The effects of alcohol and the expectancy of alcohol on snake fear

Benzodiazepines and Behavioural Treatment of Phobic Anxiety

The use of benzodiazepines during behavioural treatment is frequently encouraged. However, this review of clinical studies failed to find any beneficial effect of the drugs on therapy outcome. An examination of drug effects on different response variables revealed conflicting results concerning behaviour, i.e. approach. Whilst the anxiolytic nature of the drugs is well established in results on autonomic measures in the absence of the phobic object, they had no effect during its presence. Verbal report data again favour administration of benzodiazepines but studies on cognitive effects of long-term use are still to come. It is recommended that the use of this group of drugs as an adjunct to behaviour therapy should be discouraged.

Ein Überblick über experimentelle Befunde zur Wirkung von Alkohol auf klinisch relevante Angst

Zusammenfassung. Hintergrund: Ein überzufälliger Zusammenhang zwischen Angststörungen und Alkoholproblemen ist belegt. Trotz zahlreicher Studien mit subklinischen Populationen ist die Befundlage zur anxiolytischen Wirkung von Alkohol jedoch uneindeutig. Fragestellung: Wirkt Alkohol bei klinisch relevanten Ängsten anxiolytisch? Welche Einflussfaktoren existieren und welche Mechanismen sind beteiligt? Methode: Ein Review empirischer Studien zur anxiolytischen Wirkung von Alkohol bei pathologischer Angst. Ergebnisse: Die Ergebnisse der 11 publizierten Studien werden dargestellt. Der Fokus liegt auf der Wirkung von Alkohol bei Sozialphobie (N = 7), Panikstörung (N = 3) und spezifischer Phobie (N = 1). Zusammenfassend ist eine anxiolytische Wirkung an eine Mindestmenge Alkohol (BAK: > 0.05%), positive Wirkungserwartungen sowie andere psychologische Faktoren gebunden. Diskussion: Die Selbstmedikationshypothese hat nur unter Berücksichtigung verschiedener biologischer und psychologischer Faktoren Bestand. Mögliche Implikationen für die Behandlung werden diskutiert.

Effectiveness of complementary and self-help treatments for anxiety disorders

OBJECTIVES

To review the evidence for the effectiveness of complementary and self-help treatments for anxiety disorders.

DATA SOURCES

Systematic literature search using PubMed, PsycLit, and the Cochrane Library.

DATA SYNTHESIS

108 treatments were identified and grouped under the categories of medicines and homoeopathic remedies, physical treatments, lifestyle, and dietary changes. We give a description of the 34 treatments (for which evidence was found in the literature searched), the rationale behind the treatments, a review of studies on effectiveness, and the level of evidence for the effectiveness studies.

CONCLUSIONS

The treatments with the best evidence of effectiveness are kava (for generalised anxiety), exercise (for generalised anxiety), relaxation training (for generalised anxiety, panic disorder, dental phobia and test anxiety) and bibliotherapy (for specific phobias). There is more limited evidence to support the effectiveness of acupuncture, music, autogenic training and meditation for generalised anxiety; for inositol in the treatment of panic disorder and obsessive-compulsive disorder; and for alcohol avoidance by people with alcohol-use disorders to reduce a range of anxiety disorders.

The pharmacologic and expectancy effects of alcohol on social anxiety in individuals with social phobia

Individuals with social phobia are at an increased risk for alcohol problems. Individuals with social phobia could increase their risk for pathological alcohol use if they drink as a means of coping with anxiety-provoking social situations. Providing a circumscribed test of this view, we evaluate the effect of alcohol on the intensity of social phobia anxiety responses. Sixty-one individuals with social phobia gave two speech challenges in front of a group ('social anxiety challenge'), one occurring before and one after they consumed either: (a) an alcoholic drink they were told contained alcohol ('alcohol group'), (b) a non-alcoholic drink they were told contained alcohol ('placebo group'), or, (c) a non-alcoholic drink they were told contained no alcohol ('control group'). Both the alcohol group and the placebo group showed greater reduction in performance anxiety from the first to the second speech challenge than did the control group. Further, there was a strong trend in the data for the alcohol group to show greater reduction in performance anxiety from the first to the second speech challenge than did the placebo group. We concluded from these findings that the pharmacologic effects of alcohol and the belief that one consumed alcohol decrease social performance anxiety in an additive fashion. These results provide direct support for the negatively reinforcing properties of alcohol and are consistent with the view that symptom reduction may motivate alcohol use among socially phobic individuals.

The effects of alcohol and alcohol expectancies on subjective reports and physiological reactivity: a meta-analysis

The balanced placebo design (BPD) has been used to understand the etiology and maintenance of alcohol consumption. The utility of this design lies in its ability to examine both actual alcohol consumption and the expectation of alcohol consumption. A meta-analysis of the BPD literature was conducted in the context of cue-reactivity, which may be characterized as an experimental phenomenon observed in studies utilizing alcohol. Sixty-four studies were obtained in literature searches and coded for type of experimental setting and cues present during the actual beverage consumption. Lab setting was a moderator for both pharmacological (alcohol) and expectancy effects with the largest effects (in the same direction) noted in natural environment labs (i.e., an easy chair and casual environment). Contrary to predictions, the bar lab produced the smallest effects. Cues present during alcohol consumption served as a moderator of pharmacological effect, with the largest effect observed when alcohol was placed on the rim of the glass. Implications of these findings for cue-reactivity studies and the treatment of alcohol abuse are discussed.

