Quick Clips with Dr. Kilmer: 11. Anxiety, Expectancy, Placebo Effects, and Cannabis

In this series we talk with Dr. Jason Kilmer, professor of psychiatry and behavioral sciences at the University of Washington School of Medicine. He specializes in the development, implementation, and evaluation of substance use prevention and intervention efforts on college campuses and among 18–25 year olds.   

While Dr. Kilmer focuses on college campuses, his insights are universal and particularly helpful for parents with teenagers of any age. Share these recordings with your parenting peers as you all navigate this exciting time in human development (ages 14–25) and work to help your kids navigate away from alcohol and other drugs.

This podcast is brought to you by the Substance Abuse and Mental Health Services Administration (SAMHSA). The views expressed here are not necessarily those of SAMHSA or the U.S. Department of Health and Human Services. For questions or comments about this podcast, please contact WhatParentsAreSaying@gmail.com. 

Transcript

Quick Clips with Dr. Kilmer: 11. Anxiety, Expectancy, Placebo Effects, and Cannabis

[00:00:00] Debbie: Welcome to Quick Clips with Dr. Kilmer. Dr. Kilmer, you had more thoughts on the placebo effect and several on anxiety. Can you talk to us about that and maybe a little bit more about Dr. Mart's research? 

[00:00:20] Dr. Kilmer: One of the things that I think that's important to look about is that while we talk about the balanced placebo research, as we discuss alcohol and social effects, is how important it's to keep doing placebo research.

[00:00:32] One of the areas that we've seen some pretty exciting work come out is about cannabis and placebo effects because there are placebo effects there as well. There's been research that's been done where people are told they're getting an edible that is high, THC. They're all people that use cannabis. They all sign a consent form and say, if you give me cannabis, I get permission for that.

[00:00:53] But they actually are given a cannabis free product. They don't know that though. They're told they're getting it. They have people rate their mood, they have people rate how high they feel, and they do that immediately after finishing the edible, as well as at the 30 minute mark and the 60 minute mark, they find that there's a statistically significant decrease in negative mood.

[00:01:12] Even though people get nothing at all, there's even a statistically significant increase in people reporting that they feel high, even though they got a substance that wasn't psychoactive. One study was a, in quote, double blind experiment. What does that mean? You eliminate expectancies? People don't know what they're taking and the person bringing it to them does not know what they're bringing them.

[00:01:34] So there's no like wink, wink. Have fun with this condition opportunity. There was a brilliant study done by A and Dewitt where they asked people to be their own control group. They all signed a consent form and said, I agree to take something that could include CBD. There were four conditions, placebo 300 milligrams of CBD orally, 600 milligrams of CBD orally.

[00:02:00] Wait for it. 900 milligrams of CBD orally. Wow. They then counterbalance the order so that there weren't practice effects at play, and they would have people take something but they didn't know what they were taking, and then go through tasks that induced unwanted mood or affect. They got them upset, they got them anxious when people didn't know what they were getting.

[00:02:21] What did CBD do? Nothing. 

[00:02:25] Debbie: Wow. 

[00:02:25] Dr. Kilmer: There was no impact on reducing anxiety, which is what people sometimes report using it for. Yeah. 

[00:02:31] Debbie: Yeah. 

[00:02:32] Dr. Kilmer: And I don't want anyone to mishear me. I'm not saying CBD does nothing, period. There's some research that looks at the potential role of medical cannabinoids for, you know, certain medical conditions, but if someone says, I'm really, really anxious, and someone goes, here, take this.

[00:02:46] It'll help. It'll probably help because there's expectancy effects, right? The key is the science showing it's not having the impact that people would like. And so, you know, the world can be anxiety provoking, right? And so when someone says, I'm really anxious, it's identifying coping strategies that will work, particularly since the science is starting to show pretty compellingly that some of the products that people are hoping will help aren't having the desired impact on things like anxiety.

[00:03:12] Debbie: Right. And it sounds like CB D's not having the reverse impact, it's having more No impact. You know, there's other drugs that have the reverse impact and that, that makes you more anxious. 

[00:03:25] Dr. Kilmer: Mm-hmm. 

[00:03:27] Debbie: But to your point of placebo effect, yeah. Just thinking of that as a parent. Mm-hmm. And in some ways it's, it's kind of encouraging, you know, that let, let's look for underlying.

[00:03:46] Issues or concerns and or skill sets that my kid might be missing. And let's try and come up with skills that address emotional regulation and sense of anxiety, social, you know, and really do that stuff. And. I don't know. I feel more empowered, I guess, thinking about it. Like there's some things I could do in, instead of just waiting for my child to start drinking or drugging and then freaking out about that.

[00:04:13] Dr. Kilmer: I love how you said that, and you're very, very right there. There are things that can be done. It's, you know, I, when I was on working on my PhD, I was on internship. I had a supervisor that was very influential for me, that pointed out that one of the hardest things he hears people say is they say, well, I never want anxiety again.

[00:04:30] He's like, that's not what we wanna, that that would be a bad thing to root for. If you had no anxiety, you would never pay bills on time. You'd never study for tests, right? 

[00:04:38] Debbie: Yeah. 

[00:04:38] Dr. Kilmer: Some anxiety's. Okay. Yeah. When people say, I, I hope I'm never, ever angry, you'd be walked all over anger's. Okay? It's how it's expressed and what it does to us and what it does to people around us.

[00:04:49] And so the key is when we get anxious, do we have a method of coping with it? When we get angry, do we have a method of coping with it? And so you're very, very right that the power. That parents have, and if you don't like how you feel, what's gonna help you feel better? What's going to make a difference?

[00:05:04] Yeah, it can be as simple as let's go outside and do something. It could be something that's, you know, more complex than that, but um, especially if people say, well, I'm gonna use substances to cope, as you pointed out, sometimes they can actually worsen the very symptoms someone's trying to cope with.

[00:05:21] Additionally, it just may not have the impact that the person's rooting for. 

[00:05:26] Debbie: That's great. Thank you, Dr. Kilmer. 

[00:05:29] Dr. Kilmer: Thank you. Thanks for doing what. 

[00:05:31] Debbie: We want to remind listeners that talk they Hear You materials, including this podcast, can be found at the Talk They Hear You website. That is Talk they hear you.samhsa.gov.

[00:05:43] This podcast is brought to you by the Substance Abuse and Mental Health Services Administration Talk. They Hear You is a national prevention campaign that aims to help parents and caregivers talk with their kids about the dangers and risks of underage drinking and other drug use. As a reminder, the views expressed here are not necessarily those of SAMHSA or the US Department of Health and Human 

[00:06:05] Services.