Introduction

Social anxiety disorder (SAD) affects millions of individuals worldwide, leading to extreme feelings of fear or discomfort in social settings. Individuals with SAD often struggle with the fear of being judged or humiliated, making it difficult for them to navigate day-to-day life. Traditional treatments include therapy and medications, however, there is growing evidence and support for alternative therapies, In particular, cannabidiol (CBD) is being explored for its potential to alleviate symptoms of social anxiety. CBD has fewer side effects compared to most pharmaceutical options, however, more scientific research is necessary to fully understand the biological mechanisms behind the effects and identify any long-term side effects. This article provides an overview of SAD, CBD, and some recent studies that examine how CBD may help individuals manage social anxiety.

Social anxiety

Social anxiety disorder (SAD), or social phobia, is when a person feels overwhelming feelings of fear or anxiety in certain situations such as public speaking, job interviews, or interaction with people in normal day-to-day settings.¹ It often stems from a fear of being humiliated or judged by others. These feelings can be so strong that individuals struggle with daily tasks, preventing them from living a ‘normal’ life.

Signs that someone may have SAD include extreme blushing or sweating, increased heart rate, difficulty making eye contact, and nausea when confronted with, or the complete avoidance of, social situations. It is possible that this type of anxiety can have a genetic background, but this is often in combination with environmental factors. Additionally, SAD is more common in women than men.¹ 

Usual treatment for SAD includes speaking to a mental health professional to receive a formal diagnosis. The individual can then seek further treatment such as cognitive behavioural therapy (CBT) or medication including beta-blockers, anti-anxiety medications or antidepressants. These medications may have side effects such as gastrointestinal issues (especially nausea), headaches, movement or sensory issues, and sleep problems.

Anxiety and depression are increasingly common in the general public. Anyone experiencing symptoms is encouraged to seek advice from a healthcare provider on how to manage their condition.

Understanding CBD and its mechanism of action

What is CBD?

Cannabidiol (CBD) is a chemical in the cannabis sativa plant, also known as cannabis or hemp. It is nonaddictive and non psychotomimetic, meaning it does not cause hallucinations, sensory disturbances, or confusion.²

Cannabis has been used in Western medicine since the 19th century, although the identification of the chemical components did not happen until the 1960s.³ The legal status and availability of both cannabis and CBD vary worldwide. In the case of CBD, legality depends on the product, including the extraction process and formulation. For specific information in the United Kingdom,  check the gov.uk factsheet.

Various applications of CBD have been suggested and are under investigation, including for chronic pain, inflammation, insomnia, epilepsy and addiction.^4,5 

Endocannabinoid system (ECS) 

First described in detail in the 1990s,³ the endocannabinoid system (ECS) is a network in the body involved in various physiological processes including sleep, memory, appetite, pain control, and mood regulation (collectively, homeostasis).⁶

Endocannabinoids are molecules made by your body that interact with receptors in the ECS. These same receptors are also those that interact with cannabinoids, like THC or CBD, however, the methods by which CBD produces its therapeutic effects are still largely unclear.^4,5

There is a demand for further scientific research into the interaction of CBD with the ECS.

Influence of CBD on serotonin receptors 

CBD acts on other biological pathways, for example, the serotonin pathway. Many people report CBD producing antidepressant-like effects, and this has been demonstrated in scientific models.⁷ Similarly, in the laboratory, CBD has been shown to prevent anxiety-like behaviour.⁸ These calming effects are a major reason why members of the general public may want to try CBD products.

Dosage and administration of CBD oil

Most products on the market are oral, such as food products or beverages, but CBD can also be inhaled or used topically (creams, gels). CBD oils may be chosen by customers over gummies due to their higher bioavailability. What this means is that CBD is absorbed directly into the bloodstream when put under the tongue, whereas gummies or food products have to move through the liver and digestive tract.⁹ This means the effects of oils are often seen faster, and the concentration remains higher, compared to other oral products. Oils also allow the consumer to decide what dosage they want, whereas gummies are pre-measured. 

The best advice to anyone taking CBD products is to start low and monitor for side effects or medication interactions as reactions and responses will differ greatly from person to person. We will talk about these in more detail later in this article. 

Current research on CBD and social anxiety

Current research shows great promise in using CBD to reduce anxiety symptoms. In fact, one study showed that 65% of young adults who took a survey stated that stress and anxiety relief were the main reasons for taking CBD.¹⁰ A Japanese study in 2019 concluded that oil containing 300mg of CBD ‘reverses anxiety-like behaviour’ in teenagers with SAD when used daily for 4-weeks.¹¹ Similarly, a 2011 study in Brazil found that pretreatment with CBD (600mg) reduced anxiety and cognitive impairment when SAD patients faced a public speaking test.¹²

Compared to traditional medicines and treatments for SAD, research finds benefits of CBD including the lack of sedating side effects, low chance of addiction, and rapid course of action.¹³

Further scientific research is needed to fully understand the biological effects of CBD and to determine the most effective administration methods and dose. 

Risks and considerations

Some side effects of taking CBD include fatigue, nausea, and irritability. A literature review found the most commonly reported side effects were diarrhoea, tiredness and changes of appetite in patients taking CBD for epilepsy and psychotic disorders.¹⁴ Some studies have suggested an increase in levels of liver enzymes in the blood,⁵ so more research is needed to understand the long-term effects of chronic CBD administration.¹³

Drug-drug interactions must be considered when an individual decides to take CBD oil. For example, CBD slows the metabolism of a number of medications, like blood thinners, or immunosuppressants, increasing their levels in the blood, which can be dangerous.¹⁵

Lack of regulatory structure around legal status leads to variability in product quality.⁴ It is important that anyone wishing to invest in CBD products conducts extensive research into which brand, formula and dose is right for them.

Conclusion

CBD seems to be a viable treatment for combatting some of the symptoms of social anxiety disorder (SAD), however, its scientific backing is still in its early stages. Research suggests that CBS has lower side effects and lower dependency risks compared to traditional medications, although more work is necessary to establish safe dosage, effectiveness, and long-term impact. A careful approach is essential for those considering CBD oil as a treatment for social anxiety, including consulting healthcare providers and researching product quality.