Article

Effect of Beta Blockade and Beta Stimulation on Stage Fright

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Abstract

Stage fright, physiologically the "fight or flight" reaction, is a disabling condition to the professional musician. Because it is mediated by the sympathetic nervous system, we have investigated the effects of beta blockade on musical performance with propranolol in a double blind fashion and the effects of beta stimulation using terbutaline. Stage fright symptoms were evaluated in two trials, which included a total of 29 subjects, by questionnaire and by the State Trai Anxiety Inventory. Quality of musical performance was evaluated by experienced music critics. Beta blockade eliminates the physical impediments to performance caused by stage fright and even eliminates the dry mouth so frequently encountered. The quality of musical performance as judged by experienced music critics is significantly improved. This effect is achieved without tranquilization. Beta stimulating drugs increase stage fright problems, and should be used in performing musicians only after consideration of the detrimental effects which they may have on musical performance.

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... Several trials studying off-label use of propranolol would follow, such as its use in the treatment of high trait anxiety (Becker, 1976;Kathol et al., 1980;Meibach et al., 1987;Wheatley, 1969), substance disorder and withdrawal symptoms (Grosz, 1972), schizophrenia (Yorkston et al., 1974), autism (Ratey et al., 1987), and aggression (Fleminger et al., 2006). In addition, propranolol has been shown to mitigate milder distressing states such as exam nerves (Brewer, 1972;Drew et al., 1985;Stone et al., 1973), stage fright (Brantigan et al., 1982), performance anxiety in musicians (Clark and Agras, 1991), performance anxiety in surgeons (Elman et al., 1998), and fear of undergoing surgery (Dyck and Chung, 1991;Jakobsson et al., 1995;Mealy et al., 1996). ...
... palpitations or increased ventilation, fuel the occurrence of panic attacks. This explanation is supported by research that found that subjects suffering from high levels of general trait anxiety improved little on propranolol (Becker, 1976;Kathol et al., 1980;Meibach et al., 1987;Wheatley, 1969), whereas more favourable effects were found in the treatment of performance anxieties, in which enhanced sensitivity for adrenergic hyperactivation may similarly initiate the fear response (Brantigan et al., 1982;Brewer, 1972;Clark and Agras, 1991;Drew et al., 1985;Elman et al., 1998;Stone et al., 1973). ...
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The effects of propranolol in the treatment of anxiety disorders have not been systematically evaluated previously. The aim was to conduct a systematic review and meta-analysis of randomised controlled trials, addressing the efficacy of oral propranolol versus placebo or other medication as a treatment for alleviating either state or trait anxiety in patients suffering from anxiety disorders. Eight studies met the inclusion criteria. These studies concerned panic disorder with or without agoraphobia (four studies, total n = 130), specific phobia (two studies, total n = 37), social phobia (one study, n = 16), and posttraumatic stress disorder (PTSD) (one study, n = 19). Three out of four panic disorder trials qualified for pooled analyses. These meta-analyses found no statistically significant differences between the efficacy of propranolol and benzodiazepines regarding the short-term treatment of panic disorder with or without agoraphobia. Also, no evidence was found for effects of propranolol on PTSD symptom severity through inhibition of memory reconsolidation. In conclusion, the quality of evidence for the efficacy of propranolol at present is insufficient to support the routine use of propranolol in the treatment of any of the anxiety disorders.
... Promising evidence has emerged from studies reporting that administration of a non-selective β-adrenergic receptor (β-AR) antagonist, propranolol, which blocks epinephrine/ norepinephrine signaling [4], may also offer PTSD relief [6]. Furthermore, propranolol was proven to be effective in eliminating stage fright [7], improving anxiety-related cognitive dysfunction [8], and in reducing emotional arousal [9]. However, in a double-blind study with propranolol and atenolol, positive effects were not observed in phobic subjects [10]. ...
... However, it is premature to disregard the role of β-AR antagonists in PTSD treatment, especially considering their beneficial role in the treatment of numerous psychiatric ailments including anxiety disorders [14][15][16][17][18], schizophrenia [19], autism [20], aggression [21], and various forms of fearful behaviors [7,[22][23][24][25][26]. It is also important to note that β-AR blockers are relatively safe drugs that are taken by hundreds of millions daily for a myriad of diseases/disorders ranging from cardiovascular disorders such as hypertension, heart failure and angina, to glaucoma and migraines. ...
Chapter
Mental health is central to normal health outcomes. A widely accepted theory is that chronic persistent stress during adulthood as well as during early life triggers onset of neuropsychiatric ailments. However, questions related to how that occurs, and why are some individuals resistant to stress while others are not, remain unanswered. An integrated, multisystemic stress response involving neuroinflammatory, neuroendocrine, epigenetic and metabolic cascades have been suggested to have causative links. Several theories have been proposed over the years to conceptualize this link including the cytokine hypothesis, the endocrine hypothesis, the oxidative stress hypothesis and the oxido-neuroinflammation hypothesis. The data discussed in this review describes potential biochemical basis of the link between stress, and stress-induced neuronal, behavioral and emotional deficits, providing insights into potentially novel drug targets.
... Previous research has shown a beneficial effect of the ␤-adrenergic antagonist, propranolol, on these unconstrained flexibility tasks in humans [1,[21][22][23]. ␤-adrenergic antagonists have long been used for the treatment of test anxiety and performance anxiety [24,25]. This contrasts with the facilitation of EDS in animals with increased adrenergic activity acting on the ␣-adrenergic receptors and the lack of effects with ␤-adrenergic antagonists on the ASST [16]. ...
... Future studies will need to replicate these findings using other types of tasks targeting unconstrained cognitive flexibility to confirm the specificity of the effect on this proposed unconstrained aspect. Furthermore, as propranolol is widely utilized for treatment of anxiety in a variety of settings [24,25], and the novel digging task may be stressful, the effects on anxiety-related behaviors will need to be also monitored in these future studies. Additionally, only males were used in this study. ...
... Similarly, results were different for different drugs Á/ both propanolol and oxprenolol reportedly reduced anxiety and bow shake while nadolol had no such effect. For those studies that used subjective as well as physiological measures to assess outcome, most reported no effect on measures such as perception of performance (Brantigan et al., 1982;Gates et al., 1985;James et al., 1983), state or trait anxiety (Brantigan et al., 1982;Gates et al., 1985), stage fright rating scale (Neftel et al., 1982), or judges' ratings of quality of performance (James et al., 1983). Berens and Ostrosky (1988) assessed the impact of beta-adrenergic blocking agents prior to musical performance on 150 musicians and singers. ...
... Similarly, results were different for different drugs Á/ both propanolol and oxprenolol reportedly reduced anxiety and bow shake while nadolol had no such effect. For those studies that used subjective as well as physiological measures to assess outcome, most reported no effect on measures such as perception of performance (Brantigan et al., 1982;Gates et al., 1985;James et al., 1983), state or trait anxiety (Brantigan et al., 1982;Gates et al., 1985), stage fright rating scale (Neftel et al., 1982), or judges' ratings of quality of performance (James et al., 1983). Berens and Ostrosky (1988) assessed the impact of beta-adrenergic blocking agents prior to musical performance on 150 musicians and singers. ...
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A systematic review of all available treatment studies for music performance anxiety was undertaken. Interventions were categorised into psychological treatments and pharmacological treatments. Psychological treatments included behavioral, cognitive, cognitive-behavioral, combined treatments and other therapies. Issues such as the number of studies in each treatment modality, their sample sizes and the methodological quality of most of the studies reviewed precluded firm conclusions about the effectiveness of any of the treatments assessed for music performance anxiety. The field is in urgent need of larger scale, methodologically rigorous studies to assist the large minority of musicians who suffer from performance impairing music performance anxiety.
... As early as in the 1960s and 1970s, many studies were conducted aimed at determining the significance of propranolol in treating psychological disorders. Early studies suggested effectiveness of propranolol in relieving the symptoms of severe anxiety [38,39,40], but also of mild situational anxiety in stress-inducing situations such as an exam [41,42], public appearances [43] or the anxiety experienced by surgeons before performing a surgery [44,45]. Moreover, experimental studies were undertaken in order to identify the effects of this drug in situations of panic attacks. ...
... Już w latach 60- tych oraz 70-tych XX wieku przeprowadzono wiele badań mających na celu dookreślenie znaczenia propranololu w leczeniu zaburzeń psychicznych. W przeprowadzonych wczesnych badaniach postulowano efektywność propranololu w łagodzeniu objawów silnego lęku [38,39,40], ale również łagodnych sytuacyjnych stanów niepokoju i lęku w stresogennych sytuacjach jak np.: egzamin [41,42], wystąpienia publiczne [43], czy lęk odczuwany przez chirurgów przed przeprowadzeniem zabiegu operacyjnego [44,45]. Podejmowano również badania eksperymentalne w celu zidentyfikowania efektów działania tego leku w przypadku ataków lęku panicznego. ...
