The Cure For Fear
May 2, 2016 3:30 PM   Subscribe

 
How cool. I would love to get this treatment for a few assorted fears of spiders, cockroaches and airplane turbulence . Also, someone should try this on Sashimi-san for her feelings about SOEZIMAX.
posted by bearwife at 3:44 PM on May 2, 2016 [2 favorites]


Is it just me, or is that spider graphic kind of insensitive to anyone with an actual phobia who might happen to visit the article? I guess you can't have trigger warnings for everything...
posted by limeonaire at 3:45 PM on May 2, 2016 [10 favorites]


I'll be discussing this with my doctor next visit. Thanks.
posted by Splunge at 3:47 PM on May 2, 2016


I wonder if it works for people who are afraid of pills...
posted by clawsoon at 3:56 PM on May 2, 2016 [9 favorites]


So when is someone going to use this to wipe out memories of an old love affair, a la "Eternal Sunshine of the Spotless Mind?"
posted by King Sky Prawn at 3:59 PM on May 2, 2016 [8 favorites]


At least, according to the article, it doesn't wipe out memories, it just removes the emotional content of them. They become events rather than painful memories.
posted by MythMaker at 4:00 PM on May 2, 2016 [10 favorites]


Given how crippling PTSD and phobias can be, and the fact that propranolol is easy to get, I'm betting this starts getting used by non-medical personnel. Which makes it kind of weird that people seem to be slow about trying to replicate it in a medical environment, unless there are issues that the article is skipping over. I mean, if I had PTSD and panic attacks/flashbacks, I'd be getting myself a propranolol prescription and a friend to help replicate.
posted by tavella at 4:01 PM on May 2, 2016 [6 favorites]


wow. seems almost too good to be true.
posted by dhruva at 4:01 PM on May 2, 2016 [2 favorites]


Is it just me, or is that spider graphic kind of insensitive to anyone with an actual phobia who might happen to visit the article?

YES it is very insensitive and NO it’s not just you! I cannot forgive websites who do that!

MythMaker: don’t feel bad please, this is not meant to criticise you, it’s the website’s responsibility not yours - but if you wanted to be extra nice to hyper-aracnophobes like me yes maybe a [WARNING: GIANT BLACK HAIRY SPIDER PHOTO] would be cool. Just so someone else avoids getting a shock :)

(good thing I was just about to watch the latest Game of Thrones, hope there’s enough blood and gore in this episode to put the giant black hairy spider image to the back of my mind brrrr)

Is there any way to get a text-only version without going through that monstrosity?
posted by bitteschoen at 4:04 PM on May 2, 2016 [10 favorites]


So are the people who take beta-blockers regularly, for let's say high blood pressure, just not afraid of anything after a couple of years?
posted by rtimmel at 4:06 PM on May 2, 2016 [6 favorites]


Is there any way to get a text-only version without going through that monstrosity?

you can turn off images in your browser before viewing stuff that you think might have terrible images, like the time i had to wiki necrotizing fasciitis (dont wiki this)
posted by poffin boffin at 4:07 PM on May 2, 2016 [2 favorites]


So when is someone going to use this to wipe out memories of an old love affair, a la "Eternal Sunshine of the Spotless Mind?"

Good point! If only they'd addressed that specific concern like 3 times within the very text of the article.
posted by Joey Buttafoucault at 4:09 PM on May 2, 2016 [33 favorites]


thanks for the inadvertent heads up, limonaire, I won't be clicking this link...
posted by supermedusa at 4:12 PM on May 2, 2016 [1 favorite]


In one mailing list I was on, there was only ever talk of sredips.
posted by clawsoon at 4:14 PM on May 2, 2016


At least, according to the article, it doesn't wipe out memories, it just removes the emotional content of them. They become events rather than painful memories.

Gonna need to apply this technique to every thing that happened to me between the ages of 5 and about 20 or so.
posted by tobascodagama at 4:18 PM on May 2, 2016 [8 favorites]


So this is an awesome article. I already knew about people taking b-blockers prior to a performance or giving a lecture, but it's fascinating to think it might work on emotion. That suggests that if you interrupt the physiological response to fear it also interrupts the emotional response, and how weird that it appears to be permanent! I'm also interested in the question asked above re: what about people who are on b-blockers as part of their usual care? WEIRD and cool! Looking forward to seeing more research!

Kindt, a striking woman with sharp features, crisp blue eyes, and stylishly tousled blonde hair, ushered Klaver into a small, plain room with a table and two chairs. Klaver, who has shoulder-length silver hair, wore black to the session.

argh why is this relevant
posted by supercrayon at 4:33 PM on May 2, 2016 [39 favorites]


She believes reconsolidation is normally initiated by what she calls a “prediction error”: The actual events that follow a trigger must be different from the outcome the patient anticipated.

