of the primary treatments for people suffering from PTSD. As research on trauma, psychotraumatology, and crisis intervention in psychology advance, numerous therapeutic methods have emerged for people who have experienced trauma.

In most cases, psychologists assume that trauma causes a freezing of emotions and thoughts related to the event, which is why people experiencing PTSD are unable to distance themselves from it and continually relive it. The goal of psychotherapy may be to process the traumatic event in their consciousness and create distance from it so that it no longer has such a profound impact on the person's life.

Pharmacotherapy often relies on antidepressants (e.g., SSRIs), which help manage depressive and anxiety symptoms. Benzodiazepines may also be used on an ad hoc basis if symptoms are severe.

CBD as a therapy support PTSD

Medical dried hemp It has been approved as a method supporting PTSD psychotherapy in many countries around the world. Scientific research on this topic primarily considers the following properties of cannabis:

anti-anxiety effect,
regulation of sleep and wakefulness rhythm,
regulation of processes related to remembering and processing memories,
alleviating intrusive thoughts about trauma and flashbacks.

Selected studies on the use of dried hemp in PTSD

In a study conducted with war veterans, a statistically significant reduction in symptoms such as anxiety, fear, and insomnia was observed in a group of patients. Under the influence of cannabinoids, the subjects were better able to cope with difficult memories and emotions.
In another study, researchers used a well-being reporting app. Participants with PTSD provided researchers with information about their symptoms during treatment. dried hemp. Approximately 12,000 reports submitted by 400 individuals over a 2.5-year period were analyzed. Immediately after taking the drug, 98% participants experienced reduced intrusive thoughts about the trauma, 97% participants experienced reduced sensitivity, anxiety and restlessness decreased in 93% participants, and 92% participants experienced fewer flashbacks. The researchers noted that these effects may subside after cannabis therapy ends, suggesting the need to repeat the study under more controlled conditions and with participants who are also undergoing psychotherapy.

Scientists see therapeutic potential CBD and other hemp cannabinoids in post-traumatic stress disorder therapy, however, indicate the need for more research with a different, more controlled course. Such an approach could lead to the creation of cannabis-based drugs supporting the treatment of mental disorders, including PTSD.