Effects of beta 1- and beta 2-blockade on blood pressure and sympathetic responses to flight phobia stress

Anxiety sensitivity moderates the relationship of changes in physiological arousal with flight anxiety during in vivo exposure therapy

Physiological sensations and discomfort constitute the major symptoms reported by aviophobics. Anxiety sensitivity (AS) seems to moderate the relationship between self-reported somatic sensations and flight anxiety, and AS has been identified as a vulnerability factor for flight phobia. In this study we examined whether AS moderates the effects of somatic sensations and autonomic nervous system reactivity on flight anxiety induced by real flight. In fifty aviophobics participating in Cognitive Behaviour Group Therapy (CBGT), flight anxiety, somatic sensations and autonomic nervous system reactivity were assessed during a guided return flight. Results indicate that physiological reactivity interacted with AS. Changes in heart rate and parasympathetic activity were more strongly associated with changes in reported flight anxiety for high AS participants, and less for participants low on AS. Results did not indicate a moderating effect of AS on the relationship between self-reported somatic sensations and flight anxiety. Our results suggest that therapy for flight phobia might benefit from addressing the physical effect of anxiety, by means of cognitive restructuring and exposure to interoceptive stimuli, particularly in aviophobics high in AS.

The psychology of fear of flying (part II): a critical evaluation of current perspectives on approaches to treatment

This is the second of a two part review which critically evaluates research published in disparate sources into the psychological treatment of fear of flying. Part I established fear of flying as a complex heterogeneous clinical phenomenon. This paper discusses the way in which evidence from clinical trials translates to best practice in treating fear of flying. Published research on psychological interventions uses terminology which bears a close resemblance to cognitive behavioural therapy. It is, however, questionable whether some treatment approaches reflect the implementation of the cognitive behavioural model as it is described in the wider literature on the treatment of anxiety disorders. This review evaluates a synthesis of published research which considers fear of flying and related anxiety disorders with the aim of deriving best practice. It concludes that the most effective psychological interventions will be those based on an accurate functional assessment of an individual and their social context relevant to fear of flying and not merely a set of standard and invariant protocols. Most published research has been carried out on participants who self refer or volunteer for treatment and it is probable that this is a biased clinical group which may distort reported efficacy and treatment outcomes. It concludes by highlighting directions for future research and the development of psychological treatments for fear of flying.

Physiological reactivity to phobic stimuli in people with fear of flying

OBJECTIVE

The nature of the relationship between physiological and subjective responses in phobic subjects remains unclear. Phobics have been thought to be characterized by a heightened physiological response (physiological perspective) or by a heightened perception of a normal physiological response (psychological perspective).

METHOD

In this study, we examined subjective measures of anxiety, heart rate (HR), and cardiac autonomic responses to flight-related stimuli in 127 people who applied for fear-of-flying therapy at a specialized treatment center and in 36 controls without aviophobia.

RESULTS

In keeping with the psychological perspective, we found a large increase in subjective distress (eta(2)=.43) during exposure to flight-related stimuli in the phobics and no change in subjective distress in the controls, whereas the physiological responses of both groups were indiscriminate. However, in keeping with the physiological perspective, we found that, within the group of phobics, increases in subjective fear during exposure were moderately strong coupled to HR (r =.208, P=.022) and cardiac vagal (r =.199, P=.028) reactivity. In contrast to predictions by the psychological perspective, anxiety sensitivity did not modulate this coupling.

CONCLUSION

We conclude that subjective fear responses and autonomic responses are only loosely coupled during mildly threatening exposure to flight-related stimuli. More ecologically valid exposure to phobic stimuli may be needed to test the predictions from the physiological and psychological perspectives.

Fear of flying treatment programs for passengers: an international update

BACKGROUND

This article is an update of an earlier international review of fear of flying treatment programs. METHOD. One hundred and sixty two airlines and treatment facilities around the world were approached for information on treatment programs for flying phobia. In comparison to the earlier review, the number of treatment facilities able to provide relevant and valid information increased from 15 to 36. Information was obtained both with a written questionnaire and by obtaining oral information from treatment facility representatives. This information was obtained at the second international fear of flying conference in Vienna on December 2000. The increase in the number of participating facilities can presumably be attributed both to a world wide increase in the demand for treatment for fear of flying and professionals becoming more interested in entering the field of fear of flying treatment. However, the increase may also be due to the fact that some clinics or programs have only recently discovered the international network of treatment facilities. RESULTS. In comparison to the previous review, the number of facilities that provide treatment programs that meet high professional standards has increased considerably over the past few years. Although there is still substantial variety in the quality and components of treatment programs, there is also a significant number of facilities that provide more or less similar qualified treatment programs and carry out treatment evaluation on a regular basis. Furthermore, experts from the participating centers reached consensus on 'golden rules' for fear of flying patients and flying-phobia therapists. CONCLUSIONS. There is a growing consensus among fear of flying treatment facilities on methods and protocols.

Resolution of fear of flying with fluoxetine treatment

Fear of flying is a common specific phobia usually treated with behavior therapy; the possibility of pharmacologic treatment has received very little study. The authors report two cases in which successful fluoxetine treatment of major depressive disorder unexpectedly and unintentionally resolved a concomitant fear of flying that had preceded the depressive disorder.

