title: Effect of beta-receptor blockade on anxiety with reference to the three-systems model of phobic behavior. Comparative efficacy of propranolol, chlordiazepoxide, and placebo in the treatment of anxiety: a double-blind trial. Effect of a Beta-adrenergic Blocking Agent on Dental Anxiety Comparative effects of propranolol and chlordiazepoxide in anxiety states. The effect of acute beta-adrenoceptor blockade on examination performance. The assessment and treatment of performance anxiety in musicians. Efficacy of usual antidepressant dosing regimens of fluoxetine in panic disorder: randomised, placebo-controlled trial. A controlled study of alprazolam and propranolol in panic-disordered and agoraphobic outpatients. Propranolol reduces the anxiety associated with day case surgery. The Treatment of Social Phobia: Real‐life Rehearsal with Nonprofessional Therapists A comparison of propranolol and diazepam for preoperative anxiolysis The effect of propranolol versus placebo on resident surgical performance. Propranolol in chronic anxiety disorders. A controlled study. Imipramine versus propranolol for the treatment of panic attacks: a pilot study. Alprazolam, Propranolol, and Placebo in the Treatment of Panic Disorder and Agoraphobia with Panic Attacks Oral premedication one hour before minor gynaecological surgery — does it have any effect? Oxprenolol and propranolol in anxiety states. A double-blind comparative study. Effect of post-retrieval propranolol on psychophysiologic responding during subsequent script-driven traumatic imagery in post-traumatic stress disorder. Somatic and psychological symptoms during isoproterenol-induced panic attacks Narcotic withdrawal symptoms in heroin users treated with propranolol. Diazepam and propranolol in panic disorder and agoraphobia. Paroxetine in the treatment of panic disorder. A randomised, double-blind, placebo-controlled study.
abstract: 14 phobic subjects were given propranolol ( Inderal ) , atenolol ( Tenormin ) and placebo in a double-blind fashion according to a repeated measurement design . Subjects were exposed to their source of fear while their anxiety and cardiovascular responses ( heart rate , blood pressure and peripheral temperature ) were recorded . In accordance with the Three-Systems Model of fear and phobias , the subjects were divided into two groups of high and low physiological reactors , operationalized by the cardiovascular items in their anxiety pattern from a revised version of the Autonomic Perception Question naire ( APQ ) . It was found that beta-blockade had the predicted effect on heart rate and peripheral temperature while diastolic blood pressure was unaffected . The systolic blood pressure finally was lowered for the low cardiovascular reactors . The subjectively rated anxiety rose consistently during exposure . There was no general effect of the beta-blocking drugs on subjective anxiety . For the high cardiovascular reactors propranolol was associated with a higher anxiety level The efficacy and safety of propranolol in the treatment of anxiety was compared with those of chlordiazepoxide and placebo in a 3-week , double-blind study of 212 patients . After a 1-week , single-blind placebo-washout period , patients were r and omized to receive either propranolol ( 80 , 160 , or 320 mg/day ) , chlordiazepoxide ( 30 , 45 , or 75 mg/day ) , or placebo . Patients were evaluated by three physician-rated scales -- Hamilton Rating Scale for Anxiety ( HAM-A ) , Covi Anxiety Scale ( CAS ) , and Clinical Global Impressions scale-- and two patient-rated scales -- Symptoms Checklist 90 and Profile of Mood States . Patients in all groups demonstrated significant improvement in their level of anxiety at all time points compared with their baseline level . At Week 1 propranolol and chlordiazepoxide patients were significantly better than placebo patients , as measured by the HAM-A and CAS . At Week 2 only propranolol was superior to placebo , based on HAM-A and CAS scores . Fifteen patients prematurely terminated because of adverse reactions ( 4 taking propranolol , 4 taking placebo , and 7 taking chlordiazepoxide ) . The incidence of side effects was similar for the two active drugs ; fatigue , drowsiness , and change in libido were significantly more frequent with chlordiazepoxide and drowsiness and indigestion were more frequent with propranolol compared with placebo 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 The trial showed propranolol to be as effective as  chlordiazepoxide overall in the treatment of these cases of anxiety states , but in  depression and sleep disturbance  chlordiazepoxide was better . Nevertheless , the new drug may have some part to play in the treatment of anxiety as an alternative to tranquillizers , and it may be possible in future to define more precise indications for its use Simple tests of verbal reasoning and mental arithmetic , taken under mildly stressful conditions , have been shown to give a reproducible test of intellectual function within groups of normal subjects . Using these tests , in two separate examinations , a double-blind cross-over study was performed on 35 medical students to assess the effects of acute beta-adrenoceptor blockade with propranolol on intellectual function . With placebo treatment , students recorded an average total score of 231.3 marks , with average