Stress Management: Beta Blockers

Biological Explanations of Stress

• Biological approaches to modifying stress target the physiological response, particularly the sympathetic nervous system.
• Beta blockers are drugs prescribed to reduce the physical symptoms of stress, like increased heart rate and blood pressure.
• They have an antagonistic action, reducing nervous system activity by blocking receptor sites for adrenaline and noradrenaline.
• Beta blockers lower heart rate, blood pressure, and breathing rate, inducing a calmer state.
• They are commonly prescribed for both acute and chronic stress, and treat stress-related conditions like angina and hypertension.
• While they don't directly affect psychological symptoms, they can reduce palpitations and sweating, helping individuals feel calmer.

Types of Beta Blockers

• Selective beta blockers (e.g., atenolol) target cardiac output by blocking beta 1 receptors: slowing heart rate.
• Non-selective beta blockers (e.g., propranolol) target adrenaline and noradrenaline in the heart, liver, and kidneys by blocking beta1 and beta2 receptors.
• Lack of clinical trials for stress-related use due to original development for heart conditions leads to unsubstantiated safety and effectiveness claims.

Examples of Beta Blocker Use

• Lockwood's (1989) study showed that 27% of musicians used beta blockers to reduce performance anxiety, suggesting a calming effect and improved performance.
• The World Anti-Doping Agency has banned beta blockers due to their performance-enhancing effects.

Effectiveness

• Beta blockers improve performance by reducing performance anxieties.
• Neftel et al. (1982) found that musicians taking atenolol experienced fewer physiological signs of stress, lower heart rates and blood pressure, and played more accurately.
• Beta blockers reduce the physiological response to stress, but its effectiveness in reducing an individual’s perception of stress is questionable.
• Schweizer et al. (1991) found that beta blockers inhibited the physiological response to stress during exams but did not significantly affect students' subjective ratings of stress.
• Stressed individuals often develop coping habits like alcoholism, smoking, or changes in eating/sleeping habits.
• Schwabe et al. (1990) found that stressed individuals given beta blockers remained goal-oriented, unlike those given placebos, suggesting beta blockers help focus on problems rather than distractions.
• Beta blockers provide a 'plaster effect' by reducing physiological symptoms without addressing underlying psychological causes like personality traits, life events, or lack of support.
• Critics argue that approaches like stress inoculation training, which address the root cause, are more effective in the long term.

Ethical Implications

• Side effects such as fatigue, dizziness, poor circulation, gastrointestinal symptoms, sexual dysfunction, and weight gain must be considered.
• Less common side effects include difficulty breathing, high blood sugar, depression, insomnia, and nightmares.
• There are risks associated with addiction and over-reliance, with people feeling unable to cope without beta blockers.
• Sudden cessation of beta blockers can cause palpitations and increased blood pressure.
• Beta blockers can enhance performance in music and sports.
• The World Anti-Doping Agency prohibits beta blocker use in many sports due to the unfair advantage they provide.
• Beta blocker use removes responsibility for managing one’s own stress and promotes a deterministic view, assuming behavior is controlled by physiology.

Social Implications

• Beta blockers are prescribed 'off label' for stress, without the same rigorous testing.
• Increased demand for beta blockers provides a quick solution for GPs but creates dependency.
• Repeat prescriptions are common since beta blockers do not address the root cause.
• "Off-label" drugs can cause harm.
• Prescriptions for beta blockers increased by 7% between 2012 and 2013.
• The Scottish Medical Council (2017) raised concerns about propranolol prescriptions for under-18s after deaths due to toxicity.
• "Talking therapies" are preferable for building resilience and long-term coping strategies.

Conclusion

• Beta blockers effectively reduce performance anxiety and destructive coping habits.
• They do not reduce the subjective experience of anxiety or address the root causes of stress.
• Safety testing is "off-label".
• There are problems with side effects, dependency, and disempowerment.
• Should be used as an addition to talking therapies for a long-term solution.