An evaluation of the balanced placebo design in alcohol administration research

Results from a study using the balanced placebo design to assess alcohol's effects on anxiety raise serious doubts about the utility of the design even at moderate blood alcohol concentrations. Despite being informed that they were not drinking alcohol, 44% of the subjects who were administered alcohol reported consuming at least some alcohol. Moreover, subjects' scores on the Marlowe-Crowne Social Desirability Index (MCSD) were associated with deception success, suggesting that individual differences in reporting bias influence the manipulation. In contrast, only 6% of subjects who were told that they had consumed alcohol but were given tonic water were not deceived. Among subjects in this placebo condition, scores on the MCSD were not associated with success of the deception. These data suggest that at a moderate dose of alcohol, drink deception in the antiplacebo condition is much more difficult to execute than in the placebo condition, and that deception in the former condition may be confounded with experimenter demand.

Stress and alcohol interaction: an update of human research

The literature on alcohol and stress in human subjects carried out since 1981 is reviewed. The review covers selected aspects of the interaction of alcohol and stress. (1) Most of the review focuses on the role of stress on alcohol ingestion. Retrospective research based on data from the Health and Nutrition Examination Survey indicated an increase in alcohol consumption with anxiety in certain groups of, as yet not well characterized, individuals. For example, although still insufficiently documented, stress does not appear to play a significant role in alcohol ingestion by women and the elderly. By contrast, stress does appear to play a role in the control of alcohol ingestion by adolescents. Prospective studies employing questionnaire-interview formats generally support an effect of stress on alcohol ingestion. However, studies employing male college aged social drinkers did not find a correlation between levels of stress and ingestion of alcohol. Alcoholics also differ in the reasons for drinking alcohol, but generally ingest alcohol to lessen anxiety/stress. It is clear that the Tension Reduction Hypothesis as originally postulated is no longer adequate. Many new models based on an interaction of alcohol and stress have been proposed to explain the control of alcohol consumption. Considering the multidimensionality of factors that appear to contribute to the control of alcohol ingestion, it is unlikely that a single model could possibly be relevant to alcohol ingestion under all conditions. More likely different models may be relevant to alcohol consumption under specific conditions, or for specific populations. (2) Alcohol has been reported to decrease anxiety in agoraphobics. The self-medication by agoraphobics may contribute significantly to their alcohol abuse. (3) Alcohol has also been reported to decrease tremor of the hands in stressed subjects as well as in patients with essential tremor. (4) Although a number of studies have employed electrodermal activity in studies aimed at the interaction of alcohol and stress, the results have been rather inconsistent. (5) The controversy on the purported beneficial effect of alcohol on the cardiovascular system persists. A number of studies have shown a J- or U-shaped relationship between alcohol ingestion and incidence of coronary heart disease. Alcohol may also influence stress-induced changes in blood pressure. Although a number of studies have demonstrated lower blood pressure in individuals ingesting less than two drinks per day compared with abstainers or heavy alcohol imbibers, the evidence is not conclusive. (6) It is not clear whether the interaction of alcohol and stress involves alterations in plasma catecholamines.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of diazepam on approach, self-reported fear and psychophysiological responses in snake phobics

The effects of diazepam was assessed on a number of measures of phobic anxiety. Snake-phobic subjects underwent two sessions on either diazepam or placebo in a crossover design. In addition to a habituation series, a slide with the phobic object was displayed as well as a live snake which subjects were asked to approach. The anxiolytic effect of diazepam was manifest in only one measure of fear, namely self-rated fear at the point of closest approach when it also attained the highest level. The result would indicate that diazepam has an anxiolytic only on high levels of subjective anxiety. The magnitude of the phasic cardiac reaction to the slide was highly and positively correlated with self-rated fear of the slide.

The tension reduction hypothesis revisited: an alcohol expectancy perspective

The tension reduction hypothesis has been historically and cross-culturally a predominant explanation of alcohol's effects. However, its validation has been inconsistent. One speculative reason for this inconsistency is a failure to control for preheld alcohol expectancies. Past research may have confounded results due to studying populations mixed regarding their expectations of alcohol's tension reducing effects. Only two studies could be found which have comprehensively attempted to control for tension reduction expectancies, both supporting a modified tension reduction hypothesis which does not offer tension reduction as the only explanation of drinking behaviour. The interaction of pharmacology, expectancy, gender role and situation suggest that tension reduction is of major importance in understanding the drinking of many, but not all, individuals. This is consistent with recent 'metatheories' of alcohol use which emphasize the complexity and multiplicity of alcohol's effects. Future theoretical and clinical implications of the revised tension reduction hypothesis and expectancies are briefly discussed.

Ethanol retards desensitisation of simple phobias in non-alcoholics

Twenty non-alcoholic patients with DSM-III defined simple phobias for small animals received behavioural approach tests and exposure therapy while under the influence of a moderately intoxicating dose of ethanol or after placebo administration. Ethanol did not demonstrate any acute anti-anxiety effect, but retarded the rate of behavioural in vivo desensitisation, without changing the final treatment outcome. State-dependent effects of ethanol on anxiety were not demonstrated. This study supports prior research indicating no anti-anxiety or 'tension-reducing' effects of ethanol for simple phobias.

A balanced placebo investigation of the effects of alcohol vs. alcohol expectancy on simulated driving behavior

The present investigation employed a balanced placebo design to examine the effects of alcohol versus the belief that one has consumed alcohol, i.e. alcohol expectancy, on error production while operating a driving simulator. The male subjects employed were social drinkers, having no history of alcohol abuse. The alcoholic beverage consisted of vodka and tonic in the ratio of 1:5, resulting in a mean blood alcohol level of .064%. The placebo beverage consisted of water and tonic, also in the ration 1:5. Principal findings were that alcohol ingestion had a debilitating effect on certain measures of driving behavior (operation of brakes, steering), whereas the belief that one had consumed alcohol had no discernable effects. The results are discussed in relation to other findings using the balanced placebo design. It was concluded that reckless driving under the influence of alcohol, is at least partly a result of the pharmological effects of ethanol.