scores of 108.9 marks on the mental arithmetic paper and 122.4 marks on the verbal reasoning paper . Treatment with propranolol was associated with an improvement in total score of 9.2 + /- 3.9 marks ( P less than 0.05 ) , an improvement in mental arithmetic score of 5.6 + /- 2.3 marks ( P less than 0.05 ) and an improvement in verbal reasoning score of 3.6 + /- 2.4 marks ( NS ) . Eighteen out of the 35 students said that they were mildly anxious before one examination and 13 students said they were anxious before both examinations . Those students who admitted anxiety seemed to benefit the most , in terms of improved examination performance , from treatment with propranolol OBJECTIVE Performance anxiety in musicians may be severe enough to require intervention but has been the subject of relatively little clinical research . The authors ' objectives were to describe the results of a comprehensive clinical and laboratory assessment and to perform a double-blind , placebo-controlled study comparing buspirone , cognitive-behavior therapy , and the combination of these treatments for performance anxiety . METHOD Ninety-four subjects were recruited by mass media announcements and were seen in a university-based outpatient psychiatric clinic . Assessment s were 1 ) question naires for all 94 subjects , 2 ) diagnostic interview of 50 subjects , and 3 ) laboratory performance of 34 subjects . Treatment conditions were 1 ) 6 weeks of buspirone , 2 ) 6 weeks of placebo , 3 ) a five-session , group cognitive-behavior therapy program with buspirone , or 4 ) the cognitive-behavior therapy program with placebo . Treatment outcome measures included subjective anxiety ratings and heart rate measures during a laboratory performance , a question naire measure of performance confidence , and a blind rating of musical performance quality . RESULTS All subjects fulfilled criteria for DSM-III-R social phobia . Of the 15 full-time professional musicians , ten had tried propranolol and three had stopped performing . Most of the subjects had substantial anxiety and heart rate increases during laboratory speech and musical performances . Cognitive-behavior therapy result ed in statistically significant reductions in subjective anxiety , improved quality of musical performance , and improved performance confidence .  Buspirone was not an effective treatment . CONCLUSIONS Cognitive-behavior therapy is a viable treatment approach for performance anxiety in musicians BACKGROUND Although serotonin reuptake inhibitors are effective in panic disorder , questions concerning whether doses associated with antidepressant efficacy are also effective for panic disorder remain . AIMS To assess the efficacy of the usual antidepressant dose of fluoxetine in treating full panic attacks . METHOD Patients with panic disorder were r and omised to placebo or to fluoxetine initiated at 10 mg daily for 1 week and then increased to 20 mg daily . The trial lasted 12 weeks , but after 6 weeks patients who had failed to achieve a satisfactory response were eligible for dose escalation to a maximum of 60 mg of fluoxetine daily . RESULTS Fluoxetine was associated with a statistically significantly greater proportion of panic-free patients compared with placebo after 6 weeks and at end-point . CONCLUSIONS Fluoxetine at a dose of 20 mg daily is safe and efficacious in reducing symptoms of panic disorder . Patients who fail to obtain a satisfactory response at 20 mg daily may benefit from further dose increases We studied the efficacy of propranolol ( Inderal ) compared to alprazolam ( Xanax ) in 29 patients with a diagnosis of agoraphobia with panic disorder or panic disorder with or without limited phobic avoidance in a 6-week double-blind controlled experiment . Alprazolam is effective in those syndromes , whereas to date only negative or ambiguous results had been reported for propranolol .  Fourteen patients received a mean daily dose of 5.0 + /- 2.3 mg of alprazolam and 15 patients received 182.0 + /- 60.5 mg mean daily dose of propranolol . We found both drugs to be effective to suppress panic attacks and reduce avoidance behavior . The only significant between-drug difference was a more rapid onset of alprazolam 's panicolytic effect .  Propranolol merits further study . We suggest patients worthy of a clinical trial OBJECTIVE To find out if propranolol , a non-cardioselective beta-blocker , can reduce the anxiety associated with day case surgery . DESIGN Prospect i ve r and omized double blind trial . SETTING University hospital , Irel and . SUBJECTS An unselected group of 53 patients undergoing day case surgery . INTERVENTION Subjects r and omised to receive either propranolol ( 10 mg ) or placebo on the morning of operation . MAIN OUTCOME MEASURES Blood pressure ; pulse , anxiety , pain score and patient satisfaction . RESULTS Mean ( SD ) Hospital Anxiety and Depression score was significantly lower in the propranolol group than in the control group ( 2.5 ( 0.7 ) compared with 4.6 ( 0.7 ) , p < 0.0001 ) before discharge . CONCLUSION A low dose of propranolol given on the morning of day case surgery significantly reduced patients ' anxiety Sixteen socially phobic out patients underwent a 4-week course of social skills training that attempted to maximize rehearsal in real-life setting s. The therapy was largely conducted by nonprofessional