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

Abstract

BackgroundA 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 presentationA 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.ConclusionsThere 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.

The Montreal model: an integrative biomedical-psychedelic approach to ketamine for severe treatment-resistant depression

“…Namely, drug experiences are not seen as treatment side-effects, but rather as essential drivers of potential benefits ( 80 ). While some experts reserve the psychedelic label specifically for agonists of serotonin 2A receptors like psilocybin ( 81 ), psychedelic treatment models have been utilized with diverse psychoactive drugs including MDMA ( 82 ), ibogaine ( 83 ), and cannabis ( 84 ), in addition to ketamine.…”

The potential of 5‐methoxy‐N,N‐dimethyltryptamine in the treatment of alcohol use disorder: A first look at therapeutic mechanisms of action

“…48 Most recently, a retrospective online survey (n = 160) demonstrated that the reduction in alcohol consumption was significantly associated (p = 0.03) with the intensity of the mystical experience. 49 Furthermore, survey studies demonstrate that the 5-MeO-DMT-induced mystical experience is associated with improvements in symptoms of depression, 47,50 post-traumatic stress disorder (PTSD), 47,51,52 and anxiety. 47,50 This indicates that 5-MeO-DMT could alleviate psychiatric mood-related comorbidities that are highly prevalent in AUD.…”

“…Furthermore, survey studies demonstrate that the 5‐MeO‐DMT‐induced mystical experience is associated with improvements in symptoms of depression, 47,50 post‐traumatic stress disorder (PTSD), 47,51,52 and anxiety 47,50 . This indicates that 5‐MeO‐DMT could alleviate psychiatric mood‐related comorbidities that are highly prevalent in AUD 92 .…”

Open MDMA: An Open Source Framework and Practical Guide for the Therapeutic use of MDMA

“…• Psychedelic Somatic Interactional Psychotherapy (PSIP): Though rigorous trials have not yet been done, we think this method shows particular promise for reducing panic or dissociation that impede typical therapeutic methods [128,126]. In this method, a small dose of THC or ketamine is used to directly engage with, and process, the hyper or hypo-activated defense cascade.…”