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Study breakdown

Cannabis with equal THC and CBD causes less anxiety than THC alone, especially in calm users

Randomized Controlled TrialStrong evidence
The takeaway

In a placebo-controlled study of 26 recreational users, vaporized cannabis with equal THC and CBD produced significantly less anxiety than THC-dominant cannabis, with CBD fully counteracting THC anxiety in people with low baseline anxiety.

Cannabis consumers concerned about anxiety, clinicians recommending cannabis products, and regulators considering THC/CBD ratio requirements.

CBD fully counteracted THC anxiety when baseline anxiety was low

What the researchers found

Both THC and THC/CBD increased state anxiety compared to placebo, but anxiety after THC/CBD was significantly lower than after THC alone. When baseline anxiety was low, CBD completely counteracted THC-induced anxiety. When baseline anxiety was high, CBD did not counteract THC-induced anxiety. THC-induced anxiety was independent of baseline anxiety levels.

Why it matters

As cannabis products vary widely in THC-to-CBD ratios, this study provides direct evidence that balanced products may produce less anxiety, which could inform both product selection and regulation.

The numbers in context

26 participants. 13.75 mg THC and/or 13.75 mg CBD per condition. THC/CBD produced significantly less state anxiety than THC alone. CBD fully counteracted THC anxiety when baseline anxiety was low, but not when it was high.

How the study worked

Placebo-controlled, randomized, within-subjects study of 26 healthy recreational cannabis users. Four conditions: vaporized THC-dominant (13.75 mg THC), CBD-dominant (13.75 mg CBD), THC/CBD-equivalent (13.75 mg each), and placebo. Anxiety measured by STAI, visual analogue scale, and emotional Stroop task.

What this study cannot tell us

Small sample (26 participants). Single-dose study may not reflect repeated use. Recreational users with low tolerance may respond differently than daily users. No effects detected on the objective emotional Stroop task.

How to read the evidence

Placebo-controlled, randomized, within-subjects design with validated anxiety measures, though small sample size.

When this study was published

Published in 2022.

The bigger picture

The finding that baseline anxiety moderates whether CBD can counteract THC-induced anxiety explains some of the conflicting results in the literature and suggests that individual factors determine who benefits from balanced products.

Questions still open

  • Could screening for baseline anxiety help predict who will benefit from balanced THC/CBD products? Does the CBD protective effect persist with repeated use?

Common questions

Does CBD reduce THC anxiety?
In this study, cannabis with equal THC and CBD produced significantly less anxiety than THC alone. CBD fully counteracted THC-induced anxiety in people with low baseline anxiety, but not in those who were already anxious.
Should I choose cannabis with both THC and CBD?
This study found that balanced THC/CBD cannabis produced less anxiety than THC-dominant cannabis, but the protective effect of CBD depended on the user's baseline anxiety level.

Read the original research

Cannabis containing equivalent concentrations of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) induces less state anxiety than THC-dominant cannabis.

Psychopharmacology, 239(11), 3731-3741

Citation

Hutten, Nadia R P W; Arkell, T R; Vinckenbosch, F; Schepers, J; Kevin, R C; Theunissen, E L; Kuypers, K P C; McGregor, I S; Ramaekers, J G. (2022). Cannabis containing equivalent concentrations of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) induces less state anxiety than THC-dominant cannabis.. Psychopharmacology, 239(11), 3731-3741. https://doi.org/10.1007/s00213-022-06248-9

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