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Introduction: Beta blockers are mainly used in treating cardiovascular diseases. However, it has been observed that these drugs have also an anxiolytic potential. Over the years, a number of clinical trials have been conducted aimed at determining the effectiveness of beta blockers in treating anxiety disorders. The aim of the article: The main objective of the article is to present the significance and position of adrenolytic drugs in the pharmacotherapy of anxiety disorders on the basis of available literature. Moreover, the authors also decided to take into account the data from current research results, considering the problem of side effects of using adrenolytic drugs - especially the controversial reports on their effect on the development of affective disorders. Method: An analysis was conducted of articles from Medline/PubMed database, selected on the basis of the following key words: anxiety disorders, beta blockers, adrenolytic drugs, as well as on the basis of their dates of publication: 1960-2017. In order to conduct a reliable and complete review of literature, the authors decided to include works from quite an extended period of time. The articles included in the review were published in Polish and English. Results: The review of articles concerning the treatment of anxiety disorders clearly suggests that propranolol is effective in reducing the frequency of panic attacks and the tendency for avoidance behavior in patients with agoraphobia. Other studies report on potential benefits in terms of early interventional prevention and treating posttraumatic stress disorder with propranolol. However, there is lack of randomized clinical trials concerning the therapeutic effect of other adrenolytic drugs in treating anxiety disorders. Early research works reported that (mainly lipophilic) beta blockers may have a depressogenic effect; however, the latest studies have not confirmed it. The contemporary research on the therapeutic potential of beta blockers in treating anxiety disorders is insufficient. What seems to be most promising, however, are reports concerning the desirable effects of using adrenolytic drugs in treating posttraumatic stress disorder, which implicates the necessity of conducting further research verifying the validity of their application.
... Promising evidence has emerged from studies reporting that administration of a non-selective β-adrenergic receptor (β-AR) antagonist, propranolol, which blocks epinephrine/ norepinephrine signaling [4], may also offer PTSD relief [6]. Furthermore, propranolol was proven to be effective in eliminating stage fright [7], improving anxiety-related cognitive dysfunction [8], and in reducing emotional arousal [9]. However, in a double-blind study with propranolol and atenolol, positive effects were not observed in phobic subjects [10]. ...
... However, it is premature to disregard the role of β-AR antagonists in PTSD treatment, especially considering their beneficial role in the treatment of numerous psychiatric ailments including anxiety disorders [14][15][16][17][18], schizophrenia [19], autism [20], aggression [21], and various forms of fearful behaviors [7,[22][23][24][25][26]. It is also important to note that β-AR blockers are relatively safe drugs that are taken by hundreds of millions daily for a myriad of diseases/disorders ranging from cardiovascular disorders such as hypertension, heart failure and angina, to glaucoma and migraines. ...
Article
Benzodiazepines and SSRIs are considered as standard treatment options for anxiety and depression, hallmarks of Post-Traumatic Stress Disorder (PTSD), although their use is often limited by adverse effects. While promising evidence emerged with β-adrenergic receptor (β-AR) antagonists (or ‘β-blockers’) and PTSD relief, efficacy issues dampened the excitement. However, we believe it is premature to completely eliminate a beneficial role of β-blockers. Our previous work has suggested that social defeat (SD) results in anxiety-like and depression-like behaviors in rats. Here, using the SD paradigm, we examined the effect of several β-adrenergic receptor antagonists (propranolol, nadolol, bisoprolol) on these behaviors in rats. Following acclimatization, Sprague-Dawley rats received no treatment (for control groups) or treated with ; propranolol (50 mg/kg/day in water), or nadolol (18 mg/kg/day in rats’ chow), or bisoprolol (15 mg/kg/day in water). The treatment lasted for 36 days, following which rats were subjected to SD/control exposures (1 week). Later, anxiety-like and depression-like behaviors, social interaction and learning-memory function tests were conducted. SD rats exhibited anxiety- and depression-like behavior as well as learning-memory impairment. Propranolol and nadolol protected SD rats from exhibiting anxiety-or depression-like behaviors. Bisoprolol treatment did not mitigate SD-induced behavioral impairments in rats. Nadolol, propranolol or bisoprolol have no effect in attenuating SD-induced memory function tests. These results suggest that certain ‘β-blockers’ have the potential to mitigate the negative psychological effects of traumatic events.
... Several trials studying off-label use of propranolol have been conducted, such as its application in the treatment of high levels of trait anxiety [25][26][27], substance disorder and withdrawal symptoms [28], schizophrenia [29], autism [30], and aggression [31]. In addition, propranolol has been shown to mitigate milder distressing states such as exam nerves [32][33][34], stage fright [35], performance anxiety among musicians [36] and surgeons [37], and fear of undergoing surgery [38][39][40]. Evidence suggests that propranolol positively influences dental state anxiety and reduces the storage of fear memories. ...
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Background: Undergoing an extraction has been shown to pose a significantly increased risk for the development of chronic apprehension for dental surgical procedures, disproportionate forms of dental anxiety (that is, dental phobia), and symptoms of post-traumatic stress. Evidence suggests that intrusive emotional memories of these events both induce and maintain these forms of anxiety. Addressing these problems effectively requires an intervention that durably reduces both the intrusiveness of key fear-related memories and state anxiety during surgery. Moreover, evidence suggests that propranolol is capable of inhibiting "memory reconsolidation" (that is, it blocks the process of storing a recently retrieved fear memory). Hence, the purpose of this trial is to determine the anxiolytic and fear memory reconsolidation inhibiting effects of the ß-adrenoreceptor antagonist propranolol on patients with high levels of fear in anticipation of a dental extraction. Methods/design: This trial is designed as a multicenter, randomized, placebo-controlled, two-group, parallel, double-blind trial of 34 participants. Consecutive patients who have been referred by their dentist to the departments of oral and maxillofacial surgery of a University hospital or a secondary referral hospital in the Netherlands for at least two tooth and/or molar removals and with self-reported high to extreme fear in anticipation of a dental extraction will be recruited. The intervention is the administration of two 40 mg propranolol capsules 1 hour prior to a dental extraction, followed by one 40 mg capsule directly postoperatively. Placebo capsules will be used as a comparator. The primary outcome will be dental trait anxiety score reduction from baseline to 4-weeks follow-up. The secondary outcomes will be self-reported anxiety during surgery, physiological parameters (heart rate and blood pressure) during recall of the crucial fear-related memory, self-reported vividness, and emotional charge of the crucial fear-related memory. Discussion: This randomized trial is the first to test the efficacy of 120 mg of perioperative propranolol versus placebo in reducing short-term ("state") anxiety during dental extraction, fear memory reconsolidation, and lasting dental ("trait") anxiety in a clinical population. If the results show a reduction in anxiety, this would offer support for routinely prescribing propranolol in patients who are fearful of undergoing dental extractions. Trial registration: ClinicalTrials.gov identifier: NCT02268357 , registered on 7 October 2014. The Netherlands National Trial Register identifier: NTR5364 , registered on 16 August 2015.
... Propranolol is a synthetic b-adrenergic receptor blocker that crosses the bloodebrain barrier and exerts peripheral as well as central effects (O'Carroll, Drysdale, Cahill, Shajahan, & Ebmeier, 1999). Propranolol is commonly used to treat migraine (Holroyd, Penzien, & Cordingley, 1991), tachycardia (Raj et al., 2009), and performance anxiety (Brantigan, Brantigan, & Joseph, 1982). It is indicated as a second line of treatment for anxious states. ...
Article
Background: Considering the pivotal role of negative emotional experiences in the development and persistence of mental disorders, effectively interfering with the consolidation/reconsolidation of such experiences would open the door to a novel treatment approach in psychiatry.Objective: We assessed the current evidence regarding the capacity of the β-blocker propranolol to block the consolidation/reconsolidation of emotional memories by means of a meta-analytic review.Data sources: An extensive multilingual literature search from 1994 to 2011 yielded 189 potential articles.Study selection: Selected studies consisted of randomized, double-blind experiments assessing long-term memory for emotional material in adults and involving at least one propranolol and one placebo condition. Of 189 potential studies, 13 consolidation (. n = 310) and 9 reconsolidation (. n = 327) experiments with adults met inclusion criteria for statistical analysis.Data extraction: Two independent reviewers extracted outcome and descriptive data from each study. Effect sizes were calculated using a random effects model.Data synthesis: Compared to placebo, propranolol given before memory consolidation reduced subsequent recall for negatively valenced stories, pictures, word lists, and the expression of cue-elicited fear responses: Hedge's g = 0.47, 95% CI = 0.22-0.72. Moreover, compared to placebo, propranolol before memory reconsolidation reduced subsequent recall for negatively valenced emotional words, as well as the expression of cue-elicited fear responses, g = 0.59, 95% CI = 0.16-1.01. Splitting the results according to episodic retention and physiological responding did not yield a significant difference in effect size for consolidation or reconsolidation blockade. Removing the clinical studies from the larger group of nonclinical studies did not impact the statistical significance of the results either.Conclusions: Propranolol shows promise in reducing subsequent memory for new or recalled emotional material in healthy subjects. Studies of clinical populations, however, have yet to independently demonstrate that such findings can translate into powerful clinical effects.