I know someone who has a terrible needle phobia going back to a traumatic childhood experience, but I feel like more than half the time he gets his blood drawn he gets re-traumatized by unskilled phlebotomists rooting around in his arm. I'm not sure he actually experiences "prediction errors". Or maybe his perception of them being unskilled is colored by his inability tolerate what they're doing because of the fear signals being sent.

I am also curious about how this would effect people with vaginismus.
posted by bleep at 4:36 PM on May 2, 2016 [3 favorites]


'So when is someone going to use this to wipe out memories of an old love affair, a la "Eternal Sunshine of the Spotless Mind?"'

"Good point! If only they'd addressed that specific concern like 3 times within the very text of the article."

Ah, that's what I get for speed-skimming at work.
posted by King Sky Prawn at 4:37 PM on May 2, 2016 [1 favorite]


rtimmel: "So are the people who take beta-blockers regularly, for let's say high blood pressure, just not afraid of anything after a couple of years?"

I can't speak for anyone else. For me that's a hell no.
posted by Splunge at 4:41 PM on May 2, 2016 [6 favorites]


I got my undergraduate degree in Psychology, with an emphasis on research. To this day, I am convinced that part of the degree is being able to decipher word salad like:

"disrupting reconsolidation by the noradrenergic β-blocker propranolol"
posted by Chuffy at 4:47 PM on May 2, 2016 [4 favorites]



Also this quote?
In 2003, the President’s Council on Bioethics condemned the use of “memory blunters” like propranolol following trauma. “In the immediate aftermath of a painful experience, we simply cannot know either the full meaning of the experience in question or the ultimate character and future prospects of the individual who experiences it,” the council wrote. “By ‘rewriting’ memories pharmacologically we might succeed in easing real suffering at the risk of falsifying our perception of the world and undermining our true identity.”

I find this troubling. It seems like all the therapy is doing is stopping the association between a memory and the rush of adrenaline experienced during forming the memory. So if I make a memory and my adrenaline was going at the time the memory gets a flag. The flag says "Make sure to run the adrenaline next time something like this comes up, it's super dangerous". If I stop that flag from being formed I don't have to deal with the maladaptive consequences of it later. It seems to me to be analogous to putting ice on something to stop it from swelling. In olden days the swelling served a purpose but not so much anymore. It's not like you're going to forget what things are dangerous right?
posted by bleep at 4:51 PM on May 2, 2016 [16 favorites]


arachnophobes: if you're running the uBlock Origin browser extension, the dynamic filtering rule newrepublic.com * image block should do the trick (in the My Rules tab). If you're not familiar with dynamic blocking, check the box "I am an advanced user" in the Settings tab to enable it.
posted by indubitable at 5:01 PM on May 2, 2016 [2 favorites]


"So are the people who take beta-blockers regularly, for let's say high blood pressure, just not afraid of anything after a couple of years?"

I started taking short acting metoprolol as needed for an arrhythmia a few months ago, and as someone who has dealt with chronic anxiety with panic, I've found that it's more effective than xanax or ativan for interrupting a panic response, and with no (apparent) side effect or risk of addiction. Knowing there's the possibility it might be blunting my memory formation around those events? *shrug* Worth it.
posted by lilnublet at 5:02 PM on May 2, 2016 [8 favorites]


I find this troubling. It seems like all the therapy is doing is stopping the association between a memory and the rush of adrenaline experienced during forming the memory.

Yeah, but when you're getting that rush of adrenaline because you know you're going to go out with friends in a few days, and it's not even scary, but you just know that it's something you have to do - I mean, I don't know what having your fingertips tingle at the thought of going outside means from an evolutionary perspective, but I do know that it sucks hard to have to go through that a dozen times a day. I am 1000% willing to risk upsetting some kind of risk-consequence memory formation if it means being able to get a break for once.
posted by teponaztli at 5:03 PM on May 2, 2016 [11 favorites]


Thanks for the post! At the end, the researcher expresses regret that she popped a pill to avoid being worried and all emotional during the surgery of her child. I sat through an operation on my kid, terrified the whole time, and while it didn't scar me for life I can say that the researcher's regret is misguided. Suffering isn't noble, it's painful. This potential treatment doesn't rob anyone of memories, it just acts as a kind of safety net so thoughts of what happened (or might happen), do not send your system into horrible, awful, no-good very bad places. It doesn't erase your memory, it (seems to me, in a bad metaphor perhaps) kind of reboots your system so the memories no longer trigger suffering. And hooray for that, if it's true and without major side effects, because I know lots of people who barely have a life right now courtesy of different flavours of PTSD.
posted by Bella Donna at 5:05 PM on May 2, 2016 [16 favorites]


It'd be pretty funny if we get the whole 'trigger warning' thing worked out just in time to have science come along and come up with a simple way to remove a trigger from someone.
posted by Mitrovarr at 5:05 PM on May 2, 2016 [4 favorites]


Sorry if I wasn't clear, I found the moral hazard stuff in that quote troubling, not the therapy itself; the therapy itself sounds great.
posted by bleep at 5:06 PM on May 2, 2016 [8 favorites]


There's fear and then there's FEAR. I sort of get what the President's Council is concerned about, but in the end it should be up to a patient to decide what kind of emotions they want to feel, and not some distant board of ethicists. Their conclusion is kind of patronizing, actually.

