Cannabidiol and Prolonged Exposure (CBD-PE)

Cannabidiol as an Adjunctive to Prolonged Exposure for the Treatment of PTSD

The trial will include a randomized control trial to evaluate the efficacy of using Cannabidiol (CBD), a non-intoxicating cannabinoid, as an adjunctive to Prolonged Exposure therapy (PE). The trial will compare PE + CBD to PE + placebo in a sample of 136 military Veterans with PTSD at the VA San Diego Medical Center. The study represents the logical and innovative next step for augmenting existing treatments and developing novel pharmacotherapy for PTSD. Findings from the proposed RCT will inform clinical practice and policy by investigating whether administration of CBD in the context of PE therapy will improve treatment outcomes for military Veterans with PTSD.

Study Overview

• Status: Completed
• Conditions: PTSD
• Intervention / Treatment: Behavioral: Prolonged Exposure; Drug: Cannabidiol; Drug: placebo

Detailed Description

Prolonged exposure therapy (PE) is among the most efficacious treatments for PTSD and is designated as a VA/DoD frontline treatment. However, PE does not always lead to clinically meaningful symptom reductions in Veterans with PTSD. Successful PE treatment relies on extinction learning, which is often impaired in patients with PTSD. Cannabidiol (CBD) is a non-intoxicating phytocannabinoid. Administration of specific phytocannabinoids, like CBD, increase extinction learning in patients with PTSD, and could increase the speed and effectiveness of PE therapy. CBD also modulates 5-HT1A, which may directly improve hyperarousal/insomnia symptoms, and improve engagement and retention in treatment. Given these findings, adjunctive administration of CBD+PE could improve response rates to PE and reduce the number of sessions of PE needed to reach clinically meaningful change. The proposed study is designed to test the efficacy of using CBD in conjunction with PE for the treatment of PTSD in US Military Veterans. A randomized, controlled, double-blind study will compare Veterans who receive PE+CBD to PE+placebo. Participants will include 136 male and female Veterans from all service eras with PTSD. The primary hypothesis is that PE+CBD will reduce PTSD symptoms to a greater degree than PE+placebo.

• Study Type: Interventional
• Enrollment (Actual): 136
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • California
    • San Diego, California, United States, 92161-0002
      • VA San Diego Healthcare System, San Diego, CA

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Over the age of 18 at the time of screening.
• Judged by the study physician to be in generally good health.
• Meet clinical criteria for Posttraumatic Stress Disorder (PTSD) on the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5).
• Negative urine pregnancy test.

Exclusion Criteria:

• History of significant allergic condition, significant drug-related hypersensitivity, or allergic reaction to cannabinoids.
• Used cannabis, synthetic cannabinoid, cannabinoid analogue, or any CBD or THC-containing product within 30 days of eligibility screening.
• Patient has had a change in psychopharmacotherapy regimen in the last 4 weeks, or has any plans to change regimen over the course of the study.
• Patient is engaged in trauma-related psychotherapy for PTSD.
• Current or past DSM-5 diagnosis of dissociative identity disorder, eating disorder with active purging, personality disorders, primary psychotic disorder, or bipolar affective disorder type 1.
• Patient is currently prescribed medications with possible CBD-drug interactions.
• History of actual suicide attempt in the last 5 years.
• Unmanaged obstructive sleep apnea.
• Positive drug screen for THC, barbiturates, amphetamines (if not prescribed), benzodiazepines, and/or opiates.
• History of treatment for, or evidence of, moderate to severe alcohol or drug abuse within the past year or regular alcohol consumption exceeding recommended limits.
• Lifetime history of Cannabis Use Disorder.
• Pregnant or breastfeeding.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Prolonged Exposure + Cannabidiol; Psychotherapy plus active medication	Behavioral: Prolonged Exposure; psychotherapy; Other Names: PE; Drug: Cannabidiol; active medication; Other Names: CBD
Active Comparator: Prolonged Exposure + Placebo; Psychotherapy plus placebo medication	Behavioral: Prolonged Exposure; psychotherapy; Other Names: PE; Drug: placebo; non-active medication

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clinician-Administered PTSD Scale DSM 5 (CAPS-5)	Change in PTSD Symptoms will be assessed by change in Total Severity Score (summed severity ratings on items 1-20) on the Clinician-Administered PTSD Scale DSM 5 (CAPS-5); CAPS-5 Total Severity scores range from 0 to 80; Higher scores indicate higher severity.	Baseline, Post Treatment (16-weeks), 1-Month Follow-up (20-weeks), 3-Month Follow-up (28-weeks)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
PTSD Checklist (PCL-5)	Rate of PTSD symptom reduction will be assessed by comparing the time-to-event of clinical response to treatment. The time-to-event is defined by number of PE sessions completed before patient achieves a 10-point reduction from baseline in total (summed) PTSD Checklist scores (PCL-5). PCL-5 Total Scores range from 0 to 80; Higher scores indicate worse functioning.	Baseline, Weekly (up to 16-weeks)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
UKU Side Effects Rating Scale, Patient Version (UKU-SERS-Pat)	Total Adverse Events (AEs) will be tallied numerically by condition using the UKU Side Effects Rating Scale, Patient Version (UKU-SERS-Pat)	Weekly (up to 16 weeks)

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Collaborators: University of California, San Diego
• Investigators: Principal Investigator: Catherine R Ayers, PhD, VA San Diego Healthcare System, San Diego, CA; Principal Investigator: Brian Martis, MD, VA San Diego Healthcare System, San Diego, CA

Study record dates

Study Major Dates

• Study Start (Actual): October 1, 2019
• Primary Completion (Actual): September 30, 2025
• Study Completion (Actual): September 30, 2025

Study Registration Dates

• First Submitted: April 16, 2018
• First Submitted That Met QC Criteria: April 25, 2018
• First Posted (Actual): May 8, 2018

Study Record Updates

• Last Update Posted (Actual): May 8, 2026
• Last Update Submitted That Met QC Criteria: May 6, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: PTSD; Veterans; CBD; cannabidiol
• Additional Relevant MeSH Terms: Trauma and Stressor Related Disorders; Mental Disorders; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic; Organic Chemicals; Hydrocarbons; Terpenes; Cannabinoids; Cannabidiol
• Other Study ID Numbers: MHBB-001-17F

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No