... In view of the clinical studies and off-label use of various beta blockers, psychiatrists are aware that beta blockers can provide some symptomatic relief with regard to performance anxiety [53]. However, beta blockers alone do not sufficiently address the aggregate symptoms of panic and acute anxiety episodes, and especially the psychic symptoms thereof (e.g., fear, avoidance, and anxiousness). ...
... One of the reasons brought up in the rationale for using beta-blockers is the reduced adrenergic activity at central or peripheral level [4]. The appeasing effect of beta-blockers in stress-inducing situations is also very well-known [17]. ...
Article
Methods: The elaboration of these guidelines followed the procedure validated by the French health authority for good practice recommendations, close to the Prisma statement. Guidelines were elaborated on the basis of a systematic and critical review of the literature. Results: Twenty-eight articles concerning 376 patients were analyzed. Recommendations are: when faced with an agitation crisis, the management strategy implies to search for an underlying factor that should be treated such as pain, acute sepsis, and drug adverse effect (expert opinion). Physical restraints should be discarded when possible (expert opinion). Neuroleptic agent with a marketing authorization can be used in order to obtain a quick sedation so as to protect the patient from himself, closed ones or the healthcare team but the duration should be as short as possible (expert opinion). The efficacy of beta-blockers and antiepileptics with mood regulation effects like carbamazepine and valproate yield the most compelling evidence and should be preferably used when a background regimen is envisioned (grade B for beta-blocker and C for antiepileptics). Neuroleptics, antidepressants, benzodiazepines, buspirone may be prescribed but are considered second-line treatments (expert opinion). Conclusion: This study provides a strategy for treating the agitation crisis based on scientific data and expert opinion. The level of evidence remains low and published data are often old. New studies are essential to validate results from previous studies and test new drugs and non-pharmaceutical therapies.
... One possibility is that propranolol acts indirectly to inhibit protein synthesis, thereby disrupting reconsolidation and erasing the fear memory. An alternative but not mutually exclusive possibility is that propranolol, which has known anxiolytic effects (Brantigan, Brantigan, & Joseph, 1982), may help reduce the psychological stress associated with encountering a feared stimulus upon extinction training, helping to restore an optimal level of NE signaling to promote extinction learning. Here we review the existing literature comparing the efficacy of propranolol in reconsolidation versus its effects on extinction learning, both in rodents and in humans. ...
Article
Posttraumatic stress disorder (PTSD) has been described as the only neuropsychiatric disorder with a known cause, yet effective behavioral and pharmacotherapies remain elusive for many afflicted individuals. PTSD is characterized by heightened noradrenergic signaling, as well as a resistance to extinction learning. Research aimed at promoting more effective treatment of PTSD has focused on memory erasure (disrupting reconsolidation) and/or enhancing extinction retention through pharmacological manipulations. Propranolol, a β-adrenoceptor antagonist, has received considerable attention for its therapeutic potential in PTSD, although its impact on patients is not always effective. In this review, we briefly examine the consequences of β-noradrenergic manipulations on both reconsolidation and extinction learning in rodents and in humans. We suggest that propranolol is effective as a fear-reducing agent when paired with behavioral therapy soon after trauma when psychological stress is high, possibly preventing or dampening the later development of PTSD. In individuals who have already suffered from PTSD for a significant period of time, propranolol may be less effective at disrupting reconsolidation of strong fear memories. Also, when PTSD has already developed, chronic treatment with propranolol may be more effective than acute intervention, given that individuals with PTSD tend to experience long-term, elevated noradrenergic hyperarousal.
... There is a body of evidence that suggests that β-antagonists can be useful in the treatment of anxiety, particularly related to performances and taken about an hour before hand (Brantigan et al. 1982;Hartley et al. 1983;Liebowitz et al. 1985;Schneier 2006). Propranolol has also been shown to improve test scores during exams presumably by reducing the stress-induced impairment of cognitive functioning (Faigel 1991). ...
Chapter
Cardiac medications including β-blockers, cardiac glycosides, and antiarrhythmics have long been known to have CNS effects including alterations in mood, emotion state anxiety, and depression. While the predominant effects come from those with higher lipophilicity and when used at high doses, the evidence is actually quite mixed. At cardiac therapeutic doses, lipophilic β-blockers like propranolol have actually few CNS effects on mood. The effectiveness of β-blockers is established for relieving performance anxiety, but the actions involve more a peripheral relief of somatic symptoms rather than a central effect. By contrast the reduction in consolidation of aversive and stressful memory by propranolol appears to involve altering the functioning of the amygdala and hippocampus directly. While evidence suggests that β-blockers reduce aggressive behaviors associated with various psychological conditions such as schizophrenia, they are now used relatively rarely. Cardiac glycosides such as digoxin have been implicated in causing a variety of mental dysfunctions including depression, yet quality prospective trials are lacking and evidence is largely anecdotal. The difficulty is that the patients likely to receive either β-blockers or digoxin are often suffering heart failure which in itself causes mood alterations such as depression. The current review analyzes the evidence of mood-altering side effects for the various pharmacological agents used to treat cardiac disease.
... During the exercise the heart rate increase at least 115 beat/ minute, also plasma adrenaline and noradrenalin showed experimental increase during exercise with threshold of 204-208 watt of cycling ergometer efforts; then plasma adrenaline threshold was lower at the end of exercise [2]. ...
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The aim of this study is to show the effects of carvedilol on exercise parameters. Fifty four volunteers enrolled in this study, 35 males &19 females. They do exercise on bicycle ergometer, the results was non-significant effects of carvedilol on the exercise unlike other β-blocker that produce fatigue.
... Obviously there are parallels between sport and dance in terms of athletic requirements (e.g., strength, power, flexibility) that mean substances outlawed in sport (e.g., anabolic steroids, ephedrine stimulants) may benefit performance in dance. However, it is important to acknowledge that unlike sport, dance is a performing art and performance enhancing substances banned in sport (e.g., beta-blockers such as propranolol) are used in other art forms (e.g., music; see Brantigan, Brantigan, & Joseph, 1982) without apparent need for proscription. Further, although at the professional level there is undoubtedly competition between dancers for roles and rank, during performances dancers are not looking to outperform an opponent as a sportsperson would. ...
... As propranolol is highly lipophilic, it enters the blood-brain barrier, indicating its potential use for anxiety disorders (Steenen et al., 2016). Anecdotally, beta blockers such as propranolol have been used for decades to manage situational anxiety such as stage fright, exam-or interview-related anxiety (Brantigan et al., 1982;Stone et al., 1973). ...
Article
Objectives: To date, there is no single medication prescribed to alleviate all the core symptoms of Autism Spectrum Disorder (ASD; National Institute of Health and Care Excellence, 2016). Both serotonin reuptake inhibitors and drugs for psychosis possess therapeutic drawbacks when managing anxiety and aggression in ASD. This review sought to appraise the use of propranolol as a pharmacological alternative when managing emotional, behavioural and autonomic dysregulation (EBAD) and other symptoms. Materials and methods: Sixteen reports examined the administration of propranolol in the context of ASD. Results: Sixteen reports broadly covered cognitive domains, neural correlates, and behavioural domains. From the eight single-dose clinical trials, propranolol led to significant improvements in cognitive performance - verbal problem solving, social skills, mouth fixation, and conversation reciprocity; and changes in neural correlates - improvement in semantic networks and functional connectivity. The remaining eight case series and single case reports showed improvements in EBAD, anxiety, aggressive, self-injurious and hypersexual behaviours. Additionally, propranolol significantly improved similar behavioural domains (aggression and self-injury) for those with acquired brain injury. Conclusion: This review indicates that propranolol holds promise for EBAD and cognitive performance in ASD. Given the lack of good quality clinical trials, randomised controlled trials are warranted to explore the efficacy of propranolol in managing EBAD in ASD.
... Both on long-term (Dietrich et al., 2008;Holmqvist et al., 2013) as in acute occasions (Giddens et al., 2013), stress can mark the voice output negatively. Maybe the most recognizable interrelation between the voice, stress and human physiology is stage-fright that can ruin a performance by physical voice and breathing impediments (e.g., Brantigan et al., 1982;Dietrich and Abbott, 2012). Other stressful professions that demand a large stress regulation, and in which the voice occupies a prominent position include those that rely on radio contact such as aviation operators and ground controllers (e.g., Simonov and Frolov, 1977;Simonov et al., 1980). ...
