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Trauma is a generic term that describes a range of conditions. The America Psychological Society has defined trauma as “an emotional response to a terrible event, including natural disasters, accidents, and rape.” Many studies have interestingly connected trauma with both emotional disturbances and physical injuries. The response to traumatic events can also vary greatly. In some individuals, the response reported may include flashbacks, shock, and unstable emotions. In others, feelings of anxiety, depression, or fright may present with physical responses ranging from persistent headaches to system organ failure.
Depending on the frequency of symptoms, people who have been exposed to traumatic conditions can be diagnosed with post-traumatic stress disorder (PTSD). The Anxiety and Depression Association of America holds that the frequency of symptom recurrence must be up to one month before a PTSD diagnosis can be considered. In essence, PTSD is characterized by three main types of symptoms. Patients may re-experience trauma through distressing recollections, or they may experience increased mental activity causing difficulty concentrating and maintaining a normal sleep cycle. Patients may also feel emotional numbness and avoidance of events, places, people, and activities associated with the trauma.
In modern medicine, the new guideline of the National Institute for Clinical Excellence for the management of PTSD is considered a gold standard in diagnosis and care plan designing. According to this guideline, patients who present symptoms, including sleep problems, flashbacks, and emotional liability, for less than one month after trauma should be closely observed. Management should intervene only when patients show symptoms like depression, suicidal tendencies, addiction, and dissociative disorders. Epidemiological studies have indicated that women are more predisposed to PTSD. PTSD is widely believed to be caused by a deregulation of the fear system following a traumatic event. Dysfunctional regulation of the fear system causes increased alertness and exaggerated response to trauma cues in subsequent time frames following a traumatic event.
Conventional trauma treatment models
The incidence rate of PTSD has increased globally over the last decades. PTSD presents with a number of symptoms, and mental health experts have designed an extensive therapy modality for its management. Currently, cognitive behavior therapy is considered the gold standard for the management of PTSD. Cognitive behavior therapy can involve different sessions of cognitive restructuring and exposure therapy.
Exposure therapy typically involves imaginary exposure of the patient to the triggers of the traumatic events in a safe way. Safe exposure to traumatic triggers can be done with imagining, writing about, or visiting locations associated with the trauma. This therapy is usually an efficient way to recalibrate the body’s fear regulation system.
Cognitive restructuring involves reconditioning the patient’s orientation about the trauma. Mental health therapists simply help PTSD patients make sense of the trauma by remembering it differently.
Drug therapy is also available for the symptomatic treatment or for patients who are not improving with cognitive behavior therapy sessions.
Role of the endocannabinoid system in trauma onset and management
In an attempt to better understand trauma and the complex circuitry responsible for its onset and development, scientists have consistently investigated the functions of cannabinoids in trauma patients. In 2013, researchers from the NYU Langone Medical Center conducted brain-imaging studies in patients with a confirmed diagnosis of PTSD. Using a participant pool of 60 patients, the researchers discovered a connection between the quantity of CB1 receptors in the brain and post-traumatic stress disorder.
Research results indicated that patients with PTSD, especially women, expressed increased concentration of CB1 receptors in brain regions associated with fear and anxiety. In essence, this first-of-its-kind inquiry suggested that the endocannabinoid system can be a possible drug target for the management of PTSD and trauma-related impairments.
There is much anecdotal evidence suggesting that marijuana helps patients deal with PTSD. Different independent inquiries have established the role of the endocannabinoid system in cognition, memory formation, and neuronal transmission. Currently, there are emerging interests in the endocannabinoid-mediated modulation of emotionality. These studies are focused on establishing a possible link between the endocannabinoid system and fear memory.
In a study published in Nature, researchers established that the genetic deletion of the CB1 receptor impaired auditory-conditioned fear. Although the details of the study are complex, it established a central role for endocannabinoids in the blockage of fear memory. In all studies investigating a link between trauma and the endocannabinoid system, results have shown that the endocannabinoid components are altered in PTSD, and region-specific brain changes are common in advanced stages of the disorder.
Potential benefits of cannabidiol in the management of trauma
- Cannabidiol reduces the frequency of trauma flashbacks and nightmares.
The Anxiety and Depression Association of America recognized trauma flashbacks, nightmares, and emotional detachments as some of the principal symptoms of PTSD. Any symptomatic treatment is expected to reduce the frequency of these symptoms in addition to improving a patient’s quality of life. In 2009, CNS Neuroscience and Therapeutics published the reports of a reference study investigating the management of treatment-resistant nightmares in PTSD. The clinical study involved treating 47 PTSD patients with a synthetic cannabinoid, Nabilone. At the end of the study, 28 patients experienced total cessation of nightmares, and another six patients reported a satisfactory reduction in the frequency of nightmares. Some patients, however, experienced nightmare recurrence on withdrawal of Nabilone.
- Cannabidiol blocks the formation of fear memories.
This is perhaps an important therapeutic benefit of cannabidiol for patients with PTSD. Emotional and physical triggers of fear memory have been linked to the reoccurrence of trauma events in patients with PTSD. To help these patients, therapy must be aimed at blocking the fear memory processing cycle associated with trauma. Experiments in animal models of PTSD have confirmed that the endocannabinoid system plays a central role in the extinction of aversive memories and can be exploited to block the retention of trauma memories.
- Cannabidiol reduces anxiety and depression in PTSD patients.
PTSD patients also experience a repeated cycle of anxiety and depression episodes. Anecdotal reports from long term cannabis users have suggested that cannabinoids can effectively induce a characteristic calming effect that reduces panic attacks, compulsiveness, and manage depression. In 2015, Neurotherapeutics published the report of a review studying the therapeutic benefit of cannabidiol in the treatment of anxiety disorders. Available clinical evidence now suggests that at oral doses ranging from 300-600mg, cannabidiol effectively manages anxiety, enhances fear extinction, and reduces the severity of symptoms connected with depression.
- Cannabidiol helps manage sleep disorders.
For a long time, sleep disorders have been a conventional indication of cannabis and cannabis-derived products. This treatment option is balanced in the biological role of the endocannabinoid system in the regulation of the sleep-wake cycle. Different studies have provided research evidence suggesting that cannabidiol can improve the quality and quality of sleep. The Journal of Chemistry and Biodiversity published a report on the benefits of cannabis in the management of pain and sleep disorders based on research results from clinical trials of Sativex—a cannabinoid-based drug. This study reported no tolerance to the benefits of Sativex as a sizable percentage of the subjects reported an enhancement of sleep quality.
Cannabidiol has shown impressive results in the management of trauma. Since no single standard drug treatment plan exists for PTSD, many experts are currently experimenting with cannabidiol in an integrative therapy approach for trauma management. It is advisable that cannabidiol should only be used in PTSD patients under medical supervision.