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Case Reports
. 2023 Feb 9:14:1051542.
doi: 10.3389/fpsyt.2023.1051542. eCollection 2023.

Cannabis-assisted psychotherapy for complex dissociative posttraumatic stress disorder: A case report

Anya Ragnhildstveit  1   2   3 , Miriam Kaiyo  1   4 , Matthew Brian Snyder  1 , Laura Kate Jackson  1 , Alex Lopez  1 , Chasity Mayo  1 , Alyssa Claire Miranda  1   5 , River Jude August  1   4 , Paul Seli  3 , Reid Robison  6   7 , Lynnette Astrid Averill  8   9   10   11
Affiliations
Case Reports

Cannabis-assisted psychotherapy for complex dissociative posttraumatic stress disorder: A case report

Anya Ragnhildstveit et al. Front Psychiatry. .

Abstract

Background: A dissociative subtype of posttraumatic stress disorder, known as "D-PTSD", has been included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. In addition to meeting criteria for PTSD, patients endorse prominent dissociative symptoms, namely depersonalization and derealization, or detachment from one's self and surroundings. At present, this population is supported by a highly heterogeneous and undeveloped literature. Targeted interventions are therefore lacking, and those indicated for PTSD are limited by poor efficacy, delayed onset of action, and low patient engagement. Here, we introduce cannabis-assisted psychotherapy (CAP) as a novel treatment for D-PTSD, drawing parallels to psychedelic therapy.

Case presentation: A 28-year-old female presented with complex D-PTSD. In a naturalistic setting, she underwent 10 sessions of CAP, scheduled twice monthly over 5 months, coupled with integrative cognitive behavioral therapy. An autonomic and relational approach to CAP was leveraged, specifically psychedelic somatic interactional psychotherapy. Acute effects included oceanic boundlessness, ego dissolution, and emotional breakthrough. From baseline to post-treatment, the patient showed a 98.5% reduction in pathological dissociation, as measured by the Multidimensional Inventory of Dissociation, no longer meeting criteria for D-PTSD. This was accompanied by decreased cognitive distractibility and emotional suffering, as well as increased psychosocial functioning. Anecdotally, the patient has sustained improvements for over 2 years to date.

Conclusions: There is urgency to identify treatments for D-PTSD. The present case, while inherently limited, underscores the potential of CAP as a therapeutic option, leading to robust and sustained improvement. Subjective effects were comparable to those produced by classic and non-classic psychedelics, such as psilocybin and ketamine. Further research is warranted to explore, establish, and optimize CAP in D-PTSD, and to characterize its role in the pharmacological landscape.

Keywords: cannabis; cannabis-assisted psychotherapy; case report; dissociation; medicinal cannabis; posttraumatic stress disorder; trauma; treatment.

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Conflict of interest statement

AR is the Founding Director of the Integrated Research Literacy Group. RR serves as Chief Clinical Officer of Numinus Wellness, and is an equity holder in the company. LA serves as a Consultant, Speaker and/or Advisory Board Member for Guidepoint, Transcend Therapeutics, Beond, Source Research Foundation, Reason for Hope, and Ampelis. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Timeline of clinical events. The patient received 10 CAP sessions, scheduled twice monthly, two-to-three weeks apart, as a treatment for complex D-PTSD. An autonomic and relational approach to psychotherapy was leveraged, namely PSIP. Each CAP session was accompanied by CBT, using the ACE model for integration, to decode experiential phenomena. CBT sessions occurred within 1 week of CAP. ACE, accept, connect, and embody (psychotherapy); CAP, cannabis-assisted psychotherapy; CBT, cognitive behavioral therapy; D-PTSD, dissociative posttraumatic stress disorder; M, month; MID, multidimensional inventory of dissociation; PSIP, psychedelic somatic interactional psychotherapy; S, session; Tx, treatment.
Figure 2
Figure 2
Treatment framework. In line with the PSIP model, CAP involved three criteria: surfacing, resourcing, and dosing. Surfacing readied the patient for treatment, integrating experiences from prior sessions, excluding the first one. Resourcing grounded the patient before and after treatment, comprising mindfulness and nervous system regulation. Dosing included cannabis and psychotherapy, as an interactive treatment, targeting dissociative symptoms and interpersonal trauma. CAP, cannabis-assisted psychotherapy; PSIP, psychedelic somatic interactional psychotherapy.
Figure 3
Figure 3
Change in scoring on the MID. From baseline to post-treatment, following all CAP and CBT sessions, the patient showed a robust improvement in clinically significant dissociative symptoms, no longer meeting criteria for D-PTSD. CAP, cannabis-assisted psychotherapy; D-PTSD, dissociative posttraumatic stress disorder; MID, multidimensional inventory of dissociation; RD, reduction.
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