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People rely on speech for communication, both in a personal and professional context, and often under different conditions of physical, cognitive and/or emotional load. Since vocalization is entirely integrated within both our central (CNS) and autonomic nervous system (ANS), a mounting number of studies have examined the relationship between voice output and the impact of stress. In the current paper, we will outline the different stages of voice output, i.e., breathing, phonation and resonance in relation to a neurovisceral integrated perspective on stress and human performance. In reviewing the function of these three stages of voice output, we will give an overview of the voice parameters encountered in studies on voice stress analysis (VSA) and review the impact of the different types of physiological, cognitive and/or emotional load. In the section “Discussion,” with regard to physical load, a competition for ventilation processes required to speak and those to meet metabolic demand of exercised muscles is described. With regard to cognitive and emotional load, we will present the “Model for Voice and Effort” (MoVE) that comprises the integration of ongoing top-down and bottom-up activity under different types of load and combined patterns of voice output. In the MoVE, it is proposed that the fundamental frequency (F0) values as well as jitter give insight in bottom-up/arousal activity and the effort a subject is capable to generate but that its range and variance are related to ongoing top-down processes and the amount of control a subject can maintain. Within the MoVE, a key-role is given to the anterior cingulate cortex (ACC) which is known to be involved in both the equilibration between bottom-up arousal and top-down regulation and vocal activity. Moreover, the connectivity between the ACC and the nervus vagus (NV) is underlined as an indication of the importance of respiration. Since respiration is the driving force of both stress and voice production, it is hypothesized to be the missing-link in our understanding of the underlying mechanisms of the dynamic between speech and stress.
... Anger 1 (Kreibig, 2010) Post prandial hypotension a− br↓ ( Kawaguchi et al., 2002;Lipsitz et al., 1986;Ryan et al., 1992) Dementia: PTSD 1,4 (Buckley and Kaloupek, 2001;Fonkoue et al., 2020;Park et al., 2017;Pole, 2007) -short-term microgravity 3 (Mano, 2005;Mano et al., 1998Mano et al., , 1985Miwa et al., 1996) - Malignant Serotonin Syndrome 1 (Ener et al., 2003;Francescangeli et al., 2019;Mills, 1997) or Neuroleptic Syndrome 1 (Feibel and Schiffer, 1981;Gurrera, 1999) Stage Fright 1,4 (Berntson and Cacioppo, 2004;Brantigan et al., 1982;Yoshie et al., 2009) Insomnia 1,4, a− br↓ (Carter et al., 2018;Jerath et al., 2019;Tsai et al., 2015) Diencephalic Syndromes 1 (Andy and Jurko, 1983;Bullard, 1987;Carr-Locke and Millac, 1977;Fox et al., 1973;Giroud et al., 1988;Rovne and Williams, 1962;Solomon, 1973) Alcohol/Opioid drug withdrawal 1 (Hawley et al., 1994;Kienbaum et al., 2002Kienbaum et al., , 1998Linnoila et al., 1987) Meditation: ...
Article
The Autonomic Nervous System (ANS) is a critical part of the homeostatic machinery with both central and peripheral components. However, little is known about the integration of these components and their joint role in the maintenance of health and in allostatic derailments leading to somatic and/or neuropsychiatric (co)morbidity. Based on a comprehensive literature search on the ANS neuroanatomy we dissect the complex integration of the ANS: (1) First we summarize Stress and Homeostatic Equilibrium – elucidating the responsivity of the ANS to stressors; (2) Second we describe the overall process of how the ANS is involved in Adaptation and Maladaptation to Stress; (3) In the third section the ANS is hierarchically partitioned into the peripheral/spinal, brainstem, subcortical and cortical components of the nervous system. We utilize this anatomical basis to define a model of autonomic integration. (4) Finally, we deploy the model to describe human ANS involvement in (a) Hypofunctional and (b) Hyperfunctional states providing examples in the healthy state and in clinical conditions.
... Beta--bloker pozwolił mu jedynie pozbyć się czynnika, który nie pozwoliłby mu na pełne zaprezentowanie swojego talentu. Beta--blokery należą do substancji dopuszczalnych także w niektórych dyscyplinach sportowych (Brantigan, Brantigan, & Joseph 1982), niemniej jednak w innych traktowane są jako doping i w związku z tym zakazane (World Anti--Doping Agency 2015). Do sportów gdzie obowiązuje ten zakaz należą m.in. ...
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The paper presents moral and legal aspects of the human’s nature enhancement in the context of answering the questions to what extent and to whom the modern technologies may be applied, which purpose is not the recovery (therapy), but the improvement of natural human potential by increasing the strength, endurance, immunity, physical fitness and human’s ability to regenerate, as well as by improving the cognitive capacities in the form of the betterment of human thinking and memory. The problems of enhancement are associated with the movement of transhumanism, which postulates the perfecting of a man and assumes the possibility to control more and more the domains of human activities, both physical and intellectual. In finding the answer to the question of the limits of moral acceptance for the enhancement of human nature, we analyze the cases of a soldier and sportsman, which illustrate the most important problems of the issue. The choice of such examples was due to the belief that social function and the types of activity connected with the exercise of these professions are very important for the determination of the acceptable limits of human enhancement. In our opinion the determination of the limit should be made by referring to the types of activity, based on the division of human activities elaborated by A. MacIntyre. According to MacIntyre, in the case of human activities known as practices, a man achieves internal goods, which define the practice and can only be achieved by improving human skills/abilities. While the external goods, like fame, money or prestige, do not belong to the essence of a practice. For these goods can be achieved both through honest work and self-improvement, and by the fraud. After considering a number of theoretical and practical problems, we argue for the thesis that the admissibility of artificial enhancements and the establishment of its acceptable limits are to be resolved by determining whether a given activity is oriented to achieve essential goods, like life, health or national security, which constitute the moral or social good (in such cases the use of enhancements sometimes will be even a duty), or this activity merely consist in the practice of virtues for the moral improvement of man, which should be made exclusively by using the natural human potential. Thus, the limit of the morally acceptable enhancement of the human nature is to be Dopuszczalność ulepszania natury ludzkiej (enhancement determined (at the stages of law-making and law-application) by indicating the nature of a given activity, its social function and importance, and therefore its moral or social significance.
... Listeners may criticize a musician who uses propranolol, a beta blocker drug that reduces performance anxiety even if the drug was used outside the competition [23]. ...
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Background: Once an elderly lady came for consultation in my chamber and after she was done, she casually mentioned about her son who accompanied her saying that although he studies sincerely but finds it difficult to remember whatever he studies and requested me to suggest a memory enhancing pill for him. This posed a question whether there were actually any memory enhancing drugs available. Methods: A thorough literature search was carried out in Pubmed and all articles till date related to memory enhancing drugs were searched with key words memory enhancing drugs, cognitive enhancement, Alzheimer's disease. Ethical, social and philosophical issues about memory enhancing drugs (MEDs) and anti-dementia drugs were analysed and health effects of these 'smart pills' were elaborated upon. Results: There is a desire for quicker, sharper, and more reliable memories. Use of cognition enhancing drugs is an ethical dilemma and the safety of these drugs is yet to be proved. Conclusion: Memory enhancement has a long way to go and memory enhancing drugs and anti-dementia drugs are of doubtful efficacy.
... We efficaciously controlled the autonomic-related symptomatology by administering propranolol, a nonselective beta-blocker blocking the catecholamines action through the beta-1 and beta-2 adrenergic receptors (Routledge & Shand, 1979). Propranolol effectively suppresses the autonomic hyperactivity and hyperarousal associated with anxiety disorder, reducing thereby its physical symptoms (Brantigan, Brantigan, & Joseph, 1982;Mealy et al., 1996). Consistently with the pharmacological effects, after 20 days of treatment patient 1 experienced an improvement of autonomic-related symptoms but the intrusive thinking and cue-induced craving persisted. ...
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Background Several behaviors, besides consumption of psychoactive substances, produce short-term reward that may lead to persistent aberrant behavior despite adverse consequences. Growing evidence suggests that these behaviors warrant consideration as nonsubstance or “behavioral” addictions, such as pathological gambling, internet gaming disorder and internet addiction. Case presentation Here, we report two cases of behavioral addictions (BA), compulsive sexual behavior disorder for online porn use and internet gaming disorder. A 57-years-old male referred a loss of control over his online pornography use, started 15 years before, while a 21-years-old male university student reported an excessive online gaming activity undermining his academic productivity and social life. Both patients underwent a high-frequency repetitive transcranial magnetic stimulation (rTMS) protocol over the left dorsolateral prefrontal cortex (l-DLPFC) in a multidisciplinary therapeutic setting. A decrease of addictive symptoms and an improvement of executive control were observed in both cases. Discussion Starting from these clinical observations, we provide a systematic review of the literature suggesting that BAs share similar neurobiological mechanisms to those underlying substance use disorders (SUD). Moreover, we discuss whether neurocircuit-based interventions, such as rTMS, might represent a potential effective treatment for BAs.
... This evaluation has been expressed in a variety of approaches. Rerecording a speech sound sample of the unidentified accompanied by a rerecording of the identical voices sound of the suspected is one of the most widely utilized auditory comparison procedures [13]. ...
