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?
Should I choose cannabis with both THC and CBD?
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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