The Current Role Of Cannabis In Psychotherapy
The role of cannabis in modern psychotherapy is turbulent at best, but there is certainly evidence that THC and CBD have something to offer those with mental health conditions. The human brain is complex, and so is the cannabis plant—is cannabis the next big treatment for mental illnesses?
Perhaps no other branch of cannabis medicine gropes in the dark like that which studies the effect of cannabinoids on a “malfunctioning” human brain.
Today, there is no evidence that cannabis use causes chronic brain disorders, although the complexity of the human brain makes it hard to understand if cannabinoids could instead be effective in treating mental illnesses. When consumed in large doses, cannabis might lead to “psychotic symptoms”, particularly in vulnerable individuals with a personal or family history of mental illness. Yet, a large number of patients with schizophrenia, paranoia, bipolar disorders, and other mental conditions have been self-medicating with cannabis for years.
Doctors in the US who prescribe large amounts of medical cannabis report that very little of it goes to patients with severe psychiatric conditions—with post-traumatic stress disorder being the most common accepted condition. Psychiatrists often advise against cannabis use, while some approve it as a complementary treatment for patients with specific symptoms or diagnoses. Numerous patients report that cannabis relieves some of their symptoms, yet the clinical literature is still underdeveloped, and many studies on the therapeutic use of cannabis for mental health conditions are not of a methodologically high quality.
CANNABIS IN PSYCHOTHERAPEUTIC PRACTICES
The role cannabis plays in current psychotherapeutic practices is indeed a complex one. Many patients already feel a sense of stigma surrounding their mental condition, with cannabis only adding fuel to the fire. Healthcare personnel of any level have a duty to protect patients’ private information, and they are not supposed to judge patients’ lifestyles. Conversely, a frank discussion on cannabis use even before starting sessions with a new therapist is highly recommended to help clarify each other’s position regarding the plant.
Therapy should be an opportunity to put oneself out in the open in the company of a caring professional. Any therapist worth their salt should be open to understanding your relationship with cannabis before making any judgment calls. Especially given that cannabis is a lot safer than other drugs patients turn to in times of distress, mental healthcare professionals would be wise not to discredit the herb outright.
On the other hand, the therapists themselves have a tough role. It’s entirely possible, for example, that THC use is causing someone to experience acute anxiety, or that their chronic weed use is keeping them from fulfilling their day to day responsibilities. Again, it’s all about communication.
It is worth mentioning that psychedelic psychotherapies are becoming accepted by the scientific community. Herbs and substances like ketamine, MDMA, ayahuasca, and magic mushrooms are being tested as therapeutic agents against mild or severe mental conditions. Cannabinoids are not psychedelics in a strict sense, yet in countries where cannabis is legal, assisted psychotherapy sessions under the effects of cannabinoids are now offered. For instance, some US states offer cannabis-assisted psychotherapy for around $350, after which a driver is required by law to return you home.
When it comes to mental illnesses, each and every condition requires unique care and treatment. That means that cannabinoids may affect different conditions in distinct ways. Let’s look into some of the research on the developing role of cannabis in mental healthcare.
DEALING WITH THE SIDE EFFECTS OF THC
It’s well-known that THC can make people feel more relaxed, less stressed, and in a better overall mood. Unfortunately, THC can also induce some side effects, particularly in inexperienced or sensitive users. THC is known to trigger anxiety and paranoia at high doses. Intriguingly, CBD is effective at reducing some of these negative psychotropic effects by lowering THC’s ability to bind with CB1 cannabinoid receptors.
While CBD is gaining more and more traction when it comes to future treatments for psychological disorders, THC displays efficacy in its own right—especially regarding bipolar disorders. These conditions involve periods of maniacal high energy, alternating with periods of extremely low mood and depressive episodes. Cannabis use is actually higher in bipolar patients, probably because they use it to alleviate depression and come down from manic episodes as well. The typical biphasic effect of cannabinoids—where different doses produce different effects (ie. sedative vs. uplifting effects)—seems to work well for some patients with this condition.
Nevertheless, and despite promising anecdotes, studies on patients with bipolar disorder or schizophrenia  using cannabis have yielded some pretty inconclusive findings, both in gauging the medical efficacy of THC, and its specific use cases. Studies did observe cannabis use was associated with better neurocognitive function in subjects with bipolar disorder, but the opposite was found in the schizophrenic subjects.
THC AND POST-TRAUMATIC STRESS DISORDER
CB1 receptors are widespread throughout the brain, and recent neuroimaging techniques have shown increased CB1 receptors in multiple brain regions linked to post-traumatic stress disorder. Cannabinoids affect the hippocampus, an area of our brain that plays a role in learning and memory. This area is important for anxiety disorders like PTSD because it contributes to the mechanisms of danger and safety.