Article
The area of forensic speech and audio analysis encompasses a vast range of operations, the much more prominent of which is, without the need of a doubt, speaker identification. In addition, comprehensibility improvement of the recorded voice signal, analysis of disputed speech, and assessment of the legitimacy of audio recordings are also activities in the field. Using voice analysis, the examiner has two ideas about how to make an identification. Initially, he or she might compare the accent, conversational habits, breathing rhythms, and intonations of the evidence sample with the suspicious samples. After then, the corresponding voiceprints are compared. Voice parametrization is the process of converting a voice signal into a set of selected features that emphasize the speaker unique characteristics. The goal of this modification is to establish a new depiction that is more concise and more appropriate to speaker characterization. While evaluating deteriorated acoustic situations, recognizing voice parts becomes challenging. Time interval measure, zero-crossing rate, pitched spectrum analysis, higher cognitive statistics in the LPC residual domain, and fusions of various characteristics are among the Voice Activity Detection (VAD) approaches employed. Keywords: Voice, analysis, crime, Forensic, India.
... This evaluation has been expressed in a variety of approaches. Rerecording a speech sound sample of the unidentified accompanied by a rerecording of the identical voices sound of the suspected is one of the most widely utilized auditory comparison procedures [13]. ...
Article
The area of forensic speech and audio analysis encompasses a vast range of operations, the much more prominent of which is, without the need of a doubt, speaker identification. In addition, comprehensibility improvement of the recorded voice signal, analysis of disputed speech, and assessment of the legitimacy of audio recordings are also activities in the field. Using voice analysis, the examiner has two ideas about how to make an identification. Initially, he or she might compare the accent, conversational habits, breathing rhythms, and intonations of the evidence sample with the suspicious samples. After then, the corresponding voiceprints are compared. Voice parametrization is the process of converting a voice signal into a set of selected features that emphasize the speaker unique characteristics. The goal of this modification is to establish a new depiction that is more concise and more appropriate to speaker characterization. While evaluating deteriorated acoustic situations, recognizing voice parts becomes challenging. Time interval measure, zero-crossing rate, pitched spectrum analysis, higher cognitive statistics in the LPC residual domain, and fusions of various characteristics are among the Voice Activity Detection (VAD) approaches employed.
... Only a few systematic reviews on the effects of propranolol for the treatment of anxiety disorders have been conducted, with a recent meta-analysis reporting the quality of evidence for the efficacy of propranolol to be insufficient to support its routine use for the treatment of anxiety disorders [170]. However, propranolol has been widely used off-label for anxiety [171], drug withdrawal symptoms [172], aggression [173], performance anxiety related to examinations [174], on stage [175], among musicians [176], among surgeons [177], for patients who fear undergoing surgery [178], and in the field of psychiatry. ...
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Stress-induced changes in the immune system, which lead to neuroinflammation and consequent brain alterations, have been suggested as possible neurobiological substrates of anxiety disorders, with previous literature predominantly focusing on panic disorder, agoraphobia, and generalized anxiety disorder, among the anxiety disorders. Anxiety disorders have frequently been associated with chronic stress, with chronically stressful situations being reported to precipitate the onset of anxiety disorders. Also, chronic stress has been reported to lead to hypothalamic-pituitary-adrenal axis and autonomic nervous system disruption, which may in turn induce systemic proinflammatory conditions. Preliminary evidence suggests anxiety disorders are also associated with increased inflammation. Systemic inflammation can access the brain, and enhance pro-inflammatory cytokine levels that have been shown to precipitate direct and indirect neurotoxic effects. Prefrontal and limbic structures are widely reported to be influenced by neuroinflammatory conditions. In concordance with these findings, various imaging studies on panic disorder, agoraphobia, and generalized anxiety disorder have reported alterations in structure, function, and connectivity of prefrontal and limbic structures. Further research is needed on the use of inflammatory markers and brain imaging in the early diagnosis of anxiety disorders, along with the possible efficacy of anti-inflammatory interventions on the prevention and treatment of anxiety disorders.
... 6 Anxiety disorders for which propranolol has been studied include anxiety, panic, performance anxiety, test-taking anxiety, prevention of PTSD after a trauma, and aggression. [10][11][12][13][14][15][16][17][18][19][20][21][22] Propranolol is the most widely studied and utilized beta-blocker for anxiety, yet it has a number of drawbacks (further elaboration provided below) among betablockers which often make it poorly tolerated. To date, there are a limited number of publications regarding the use of atenolol for treating anxiety, and all are for as needed use only. ...
Article
Introduction Anxiety disorders are among the most commonly diagnosed of psychiatric disorders. Many symptoms of posttraumatic stress disorder are also anxiety-related. Traditional medications used to treat these disorders, such as antidepressants and benzodiazepines, are often ineffective, not well-tolerated, and can be habit forming. An alternative agent is, therefore, needed. Beta-blockers are one class of medication with potential to treat anxiety-related disorders; however, current evidence remains limited and requires further characterization. To this end, this retrospective study aims to present a novel preliminary report on the use of the beta-blocker, atenolol, to potentially treat anxiety-related disorders. Materials and methods Ninety-two patients were identified from outpatient military mental health clinics in Okinawa, Japan, who had received atenolol for mental health-related symptoms. Primary measures collected were the rates of patient-reported (1) general beneficial/positive effect of atenolol, (2) adverse effects from atenolol, and (3) preference of atenolol to propranolol. Data were collected from patients who were given binary response options to report their perceived experiences for each primary measure. This study was approved by the Naval Medical Center San Diego Institutional Review Board. Results The results showed 86% of patients reporting a positive effect and continuing to take atenolol, including 87% with a diagnosis of posttraumatic stress disorder, 100% with diagnosis of other specified trauma- and stressor-related disorder, and 81% diagnosed with anxiety disorders. In total, 90% of patients denied adverse effects or found the adverse effects tolerable. Additionally, 100% of patients who had previously taken propranolol for anxiety reported that they preferred atenolol. Conclusions The present preliminary observational data suggests that atenolol may be well-tolerated and effective among persons with anxiety disorders. These data also suggest that atenolol may be more effective and better tolerated than propranolol, which is the most commonly prescribed beta-blocker for these conditions; however, more rigorously controlled empirical studies are needed to further substantiate this claim. Despite an overwhelmingly high rate of positive reports from patients’ self-evaluations of atenolol treatment for anxiety-related disorders, this early investigation was not placebo-controlled nor double-blinded, and formal outcome measures were not assessed due to a lack of availability. More detailed examinations are needed to further determine whether atenolol is a viable alternative or augmenting agent to propranolol, benzodiazepines, and antidepressants for anxiety disorders and trauma-related disorders.
... Dews and Williams (1989) argued that this was a matter for concern in an environment which was so intensely competitive and the chances of failure were high. Brantigan et al (1982) have argued that much of a musical conservatory training involves frequent unpolished performances which are conducted in front of highly critical judges. The authors suggested that the experience o f being forced into repeated high pressure performances when one is unprepared is bound to lead to performance anxiety. ...
Thesis
Three groups of children and adolescents aged between 11 and 16 were recruited for this study, dancers and musicians attending specialist schools for the performing arts and a third group of students from "non performing arts" schools. It was hypothesised that the dancers would have higher rates of eating disorder and eating disorder symptomatology than non dancers. It was also hypothesised that all of the dancers with a diagnosis of Anorexia Nervosa would be classified as "neurotic perfectionists" as assessed by the Setting Conditions for Anorexia Nervosa Scale (SCANS; Slade and Dewey 1986) and that significantly more dancers would be classified as "neurotic perfectionists" than non dancers. It was further hypothesised that the musicians would have higher rates of non eating disorder diagnoses and symptoms than controls. Finally, it was predicted that the specialist students whose perceived performance expectations exceeded their perceived performance in the specialist subject would have a greater number of symptoms than individuals without this discrepancy. Two cases of Anorexia Nervosa were found in the dance group and no such cases were found in the non dancers. Similar rates of Bulimia Nervosa were found in both the dancers and non dancers. Chi-square analysis revealed that there was no association between group membership (dancer/non dancer) and an eating disorder diagnosis. There were also no significant differences between the dancers and non dancers in terms of eating disorder symptomatology. One of the two dancers with Anorexia Nervosa was classified as a "neurotic perfectionist". There were also more "neurotic perfectionists" in the dance group in comparison to the non dancers, although this was not statistically significant. The musicians did not have a greater number of non eating disorder diagnoses or symptoms than controls. Finally, the specialist subjects whose perceived performance expectations exceeded their perceived performance had significantly more symptoms than individuals without this discrepancy. However, perceived performance alone appeared to be the most important variable in terms of psychopathology. The implications of these and other findings are discussed.
... Beta--bloker pozwolił mu jedynie pozbyć się czynnika, który nie pozwoliłby mu na pełne zaprezentowanie swojego talentu. Beta--blokery należą do substancji dopuszczalnych także w niektórych dyscyplinach sportowych (Brantigan, Brantigan, & Joseph 1982), niemniej jednak w innych traktowane są jako doping i w związku z tym zakazane (World Anti--Doping Agency 2015). Do sportów gdzie obowiązuje ten zakaz należą m.in. ...
