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Effect of Beta Blockade and Beta Stimulation on Stage Fright
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.
... According to a meta-analysis, propranolol may be useful in the treatment of anxiety disorders caused by unsettling memories, notably PTSD [46]. Furthermore, propranolol is useful in lowering emotional arousal [47], eradicating stage fright [48], and alleviating anxiety-related cognitive dysfunction [49]. ...
... Following memory reactivation, this API can decrease the identification of emotional pictures, according to additional research utilising functional magnetic resonance imaging [68]. A propranolol-mediated decrease in sympathetic tone in the period surrounding re-exposure can lead to changes in the subjective qualities of emotional memories, which is compatible with propranolol's anxiolytic effects [48,67,[69][70][71]. A meta-analysis of healthy humans found that a single memory reactivation session combined with propranolol medication lowered the strength of negatively valenced emotional memories [46]. ...
... It has been demonstrated that propranolol has an acute effect on fear-potentiated startle responses [89]. Additionally, studies on propranolol have indicated that it can alleviate less stressful conditions such as exam anxiety [90][91][92], stage fright [48], performance anxiety in musicians [93], and fear of surgery [94,95]. ...
Propranolol, a non-cardioselective β1,2 blocker, is most commonly recognised for its application in the therapy of various cardiovascular conditions, such as hypertension, coronary artery disease, and tachyarrhythmias. However, due to its ability to cross the blood–brain barrier and affinity towards multiple macromolecules, not only adrenoreceptors, it has also found application in other fields. For example, it is one of the very few medications successfully applied in the treatment of stage fright. This review focuses on the application of propranolol in the treatment of various types of anxiety and stress, with particular reference to stage fright and post-traumatic stress disorder (PTSD). Both mechanisms of action as well as comparison with other therapies are presented. As those indications for propranolol are, in most countries, considered off-label, this review aims to gather information that can be useful while making a decision about the choice of propranolol as a drug in the treatment of those mental conditions.
... Their hypothesized mechanism of action is suppression of the physiological hyperarousal that occurs in the fear response to such situations. This process interrupts an escalating feedback loop in which patients become distressed and self-conscious about physical manifestations such as flushing, palpitations, and sweating, which subsequently causes them to further amplify these symptoms; this amplification, in turn, begets more psychic anxiety about these manifestations being scrutinized by others and so on (105,106). For reasons that are not fully understood, beta blockers have not demonstrated efficacy in treating generalized social anxiety disorder. ...
... One should take a "test" dose on a day with no performance obligations to get accustomed to the feeling of the medication. Typical adverse effects include orthostatic hypotension and lightheadedness, bradycardia, sedation, and nausea; in the case of nonselective propranolol, effects include worsening of underlying airway obstruction among patients with asthma or chronic obstructive pulmonary disease (105,106,108,109). ...
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.
... 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. ...
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.
... 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. ...
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.
... 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. ...
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.
... 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. ...
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.
... 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. ...
... Adicionalmente, la mifepristona, otro antagonista glucocorticoide, también muestra potencial para reducir el miedo condicionado en humanos, tal y como se puede observar en estudios como el de Pitman et al. (2011). Otro formato de intervención en la reconsolidación propone disminuir los síntomas de estrés y ansiedad producidos por la memoria del miedo mediante la administración de ansiolíticos (Brantigan et al., 1982). ...
In recent years, a controversial approach to the high rate of relapse in exposure therapy has resurfaced. Theoretically, the recovery of an already treated fear can be explained due to the competition that seems to take place between initial excitatory learning and a new inhibitory learning (produced by training in extinction) in which the former is shown superior. To address this matter, the weakening of the original learning is proposed by means of reactivating it and blocking its reconsolidation through pharmacological or behavioural methods. The great variability and inconsistency of methods and results that characterize this paradigm is shown in this work, which, on the one hand, invites to continue the research aimed at reaching firm conclusions and, on the other hand, questions the applicability of this strategy for the treatment of different psychopathologies.
... 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: ...
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.
... 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]. ...
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.
... 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]. ...
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.
... 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]. ...