The negative aspect of this is implied by the author, but not quite stated. It's that overcoming fear is a big part of what makes life great. So if someone took propranolol constantly, whenever they felt even slightly afraid, they might become a sort of stereotypical jaded hipster. Every life experience might just become: "been there, done that, got the T shirt, it was no big whoop." They wouldn't get that feeling of catharsis and profound achievement that comes from overcoming one's fears.

But that is not what most people would use the drug for. The truth is that we are often overcome by fear, and that fear itself is a sort of monster that drastically limits the ability many people have to enjoy their lives. So I'm all for seeing this become standard medical practice, to treat people who have severe phobias and PTSD.
posted by Kevin Street at 5:06 PM on May 2, 2016 [10 favorites]


I've been taking propranolol for migraines for about a month. I still have anxiety, but in general I feel more relaxed.
My son has anxiety as well, and he can't take ssri's so there aren't a lot of options. I will bring this up to his dr.
posted by Biblio at 5:24 PM on May 2, 2016


I really hope this stays personal choice oriented and not yet another thing people are expected to do for those around them even they don't want to. I am one hundred percent behind people wanted to numb/erase emotions- but a lot of the reason people are forced to shut out emotions (in addition to just wanting to which is fine) is simply that we refuse to support people carrying the weight of emotional burdens, especially because we expect people to numb or erase them.

Personally, I don't expect anyone else to support my own attitude, but I think that we do process trauma biologically and that healing can take generations as we evolve adaptations to meet stressful environmental variables. I believe it's at least possible our genes respond and adapt to environmental variables and that turning off those processes is harmful.

This is relative and personal, I respect people doing what they need or want to do, even including drugs and alcohol. I just hope this won't be another thing everyone hears about and wants to shove down anyone's throat they know is dealing with PTSD or trauma like so many things.
posted by xarnop at 5:26 PM on May 2, 2016 [6 favorites]


Yeah, this:

“By ‘rewriting’ memories pharmacologically we might succeed in easing real suffering at the risk of falsifying our perception of the world and undermining our true identity.”

Is bullshit, and sounds like every excuse mentally ill people (myself included) has ever presented for not taking their meds. "I don't want to take my antidepressants because they change who I am" is a pretty common excuse (I've used it myself), and it's not limited to antidepressants. People should be free to choose their meds, but to explicitly recommend avoiding a specific course of treatment for "real suffering" for some vague, ill-defined notion of an objective perception of the world and "true identity" seems idiotic.

Perception is coloured by the person who perceived, obviously. That's why when you're depressed, the world seems like a horrible shithole and your life seems to be without value or meaning. That's not any more true than the perception you get when you're on antidepressants. And the perception of the world of someone having an acute psychotic episode is sure as hell not any less "false" than what they have when they take their meds.

I don't see why this should be any different. Forcing people to suffer for some ideal of purity and reality and identity that most people can't even agree on a good definition of is cruel.
posted by Joakim Ziegler at 5:32 PM on May 2, 2016 [27 favorites]


Cue James T. Kirk: I NEED MY PAIN!
posted by Bringer Tom at 6:04 PM on May 2, 2016 [1 favorite]


"Their conclusion is kind of patronizing, actually."

That was Leon Kass, who Bush appointed as Chair of the Bioethics Council, and you should dismiss everything he writes on this and related topics with extreme prejudice. His whole thing is constructing a moral philosophy around (supposedly) innate disgust -- he is an example of the more rarefied version of the cultural conservative intellectual.

The idea that memories are in some sense re-experienced when they are recalled, variously altered during the recollection, and then consolidated again into long-term memory in that altered form, is the product of the last couple of decades of research and is very, very slowly disseminating. I don't know how long it will take for it to reach the general culture, which continues to believe that all (retained) memories are in some sense inherently reliable, absent extraordinary intervention.

But what's interesting is the bias within the field with regard to memories consolidated in the amygdala versus the hippocampus that assumed that the emotion-centric memories in the amygdala were much less mutable than elsewhere. As I understand it, there's good reason to believe that this is true to some extent, but I can't see why anyone would assume a qualitative difference, that reconsolidation happens elsewhere but not with the amygdala.