Article
The paper presents moral and legal aspects of the human’s nature enhancement in the context of answering the questions to what extent and to whom the modern technologies may be applied, which purpose is not the recovery (therapy), but the improvement of natural human potential by increasing the strength, endurance, immunity, physical fitness and human’s ability to regenerate, as well as by improving the cognitive capacities in the form of the betterment of human thinking and memory. The problems of enhancement are associated with the movement of transhumanism, which postulates the perfecting of a man and assumes the possibility to control more and more the domains of human activities, both physical and intellectual. In finding the answer to the question of the limits of moral acceptance for the enhancement of human nature, we analyze the cases of a soldier and sportsman, which illustrate the most important problems of the issue. The choice of such examples was due to the belief that social function and the types of activity connected with the exercise of these professions are very important for the determination of the acceptable limits of human enhancement. In our opinion the determination of the limit should be made by referring to the types of activity, based on the division of human activities elaborated by A. MacIntyre. According to MacIntyre, in the case of human activities known as practices, a man achieves internal goods, which define the practice and can only be achieved by improving human skills/abilities. While the external goods, like fame, money or prestige, do not belong to the essence of a practice. For these goods can be achieved both through honest work and self-improvement, and by the fraud. After considering a number of theoretical and practical problems, we argue for the thesis that the admissibility of artificial enhancements and the establishment of its acceptable limits are to be resolved by determining whether a given activity is oriented to achieve essential goods, like life, health or national security, which constitute the moral or social good (in such cases the use of enhancements sometimes will be even a duty), or this activity merely consist in the practice of virtues for the moral improvement of man, which should be made exclusively by using the natural human potential. Thus, the limit of the morally acceptable enhancement of the human nature is to be Dopuszczalność ulepszania natury ludzkiej (enhancement determined (at the stages of law-making and law-application) by indicating the nature of a given activity, its social function and importance, and therefore its moral or social significance.
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This research requires personal, psychological analysis which reflect korean culture`s characteristics and emotions for stage-fright and factors of fear-causing, solution-centered, humanism, recognition-acting by approaching through psychology counsel. It studies former stage, and base on this psychological therapy. It can be suggested that applying various psychological arbitration training program. Also stage fear and fright which factors are not overcome and explained, with them It is necessary to show alternative plan with put physiological analysis together, with this procedure, The goal is to develop systematical and synthetic training course.
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In this review, the author examines the evidence for psychopharmacologic treatments among adults for generalized anxiety disorder, panic disorder, and social anxiety disorder derived from clinical trials. For each disorder, major categories of drugs are reviewed, and then the evidence-based medications in each category are discussed. The author reviews key safety and tolerability considerations for each of the medications or classes. Evidence-based dosing for most specific agents is displayed in a comprehensive reference table. Subsequently, the author synthesizes the available information to suggest a pragmatic stepwise approach to treatment that accounts for patient-specific factors. To inform the guidance, the author incorporates and refines perspectives from treatment guidelines already written by clinical professional organizations. The author also briefly reviews the relatively new quantitative systematic review methodology of network meta-analysis (NMA) and discusses how NMA may help guide pharmacologic treatment sequencing decisions in the future by way of ranking treatments according to effect size and the relative amount of study to which treatments have been subject. Caveats of NMA studies are briefly discussed, as are results of recent NMAs regarding the pharmacologic treatment of anxiety disorders.
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Chapter
Temporary distress in social situations is familiar to most people. For example, for many people, speaking or performing in public is associated with trembling of the voice and hands, heartpounding, dry mouth, and sweating. An essential characteristic in these situations is the fear of scrutiny by other people. However, most people do not feel incapacitated by these fears and may even see the associated arousal and alertness as conducive to their performance.
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The aims of the current study were to: (a) investigate the reported prevalence of nutritional, medicinal, and performance enhancing substance use in dance, including any gender or professional status differences, and (b) examine the amount of importance dancers place on potential sources of information regarding supplementation. Methods involved administering an anonymous survey to 371 male (n = 83) and female (n = 286) UK-based dancers (Mage = 20.87 years). Use of at least one supplement was reported by 91.9% of the dancers surveyed, and prevalence rates were highest for multivitamins, over-the-counter painkillers, and high energy drinks. Prevalence of use varied from low to high for specific nutritional and medicinal supplements, whereas very low levels of supplementation were seen for all performance enhancing supplements. Numerous forms of supplementation were more prevalent in male and professional dancers in comparison to female and amateur dancers, respectively. Across all categories of supplementation, physiotherapists and GPs/physicians were considered to be important sources of information on supplementation, whereas non-dance friends were considered to be the least important source of information. In conclusion, the current study provides much needed information on nutritional, medicinal and performance enhancing supplementation in dancers, and identifies key sources of information for dancers on all forms of supplementation.
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Objective: Beta-adrenergic receptor signaling, a critical mediator of sympathetic nervous system influences on physiology and behavior, has long been proposed as one contributor to subjective stress. Yet prior findings are surprisingly mixed about whether beta-blockade (e.g., propranolol) blunts subjective stress, with many studies reporting no effects. We re-evaluated this question in the context of an acute psychosocial stressor with more comprehensive measures and a larger-than-typical sample. We also examined the effects of beta-blockade on psychophysiological indicators of sympathetic and parasympathetic nervous system reactivity, given that beta-blockade effects for these measures specifically under acute psychosocial stress are not yet well-established. Methods: In a double-blind, randomized, placebo-controlled study, 90 healthy young adults received 40 mg of the beta-blocker propranolol or placebo. Participants then completed the Trier Social Stress Test, which involved completing an impromptu speech and difficult arithmetic in front of evaluative judges. Self-reported emotions and appraisals as well as psychophysiology were assessed throughout. Results: As expected, propranolol blunted TSST pre-ejection period reactivity (b=9.68, p=.003), a marker of sympathetic nervous system activity, as well as salivary alpha amylase reactivity (b=-.50, p=.006). Critically, propranolol also blunted negative, high arousal emotions in response to the stressor (b=-.22, p=.026), but cognitive appraisals remained intact (bs<-.17, ps>.10). Conclusions: These results provide updated experimental evidence that beta-adrenergic signaling contributes to negative, high arousal emotions in response to a psychosocial stressor while also blunting sympathetic nervous system reactivity. Together, these findings shed light on the neurophysiological mechanisms by which stressors transform into the subjective experience we call “stress.”
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The thrill of a live performance can enhance endorphin, serotonin, dopamine, and adrenaline levels in the body. This mixture of heightened chemical levels is a result of “performance adrenaline.” This phenomenon can positively and/or negatively affect a performing singer. A singer’s body is her instrument, and therefore, any bodily change can alter the singing voice. The uptake of these chemicals can especially influence a central aspect of singing: breath. “Performance adrenaline” can induce shallow or clavicular breathing, alter phonation, and affect vibrato. To optimize the positive effects and counteract the negative, diaphragmatic breathing, yoga, and beta-blockers are explored as viable management tools. When managed properly, the boost offered by “performance adrenaline” can aid the singer in performing and singing. After a review of medical and psychological studies that reveal the physiological and emotional effects of endorphins, serotonin, dopamine, and adrenaline, this paper explores the biological changes specific to vocalists and methods to optimize these effects in performance.
Chapter
Anxiety is perceived as a pervasive feeling of apprehension about some unspecified future threat to self-esteem. The somatic manifestations of anxiety are many, affecting virtually all organ systems. However, anxiety must be distinguished from other organic illnesses whose symptoms may resemble those of anxiety. A complex interaction may occur in which anxiety and organic disease may have mutually aggravating effects.
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Randomized controlled trials have concluded that the cardiovascular outcome of first-step treatment of hypertension with traditional vasoconstricting beta-blockers is inferior to treatment with other antihypertensive drug classes. Beta-blocker use is also associated with undesireable side effects. Consequently, some recent guidelines consider beta-blockers an inferior option for first-step treatment of hypertension. Despite this, beta-blockers are still widely prescribed, and likely overused, in the management of hypertension.
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In brief: Beta-blocking drugs are now? commonly used in patients with hypertension or coronary artery disease (CAD). This article reviews the effects of beta-blockade and recommends exercise prescriptions for patients taking these drugs. In patients with asymptomatic, uncomplicated hypertension, these medications impair exercise performance to some degree, especially endurance exercise or exercise lasting more than 30 minutes. Beta-blockers also hinder these patients' ability to improve performance with training. In patients with CAD and angina, however, exercise capacity often increases substantially because of improved angina control and the effects of peripheral conditioning. However, once their initial deconditioning has been overcome, their capacity for endurance exercise training may be impaired by the effects of beta-blockade on muscle metabolism. This effect may be lessened by the choice of a more cardioselective beta-blocking drug.
