BIOLOGICAL THERAPIES FOR PHOBIC DISORDERS
To read up on the biological therapies for phobic disorders, refer to pages 497–500 of Eysenck’s A2 Level
Psychology.
Ask yourself
 If a biochemical imbalance is the cause of phobia what would be the
treatment?
 How do the drug treatments vary for the different types of phobias?
 What are the main weaknesses of drug therapy?
What you need to know
DRUG THERAPY
The effects of drug therapy on social phobia, panic disorder with
agoraphobia, and specific phobia
 Evaluation of drug therapy
Drug therapy
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Drug therapy is the main biological treatment of phobic disorders and the types of drugs used can vary
slightly across the different phobias.
Social phobia
Anti-anxiety drugs, the benzodiazepines such as Valium and Librium, and the
antidepressants, monoamine oxidase inhibitors (MAOIs), have been used to treat
social phobics.
Benzodiazepines act on the central nervous system, i.e. the brain. They increase the activity of the
neurotransmitter GABA and GABA decreases serotonin activity. Serotonin is linked to arousal and so
lowering serotonin activity reduces arousal and so decreases anxiety.
The MAOIs block monoamine oxidase and by so doing help to prevent the destruction of noradrenaline.
The increased noradrenaline activity leads to a reduction in anxiety symptoms.
Currently, selective serotonin reuptake inhibitors (SSRIs) are more commonly used to treat social phobia.
The SSRIs include fluvoxamine, fluoxetine (Prozac), sertraline, and paroxetine, and are also used in the
treatment of depression.
Antidepressant drugs are often used in drug therapy for social phobia because social phobics often have
high levels of depression (Rachman, 2004, see A2 Level Psychology page 497).
Panic disorder with agoraphobia
Benzodiazepines and SSRIs are often used to treat panic disorder with agoraphobia.
Tricyclic antidepressants, which increase the activity of noradrenaline and
serotonin, are also used. The antidepressant drugs are used because patients
frequently have many depressive symptoms.
Specific phobia
Drug therapy has seldom been used in the treatment of specific phobia. This is
because with this type of phobia patients are not are not generally anxious and it is
not as serious a condition as the other types of phobias. Consequently, specific
phobia does not warrant the taking of mind-altering drugs, particularly when
psychological treatment can be used instead; behavioural therapy is very effective
with this type of phobia.
EVALUATION OF DRUG THERAPY
Effectiveness
 Moderate effectiveness for social phobia. Drugs are moderately effective
for social phobia. They tend to be more fast-acting than psychological
therapy but no more effective in reducing symptoms by the end of treatment
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(Heimberg et al., 1998, see A2 Level Psychology page 498). Similarly,
Bandelow et al. (2007, see A2 Level Psychology page 498) reviewed six
studies in which drug therapy was compared with psychological forms of
therapy in the treatment of social phobia. Drug and psychological therapy
both led to similar substantial improvements.
Moderate effectiveness for agoraphobia with panic disorder. Mitte
(2005, see A2 Level Psychology page 498) reported a meta-analysis focusing
on the effectiveness of benzodiazepines, SSRIs, and tricyclics. The different
drugs were equally effective in treating panic disorder with agoraphobia.
A multi-dimensional approach. Mitte (2005, see above point) found that
combining drug therapy and cognitive or cognitive-behavioural therapy
increased the effectiveness of treatment. However, note Marks et al.’s (1993,
see A2 Level Psychology pages 498–499) findings under relapse rates, as
these show that a combined approach is not always the most effective
treatment of agoraphobia.
No more effective than cognitive or CBT therapy. Mitte found drugs to be
no more effective in reducing symptoms than the psychological therapies,
and in other respects the psychological therapies are better.
Drop-out rate. Mitte found the drop-out rate was significantly higher for
drug therapy than for cognitive or cognitive-behavioural therapy (20% vs.
15%).
Relapse rates. Drugs compare unfavourably to psychological treatments in
terms of relapse rates and so their effects are not as long-lasting. Liebowitz et
al. (1999, see A2 Level Psychology page 498) followed up on the patients
studied by Heimberg et al. (1998, see above). None of those receiving
cognitive-behavioural therapy for social phobia suffered a relapse during the
following 6-month period compared to 33% of the patients who had received
drug therapy. Marks et al. (1993, see A2 Level Psychology pages 498–499)
found the benefits of drug therapy for agoraphobia were short term as over a
6-month period patients fared better if they had just been treated with
exposure therapy, than when they had been treated with a benzodiazepine,
or the two therapies combined.
Treats symptoms not causes. The relapse rates suggest drugs just treat the
symptoms, not the underlying causes, of phobias, and so drug therapy is
palliative (manages the disorder) rather than a curative treatment.
Placebo effect. The placebo effect occurs when patients given an inactive
substance or placebo (e.g. a salt tablet) show significant reductions in their
symptoms. It is difficult to know how much any improvement is due to the
drug and how much to the placebo effect, i.e. the patient improves because
they expect the drug to work.
Appropriateness
 Reduces anxiety. Most patients with phobias are very concerned or
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distressed at the extreme levels of anxiety they experience and drugs
successfully reduce that anxiety.
Fast-acting. Many patients find that drug therapy is appropriate because the
drugs act quickly and effectively.
Effects are short-lived. The symptom reduction obtained is often lost very
quickly afterwards. The main effect of drug therapy is to suppress phobic
patients’ symptoms, and this suppression effect stops when drug treatment
comes to an end.
 Palliative not curative. Drug therapy treats symptoms not the underlying
causes and so does not cure phobia.
 Side effects. All the drugs used in the treatment of phobias possess
unwanted side effects. For example, the SSRIs can cause insomnia, reduced
sex drive, and nausea; tricyclics can cause blurred vision, dry mouth, and
dizziness; the benzodiazepines can cause drowsiness and lethargy; and the
MAOIs can block the production of monoamine oxidase in the liver, leading to
an accumulation of tyramine and increased blood pressure.
 Drop-out rate. The fact the drop-out rate is higher than for psychological
therapies questions appropriateness.
 <SAD BULLET>Lack understanding of their effect. We do not fully
understand how the different drugs reduce the symptoms of phobia. It is not
as simple as them increasing neurotransmitter levels because they do this
almost instantly, but can take a few weeks to have an effect. Some would
argue we shouldn’t use them if we do not fully understand how they work.
 Compare unfavourably to psychological treatment. The fact that patients
treated with cognitive therapy have lower relapse rates suggests that
cognitive therapy may be more appropriate than drug therapy, particularly
given that cognitive therapy is far less invasive as it does not have the side
effects of drug therapy.
So what does this mean?
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Drug therapy has the strength of being fast-acting and reasonably effective in the treatment of phobias, at
least in the short term. However, the length of any improvement is a key issue, as research suggests the
improvement lasts only as long as patients stay on the drugs, and of course being on drugs is not a
permanent solution!
Furthermore, all biological treatments raise issues of appropriateness such as side effects, and the fact they
treat the symptoms not the causes, which leads to a high relapse rate. This last criticism is a key weakness
as this makes biological treatments palliative, because they manage the disorder rather than cure it, and so
we need to consider if psychological treatments offer more hope of a cure. Evidence suggests that this is the
case as drugs have been compared negatively to cognitive and cognitive-behavioural therapies. But, on the
other hand, some patients may need drug therapy to calm them down to a state in which they can benefit
from psychological therapy.
Over to you
(a) Outline one or more biological therapy(ies) for one anxiety disorder. (9 marks)
(b) Evaluate the therapy(ies) described in (a). (16 marks)