Not mentioned in this article is other research into PTSD that indicates that recollection and specifically a lot of talk therapy about a trauma may often do more harm than good -- but you can see how this might function given the context of this article. Triggered flashbacks and recollection in talk therapy can involve or even increase the autonomic responses that tag these memories within the amygdala, reinforcing rather then defusing the trauma-as-memory.
posted by Ivan Fyodorovich at 6:18 PM on May 2, 2016 [11 favorites]


Does anyone else think this article is really poorly written? Or is it just cause I come from a psychology background? Particularly I think the author uses the word memory many times when he shouldn't be. I think the idea that this treatment and similar alter memories is a false one that comes from poor understanding of how the brain works.

What this is actually targeting isn't the memory, but the CONNECTION between the memory and the fear response. It's the same thing that is targeted in traditional exposure therapy (which I thought was very poorly presented.) Exposure therapy seeks to decouple the memory from the fear by having people relive the memory or experience the trigger while not feeling afraid, which is essentially the same thing this is doing. Except this is using a specific beta blocker that seems to work really well whereas other work that's been done has used other types of anti-anxiety meds, even things like THC and LSD or meditation, deep breathing, etc.

And, as a related bit of info, I've been on a beta blocker since I was 23 (I'm 36) for high blood pressure. I'm on a pretty low dose and it works well to keep my blood pressure under control. A few years ago I was reading about the off-label use of beta blockers to treat anxiety when I realized that I used to have pretty intense social anxiety, and it gradually went away in my mid-twenties. I had put it down to my own kind of exposure therapy, i.e. forcing myself to go into situations that caused me anxiety. And I think that's still part of it. But in retrospect, gee, I guess I was taking medication for anxiety this whole time.

But no, it doesn't make me unable to have emotions or remember emotions or have fearful experiences. In fact, I'd say that I developed a tiny bit of PTSD at a time I was taking it. Now I don't take this specific beta blocker, but one in the same class, and again I take low doses of it. I imagine the one-time dose given is pretty significant, though apparently not enough to dangerously lower blood pressure.

Anyway, the science is fascinating, but I side-eye the article quite a bit. It seems like while asserting that the treatment doesn't actually change memories, the author keeps talking about changing memories. Which just leads to all the Eternal Sunshine BS and "omg ethics" concerns by people who don't understand the underlying science.
posted by threeturtles at 6:35 PM on May 2, 2016 [11 favorites]


This is neither new nor radical; 60 minutes reported on this in 2006. Still worth learning about, but let's not get carried away.
posted by TedW at 6:43 PM on May 2, 2016 [1 favorite]


But what's interesting is the bias within the field with regard to memories consolidated in the amygdala versus the hippocampus that assumed that the emotion-centric memories in the amygdala were much less mutable than elsewhere. As I understand it, there's good reason to believe that this is true to some extent, but I can't see why anyone would assume a qualitative difference, that reconsolidation happens elsewhere but not with the amygdala.

Thanks, that was one of my first questions while reading, having read more recent research about PTSD, I was wondering why any psychologist would assume memory is hard-wired when we have tons and tons of research showing generally how mutable human memory is. I mean, certainly witness testimony is known to be fairly unreliable, and that can be very emotional memory if someone is witnessing violence or if someone is a victim of a crime. But again, this is conflating the memories themselves with the activation of the fear response.
posted by threeturtles at 6:46 PM on May 2, 2016 [1 favorite]


I find this troubling. It seems like all the therapy is doing is stopping the association between a memory and the rush of adrenaline experienced during forming the memory.

I think that's sort of what they're doing, yes. But these are memories that are a stored in an area of the brain that triggers the flight or fight response. Spiders might be dangerous, but they're not dial-my-survival-instincts-to-11 dangerous (typically). So if spiders any spider or spider shaped thing triggers my flight-or-flight response I'd want to change that if I could. I won't forget that spiders can be dangerous, I just won't try to throw a grenade at a dachshund in a spider costume.
posted by VTX at 7:01 PM on May 2, 2016 [3 favorites]


I just won't try to throw a grenade at a dachshund in a spider costume.

Well, this certainly sounds like an amusing anecdote you should share with the class.
posted by Joakim Ziegler at 7:09 PM on May 2, 2016 [3 favorites]


So if it was demonstrated 10 years ago that this works even for old memories, what's the catch? Because otherwise, given the harmlessness and wide use of the drug in question and the ease of the method, it seems downright unconscionable that this isn't being widely used. Even if it only worked for 10 or 20 percent of PTSD sufferers, it'd be a great treatment option, and at least from the articles it seems to work for more than that. So I'm assuming that there must be some deficit, since I assume mental health personnel aren't dicks.

Yet it's still being presented as a new and not widely accepted thing.
posted by tavella at 7:15 PM on May 2, 2016 [5 favorites]


Replication, replication, replication— this is irresponsible hype at this stage. There are many, many studies of PTSD treatments that looked good at this stage and then later failed or only helped a small minority. This might work for PTSD linked with a one-off event— but most treatments that do so do not work for the most traumatized folks who dealt with issues like repeated sexual abuse during childhood.

