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I feared that many participants here would react to this interesting article's headline rather than to its content, and it appears that that fear is warranted.

I feared that many participants here would react to this interesting article's headline rather than to its content, and it appears that that fear is warranted. But, seriously, this is a thoughtful article and well worth reading for better understanding of debilitating phobias and how they are currently treated. It is also good to read the whole fine article to see what the medical doctor author has to say about the trade-offs of the proposed drug treatment suggested as an addition to the currently standard exposure therapy. I don't know anyone among my close friends who has a phobia as disabling as those described in the article. There is a big difference between such phobias and the everyday caution and avoidance of rash behavior that helps keep us all safe. AFTER EDIT, AFTER OTHER COMMENTS TO THE THREAD: I remember that back in the 1980s propranolol (a beta-blocker originally prescribed to prevent heart disease) was investigated for anxiety conditions like stage fright. (The cases of stage fright among performers I know best largely resolved as the performers gain in performance competence from more coaching and practice and reduced fear of performing by performing in public more often.) So this line of research about propranolol has been going on for a long time.

facetube 11y ago
Yeah, I get that feeling too. The idea that someone exposed to a traumatic event (e.g. rape, child abuse) could immediately given a single dose of a drug that would prevent a possible 30-40 years of painful PTSD is, honestly, pretty compelling.
category 11y ago
If there are more than 3 negative reactions to an article I definitely go read it because at this point it's hugely probable that the backlash is mainly cultural/traditional rather than logical.
nathanb 11y ago
A fair comment. I think it's important to note that a fear or anxiety reaction may not, as you say, keep us safe. When I'm calm and rational, I make better decisions than when I'm gripped by fear. As an avid hiker and explorer, occasionally my fear of heights interferes with my enjoyment of my hobby. I try to push past it as much as possible, but when my heart is racing and my legs are shaking, a situation which would otherwise be safe can become dangerous. Also, unlike you, I do have two friends who suffer from PTSD (it's common enough that one may be surprised to find that a friend one has known for years wrestles with PTSD in some aspect of life but doesn't advertise that fact). One of those friends has gotten off an elevator early because being in an enclosed situation with a stranger gave her a panic attack. Another called me on the phone nearly in tears because she had to stay late at work and walking across the deserted, dark carpark to her car was almost more than she could handle. I think it would be great if a drug could help people like these two friends of mine go through life without feeling controlled by anxiety in situations like these. I also think it would be great if people like me whose day-to-day lives are unmarred by fear can do more things -- safely; the drug does not impair reason -- through this therapy. The tradeoffs are important to know (and as you say, the article does a great job exploring them), but to me this sounds really promising.
spangry 11y ago
This article seems a little inaccurate to me, or at least incomplete. On phobias, it's not quite as simple as a 'fear memory', although certainly a part of it when we're discussing 'conditioned fear' (e.g. PTSD). There's a part of your brain called the amygdala that is implicated in modulation of memory formation and emotional processing. It's part of the limbic system, which is tied in to the body's autonomic nervous system. This controls your 'fight or flight' response, essentially a sudden release of adrenaline into your system which causes 'anxiety symptoms': increased heart rate, increased perspiration, butterflies in stomach (due to diversion of blood flow to large muscles in your limbs). The amygdala is sort of like a 'heuristic co-processor' that receives sensory input earlier than other parts of the brain. If the input matches a heuristic, the body's fight or flight response is activated. If the amygdala is dysfunctional, is 'pre-programmed' with heuristics now considered maladaptive, or you've had experiences that have 'programmed' inappropriate heuristics, it will activate your fight or flight response in response to non-threatening stimuli. Drugs like propranolol, which I take daily for a panic disorder, antagonise (i.e. block) beta-adrendergic receptors, blocking the action of adrenaline and noradrenaline, which dampens the fight or flight response. This reduces or eliminates panic/anxiety like symptoms, and alters how memories are encoded while under its effects (however I'm not clear on whether this interferes with memory formation, or whether it causes the memories to be encoded in a different way). The part I find most interesting is the 'pre-programmed maladaptive heuristics' still present in our heuristic database. Evolution is a slow process, and has not caught up to our rapidly changing context. For instance, if you've ever given a public speech, you've probably experienced a 'fight-or-flight' response. It's not because you've had some bad past experience with public speaking that has conditioned a 'fear response'; it's because of a left over heuristic in your amygdala that may have been adaptive a thousands of years ago. Humans used to live in small tribes or groups with maybe a dozen other humans, and the only other humans they might have contact with in their life would be when fighting other groups for resources. If you publicly humiliated yourself in this context, it would have likely meant elimination from the gene pool or possibly even death. In a modern context, where you're giving a speech to a room full of people in another country, this isn't even mildly the case. But evolution is a slow process, so many of us still experience a fight or flight response anyway, which is maladaptive.
- 11y ago