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.
... 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. ...
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.
... 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. ...
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. ...
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. ...
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. ...
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.
... 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. ...
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.
... Propranolol can also be prescribed to be taken before a public performance situation such as delivering a lecture or singing in a concert. [23,41] Propranolol has been effectively used to treat perioperative anxiety. In a randomized, double-blind study, anxiety and depression scores were significantly lower in the propranolol group (P < 0.0001) when compared to the placebo group. ...
Propranolol is a beta-adrenergic receptor antagonist that was developed by the British scientist Sir James Black primarily for the treatment of angina pectoris, more than 50 years ago. It was not long before several other cardiovascular as well as noncardiovascular therapeutic uses of propranolol were discovered. Propranolol soon became a powerful tool for physicians in the treatment of numerous conditions such as hypertension, cardiac arrhythmias, myocardial infarction, migraine, portal hypertension, anxiety, essential tremors, hyperthyroidism, and pheochromocytoma. Owing to its action at multiple receptor sites, propranolol exerts several central and peripheral effects and is therefore useful in various conditions. Right from reduction in postmyocardial mortality to control of anxiety in performers, propranolol plays an important role in a plethora of medical conditions. Interestingly, even today, newer indications of this age-old drug are being discovered. Moreover, propranolol treatment has been found to be cost-effective when compared to other corresponding treatment options for individual indications. In this article, we attempt to recount the journey of propranolol right from its inception to the present day.
... 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). ...
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.
... 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). ...
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.
... Or why are classical musicians allowed to take drugs before a performance and nobody looks down on them for doing so? Research performed by Brantigan et al. ( 1982 ) showed that beta-blockers improved the musical performance of musicians that used those drugs. ...
This book addresses the emerging field of neuromarketing, which, at its core, aims to better understand the impact of marketing stimuli by observing and interpreting human emotions. It includes contributions from leading researchers and practitioners, venturing beyond the tactics and strategies of neuromarketing to consider the ethical implications of applying powerful tools for data collection. The rationale behind neuromarketing is that human decision-making is not primarily a conscious process. Instead, there is increasing evidence that the willingness to buy products and services is an emotional process where the brain uses short cuts to accelerate the decision-making process.
At the intersection of economics, neuroscience, consumer behavior, and cognitive psychology, neuromarketing focuses on which emotions are relevant in human decision-making, and uses this knowledge to make marketing more effective. The knowledge is applied in product design; enhancing promotions and advertising, pricing, professional services, and store design; and improving the consumer experience as a whole. The foundation for all of this activity is data gathering and analysis. Like many new processes and innovations, much of neuromarketing is operating far ahead of current governmental compliance and regulation and thus current practices are raising ethical issues. For example, facial recognition software, used to monitor and detect a wide range of micro-expressions, has been tested at several airports—under the guise of security and counterterrorism. To what extent is it acceptable to screen the entire population using these powerful and intrusive techniques without getting passengers’ consent? Citing numerous examples from the public and private sectors, the editors and contributing authors argue that while the United States has catalyzed technological advancements, European companies and governments are more progressive when it comes to defining ethical parameters and developing policies. This book details many of those efforts, and offers rational, constructive approaches to laying an ethical foundation for neuromarketing efforts.
... 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. ...
... 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]. ...
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.
... 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). ...
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.
... 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. ...
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.
Pharmacological neuroenhancement (PN) describes the use of divergent psychoactive substances to enhance mental performance (cognition) without medical need. This kind of substance abuse takes place predominantly in stressful situations. Users implicitly—or even explicitly—describe this kind of drug abuse to be a coping strategy. Regarding the decision making process whether to use PN drugs or not, users indicate that legal aspects to be decisive. However, the legal situation has been neglected so far. To elucidate the German legal situation, PN substances have to be divided into over-the-counter drugs, prescription drugs and illegal drugs. Amphetamines have the highest cognition-enhancing potential, followed by modafinil and caffeine-containing substances. It is pointed out that the use of both freely available and prescription PN substances and narcotics without medical indication have so far been largely exempt from punishment under German law. However, individuals (physicians, bus and truck drivers, etc.) taking PN substances may expose others at risk due to wrong decisions (driving or treatment), errors based on side effects of the used substances. Therefore, the protection of life and health of others could legitimize criminal regulation.
