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11 doctor focus cannapatientcare.com november/december 2022 | cannabis patient care reduced symptoms in 10 patients by an average of 28% after 8 weeks of treatment (24). Finally, a recent open-label study followed 2820 subjects who used one of 13 brands of CBD products (including Healer) over four weeks, and collected survey responses on pain, anx- iety, sleep, and quality of life. The results of those taking CBD products were compared with a control group of individuals on a wait list. Among those with anxiety, 46.6% of those us- ing a CBD product experienced a clinically relevant improve- ment in their anxiety score, compared to 19.6% in the wait list group (25). For some people, using a CBD-dominant preparation for anxiety may require fairly high doses, which can become cost-prohibitive. Though it hasn't been directly studied in hu- mans, my clinical observations also suggest cannabidiol- ic acid (CBDA) can help with anxiety, often at much lower dos- es than CBD. Some rodent data support this observation; one study found CBDA prevented the anxiety response to a specif- ic trigger at a dose of 1 μg/kg, while the dose of CBD required to achieve the same effect was 5000 μg/kg (26). This is likely because CBDA also impacts the same 5-HT1A serotonin recep- tor as CBD, but much more potently. When Cannabis Brings Trauma to the Surface Consistent with the often-observed paradoxical effects of cannabis, it's clear that for some people, at certain times, can- nabis can provoke the surfacing of long-ago buried traumatic memories. I've listened to many reports of adults who have had years or decades of a relationship with cannabis that has reduced trauma-related symptoms and permitted improved function and quality of life, and then something changes. Often suddenly, though sometimes gradually, cannabis begins doing the opposite, increasing anxiety and remembering or re-experi- encing traumatic memories. My understanding of the healing nature of cannabis and ob- servation of patients have always suggested that cannabis is more likely to have this effect when the individual becomes ready to heal the cause of the anxiety, usually trauma, and can ultimately derive more benefit from cannabis by address- ing the underlying cause than simply relieving symptoms. As our self-understanding and self-love develops and we culti- vate more supportive resources in our lives, our readiness to deal with the underlying trauma increases. My recent work with a modality called Psychedelic Somatic Interactional Psychotherapy (PSIP) (27) confirmed my hypoth- esis and provided a framework for taking advantage of can- nabis' capacity to encourage the surfacing of old trauma. PSIP is a model of trauma therapy based in-part on the concept that some traumatic events are so overwhelming that aspects or layers of our psyche become dissociated (checked-out) to more easily deal with the intense terror and anxiety. While this can be adaptive in the short-term, over time it limits our capacity to fully feel like and act like ourselves. As we move towards healing, self-acceptance, and loving relationships, these limitations may become more apparent bottlenecks in our ability to live fully, and eventually our health attempts to re-integrate the dissociated parts. Often, the process of reclaiming these lost parts of our- selves requires us to move from a comfortable but limited state of dissociation, back into the feelings of intense terror and anxiety associated with the trauma, and then finally back to a neutral, integrated state. The PSIP technique allows the soma (physical body) to express involuntary activity such as shaking, crying, vocalizations, and physically re-enacting as- pects of old trauma, which can be very helpful in proceed- ing through these uncomfortable feelings and back to whole- ness, instead of just visiting them and quickly retreating back into dissociation. Of all the psychedelic-like substances that can facilitate this healing process, cannabis appears to be the strongest and most effective at catapulting these dissociated parts into the often-uncomfortable light of healing. Strategies for Success The following tips can help people with anxiety or PTSD get the best results with cannabis. For those who are used to using only inhaled cannabis for anxiety, I strongly recommend becoming familiar with and finding your optimal dose of cannabis drops or another oral or oromucosal product. Healer. com offers complimentary dosage programs that guide users through a process that will help you find your individualized, optimal dose. • One of the most important strategies for success is to prevent symptoms, instead of chasing them around, with low to moderate oromucosal or oral dosing 2–3 times daily. Many patients do well with CBD-dominant prepara- tions in the daytime (10–50 mg per dose) and THC-dom- inant preparations before bed (5–25 mg). Many people also do well with THC-dominant preparations during the day, often at 1/4 to 1/3 of the dose required for sleep (such as 1–5 mg), which rarely causes any unwanted psy- choactivity or impairment, and can be more cost effec- tive than CBD for some. • For people who require high doses of CBD or don't find that CBD helps with anxiety in the doses they've tried, CBDA may provide better anti-anxiety results at much lower doses, for example, 5–20 mg. • Cannabigerol (CBG)-dominant preparations can be very effective for relieving and preventing anxiety and trau- ma-related symptoms, especially the physical manifes- tations of anxiety. I see responses at doses as low as 5 mg, though some do well with up to 40 mg per dose. • Low-dose inhaled cannabis can be extremely help- ful for breakthrough anxiety symptoms and, in the