The role of cannabinoids in learning processes related to danger and safety indicates that cannabis can be effective against anxiety and PTSD symptoms. The endocannabinoid system appears to be involved in the extinction of aversive memories, and both THC and CBD have been shown to facilitate the removal of the pathological fear response.
Millions of patients with anxiety disorders report that cannabis provides relaxation, serenity, and a calming effect. PTSD patients specifically report that cannabis helps them with insomnia, anxiety, and mood swings. Still, even here the reports on THC efficacy are varied. Some research says cannabis use alone does not appear to lead to long-term recovery from anxiety disorders or PTSD, yet other studies suggest that cannabis might play some role in a proper treatment. In short, little is known about the effect of cannabis on the natural recovery from anxiety disorders and PTSD.
CBD AND SCHIZOPHRENIA
CBD has been able to treat symptoms of schizophrenia in controlled clinical trials, with results comparable to approved antipsychotic drugs, and with less adverse effects. Because of its non-psychotropic nature, CBD can be experimented with more easily than THC for psychiatric disorders. Research shows that CBD may be effective as an additional therapy for schizophrenia  , catalysing significantly reduced psychotic symptoms in patients who received a cannabidiol treatment.
Studies also showed that CBD may improve learning and memory for those with cognitive impairments, but its efficacy in improving cognition in schizophrenia cannot be fully confirmed due to lack of clinical evidence. However, CBD has been shown to improve cognition in multiple studies of impairment with preclinical models of schizophrenia, Alzheimer’s disease, meningitis, and brain ischemia.
INTERACTIONS AMONG THC, CBD, AND PRESCRIPTION DRUGS
Patients who use cannabis with decent amounts of THC are happy with its lack of side effects compared to common prescription drugs. However, there are some cases where THC has the potential to decrease the effectiveness of other drugs, or even cause unpredictable reactions and worsen the condition. Cannabis has shown to help people who suffer from depression, but using it while on antidepressants can be dangerous as cannabinoids can intensify the side effects. This can also happen with sedatives, alcohol, or other drugs, as patients may feel overly sedated when consuming THC together with a tranquiliser.
CBD is non-psychotropic, and it also has the potential benefit of helping break addiction  to specific deadly substances. However, cannabidiol can prevent the proper metabolisation of many pharmaceutical drugs. CBD is metabolised by cytochrome P450 enzymes; it then essentially deactivates these enzymes, preventing them from effectively metabolising other drugs. This is crucial to understand for those individuals taking certain medications—like some antipsychotics—as it can result in more pronounced side effects.
NOT A CONCLUSION
The peculiar interactions between cannabinoids and our mind are far from being understood. The lack of comprehensive, large-scale studies makes it exceedingly difficult to draw conclusions on a psychological or psychiatric perspective. Cannabinoids might help with some mental conditions, but they also might increase some symptoms or worsen a therapy. Furthermore, we are far away from knowing the optimal doses and standard methods of cannabis administration for psychiatric use.
Despite our present lack of knowledge, cannabinoids are seen as greatly promising since they target different neurotransmitter systems than traditional drugs, with the potential of being more effective and less disruptive.
The complexity of the human brain makes it hard to understand if cannabis could treat mental conditions. While many patients use it, research is inconclusive.
Psychotherapist Uses Marijuana to Unlock the Mind
If you’re a regular cannabis consumer, you’ve likely experienced what struck you as moments of piercing insight and emotional depth while you were high. Could those aha moments be harnessed for self-growth in a professional therapy session? Some psychotherapists believe they can, and a small number are practicing what they call cannabis-assisted therapy.
In scientific literature and pop culture mythology alike, the power of mind-altering substances to produce insights has been met with disdain and delight alike. Recently, however, some researchers are investigating the beneficial aspects of cannabis and how its so-called psychedelic properties can work therapeutically. Famed American psychologist James Fadiman explored its potential in the 1960s and other researchers have continued to build on his findings.
“The term psychedelic is definitely hard for the public to discern,” said neuroscientist Adie Wilson-Poe of the Washington University School of Medicine in St. Louis, who studies the addictive and pain-relieving properties of opioids and cannabinoids.
“There is still a lot of misinformation and stigma out there. Experts would agree that the term psychedelic means the ‘mind-manifesting’ or consciousness-expanding properties of a substance,” Wilson-Poe said. “Cannabis fits some of the criteria, but not all, and probably only under the right conditions or in certain individuals.”
Now other professionals are ushering cannabis into new realms of treatment. Marijuana.com spoke with Sara Ouimette , a licensed marriage and family therapist in Oakland, California, who explained how cannabis is useful in psychotherapy.
