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Discuss one or more biological therapies for phobic disorders (8 + 16 marks)
Two types of drugs are used in the treatment of phobic disorders, anti-anxiety drugs and antidepressants. One
type of anti-anxiety drug called Benzodiazepines (BZs) slow down the activity of the central nervous system by
enhancing the activity of GABA, a neurotransmitter that has general quietening effect on many of the neurons in
the brain. They do this by locking into GABA receptors on the outside of receiving neurons, which opens a
channel to increase the flow of chloride ions into the neuron. Chloride ions make it harder for the neuron to be
stimulated by other neurotransmitters thus slowing down its activity and making the person feel more relaxed.
Kahn et al. found that BZs were more effective than placebos in reducing anxiety and Hildalgo et al. found that
BZs were more effective than antidepressants in reducing the anxiety associated with phobic reactions
therefore showing strong support for BZs. Another ant-anxiety drug used, Beta-Blockers (BBs), reduce the
activity of adrenaline. BBs bind to receptors on the cells of the heart and other parts of the body that are usually
stimulated during arousal. By blocking these receptors, it is harder to stimulate these cells, so the heart beats
slower and blood vessels do not contract so easily, resulting in a fall in blood pressure, and less feelings of
anxiety. Research has shown that BBs can also provide an effective means of anxiety control, however, some
studies have shown that the benefits may be largely explained in terms of placebo effects, e.g. Turner et al.
found no difference between Beta-blockers and placebo groups in terms of reduced heart rate, feelings of
nervousness and so on.
SSRIs are a type of antidepressant and the currently the preferred drug for treating anxiety disorders. They
increase levels of the neurotransmitter serotonin that regulates mood/anxiety. MAOI, an older class of
antidepressants, is more effective with some patients and it works by the enzyme monoamine oxidase breaking
down monoamine neurotransmitters such as serotonin and dopamine. An inhibitor prevents this happening
therefore leading to higher levels of monoamines in the synaptic gap. Comparing antidepressants to anti-anxiety
drugs, it has been found MAOIs to be more effective in the reduction of anxiety than BBs and placebos showing
support for antidepressants. Katzelnick et al. also found strong support as SSRIs led to improved levels of
self-rated anxiety when compared to a placebo treatment. Aouizerate et al. concluded that SSRIs provide relief
for social phobics in 50%-80% of cases, a level fairly similar to BZs, but SSRIs are overall preferable due to fewer
side effects. Although, SSRIs are linked to increased suicide in adolescents, BZs may cause increased
aggressiveness and long-term impairment of memory. They also may become addictive even when low doses
are given which is why a maximum use of 4 weeks is recommended. In contrast, Kindt et al. proposed such
negative effects such as memory impairment may be used to remove anxiety-causing memories therefore
actually helping the patient in the long term. In terms of other side effects BBs have few and MAOIs may cause
dizziness, insomnia and blurred vision. The research found may show drugs to be effective in terms of decreasing
anxiety levels for phobics, but drugs cannot provide complete treatment as the only focus on the symptom.
Biological treatment raises ethical issues such as using placebos when studying the effectiveness of drugs. A
fundamental requirement is that if effective treatment already exists, then this should be used as controls when
new treatments are tested as appose to placebos. Placebos do not satisfy this duty as it exposes individuals to a
treatment known to be inferior. Also, the issue of informed consent concerns the extent to which patients are
not informed about the fact that drugs may not actually be much better than placebos.