The Assessment of Fear of Flying: Elaboration and Validation of a Videotape as an Analogous Situation of a Flight1

The results are presented for the validation of a videotape as an analogous situation for a flight. The video includes the most significant elements of a flight by air: confirmation of the flight, packing, going to the airport, checking-in, going through the metal-detector, departure lounge, boarding the plane, demonstration of the personal safety drills, interiors and exteriors during the flight and landing. Two physiological measures are used for validation (heart rate and temperature) and a subjective measure (situational anxiety, SA). The results (both t-tests and the discriminant analysis) indicate that the videotape is able to discriminate between phobics and non-phobics of flying in the three variables considered. With respect to sensitivity in detecting change produced by various treatments in clients with phobia of flying, the results are also satisfactory. A greater differentiation is produced between the pre-post treatment measures, both in subjective and in the physiological measures.

Sympathetic nervous system involvement in essential hypertension: increased platelet noradrenaline coincides with decreased beta-adrenoreceptor responsiveness

Platelet catecholamine content may reflect integrated plasma catecholamine concentrations over time. The present study aimed at examining sympathetic nervous system (SNS) involvement in essential hypertension by assessing platelet noradrenaline (NA) and typically beta-adrenoreceptor mediated responses to adrenaline (A) infusion as indices of sympathetic tone. Healthy white men were recruited by public advertising and screening (mean +/- SD): Hypertensives (n = 13, sitting blood pressure [BP] 153 +/- 13/106 +/- 7 mmHg, age 34 +/- 5 years, weight 83 +/- 10 kg) were compared to normotensives (n = 13, sitting BP 114 +/- 9/75 +/- 9 mmHg, age 30 +/- 6 years [n.s.], weight 82 +/- 9 kg [n.s.]). Loss of platelet granular contents (including NA) prior to analysis was minimized by studying young subjects (age range 20-40 years, minimal atherosclerosis), using arterial blood sampling, and processing blood immediately. These procedures resulted in plasma beta-thromboglobulin and platelet factor 4 levels which were not significantly different between groups. Sympathetic activation resulting from stress was minimized by not labelling subjects as either hypertensive or normotensive. Mean arterial platelet NA content was significantly higher in hypertensives (64 +/- 31 pg/mg of platelet weight) compared to normotensives (43 +/- 20 pg/mg, p < 0.05) both at baseline and following 35% expansion of the circulating platelet pool by A infusion (p < 0.05) and correlated with arterial NA in the hypertensives (r = 0.79, p < 0.002) but not in the normotensives (r = 0.04, n.s.). Similar increases in platelet and plasma A during infusion in both groups suggest unchanged platelet uptake capacity and plasma clearance in the hypertensive group.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of a beta-adrenergic blocking agent on dental anxiety

The effect of propranolol was studied on 23 dental phobics in a double-blind, placebo-controlled clinical trial involving actual dental treatment. The subjects were selected because they showed high physiological reactivity in the dental situation. Twelve subjects received the test drug and 11 subjects received the placebo at individualized doses of either 80 or 120 mg. A significant difference in self-reported anxiety at the injection phase of treatment and less overall pain intensity and aversiveness were observed for the propranolol as compared with the placebo group. No differences were detected for behavior ratings. Beta-adrenergic blocking agents may have utility for reducing anxiety in individuals fearful of dental treatment.

Clinical and humoral effects of beta-blockade with ICI 118,551 in the general neurotic syndrome

Fifty-six patients satisfying the diagnostic criteria for the general neurotic syndrome, a mixed anxiety-depressive disorder, were randomly allocated to treatment with a selective β( 2)-blocking drug, ICI 118,551, in a dose of 50 mg tds, or placebo for 4 weeks after a 2-week placebo run-in period. Ratings of anxiety using the Hamilton anxiety rating scale and patient self-assessments in 46 evaluable patients showed no significant difference in the outcome of active drug and placebo groups, and also no significant improvement over time during the study. This unusual finding supports the impression of the general neurotic syndrome as a severe form of neurotic disorder which shows little evidence of placebo response. Diastolic blood pressure was increased and heart rate reduced after 2 weeks on ICI 118,551, and plasma levels of noradrenaline and adrenaline showed no evidence of an expected decrease with active drug; on the contrary the data showed some evidence of increased catecholamine levels. The results suggest that selective β-blockade has little part to play in the treatment of anxiety and that on repeated dosage the effects of selective blockade are attenuated or reversed.

A comparison of a β2-adrenoceptor antagonist (ICI 118,551), diazepam and placebo in the treatment of acute anxiety

The effect of β( 2)-adrenoceptor antagonism in acute anxiety neurosis was investigated by comparing the effects of ICI 118,551, a specific β(2)-adrenoceptor antagonist, diazepam and placebo in a double-blind, parallel group study. Sixty-three patients, who fulfilled criteria for Anxiety Disorder (DSM III) and were psychotropic drug- free (apart from six using hypnotics), were entered. Anxiety symptoms were rated using the Hamilton Anxiety Scale (HAS) and Spielberger State Anxiety Scale. Assessments were made at entry and following a 7-day single-blind placebo treatment phase, at the end of which only 51 wished to continue and had sufficient symptoms (HAS score >16 or reduction <25% on placebo) for entry to the next phase. Following a double- blind, random allocation they then received ICI 118,551 (50 mg), diazepam (2 mg) or placebo thrice daily for 4 weeks. Symptoms were assessed after 2 and 4 weeks in this active treatment phase (i.e. at weeks 3 and 5 of the study). Thirty-five patients completed the study. A statistically significant improvement in HAS score was seen for all patients but there were no significant differences between treatments. Treatments did not differ in their effects on blood pressure or heart rate. β(2)-Adrenoceptor antagonism does not seem to have important effects on anxiety symptoms in anxiety neurosis.