Sara Ouimette, a licensed marriage and family therapist (LMFT), incorporates cannabis into her psychotherapy practice in Oakland, California. (Photo Courtesy of Sara Ouimette)
Q: We’ve heard about cannabis-assisted psychotherapy. What are the benefits of integrating weed into therapy and how does it work?
A: It’s therapy where someone doses themselves in my office or right before they come in. We have a therapy session while the person is under the influence of cannabis.
Cannabis-assisted therapy is still an experimental treatment. I’m involved in psychedelic research being done by M.A.P.S. That stands for Multidisciplinary Association for Psychedelic Studies, and it’s a nonprofit research and educational group. One of the areas they’ve studied most extensively is the use of MDMA, or “ecstasy,” therapy for people dealing with PTSD [post-traumatic stress disorder].
I see cannabis as a psychedelic, or “mind-manifesting” substance, too, and it’s the only legal psychedelic substance that can be used in psychotherapy outside of a research setting or without a prescription. Therapy with a psychedelic substance can be healing, helping people process and move through really challenging emotions and memories that might otherwise feel intolerable.
On my own, I have studied how cannabis has been used in meditation or as a spiritual tool in different cultures. In my approach I’ve combined this study with my own experience of cannabis and my knowledge as a therapist involved in psychedelic research to offer this “alternative” treatment.
Q: Tell us how the therapy works.
A: For starters, I only practice this therapy with people who are experienced cannabis users, but not everyday users.
I follow the protocols established by M.A.P.S. [the Multidisciplinary Association for Psychedelic Studies]. There are three preparatory sessions where I meet with the client and discuss what they want to work on, the symptoms they’re experiencing, and any traumas they might want to process. During these prep meetings, we also discuss what the cannabis session will look like, including what strain they may want to use.
For the cannabis session itself, I suggest that people vape . It’s easier to manage dosage that way, and there’s a quicker onset and shorter duration than other methods of consumption. I don’t want people to leave my office super-medicated.
I recommend that people choose a cannabis strain that they feel comfortable with. What often works is a well-balanced hybrid blend . Ideally, I want people to both be in their bodies and get a bit of a head high as well.
Cannabis sessions are longer than a traditional therapy session, about two hours, so I can be with people the whole time they’re medicated or altered.
I might start the session by leading the client through some breathing exercises to get in touch with themselves and their breath, and then move on to meditation and visualization. We’ve likely talked in the preparation sessions about the types of things they might want to visualize. Perhaps they want to work on getting in touch with their inner child, or working through a painful incident from their childhood, so we’ll have talked about what those visualizations might look like.
I see cannabis as useful in both amplifying feelings and bringing to the surface unconscious memories, sensations and feelings. I think it can be especially helpful for someone who has a hard time accessing their feelings.
We know that cannabis can be an effective tool for managing anxiety or depression since it’s a euphoric and it can also help people relax. With cannabis-assisted therapy, however, I’m using it in a very different way — not to cover up depression or anxiety, but to get to the roots of what’s causing these states. In this way, it can accelerate therapy.
For people who are what I’d call really defended and who have a difficult time being vulnerable, cannabis can help them loosen up a bit so that they can access deeper parts of themselves in the presence of another person.
To facilitate going deep inside, I sometimes suggest that people put on an eye mask as a type of blindfold. We might sit for a while in silence or with music playing while they go inward. Afterwards, I’ll ask them to share an insight they had.
Q: What happens after this cannabis session? More marijuana-fueled therapy?
A: As a bookend to those three preparation sessions, there are three integration sessions. We talk about what happened during the cannabis session, how it felt different from talk therapy, the insights they gained, and most importantly, how to implement whatever insights were gained so they’re not lost.
Q: Are there additional sessions under the influence of weed?
A: Not generally. I use cannabis very, very sparingly as a tool for accessing deeper parts of ourselves. In a single session, I’ve seen people have some remarkable breakthroughs, especially during visualization. One person who didn’t get a lot of affection during childhood was able to visualize getting a hug as a child, and that was an emotional release and catharsis that was really powerful. They came to recognize how hard it had been to be without that affection from their parents and that they could still get it by offering it to themselves.
Q: Can people use marijuana as a therapy tool on their own?
A: I think we get caught up in a lot on unconscious patterns, and being in a room with someone who can reflect those patterns back to you is one of the things that makes therapy powerful. The relationship between therapist and patient, which can be transformative, would be lost if you tried cannabis therapy on your own.
That said, if I were to offer advice, I’d say you might want to experiment with changing your relationship with the plant. If you’ve been using cannabis consistently to dampen feelings, try using it instead as a tool for meditation, introspection, and insight.
Psychotherapist Uses Marijuana to Unlock the Mind If you’re a regular cannabis consumer, you’ve likely experienced what struck you as moments of piercing insight and emotional depth while you