facetube 11y ago

Yeah, I get that feeling too. The idea that someone exposed to a traumatic event (e.g. rape, child abuse) could immediately given a single dose of a drug that would prevent a possible 30-40 years of painful PTSD is, honestly, pretty compelling.

category 11y ago

If there are more than 3 negative reactions to an article I definitely go read it because at this point it's hugely probable that the backlash is mainly cultural/traditional rather than logical.

nathanb 11y ago

A fair comment. I think it's important to note that a fear or anxiety reaction may not, as you say, keep us safe. When I'm calm and rational, I make better decisions than when I'm gripped by fear. As an avid hiker and explorer, occasionally my fear of heights interferes with my enjoyment of my hobby. I try to push past it as much as possible, but when my heart is racing and my legs are shaking, a situation which would otherwise be safe can become dangerous. Also, unlike you, I do have two friends who suffer from PTSD (it's common enough that one may be surprised to find that a friend one has known for years wrestles with PTSD in some aspect of life but doesn't advertise that fact). One of those friends has gotten off an elevator early because being in an enclosed situation with a stranger gave her a panic attack. Another called me on the phone nearly in tears because she had to stay late at work and walking across the deserted, dark carpark to her car was almost more than she could handle. I think it would be great if a drug could help people like these two friends of mine go through life without feeling controlled by anxiety in situations like these. I also think it would be great if people like me whose day-to-day lives are unmarred by fear can do more things -- safely; the drug does not impair reason -- through this therapy. The tradeoffs are important to know (and as you say, the article does a great job exploring them), but to me this sounds really promising.

spangry 11y ago

This article seems a little inaccurate to me, or at least incomplete. On phobias, it's not quite as simple as a 'fear memory', although certainly a part of it when we're discussing 'conditioned fear' (e.g. PTSD). There's a part of your brain called the amygdala that is implicated in modulation of memory formation and emotional processing. It's part of the limbic system, which is tied in to the body's autonomic nervous system. This controls your 'fight or flight' response, essentially a sudden release of adrenaline into your system which causes 'anxiety symptoms': increased heart rate, increased perspiration, butterflies in stomach (due to diversion of blood flow to large muscles in your limbs). The amygdala is sort of like a 'heuristic co-processor' that receives sensory input earlier than other parts of the brain. If the input matches a heuristic, the body's fight or flight response is activated. If the amygdala is dysfunctional, is 'pre-programmed' with heuristics now considered maladaptive, or you've had experiences that have 'programmed' inappropriate heuristics, it will activate your fight or flight response in response to non-threatening stimuli. Drugs like propranolol, which I take daily for a panic disorder, antagonise (i.e. block) beta-adrendergic receptors, blocking the action of adrenaline and noradrenaline, which dampens the fight or flight response. This reduces or eliminates panic/anxiety like symptoms, and alters how memories are encoded while under its effects (however I'm not clear on whether this interferes with memory formation, or whether it causes the memories to be encoded in a different way). The part I find most interesting is the 'pre-programmed maladaptive heuristics' still present in our heuristic database. Evolution is a slow process, and has not caught up to our rapidly changing context. For instance, if you've ever given a public speech, you've probably experienced a 'fight-or-flight' response. It's not because you've had some bad past experience with public speaking that has conditioned a 'fear response'; it's because of a left over heuristic in your amygdala that may have been adaptive a thousands of years ago. Humans used to live in small tribes or groups with maybe a dozen other humans, and the only other humans they might have contact with in their life would be when fighting other groups for resources. If you publicly humiliated yourself in this context, it would have likely meant elimination from the gene pool or possibly even death. In a modern context, where you're giving a speech to a room full of people in another country, this isn't even mildly the case. But evolution is a slow process, so many of us still experience a fight or flight response anyway, which is maladaptive.

11y ago