It's not fair to get people's hopes up like this before there is more data. Especially given the current replication crisis in psychology.
posted by Maias at 7:15 PM on May 2, 2016 [14 favorites]


Wait, it's just propranolol? I was prescribed it two years ago as a routine treatment for panic attacks. (And no, I've not been cured of panic attacks, alas.) What's new here?
posted by capricorn at 7:24 PM on May 2, 2016 [2 favorites]


"What's new here?"

It's the particular protocol of the therapy and the biological model (and related research) upon which it's built that's different, I think. My impression just from the article and a quick Wikipedia scan is that the past use of this as in your case was in recognition that it had some use as an anxiolytic with no explicit model for why it's effective. But I'm not really informed and I may be misunderstanding.
posted by Ivan Fyodorovich at 7:57 PM on May 2, 2016


There have been a number of studies to date concerning beta blockers in general and propranolol in particular (and a number of other articles like this going back to 2008), but nothing breakthrough.

In any case, beta blockers are already used to ameliorate PTSD symptoms: I take prazosin to reduce the severity of the nightmares I experience due to Combat Related PTSD. It does an OK job on the nightmare front, but the side effects give me grief, particularly tachycardia which causes me a fair bit of distress as it triggers anxiety and intrusive memories related to particular situations where my heart was hammering. I'm presently titrating off it due to the cost/benefit of massive nightmares vs crippling panic.

Interestingly, here is how they found out prazosin was useful off-label for PTSD: a bunch of veterans with prostate issues / hypertension say "hey doc, those pills you put me on for blood pressure really helped with my nightmares too", and after some meta analysis here we are.

I'm incredibly sceptical of the use case cited for propranolol in this piece - it seems limited to non-complex trauma and it hasn't been replicated. There have been quite a number of studies conducted using propranolol to treat or prevent PTSD, and although propranolol has shown some efficacy in preventing the encoding of traumatic memories in a peritraumatic setting, there is very limited evidence of efficacy in patients with any significant level of PTSD symptomology.

I'm with Maias on this - the article seemed very typical of the "gee whiz ain't it cool" genre of science reporting in that it only covered one angle and didn't examine the recent history of science concerning propranolol and PTSD. The whole "rewriting of memory" thing in this piece is quite a red herring and an irresponsible overstatement.
posted by Outside Context Problem at 7:57 PM on May 2, 2016 [10 favorites]


Can I just visit my highschool and gobble one of these? Might help the 30 years of social anxiety I've had since.
posted by Abehammerb Lincoln at 8:27 PM on May 2, 2016


[A few comments deleted. Trigger warnings and descriptions of women in articles are both pretty well-trod fighty ground here, and offhand references to them early in the thread don't need to mean derailing the whole thread.]
posted by LobsterMitten (staff) at 8:31 PM on May 2, 2016 [2 favorites]


“By ‘rewriting’ memories pharmacologically we might succeed in easing real suffering at the risk of falsifying our perception of the world and undermining our true identity.”

My thought process reading this
- if I took this I might not be afraid of spiders anymore!
- but if I wasn't afraid of spiders- how would I know not to touch them?
-better not to take it.

I think this might indicate a problem with my reasoning skills. Apparently I am so averse to spiders that the thought of not be averse to them sets of sirens and red flashy lights in my brain "warning! warning!"
posted by fshgrl at 8:35 PM on May 2, 2016 [5 favorites]


I know someone who has a terrible needle phobia going back to a traumatic childhood experience, but I feel like more than half the time he gets his blood drawn he gets re-traumatized by unskilled phlebotomists rooting around in his arm. I'm not sure he actually experiences "prediction errors". Or maybe his perception of them being unskilled is colored by his inability tolerate what they're doing because of the fear signals being sent.

Side note for anyone interested in the esoterica of drawing blood. Thought I'd throw this out there as someone who takes blood samples really frequently - it's actually friggin hard. It's not an exact science, even when you use something to help you visualize veins like a doppler or an accuvein. We use all our tricks (wiping the site with alcohol to stimulate the vein, really bright lights to help visualisation, have the patient make a fist, have the patient drink some water, etc). You still basically have to poke around with a needle til you get it right. There is no other option! Add to this that not every person is anatomically identical. Some people have wee little veins that you can barely puncture even with a butterfly needle. Some people's veins are really deep under their skin and you have to go purely by what you can palpate.

I'm actually really pretty good at taking blood and I still miss, or leave a bruise, or the vein rolls, or I hit a valve, or horror of horrors I punch straight through a vein and give my poor patient a hematoma. Every nurse stresses out about both this and inserting IV lines for this reason, we know patients hate it and we know it may not happen on the first go and we'll have to go rooting around. And anecdotally it always seems to be that the patients who are scared of needles who are also difficult to stick, gah.

