Biological Therapies for Phobic Disorders

Phobias are mainly treated using psychological rather than biological methods.

However, biological therapies can have their place - they can reduce the high level of anxiety experiences by phobics, allowing a patient to return to a more normal life (such as being able to go outdoors again).

Alternatively, biological therapies can be used in conjunction with psychological therapies in reducing anxiety levels in order for a patient to tackle the more psychological causes of their disorder.

Two types of drugs are used in the treatment of phobic disorders - anti-anxiety drugs and antidepressants, both of which aim to lower the anxiety levels associated with phobias and enable a patient to lead a near-normal life.

Anti-anxiety drugs

- Benzodiazepines (BZ's) are commonly used to reduce anxiety by slowing down the activity of the CNS, they do this by enhancing the activity of GABA, a neurotransmitter.

- GABA locks onto special sites known as GABA receptors which increases the flow of chloride ions, these make it harder for the receptors to be stimulated by other neurotransmitters, making the individual feel calmer and less anxious.

Beta-blockers

- BB's reduce the activity of adrenaline and noradrenaline. They bind to the receptors on the cells of the heart that are usually stimulated during arousal.

- By blocking these, it is harder to stimulate the cells so the heart beats slower and with less force, therefore the individual will feel calmer and less anxious.

Effectiveness

- Kahn et al found that BZ's were more effective than a placebo treatment & Hildalgo et al found that BZ's were more effective than antidepressants.

- However, some studies have found that the benefits may be largely explained in terms of placebo effects. Turner et al found no difference between a beta-blocker and a placebo group in terms of reduced heart rate, and feelings of nervousness.

Appropriateness

- Not a cure - Drugs have not been considered as a primary treatment for phobias, however, it is appropriate when panic attacks accompany specific phobias as it targets symptoms (not cause).

- Side effects - BZ's can cause increased aggressiveness and long-term impairment of memory - however, this has been seen to be a positive use (erase fearful memories - next revision card).

- Addiction - can be an issure with BZ's, even at low doses.

Stehberg et al

- Research has found that it may be possible to erase fearful memories, which could be a useful method of treating phobias.

- Stehberg et al have blocked memory consolidation in rats using a form of deep brain stimulation.

- Suggests that this could lead to a treatment for the traumatic memories that underlie anxiety disorders.

Psychosurgery is a surgical intervention that aims to treat a behaviour for which no pathological cause can be established.

In the case of psychosurgery, it is believed that an area of the brain is malfunctioning, and if the connection to this part of the brain is removed then psychological symptoms may be relieved.

Capsulotomy and Cingulotomy

These operations functionally remove (connections) the capsule and cingulum, which is associated with emotion. These are usually performed as a last resort and are irreversible!

Deep brain stimulation (DBS)

Involves placing wires in target areas of the brain, when the current is on this interupts the target circuits in the brain resulting in a reduciton of symptoms.

Effectiveness

- Ruck et al supported the capsulotomy - 26 patients with non-obsessive anxiety disorders were assessed using an anxiety score. It had dropped from 22.0 to 4.6 after having capsulotomy. This indicates a successful outcomr.

- However, it had potential for extremely adverse effects for example, 7 of the 26 patients had attempted suicide.

Appropriateness

- Psychosurgery is rarely suitable for phobias and even then only for extreme cases that have been proved otherwise untreatable.

- Szasz challenged psychosurgery generally because a person's psychological self is not something physical and therefore it is illogical to suggest that it can be operated on.

Biological treatments raise important ethical issues.

- A fundamental requirement of research ethics is taht if effective and established treatments existed then they should be used as controls when new treatments are tested. By giving individuals a placebo in this situation would be highly unethical as it would expose individuals to a treatment known as inferior.

- Most patients are not informed about the comparative success or unpleasant side effects they may be exposing themselves to.

- For example, Mary Lou was found unable to stand, sit or eat by herself after she had been given cingulotomy and a capsulotomy. This indicates the dangers of such operations and the issue of obtaining truly informed consent.