Phobic Disorders - Biological Therapies for Phobic Disorders

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Chemotherapy Anti-anxiety drugs (Benzodiazepines - BZs) - commonly used to reduce anxiety. They slow down the activity of the central nervous system by enhancing the activity of GABA, which is a neurotransmitter that has a quieting effect on many of the neurones in the brain.	Effectiveness of anti-anxiety drugs - Kahn et al (1986) - found that BZs were more effective than a placebo in reducing anxiety. Hildalgo et al (2001) - Found that BZs were more effective than antidepressants. Research has shown that beta blockers can also provide an effective means of anxiety control. However, some studies have found no difference between the results of beta blockers and a placebo in terms of heart rate and feelings of nervousness.
	Effectiveness of antidepressants - Aouizerate et al (2004) – Concluded that SSRIs provide relief for social phobics in 50-80% of cases, a level fairly similar to BZs. However, SSRIs are often considered preferable because they have less side effects.
Beta blockers - are also used to reduce anxiety. They work by reducing the activity of adrenaline and noradrenaline which are part of the sympathomedullary response to stress. This results in a fall in blood pressure, and so less stress on the heart. The person taking the medication will feel calmer and less anxious. Anti-depressants (SSRIs) - Increase levels of serotonin which is a neurotransmitter that regulates mood and anxiety.	Appropriateness of chemotherapy - Not a cure - Generally drugs are not the primary treatment for specific phobias. However they are appropriate for those phobias which are accompanied by panic attacks, although drugs cannot provide a complete treatment as they simply focus on symptoms.
	Appropriateness of chemotherapy - Side effects - Possible side effects of BZs include increased aggressiveness and long-term impairment of memory. Beta blockers have few, if any side effects, whereas there are many problems associated with the use of anti-depressants. SSRIs have been linked to increased suicides.
Psychosurgery Capsulotomy and Cingulotomy - Functionally remove the connection either above or below the organ. They are part of the limbic system which is the region of the brain associated with emotion. Such operations are irreversible and only performed at a last resort.	Appropriateness of chemotherapy - Addiction - Can be a problem with BZs, even when only low doses are given, for this reason the recommendation is that they should be used for a maximum of four weeks.
	Effectiveness of psychosurgery - Ruck et al (2003) - Study of capsulotomy - Reduced anxiety, but there were negative consequences. E.g. 7 tried to commit suicide and there were 2 cases of epileptic seizures. This gives some indication of the success of psychosurgery for treating a range of anxiety disorders. However, any benefits are weighed against the potential for negative.
Deep brain stimulation - Involves placing wires in target areas of the brain. When the current is on, this interrupts target circuits in the brain resulting in a reduction of symptoms. Transcranial Magnetic Stimulation - A large electromagnetic coil is placed above the scalp near the forehead. This creates painless electric currents that stimulate the frontal cortex. This is a reversible, non-invasive method.	Appropriateness of psychosurgery - Psychosurgery is rarely suitable for phobias and then only for extreme cases that have proved otherwise untreatable and that interfere with normal day-to-day functioning. Szasz (1978) - Criticised 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.
	Ethics with testing effectiveness of drugs - If effective treatments exist, then they should be used as controls when new treatments are tested. Substituting a placebo for an effective treatment does not satisfy this duty, as it exposes individuals to a treatment known to be inferior. Informed consent – Most patients are not informed about the comparative success of drugs versus placebos. They expose themselves to unpleasant side effects even though the pharmacological effects of the drug may be slim.