Part of the hype around Theranos (well for me anyways) was that it would get blood via fingerstick (small needle puncturing the skin on the finger, like what people who are checking their blood sugar already do) rather than having to use a big honking needle.

posted by supercrayon at 8:37 PM on May 2, 2016 [10 favorites]


What this is actually targeting isn't the memory, but the CONNECTION between the memory and the fear response. It's the same thing that is targeted in traditional exposure therapy (which I thought was very poorly presented.) Exposure therapy seeks to decouple the memory from the fear by having people relive the memory or experience the trigger while not feeling afraid, which is essentially the same thing this is doing. Except this is using a specific beta blocker that seems to work really well whereas other work that's been done has used other types of anti-anxiety meds, even things like THC and LSD or meditation, deep breathing, etc.

Yes! I came in to say the exact same thing, and I was really confused by the article's presentation of exposure therapy and this propranolol therapy as opposed. They're the same thing. Exposure therapy teaches clients to calm themselves, then exposes them to their trigger, then the client is supposed to use their new calming skills to feel calm even when triggered, to teach their brain that they can be calm when faced with memories of the trauma. It's not about building up blue M&M memories to drown out the red M&M memory. I... don't even know what that description fits.

And ditto to what others are saying about how these types of fixes often work great on specific phobias or PTSD from one discrete incident, but much less well on people dealing with PTSD from ongoing abuse or multiple traumatic incidents. I'd also like to see studies comparing results after more than a year.
posted by lazuli at 8:54 PM on May 2, 2016 [3 favorites]


“‘Cure’ is a word not often encountered in psychiatry”, hmm, maybe we should talk about that next week.
posted by 445supermag at 9:14 PM on May 2, 2016 [3 favorites]


I took a beta blocker for anxiety when I was a teenager. I have an irrational terror of heights. So bad that as a child I would crawl up and down stairs in sporting arenas and just refused to go as an adult. But for one brief moment, that beta blocker allowed me to take a ski lift up to a high jump in Lake Placid and feel no fear whatsoever. It was like magic. I regretted not being able to take them anymore--my blood pressure was dangerously low due to an eating disorder.
posted by xyzzy at 10:09 PM on May 2, 2016 [2 favorites]


And anecdotally it always seems to be that the patients who are scared of needles who are also difficult to stick, gah.

If fear of needles is caused by trauma, and some people are physiologically more difficult to stick, which they've probably been all their life, this makes a lot of sense, if you just flip the cause and effect around.
posted by Joakim Ziegler at 11:44 PM on May 2, 2016 [3 favorites]


Personally I've always had shy & difficult veins but I don't have a phobia. It's not the greatest sensation ever but I can deal. Usually even though there's some frowning and "Hmmm"-ing and "Your veins are shy! Let me get a smaller needle", they are in and out of there pretty quick.
posted by bleep at 12:13 AM on May 3, 2016


In parallel, there is a legitimate basic science question for the sociologists—how will introducing this apparently radical technology change the social fabric? To start, the very context and terms on which society understands and responds to trauma, PTSD, etc., should also change with it. The article barely touches on the radical consequences. This is complicated terrain, but there's hope in that scientists' future work can help unpack these complexities.
posted by polymodus at 2:33 AM on May 3, 2016


In parallel, there is a legitimate basic science question for the sociologists—how will introducing this apparently radical technology change the social fabric? To start, the very context and terms on which society understands and responds to trauma, PTSD, etc., should also change with it.

It's not really that radical, though. People have physiological fear-based responses to stimuli. Learning (whether through medication, behavioral modification, or cognitive exercises) to be calm in the face of those stimuli rewires the brain so that the brain is no longer so reactive in the face of those stimuli. That fits, as much as I can tell, our current understanding of phobias and triggers (as well as current treatments for phobias and triggers) pretty exactly. In the past, "quick fix" type treatments (like EMDR) seem to work pretty well for treating phobias and triggers generated by discrete single traumatic incidents but not nearly as well for the PTSD arising from more complex or repeated traumas, and there's currently no research showing this therapy will help any better with those, either.
posted by lazuli at 5:34 AM on May 3, 2016 [1 favorite]


Even with the idea of taking a pill immediately after a trauma to inoculate oneself against PTSD (which, again, I suspect won't work for repeated or complex trauma, and likely wouldn't be possible for many cases of child abuse, since the abuser is often the one who would be gatekeeping a child's medical treatment), it's a similar medical model to Peter Levine's Somatic Experiencing behavioral model, and he's written a book, Trauma-Proofing Your Kids: A Parents' Guide for Instilling Confidence, Joy and Resilience, about teaching children how to "discharge" trauma immediately after it happens (by affirming it was scary, by letting their bodies "shake it out," by letting their brains process it through play/retelling as they need to) so that traumas don't get "stuck" in the body and brain. I suspect if all first responders and Emergency Department staff were trained in such a method, it would end up being just about as effective as prophylactic propranolol after accidents (and quite possibly longer-lasting).
posted by lazuli at 5:53 AM on May 3, 2016 [1 favorite]


Sooo, I did manage to disable images (thanks poffin boffin and indubitable for the tips!) and read the article in the end. That was a fascinating read and well worth the effort.

