The effect of peripheral beta-blockade on psychophysiologic responses in obsessional neurotics.

Abstract Ithas been postulated that anxiety symptoms are mediated through peripheral mechanisms and that subjective feelings of anxiety are learned associations to bodily symptoms. 1 This hypothesis has been supported by findings indicating the beneficial effects of beta-adrenergic receptor blocking agents in psychiatric patients. 2,3 In anxiety states, particularly, mood changes have been reported even with beta-blockers that penetrate very slowly into the brain. 4–6 Therefore, the improvement in subjective anxiety would appear to be related to peripheral beta-blockade rather than central action. There is also evidence that obsessive-compulsive patients experience increased subjective discomfort, associated with increased autonomic reactivity, while they hold in fantasy ruminative thoughts, or when they touch “contaminating” objects, compared to neutral thoughts or objects. 7,8 The present work is an attempt to measure the psychophysiologic arousal during internal stimulation of such patients before and after beta-blockade with practolol ∗ an agent lacking central effects. A decrease in autonomic reactivity accompanied by similar amelioration in subjective anxiety would support Breggin's hypothsis. 1 On the other hand, failure of the latter to accompany the physiologic modifications brought about by practolol would support the theoretical position that assigns fundamental importance to cognitive and situational factors in the genesis and maintenance of anxiety. 9 This would be of interest with patients in which a specific type of cognitive activity and avoidance behavior dominate the clinical symptomatology.