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Fear is a natural human response to a variety of dangerous or life-threatening situations. However, in people with mental health conditions called anxiety disorders, debilitating fear responses develop in situations that most people wouldn’t regard as either dangerous or significantly threatening. Mental health professionals can help alleviate anxiety-based fear through the use of a form of psychotherapy called cognitive behavioral therapy (CBT); however, the results of this therapy are sometimes short-lived. According to the findings of two recent studies, doctors can potentially erase anxiety-related fear for extended periods of time through the use of a medication called propranolol.

Fear and Anxiety Disorders

Fear is an essential part of the human repertoire of emotional responses. In evolutionary terms, it helps alert the body/mind to looming or immediate dangers, and therefore helps activate the “fight-or-flight” response, which determines the short-term course of action taken to deal with a threatening situation. Fear can be dysfunctional as well as functional. While functional fear prepares the body for action, dysfunctional fear effectively paralyzes or freezes the body and prevents or inhibits appropriate adaptations to one’s local environment. Examples of these disorders include post-traumatic stress disorder (PTSD), social anxiety disorder (known alternately as social phobia), generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and phobias that arise only during specific events, situations or interactions.

Cognitive Behavioral Therapy Basics

In the context of anxiety disorder treatment, psychotherapists use cognitive behavioral therapy to help their patients identify specific counterproductive or damaging mental/emotional responses that arise during stressful and/or fear-inducing moments. They also provide their patients with the tools needed to gradually replace their fear-based reactions with more even-keeled responses that promote a sense of mental/emotional calm and ease. One particular CBT technique used for this purpose is exposure therapy. During exposure therapy, patients confront their fears in a monitored environment and gradually develop a feeling of mastery over those fears. This mastery comes in the form of something called an extinction memory, which essentially replaces the memories of fear that people with anxiety disorders habitually call upon when exposed to specific triggering events or situations.

Limitations of Cognitive Behavioral Therapy

Cognitive behavioral therapy is generally regarded as a highly effective treatment for anxiety disorders, and mental health professionals in the U.S. currently use this therapy more often than any other single type of anxiety treatment. However, for all of its benefits, CBT has its limitations. The main limitation of the therapy is its potential to produce only temporary results. While many patients experience lasting benefits from CBT, others experience a later resurgence of their previously treated anxiety symptoms and end up more or less where they started in terms of their fear-based responses and the severity of their anxiety-related reactions.

Effects of Propranolol

Propranolol (Inderal) is a medication approved in the U.S. for treatment of a range of physical disorders, including high blood pressure, heart beat irregularities, heart attacks, heart-related chest pain, migraine headaches, and excessive thyroid gland function. It belongs to a larger group of medications known commonly as beta-blockers, and achieves its basic effects by weakening the chemical influence of naturally occurring substances in the body called stress hormones.

In a study published in 2009 in the journal Nature Neuroscience, a team of Dutch researchers exposed a group of human test subjects to images of spiders while simultaneously administering controlled amounts of pain. After this simultaneous exposure, the test subjects anticipated pain whenever they saw the spider images, and thereby developed a fear-based reaction to those images. Later, the researchers showed the study participants the same set of images after giving each of them a dose of propranolol. This time, the participants did not exhibit fear when viewing the images, unlike a second group of subjects who did not receive propranolol.

In another study published in 2013 in the journal Science, the same team of Dutch researchers administered propranolol to a group of human test subjects in the same set of experimental circumstances, then purposefully tried to evoke fear-based reactions from these subjects both one day later and one month later. Despite these attempts, the fear reactions typically did not return in the study participants. The authors of the study believe that propranolol either wipes out the memories that produce anxiety-related fear, or essentially stops the brain from recalling those memories and using them to trigger anxiety.

Considerations

The authors of the study in Science concluded that propranolol’s fear-eradicating effects only appear to work when the patient receiving the medication develops new memories while attempting to recall the original source of fear and anxiety. This finding may indicate that propranolol works best when combined with some sort of cognitive behavioral therapy. However, further research is needed to fully investigate the effects of propranolol, with or without the inclusion of other forms of treatment.

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