Targeting the Endocannabinoid System in the Treatment of Posttraumatic Stress Disorder: A Promising Case of Preclinical-Clinical Translation?
Leah M Mayo, Christine A Rabinak, Matthew N Hill...
https://pubmed.ncbi.nlm.nih.gov/34598785/Actively Recruiting
Led by Wayne State University · Updated on 2026-03-09
90
Participants Needed
1
Research Sites
N/A
Total Duration
Researchers are evaluating the use of FDA-approved cannabidiol EPIDIOLEX4 combined with cognitive behavioral therapy CBT for treating adults aged 18 to 45 with generalized anxiety disorder GAD. This randomized, double-blind, placebo-controlled trial aims to see if adding cannabidiol to CBT improves emotion regulation by activating the dorsomedial prefrontal cortex dmPFC and reduces anxiety symptoms compared to CBT with a placebo. Participants are randomly assigned to one of four groups brief CBT with moderate-dose cannabidiol, brief CBT with low-dose cannabidiol, brief CBT with placebo matched to moderate-dose cannabidiol, or brief CBT with placebo matched to low-dose cannabidiol. The moderate-dose cannabidiol group starts at 5 mgkgday and increases to 10 mgkgday after 6 days, while the low-dose group stays at 5 mgkgday. All treatments last 5 weeks, and the placebo groups receive matching solutions resembling cannabidiol. During the study, participants undergo brain scans using functional MRI to measure dmPFC activation during emotion regulation tasks before and after treatment. Researchers also assess anxiety symptom severity, treatment tolerability, and plasma levels of cannabidiol and related biomarkers. The primary outcome is the change in dmPFC activation from baseline to post-treatment around week 5, with various secondary brain activation and symptom measures recorded during the same period.
CONDITIONS
Cannabidiol-Assisted Learning for Managing Generalized Anxiety Disorder
H
Hilary Marusak, PhD
C
Christine Rabinak, PhD, MBA
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Wayne State University
Lead Sponsor
National Institute of Mental Health (NIMH)
Collaborating Sponsor
This table compares participation in this trial with other options available for this condition. The information is drawn from published research and the trial’s study details and is provided for educational purposes only.
| Factors | Brief CBT + Moderate-Dose Cannabidiol (EPIDIOLEX®) | Brief CBT + Low-Dose Cannabidiol (EPIDIOLEX®) | Brief CBT + Placebo Matched to Moderate-Dose Cannabidiol | Brief CBT + Placebo Matched to Low-Dose Cannabidiol |
|---|---|---|---|---|
| What it is | Combination of brief cognitive behavioral therapy and oral cannabidiol solution, titrated from 5 mg/kg/day to 10 mg/kg/day, for adults with generalized anxiety disorder. | Combination of brief cognitive behavioral therapy and oral cannabidiol solution at a constant low dose (5 mg/kg/day), for adults with generalized anxiety disorder. | Brief cognitive behavioral therapy combined with a placebo solution mimicking moderate-dose cannabidiol dosing, titrated from 5 to 10 mg/kg/day. | Brief cognitive behavioral therapy combined with a placebo solution mimicking low-dose cannabidiol dosing, constant at 5 mg/kg/day. |
| Role in trial | Investigational arm assessing whether moderate-dose cannabidiol enhances effects of CBT for GAD. | Investigational arm assessing whether low-dose cannabidiol enhances effects of CBT for GAD. | Comparator arm testing placebo effects relative to moderate-dose cannabidiol adjunct to CBT. | Comparator arm testing placebo effects relative to low-dose cannabidiol adjunct to CBT. |
| Primary use | To test whether moderate-dose cannabidiol plus CBT improves emotion regulation and anxiety symptoms in adults with GAD, measured by brain activation changes and symptom scores. | To test whether low-dose cannabidiol plus CBT improves emotion regulation and anxiety symptoms in adults with GAD, measured by brain activation changes and symptom scores. | To test CBT plus a placebo solution titrated to match moderate-dose schedule for effects on emotion regulation and anxiety symptoms. | To test CBT plus a placebo solution titrated to match low-dose schedule for effects on emotion regulation and anxiety symptoms. |
| How it is given or performed | Cannabidiol solution taken orally, divided twice daily alongside brief CBT sessions. Dosing starts at 5 mg/kg/day and titrates to 10 mg/kg/day after 6 days. | Cannabidiol solution taken orally, divided twice daily alongside brief CBT sessions, maintained at 5 mg/kg/day throughout. | Placebo solution administered orally, divided twice daily to mimic the moderate-dose cannabidiol titration schedule. | Placebo solution administered orally, divided twice daily to mimic the low-dose cannabidiol schedule. |
| Evidence status | Cannabinoid modulation of brain circuits related to negative affect and stress regulation has been observed in prior clinical and neuroimaging studies, but established efficacy for cannabidiol plus CBT in GAD is not yet determined. Published studies describe effects in related anxiety disorders and PTSD populations. | Clinical and neuroimaging studies suggest cannabinoid effects on emotion regulation and stress circuits, but efficacy for low-dose cannabidiol plus CBT in GAD is not established. Prior work demonstrates dose-related effects in anxiety-related populations; no consensus on optimal dose. | Placebo effects in adjunctive CBT for GAD are evaluated as a control for active drug effects; no external published evidence for efficacy of placebo plus CBT, but trial controls for expectancy and blinding. | Placebo effects in adjunctive CBT for GAD are evaluated to control for active drug and expectancy effects; no external published evidence for efficacy of placebo plus CBT, but trial controls for blinding. |
| Important limitations | Moderate-dose cannabidiol is investigational for GAD, and prior studies focus on related anxiety disorders or PTSD. Optimal dosing and long-term safety in generalized anxiety disorder are not established in published literature. | Low-dose cannabidiol is investigational and its effects for GAD are uncertain. Dose-response relationships and efficacy for emotion regulation are not confirmed in randomized studies for this population. | Placebo arms ensure blinding and expectation control, but do not provide active pharmacological support for anxiety symptoms. | Placebo arms are essential for blinded randomized comparison, but do not add active drug effects or independent symptom management in GAD. |
Disclaimer: This comparison is created with the help of artificial intelligence(AI) and may contain errors or missing information. It is not medical advice and does not mean one option is better or safer than another. Clinical trials are still being studied, and joining a trial is your choice. Please consult your healthcare professional before making any decisions.
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Duration - 2 to 4 weeks
Participants are screened for eligibility to participate in the trial.
1 visit (in-person)
Duration - 5 weeks
Participants receive a 5-week course of brief cognitive behavioral therapy combined with oral cannabidiol or placebo. Dosing may start at a low dose and titrate to a moderate dose depending on the assigned group. The treatment targets emotion regulation and symptom improvement.
Weekly visits for 5 weeks
Study Type
INTERVENTIONAL
Masking
QUADRUPLE
Allocation
RANDOMIZED
Model
PARALLEL
Primary Purpose
TREATMENT
Number of Arms
4
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https://pubmed.ncbi.nlm.nih.gov/39412674/Wayne State University
Lead Sponsor
National Institute of Mental Health (NIMH)
Collaborating Sponsor