Chapter
The rapid advancement of technology raises ethical issues that need to be addressed in the near future. According to Kurzweil law, technology progresses at an exponential rate. Ethics, on the other hand, advances much slower and doesn’t keep pace with the number and complexity of issues brought by technology. Considering that technology’s speed of evolution won’t slow down because ethics can’t keep pace with it, we argue that all those ethical issues that are already present in the public space should be discussed and sorted out as soon. Otherwise, they will become deeper and generate even more problems. The chapter discusses at length about the cognitive and body enhancements, achieved through either medical or bionic implants, and the changes that these enhancements induce in our behavior. Computers and the internet are some of the greatest enhancers ever and they managed to change the attitude of the millennials and Generation Z towards ownership and work. Our goal was to raise questions regarding the challenge of ethical and moral principles and values by the rapid development of technology. We then argued that the future of research lies in the realm of technology and that neuromarketing, unlike traditional research, has predictive power thanks to the brain scans. It was not our intention to solve or find answers to any of those issues that we raised. For some of them, it might be too soon to draw a conclusion. And for the others, there are competent bodies that can enforce suitable measures.
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Reconsolidation is the return of a memory to a transient state of lability, following memory consolidation, that can occur when memories are evoked. During the process of reconsolidation, memories may be modified by different means, including the administration of drugs, during a period called the ''reconsolidation window”. This process has been widely studied in animals, but human studies are limited and include several methodological pitfalls. Our objective was to conducte a systematic review of the literature that utilizes pharmacological interventions during the process of reconsolidation of aversive memories in humans, with a critical analysis of the methodologies used. Searches were made in the electronic databases PubMed, Scopus, Web of Science and SciELO using the following search terms: (memory) AND (consolidation OR reconsolidation) AND (pharmacological manipulation OR pharmacological intervention). We found 294 references and ten (3.4%) were included in the review, based on preestablished eligibility criteria. All studies were randomized, double-blind clinical trials. The most commonly studied drug was propranolol. Two studies used a protocol involving autobiographical aversive memories, while in the remaining aversive memories were produced in the laboratory. The timing of pharmacological interventions is a controversial issue in the field, as drug activity must occur within the reconsolidation window. The small number of studies and some methodological difficulties of this type of research highlights the need for studies that individually evaluate some of the issues discussed, particularly the timing of pharmacological interventions and the duration of reconsolidation windows.
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Objectives This study aimed to determine the effect of selective (bisoprolol-5 mg) and non-selective (propranolol-40 mg) beta-blockers on archery performance, body sway and aiming behaviour. Methods Fifteen male archers participated in a randomised, double-blind, placebo-controlled, cross-over study and competed four times (control, placebo, selective (bisoprolol) and non-selective (propranolol) beta-blocker trials). Mechanical data related to the changes in the centre of pressure during body sway and aim point fluctuation and when shooting was collected. During the shots, heart rate was recorded continuously. Results Results indicated that, in beta-blocker trials, although shooting heart rates were lowered by 12.8% and 8.6%, respectively, for bisoprolol and propranolol, no positive effect of beta-blockers was observed on shooting scores. Also, the use of beta-blockers did not affect shooting behaviour and body sway. Conclusion The use of either selective or non-selective single dose beta-blockers had no positive effect on shooting performance in archery during simulated match conditions.
Article
Background Post-traumatic stress disorder (PTSD) can develop following a traumatic event and results in heightened, inappropriate fear and anxiety. Although approximately 8% of the United States population suffers from PTSD, only two drugs have been approved by the FDA to treat it, both with limited efficacy. Propranolol, a non-selective β-adrenergic antagonist, has shown efficacy in decreasing exaggerated fear, and there has been renewed interest in using it to treat fear disorders. Methods Here, we sought to determine the mechanisms by which propranolol attenuates fear by utilizing an activity-dependent tagging system, the ArcCreERT2 x enhanced yellow fluorescent protein (eYFP) mice. 129S6/SvEv mice were administered a 4-shock contextual fear conditioning (CFC) paradigm followed by immediate or delayed context re-exposures. Saline or propranolol was administered either prior to or following the first context re-exposure. To quantify hippocampal, prefrontal and amygdalar memory traces, ArcCreERT2 x eYFP mice were administered a delayed context re-exposure with either a saline or propranolol injection prior to context re-exposure. Results Propranolol decreased fear expression only when administered prior to a delayed context re-exposure. Fear memory traces were affected in the dorsal dentate gyrus and basolateral amygdala following propranolol administration in the ArcCreERT2 x eYFP mice. Propranolol acutely altered functional connectivity between hippocampal, cortical, and amygdalar regions. Conclusions These data indicate that propranolol may decrease fear expression by altering network correlated activity and by weakening the reactivation of the initial traumatic memory trace. This work contributes to the understanding of noradrenergic drugs as therapeutic aids for PTSD patients.
Chapter
Cardiac medications including β-blockers, cardiac glycosides, and antiarrhythmics have long been known to have CNS effects including alterations in mood, emotion state anxiety, and depression. While the predominant effects come from those with higher lipophilicity and when used at high doses, the evidence is actually quite mixed. At cardiac therapeutic doses, lipophilic β-blockers like propranolol have actually few CNS effects on mood. The effectiveness of β-blockers is established for relieving performance anxiety, but the actions involve more a peripheral relief of somatic symptoms rather than a central effect. By contrast the reduction in consolidation of aversive and stressful memory by propranolol appears to involve altering the functioning of the amygdala and hippocampus directly. While evidence suggests that β-blockers reduce aggressive behaviors associated with various psychological conditions such as schizophrenia, they are now used relatively rarely. Cardiac glycosides such as digoxin have been implicated in causing a variety of mental dysfunctions including depression, yet quality prospective trials are lacking and evidence is largely anecdotal. The difficulty is that the patients likely to receive either β-blockers or digoxin are often suffering heart failure which in itself causes mood alterations such as depression. The current review analyzes the evidence of mood-altering side effects for the various pharmacological agents used to treat cardiac disease.
Thesis
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This study aimed at investigating the quality of instrumental performance through the orchestral excerpt of Prélude à l´après-midi d´un faune by Claude Debussy and its relationship to music performance anxiety experienced by flute students. The theoretical premise employed in the assessment of the quality of instrumental performance is based on the Process Model of Assessing Music Performance by McPherson & Thompson (1998). For music performance anxiety, we used the triple model developed by Wilson & Roland (2002) and Valentine (2002), as well as Beck & Clark´s Cognitive Theory of Anxiety (1997). The methodology consisted of a mixed approach and semi-experimental in character directed at flute students enrolled in courses of Bachelor of Music at Brazilian universities. The semi-experimental procedure comprised in a musical task recorded in audio in different situations of musical performance preceded by data collection through the psychological instruments of self-evaluation and physiological measures according to the protocol of data collection. Five Brazilian professional flute players assessed the quality of instrumental performance from the recordings by means a Flute Performance Rating Scale, proposed for this study. Data analysis occurred in two steps. While the qualitative part analyzed the content of the assessors' comments to flute students, and the quantitative examined the correlation between the quality of musical performance through the technical and interpretative skills of flute playing and music performance anxiety by descriptive and non-parametric statistics. The results indicate a direct and non-proportional relationship, presenting an improvement in the quality of instrumental performance in the individual practicing session and a reduction of the music performance anxiety in the audition. Intonation and timbre were the technical and interpretative skills most negatively influenced by anxiety. However, most of the flute students were considered non-proficient in rhythmic accuracy by the judges. Finally, the level of musical expertise and previously knowledge of the orchestral excerpt were shown to be relevant both in the proficiency of flute playing and in the reduction of the experienced music performance anxiety.
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A vital aspect of successful advocacy is effective engagement by the advocate with the Bench. However, even where mooters have innate skills and talents, they are susceptible to sub-optimal performance where anxiety impedes their transition from innate skill to competition. Stage fright is common in many fields where public performance of a repertoire is the crucial and determinative measure of achievement. However, while anxiety is an inevitable, and often negative, aspect of any performance, there is in fact a range of anxietal intensity that is conducive to optimal performance. Assisting future advocates to recognise their optimal level of anxiety, and manage their anxiety throughout the preparation and participation phases of moot competitions is a significant role for the moot coach. This article explores anxiety as a principal artefact of the affective domain, its relevance to advocacy, and proposes a model against which moot coaches can frame preparation of mooting teams against a principled construct of the anxiety/mooting relationship. In so doing, it positions the affective domain as it relates to mooting in context with the cognitive and psychomotor domains.
