Managing and Coping with Stress - Drug Therapy' (BZs and BBs) Flashcards
Biological methods of stress management assume…
…that stress/anxiety stems from abnormal physiological processes.
Therefore, treatments based on the biological approach focus on dealing with these abnormal physiological processes.
Given the evidence that anxiety is linked to high levels of activity in the central and autonomic nervous system, there are drug treatments to address this.
What do BZ’s do
BZ’s slow down the activity of the central nervous system by enhancing the activity of a natural biochemical substance called GABA (gamma-butyric acid). It does this by binding to special sites on the GABA receptor.
What is GABA
GABA is the body’s natural form of anxiety relief (it has a quietening effect on the brain’s neurons).
GABA acts in one of two ways:
GABA slows down nerve cell activity by reacting with receptors sites on receiving (post-synaptic) neurons. It locks into these receptors causing a channel to open that increases the flow of chloride ions into the neuron.
Chloride ions make it harder for the postsynaptic neuron to be stimulated by other neurotransmitters, thus slowing down its activity (having an inhibitory effect), causing the person to feel more relaxed and less anxious.
GABA also reduces serotonin activity, which then decreases arousal of the nervous system and thus reduces anxiety.
Strengths of Benzodiazepines
Easy to take – patients just need to remember to take the pills, which is much easier than the time, effort and motivation required for psychological methods (e.g. SIT).
Cost effective (in the short-term) – why do you think this is?
Effective - research support shows that BZs they are more effective than a placebo:
What did Davidson do
Davidson (1993) randomly assigned 75 patients diagnosed with social-anxiety disorder to either a BZ drug or placebo treatment for 10 weeks, and then conducted a two-year follow-up study.
Short-term effectiveness: Davidson found that 73% of patients taking BZs for social anxiety improved, compared to just 20% of the control group (taking a placebo).
Long-term effectiveness: When followed up 2 years later, these BZ patients showed better functioning compared to the control group, suggesting that the drug is effective in the short- and long-term (although many patients reported side effects).
Limitations of Benzodiazepines
Addiction - Even low doses of BZs can result in patients experiencing marked withdrawal symptoms when they stop taking them (which may result in a patient becoming addicted to avoid withdrawal).
Short-term treatment: As such, it is recommended that patients do not take BZs for longer than 4 weeks, however there are many who continue to use them and are at risk of addiction.
Side effects:
Dependency, cognitive impairment (especially long-term memory and concentration), physical unsteadiness, increased aggression, sexual dysfunction.
Therefore, it may be the case that the side effects are severe enough to outweigh the benefits of taking the drug.
Lane (2010): argues against their use, citing growing evidence that that long-term usage incurs brain damage, especially to the cerebral cortex, resulting in short-term memory damage.
How do BBs work
They work to reduce the activity of the sympathetic nervous system, by essentially blocking the transmission of nerve impulses, and the associated undesirable symptoms e.g. increased heart rate, elevated levels of cortisol.
They bind to beta-adrenergic receptor sites on the cells of the heart and elsewhere in the body, thus preventing them from being stimulated by adrenaline and noradrenaline, therefore weaken their effects.
Thus the force and rate of an individual’s heartbeat and blood pressure are reduced, breathing rate and sweating do not increase, which therefore dampens the physical effects of anxiety.
As a result, the individual feels calmer and less anxious.
Strengths of Beta-Blockers
BBs have an immediate effect on the physical aspects of anxiety – they act directly on cells throughout the body, reducing heart rate and blood pressure immediately, unlike other medications e.g. anti-depressants, which can take up to 4 weeks to reduce symptoms.
Unlike BZs, they are not associated with dependency and addiction. They are therefore crucial in treating potentially fatal cases of stress-related hypertension.
Effective – research has found that beta-blockers are successful in dealing with anxiety:
Lau et al. (1992) performed a meta-analysis of studies assessing the effectiveness of BBs in treating stress.
They found them effective in reducing high blood pressure.
They were also found to reduce the risk of death by 20% in patients with heart disease, suggesting that they are a lifesaver in some instances.
What did Beversdorf do
Beversdorf et al. (2005) stressed participants by getting them to speak publicly in front of an intimidating audience, and then perform a mathematical task whilst being filmed.
They were compared to control group completing a non-stressful task (reading aloud and counting out numbers while sitting alone in a room).
Participants’ cognitive flexibility was measured (performance on word-association and anagram tasks).
Participants were tested with or without being given a beta-blocker.
They found that stressed participants performed worse than non-stressed participants for cognitive flexibility.
However, stressed participants treated with the beta-blocker performed just as well for cognitive flexibility as the non-stressed participants.
This suggests that beta-blockers reduce the negative effects of stress on cognitive performance.
Limitations of Beta-Blockers
Side effects
Most people who take beta-blockers do not experience any side effects.
Those who do, experience side effects such as cold extremities, tiredness, nightmares, hallucinations and increased risk of developmental diabetes.
Short-term treatment
BBs have a purely physical action and are therefore more useful as an immediate, short-term treatment.
BBs are not an effective long-term treatment for stress conditions with more of a psychological element to them.
Evaluation of Drug Therapy
Overall strengths:
Drug treatments require little effort and time, and are relatively cheap in comparison to SIT, where patients are expected to attend several sessions with a therapist, discuss their thoughts and complete ‘homework’ assignments outside of the therapy sessions.
Drug therapy is a popular option with patients who lack the time, motivation, commitment and verbal skills needed for SIT. They do not require a therapist to administer.
Drugs can also reduce anxiety sufficiently for SIT to be successfully introduced later.
Drugs are not a long-term treatment for stress
Drugs don’t deal with the root cause of the disorder, merely its symptoms – drug therapy ‘papers over the cracks’ and once treatment ends, symptoms return, suggesting drug treatments are not a cure.