I’m wondering, this reminded me of reading about paracetamol/acetaminophen being used for anxiety, is this related somehow, can it be related or is it a completely different mechanism? This seems more specific and precise but I wonder if there is some common thread there?
posted by bitteschoen at 6:32 AM on May 3, 2016


What this is actually targeting isn't the memory, but the CONNECTION between the memory and the fear response. It's the same thing that is targeted in traditional exposure therapy

Is it though? To this layman, it seems like exposure therapy works not so much by changing the connection between the memory and the fear response but by the patient training themselves to deal with it in a more calm way. Like how some people can be totally calm in an emergency even though their heart is hammering away and the adrenaline is flowing at full bore. I'm thinking about situations like a pilot landing a plane on a river where the pilot is fully terrified (and hopefully has chosen "flight" of the two options) but is still able to very calmly communicate with the tower and work through their emergency procedures.

My read from the article is that memories are like computer files with different file extensions so that .fof designates that it's tied to your fight-or-flight response whereas a .nfo is just a regular memory.

When your brain accesses a .fof memory, the fight-or-flight response is triggers but if you've been practicing opening that file, you can keep calm and keep a lid on the response.

The protocol from the article opens the .fof and then saves it as a .nfo instead.

Or maybe the drug just replicates the results of about 100 years of exposure therapy with a single therapy session and a good night's sleep. I'm not an expert, but it does seem like there is a similar but slightly different mechanism of action between the two therapies.

posted by VTX at 7:41 AM on May 3, 2016


This was covered as part of a NOVA episode back in February and watching the results is so startling you start to think that the patients are actually just paid actors. Unfortunately, that episode is locked behind a paywall and I can't find a legitimate source for even a short clip of that bit. (If you want to look for it in slightly grayer waters, the episode is Memory Hackers.)
posted by Hactar at 7:42 AM on May 3, 2016 [1 favorite]


Or maybe the drug just replicates the results of about 100 years of exposure therapy with a single therapy session and a good night's sleep.

That was more or less my take-away. I think, too, that a lot of clients stop doing exposure therapy for simple phobias or traumas once they hit a "good enough" response (which is fine!), which doesn't mean that exposure therapy can't get someone there, just that many clients don't really have a need to do so.
posted by lazuli at 8:31 AM on May 3, 2016 [1 favorite]


"This PoenoBand sucks! Dad, how did you learn Latin?"

"Well, son, it's always been a bit odd, this learning of Latin - Granddad got whacked on the knuckles with a ruler by a Nun if he mis-declined, but he started early, grade school, so by the time he was your age he was doing pretty well. I wasn't doing so hot in high school, so I started snapping a rubber band on my wrist if I screwed up a conjugation - it worked pretty well. We've got scads of research now that show all kinds of interactions between memory buildup and pain-slash-pleasure: and it makes sense if you think about where pain would register in our pattern-seeking brains, and what value it might have, evolutionarily-speaking; it's actually a really good learning strategy, if your definition of learning is wide enough. But times change, and since you learn in your HarvardPod, and not at a school with teachers and other students to embarrass you, you'll need to have some extra reinforcement that learning Latin is important, as well as fun. Besides, as long as you take the right dose of OblivioPush before an exam, you won't be traumatized if you flunk! It's a win-win! Think you can handle that? "
*smiles, tousles hair*
"Now don't forget to feed and stroke Harry, your pet magnarachnoid clone, before you go to bed. See you tomorrow, sport!"
posted by eclectist at 8:55 AM on May 3, 2016


Joakim Ziegler: I agree with you, and I think I see what you're saying - in particular your conclusion:

Forcing people to suffer for some ideal of purity and reality and identity that most people can't even agree on a good definition of is cruel.

Spot on, IMO.

But the way you get there made me deeply uncomfortable:

Yeah, this:

“By ‘rewriting’ memories pharmacologically we might succeed in easing real suffering at the risk of falsifying our perception of the world and undermining our true identity.”

Is bullshit, and sounds like every excuse mentally ill people (myself included) has ever presented for not taking their meds. "I don't want to take my antidepressants because they change who I am" is a pretty common excuse (I've used it myself), and it's not limited to antidepressants.


I've been on at least 7 antidepressants. It's perhaps more - I've literally lost count. One of them, within the space of a week, changed my personality from silly, flippant, cynical, reserved, a bit shy - to aggressive, quite worrying, intolerant, asshole. I started acting bizarrely, got suspended from school, and the whole debacle ended with my mother screaming at my school principal.

That is not a positive treatment outcome.

Needless to say, I was quickly switched back to the previous antidepressant and the care providers went back to the drawing board.