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Objective: To conduct a systematic review examining the effectiveness of pharmacological management of agitation among individuals with acquired brain injury (ABI). Data sources: MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for all relevant articles published in English from 1980 to January 2016. Study selection: Studies were included for analysis all participants had moderate to severe ABI, n ≥ 3, and a pharmacological intervention was provided for the treatment of agitation and its effectiveness was assessed. Data extraction: Data extracted included participant demographics, inclusion and exclusion criteria, study design, outcome measure(s), and results. Study quality was assessed using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs). A level of evidence was assigned to each intervention using a modified Sackett scale. Data synthesis: Among 165 retrieved studies, 19 met inclusion criteria. The included studies consisted of 6 RCTs and 13 observational studies. Antipsychotic medications were studied predominately (n = 6), followed by anticonvulsants (n = 4) and dopaminergic (n = 4), antidepressants (n = 3), and beta-blockers (n = 2). Dopaminergic medications, specifically amantadine, had the highest level of evidence (Level 1a). The antipsychotic lithium carbonate was shown to be effective but was not recommended for use due to high risk of neurotoxicity. Conclusions: Studies consistently demonstrated that pharmacological treatment was effective in reducing agitation post ABI; however, there was insufficient information to develop a conclusion due to the limited number of studies and overall weakness of evidence for each individual medication.
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Background: Recognition is growing that social anxiety disorder (SAnD) is a chronic and disabling disorder, and data from early trials demonstrate that medication may be effective in its treatment. This systematic review is an update of an earlier review of pharmacotherapy of SAnD. Objectives: To assess the effects of pharmacotherapy for social anxiety disorder in adults and identify which factors (methodological or clinical) predict response to treatment. Search methods: We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR-Studies and CCMDCTR-References) to 17 August 2015. The CCMDCTR contains reports of relevant RCTs from MEDLINE (1950-), Embase (1974-), PsycINFO (1967-) and CENTRAL (all years). We scanned the reference lists of articles for additional studies. We updated the search in August 2017 and placed additional studies in Awaiting Classification, these will be incorporated in the next version of the review, as appropriate. Selection criteria: We restricted studies to randomised controlled trials (RCTs) of pharmacotherapy versus placebo in the treatment of SAnD in adults. Data collection and analysis: Two authors (TW and JI) assessed trials for eligibility and inclusion for this review update. We extracted descriptive, methodological and outcome information from each trial, contacting investigators for missing information where necessary. We calculated summary statistics for continuous and dichotomous variables (if provided) and undertook subgroup and sensitivity analyses. Main results: We included 66 RCTs in the review (> 24 weeks; 11,597 participants; age range 18 to 70 years) and 63 in the meta-analysis. For the primary outcome of treatment response, we found very low-quality evidence of treatment response for selective serotonin reuptake inhibitors (SSRIs) compared with placebo (number of studies (k) = 24, risk ratio (RR) 1.65; 95% confidence interval (CI) 1.48 to 1.85, N = 4984). On this outcome there was also evidence of benefit for monoamine oxidase inhibitors (MAOIs) (k = 4, RR 2.36; 95% CI 1.48 to 3.75, N = 235), reversible inhibitors of monoamine oxidase A (RIMAs) (k = 8, RR 1.83; 95% CI 1.32 to 2.55, N = 1270), and the benzodiazepines (k = 2, RR 4.03; 95% CI 2.45 to 6.65, N = 132), although the evidence was low quality. We also found clinical response for the anticonvulsants with gamma-amino butyric acid (GABA) analogues (k = 3, RR 1.60; 95% CI 1.16 to 2.20, N = 532; moderate-quality evidence). The SSRIs were the only medication proving effective in reducing relapse based on moderate-quality evidence. We assessed tolerability of SSRIs and the serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine on the basis of treatment withdrawal; this was higher for medication than placebo (SSRIs: k = 24, RR 2.59; 95% CI 1.97 to 3.39, N = 5131, low-quality evidence; venlafaxine: k = 4, RR 3.23; 95% CI 2.15 to 4.86, N = 1213, moderate-quality evidence), but there were low absolute rates of withdrawal for both these medications classes compared to placebo. We did not find evidence of a benefit for the rest of the medications compared to placebo.For the secondary outcome of SAnD symptom severity, there was benefit for the SSRIs, the SNRI venlafaxine, MAOIs, RIMAs, benzodiazepines, the antipsychotic olanzapine, and the noradrenergic and specific serotonergic antidepressant (NaSSA) atomoxetine in the reduction of SAnD symptoms, but most of the evidence was of very low quality. Treatment with SSRIs and RIMAs was also associated with a reduction in depression symptoms. The SSRIs were the only medication class that demonstrated evidence of reduction in disability across a number of domains.We observed a response to long-term treatment with medication for the SSRIs (low-quality evidence), for the MAOIs (very low-quality evidence) and for the RIMAs (moderate-quality evidence). Authors' conclusions: We found evidence of treatment efficacy for the SSRIs, but it is based on very low- to moderate-quality evidence. Tolerability of SSRIs was lower than placebo, but absolute withdrawal rates were low.While a small number of trials did report treatment efficacy for benzodiazepines, anticonvulsants, MAOIs, and RIMAs, readers should consider this finding in the context of potential for abuse or unfavourable side effects.
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A total of 12 chronically anxious psychiatric outpatients were treated with racemic propranolol (Inderal), diazepam (Valium), and placebo for one week each, using a balanced cross-over experimental design. Six patients had predominantly somatic anxiety, complaining mostly of bodily symptoms, and six had mainly psychic anxiety, complaining primarily of psychological symptoms. Clinical ratings of anxiety were made by patient and psychiatrist after each treatment. Though diazepam was in general more effective than propranolol or placebo in relieving anxiety, propranolol was more effective than placebo in patients with somatic anxiety but not in those with psychic anxiety. We suggest that propranolol should be reserved for patients whose anxiety symptoms are mainly somatic.
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The effect of 40 mg oxprenolol on stage-fright was assessed in 24 musicians in a double-blind crossover trial. Musical performance judged by two professional assessors was found to improve. Greatest improvement was seen on the first performance and in those most affected by nervousness.
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A 74-year-old woman with mild dementia became disoriented and developed paranoid delusions when treated with low-dose propranolol. There was no evidence of cardiovascular instability, and the symptoms resolved within a week. Rechallenge with propranolol led to a recurrence of mental status changes.
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In a double-blind preliminary study in 32 students exhibiting symptoms of examination stress, treatment with 80 mg oxprenolol daily or 4 mg diazepam daily were found to be equally effective in relieving anxiety and tension, as assessed by both students and physician. Although students on diazepam became significantly more confident of success than those on oxprenolol, their results were worse than expected. In contrast, students on oxprenolol did not gain in confidence and they were significantly more successful than anticipated by their tutors.
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Since 1964, of 725 patients presenting with anxiety syndromes, 513 were treated with propranolol for periods of several days to over 10 years, some intermittently, others virtually without interruption. Of these, 237 had previously received or were receiving psychotropic drugs, mostly benzodiazepines and/or phenothiazines, which had proved ineffective or deleterious. Dosage was adjusted to achieve an optimum clinical response and a relatively high degree of beta-blockade, as judged by the virtual abolition of orthostatic and hyperventilatory tachycardia. As a rule, 80-320 mg daily sufficed, but increments up to 1200 mg were temporarily required to control bizarre or unusually intense symptoms. With few exceptions, the somatic and psychic symptoms were relieved or moderated and overall functional capacity was restored. Depression, evident in 50% of the patients, usually lifted, but persisted in one-third as a lone symptom responsive to antidepressants. Propranolol requirements usually diminished and lasting remissions were not infrequent. The effects of propranolol contrasted sharply with those experienced by the patients receiving tranquillizers. Single-blind placebo trials involving 76 cases endorsed the specificity of the response to beta-blockade. This long term study reveals that effective control of the somatic and psychic symptoms of anxiety can be achieved with propranolol in appropriate dosage.
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In a double-blind, sequential trial, practolol 200 mg. twice daily was more effective than placebo in the treatment of fifteen patients with anxiety. Since this drug does not readily enter the brain, these results are consistent with the hypothesis that peripheral rather than central β-receptor blockade is responsible for its therapeutic activity in anxiety states.
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No unequivocal central effects were found with either +/--propranolol (120 mg) or +/--sotalol (240 mg) in acute dosage in normal subjects. Subjective feelings of drowsiness and muzziness were found with sotalol and both sotalol and propranolol caused subjects to feel more troubled. These changes were not accompanied by physiological or behavioural evidence of sedation. Adequate beta-adrenoceptor blockade was achieved as measured by a significant fall in pulse-rate on both active drugs but no other significant peripheral physiological changes occurred.
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Anxiety has three essential elements: the subjective experience, autonomic symptoms and avoidance behaviour. Various theories are considered which highlight the psychic and somatic aspects of anxiety. Beta-adrenergic receptor blocking drugs have been used with advantage to treat everyday stresses. These include the anxiety produced by the civil disturbances in Northern Ireland, performing surgery, dentistry, musical instruments or speaking in public, as well as examination nerves. The profile of symptoms such as tachycardia, palpitations and tremor which are most likely to respond to beta-blockers are discussed as well as their side effects. Their mode of action is different from other anxiolytics, with which they can be combined.
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