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.”
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.
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.
Beta adrenergic blockers (β-blockers), notably propranolol, are commonly deployed in psychiatric practice to address a multitude of clinical indications. In this mini-review, authors shed some light on β – blockers pharmacological portfolio as a pluripotent, reasonably safe and appealing contribution to the psychopharmacologic armamentarium, highlight the clinical use of β-blockers in such diverse indications whilst examining the extant evidence.
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.
Many people will experience at least one traumatic event in their lifetime, with up to 20% developing Post-Traumatic Stress Disorder (PTSD) or PTSD-like symptoms. In addition, the likelihood that females will develop PTSD after trauma is more than twice that of males. Despite its prevalence, current treatment strategies for trauma victims are limited and substantial portions of affected individuals remain resistant to treatment, suggesting that additional interventions are necessary. Using an animal model of traumatic stress, the present studies tested the hypothesis that either voluntary exercise and/or administration of the adrenergic beta-receptor antagonist propranolol, would ameliorate stress-related maladaptive behaviors. In Study 1 four groups of female rats were exposed to a sequence of stressors that included anesthesia, restraint, forced swim, exposure to predator scent and fear conditioning. Rats then underwent re-exposure sessions in which stress-related conditioned stimuli were presented. In addition to re-exposure, stressed rats were treated with propranolol (10 mg/kg) and/or given the opportunity to engage in voluntary wheel running intermittently for 4 weeks. Stress-associated maladaptive behavior was assessed using the elevated plus and open field mazes and fear memory tests. Cognitive ability was assessed using a novel odor recognition task. A main effect of exercise on behaviors related to anxiety and resilience was observed, but neither a main effect of propranolol nor a synergistic effect of propranolol and exercise were observed. Neither stress induction nor treatment influenced recognition memory. In contrast, in Study 2 in which the timing and dosage of propranolol (0.25–2.0 mg/kg), and the number and timing of re-exposure sessions were adjusted, propranolol produced both a reduction in anxiety-like behaviors as well as resilience to a subsequent stressor. These results are consistent with the notion that combining re-exposure therapy with additional interventions is beneficial for female trauma victims. Furthermore, the findings support the view that in pre-clinical models, voluntary exercise, which bolsters hippocampal function and propranolol, which affects amygdala-dependent memory reconsolidation and peripheral noradrenergic signaling, can ameliorate stress-related symptoms.
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.
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.
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.
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.
We provide a model that rationalizes variation in confidence in the time series and the cross section. Combining horizon-dependent risk aversion (“anxiety”) and selective memory, we show that overly precise beliefs (“overconfidence”) can arise in the equilibrium of a Bayesian agent’s intrapersonal game. In the time series, overconfidence is more prevalent when actual risk levels are high, while underconfidence occurs when risks are low. As more confident agents take more risk, fluctuations in confidence amplify boom-bust cycles. More anxious agents’ beliefs fluctuate more, leading them to buy in booms and sell in crashes.
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.
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.
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.
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.
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.
This chapter focuses on conflict behaviors as animal models for the study of anxiety. In this chapter, conflict behavior is operationally defined as that situation in which behavior is influenced by two opposing motivational forces. These motivational forces may be inherent in the subject or they may be controlled by the consequences of a particular behavior. The behavior of subjects in conflict paradigms usually represents a compromise between the effects which would have resulted by either of the two opposing motivational forces when applied alone. Conflict behaviors can be divided into two primary categories: those in which electric shocks are used as punishing stimuli, and those in which more natural motivational forces—for example, fear of novelty, fear of open areas, and fear associated with high levels of illumination—are used to suppress behavior. The chapter also reviews the use of behavioral conflict paradigms as animal models for the study of anxiety. It also reviews the criteria for the evaluation of conflict paradigms as animal models for anxiety.
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.
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.
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.
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.
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.
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.
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.
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.
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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