What you say here: "sounds like every excuse mentally ill people (myself included) has ever presented for not taking their meds" contains a false assumption that "meds" are going to provide adequate relief, always and easily. With psychiatric medication in particular, that is categorically not the case. As my experience demonstrates, and as others will confirm, it can take decades to find a medication or combination thereof that works well enough without fucking you up in really significant ways. You seem to be one of the lucky ones who apparently got the right combination with little effort - but do not assume your experience is universal.
posted by iffthen at 11:34 AM on May 3, 2016 [4 favorites]


huh. this is pretty interesting - i take propranolol for chronic migraines, and it seems to be working great for that since i started a little over a year ago. i also take celexa for clinical depression and anxiety (which i've been on for years, in varying dosages with various levels of success), and i have noticed that i've been more functional the past year and i wonder if that has anything to do with the propranolol
posted by burgerrr at 4:28 PM on May 3, 2016


Yeah. I suspect that this treatment probably works best for neuro- and chemical-typical people who have specific triggers.

Anyway, there has been a lot of pharma interest in the use of various blood pressure drugs for psychiatric use in the last 15 years or so. Beta blockers for situational anxiety. Clonidine for anxiety or addiction or ADHD. Guanfacine for ADHD. Sigh. The worst part is that the whole thing is just Black Box testing. Why does guanfacine make a signifigant difference in ADHD, but irbesartan doesn't? I know that they are differant classes, but the original purpose was the same: to lower blood pressure.

I can tell you this, when you have persistant resistant brain weasels and an adventurous attitude (and presciber), you get to try all kinds of drugs. I have a jar full of old pills, meds I tried; it is kind of pretty and a remider of what I had to go through to get to where I am today. But the word "cure" brings on an ironic bark of laughter that quickly becomes somewhat hysterical if I don't find something else to think about in a big damn hurry. I'd settle for decent treatments that don't cause more problems than they mask.

Be nice to your pharmacists, people, they don't get enough respect. Or a real lunch break most of the time.
posted by monopas at 5:26 PM on May 3, 2016 [2 favorites]


I'm on a low dose of Inderal (profopanol) for a too-rapid heart rate, which doctors discovered when I checked into 6West so I wouldn't commit suicide. My heart beating too fast and then my high blood pressure as a result were causing some of the psychiatric symptoms. Other meds were changed too, so it's difficult to tease them apart, but I think it's perhaps the mind knocking the body back in line, when then allows it to do its job again too. I can spiral one way mind / body, or the other. I'll take the other when it means LIVING. And sending out kudos to my fellow semi-colons!
posted by beckybakeroo at 7:01 PM on May 3, 2016


iffthen: What you say here: "sounds like every excuse mentally ill people (myself included) has ever presented for not taking their meds" contains a false assumption that "meds" are going to provide adequate relief, always and easily. With psychiatric medication in particular, that is categorically not the case. As my experience demonstrates, and as others will confirm, it can take decades to find a medication or combination thereof that works well enough without fucking you up in really significant ways. You seem to be one of the lucky ones who apparently got the right combination with little effort - but do not assume your experience is universal.

Sorry, I did worry a bit later that that bit in particular would come off a bit too bombastic. I had the luck myself to get meds that worked pretty quickly, and with little side effects. However, I do notice changes in personality, for instance, I'm less creative when I'm on antidepressants. I'm definitely aware of people who have had much more trouble finding meds that work for them.

But I've also run into a lot of people who don't really have serious side effects, and in some cases even become nicer and easier to be around when they take their meds, and for whom the meds are clearly working, who decide to go off them because they feel "different" or like they're "someone else" or some vaguely defined thing like that, and then they stop taking their meds, and immediately plunge into a self-destructive spiral that has to be much, much worse than the side effects they'd described.

People are free to do what they want, but that particular excuse, about the identity and authenticity of personality, I've heard a lot from people who have good external results from their medication, but feel iffy about changing their lives or cleaning up the mess the mental illness has left behind. I can sympathise, that's hard work, but the excuse feels pretty weak.
posted by Joakim Ziegler at 9:32 PM on May 5, 2016


People are free to do what they want, but that particular excuse, about the identity and authenticity of personality, I've heard a lot from people who have good external results from their medication, but feel iffy about changing their lives or cleaning up the mess the mental illness has left behind. I can sympathise, that's hard work, but the excuse feels pretty weak.

The intervention mentioned in the article would be given to people who have a 70-ish% chance of not developing any sort of disorder, though; I think that's why the ethics get trickier. They're not talking about withholding treatment from people who need it, but giving treatment -- which interferes with memory formation -- to a lot of people who may not need it.
posted by lazuli at 8:32 AM on May 6, 2016


« Older A cat name is Sashimi-san.Somebody tell me why...   |   This is not a Drill People-Eurovision comes to the... Newer »


This thread has been archived and is closed to new comments