Phobias are all too common. Surveys indicate that over half the population will admit to having a phobia, which probably means that most people have them. In many cases, people can probably live with their phobias without suffering excessively. They may be inconvenient and even embarrassing but are not necessarily a serious problem. However, for the businessman who wants to fly but has a flying phobia or the professional who wants to lecture but has a public-speaking phobia, the consequences of their phobias are debilitating, expensive, and can decrease self-esteem. Although behavioral therapy (gradual desensitization) is sometimes an effective way to get over a phobia, this method consumes a lot of time because the phobic fear has to be alleviated a tiny step at a time.
Now there is a new way of very rapidly relieving the acute panic feelings associated with phobias as well as the unpleasant self-perception of being a coward. This approach uses no tranquilizers or sedatives, yet it enables one to quickly, relatively painlessly, and permanently unlearn a terrifying phobia. This new method of treatment, which has been used in many successful clinical studies, is based upon recent advances in understanding underlying psychobiochemistry of phobias.
When a person enters a phobic situation, his body responds by releasing adrenalin, while his brain releases its own version of adrenalin, noradrenaline. As a result, the body goes into a classic "fight or flight" state in which the blood is diverted into the muscles and, in the brain, diverted out of the higher cognitive centers in the cerebral cortex and into the primitive, so-called reptile, brain. This type of psychobiochemical response is a good evolutionary adaptation, well suited to a situation such as a saber tooth tiger suddenly leaping at you from behind a bush. But it just doesn't work well when this archaic mechanism is triggered when you are trying to make a speech or learn how to deal with your phobic fears. Your learning capacity is crippled when your thinking brain is shut down by your reptile brain. Phobias do not go away by themselves.
Adrenalin and noradrenalin are known to interact with cell receptors called the alpha and beta adrenergic receptors. Drugs that specifically block the beta receptors, so that adrenalin or noradrenalin cannot attach themselves to these receptors, have been used to enable people to get over their phobias with remarkable ease and speed. Three beta blockers are currently available in this country, although there are several available in some European countries. Propranolol is an FDA-approved beta blocker for control of high blood pressure, a condition for which it is very effective.
In an English study using a related European high blood pressure control medication called oxprenolol, violin players who had experienced preconcert anxiety used oxprenolol and experienced much less anxiety and were judged by an independent panel of musical experts to have performed better (because their fingers shook less!). In another study, students suffering from chronic examination phobia who were treated with the beta blocker oxprenolol and then given an exam had much less anxiety, with no decrement in their intellectual performance.
One of the authors (Sandy) has used propranolol to overcome a public-speaking phobia of many years' duration. Sandy was so afraid of addressing strangers a few years ago that, even with the psychological isolation provided by a telephone, she found it very difficult to make even the most routine business call. This severe phobia even extended to trivial matters, such as a telephone call to an electronics store to ask whether they stocked a certain part. In spite of her wide knowledge, public speaking was utterly out of the question.
When Sandy took 30 to 40 milligrams of propranolol about an hour before a public address, she found that it prevented the bodily symptoms of anxiety (hands shaking, sweating, knots in stomach, etc.) and, of far greater significance, prevented her mind from "going blank." There was neither dulling of the intellect nor difficulty in the physical delivery of lectures. Outside of the phobic situation, she could subjectively sense no effect of the drug whatsoever. Best of all, Sandy found that after she had used propranolol to give two or three successful lectures, she no longer had to use the drug.
Sandy had two other phobias which promptly and permanently succumbed to propranolol. The first was a fear of flying whose symptoms had previously been temporarily mitigated through the use of meprobamate or Valium R. Each flight required the same tranquilization. A few flights taken with propranolol instead, and the phobia was eliminated, apparently forever.
Sandy also had a severe roller coaster phobia. Attempting to ride the repeatedly upside-down, looping ride of the Knott's Berry Farm Corkscrew rollercoaster was a substantial goal. Due to phobic projections of an expected terrifying experience and because a degree of sedation would not interfere seriously with the enjoyment of an amusement park, Sandy used propranolol in conjunction with a European anticholinergic drug called benactyzine. This latter substance impaired vivid phobic memories and projections, while the propranolol disconnected the primitive "fight or flight" system. Sandy was actually enjoying the ride by the time the roller coaster swooped down the first hill—and she was being filmed at the same time for an appearance in our Disney-produced science-adventure-educational film, "Black Holes, Monsters That Eat Space and Time"!
When your thinking brain is not shut down, you can learn how to benefit from your experiences. Propranolol does not eliminate the need for courage to enter a phobic situation, but it blocks the "fight or flight" syndrome that normally prevents the phobic individual from learning to overcome these fears.
Your physician is exceptionally well informed if he has heard of this use of propranolol and other beta blockers (approved by the FDA only for the control of high blood pressure), FDA regulations make it a criminal offense for a drug manufacturer to report to doctors on drug uses not specifically approved by the FDA, no matter how scientifically justified, even if the drug has already been approved for some other purpose. The cost of FDA approval for additional drug uses is usually tens of millions of dollars, and the regulatory delay is generally several years. Since the patents on propranolol have expired, it is in no one's economic interest to foot this huge bill. Although very safe (doses used a few times for phobias are typically about as much as those used a few times each and every day for hypertension) and remarkably effective, propranolol will probably never receive FDA approval for the treatment of phobias.
It is perfectly legal, however, for your physician to prescribe propranolol for any purpose whatsoever, including the treatment and cure of phobias. Before he is willing to explore this new use for an old drug, you will probably have to give him copies of the relevant scientific literature. A Therapeutic Approach to the Psyche via the Beta-adrenergic System, edited by Kielholz, contains a number of original papers presented at a 1977 symposium; the book is available from University Park Press, 233 East Redwood St., Baltimore, MD 21202.
Copyright © 1981 by Sandy Shaw and Durk Pearson
Durk Pearson and Sandy Shaw are consulting scientists, authors, and TV personalities.