volunteers after a 2-hour training workshop . It consisted of multiple role-played practice in the clinic , followed immediately by rehearsal in a real-life setting in the company of a nonprofessional therapist and a fellow patient . Subsequently , patients were r and omly paired to perform further rehearsals between sessions . Drug therapy was controlled by double blind assignment to propranolol or inert placebo throughout the course of treatment . Measures of specific fears , generalized social anxiety , self-image , and global tension and anxiety were administered 1 month before treatment , immediately before and after treatment , and at 6 months follow-up . During a 4-week drug-free period prior to active treatment no improvement was noted on any measures . After the 4-week treatment period significant improvement had occurred on all outcome measures . Propranolol and placebo subgroups showed very similar results . Treatment gains were sustained at follow-up . It was concluded that repeated behavior rehearsal , both in the clinic and in real life is a cost-effective treatment procedure for many social phobias . The approach is straightforward and can be applied by nonprofessionals , including the patients themselves , after limited training and with minimal supervision The effectiveness of propranolol , a nonsedating anxiolytic premedication , was studied by monitoring preoperative anxiety and postoperative recovery of cognitive function in 92 healthy ASA physical status 1 females aged 15–42 yr undergoing outpatient dilatation and curretage (D&C)for therapeutic abortion . In a r and omized double-blind design , patients received one of the following oral medications 1–1.5 hr preoperatively : ( 1 ) diazepam 10 mg ( n = 31 ) ; ( 2 ) propranolol 80 mg ( n = 31 ) ; ( 3 ) placebo ( n = 30 ) . Anxiety throughout the hospital stay was monitored using the State-Trait Anxiety Inventory ( STAI ) . Postoperative cognitive recovery was assessed using the digit span and Trieger tests . STAI anxiety levels were recorded on admission to hospital , immediately before entering the operating room , and two hours postoperatively . There was no difference among the anxiolytic properties of the three medications and all three patient groups showed a significant decrease in anxiety levels after administration of the medication . Tests of cognitive function after anaesthesia showed the fastest return to baseline status in patients receiving propranolol , possibly because beta adrenergic blockade blunted the autonomic signs of light anaesthesia and less anaesthetic was administered . None of the study premedications was demonstrated to have an anxiolytic advantage , but propranolol did offer a faster return of cognitive function in the postoperative period . RésuméNous avons voulu évaluer l’efficacité du propranolol à litre de prémédication anxiolytique non-sédative en mesurant le degré d’anxiété préopératoire et la rapidité de la récupération postopératoire des fonctions cognitives . Quatre-vingt douze femmes de 15 à 42 ans de classe ASA I , c and i date s à une dilatation cervicale et curetage pour avortement en externe , se sont prêtées à notre étude . Après r and omisation à double-insu , elles prenaient par la bouche soit 10 mg de diazépam ( n = 31 ) , soit 80 mg de propranolol ( n = 31 ) , soit un placebo ( n = 30 ) et ce , de 60 à 90 minutes avant l’intervention . Nous mesurions le niveau d’anxiété à l’admission , juste avant d’entrer en salle d’opération et deux heures après l’intervention en utilisant le  « State-Trait Anxiety Inventory ( STAI ) » . Le « digit span » , test mnémonique numérique et le test de Trieger nous servaient à mesurer les fonctions cognitives avant et après l’opération . Les trois médications utilisés n’ont pas démontré de propriétés anxiolytiques différentes , les niveaux d’anxiété allant décroissant dans les trois groupes à partir de l’admission à l’hôpital . Par contre , après l’opération , les fonctions cognitives retournaient plus vite à la normale chez les patientes du groupe propranolol , peut-être parce que le blocage β-adrénergique avait permis de surestimer la profondeur de l’anesthésie pendant l’intervention entraînant l’utilisation de moindres doses d’anesthésique PURPOSE To determine whether propranolol can decrease surgical tremor and anxiety in residents performing ocular microsurgery without impairing patient or physician safety . METHODS In this r and omized , double-masked , crossover study , 5 third-year ophthalmology residents ingested a capsule containing either propranolol , 40 mg , or placebo 1 hour prior to performing ophthalmic microsurgery . All residents were healthy men under age 30 years . Prior to commencement of the study , all participants had successfully been administered a test dose of propranolol without side effects . The study took place over a 10-week period . At the conclusion of each case , both the resident and attending surgeon observer independently completed a form grading , on a sliding scale : ( 1 ) amount of overall tremor ; ( 2 ) amount of tremor during placement of the first 3 sutures after lens or nucleus extraction ; ( 3 ) anticipated difficulty of the case ; ( 4 ) actual difficulty with the case ; and ( 5 ) anxiety ( surgeon only ) . In addition , the type of procedure performed , complications encountered , and surgeon side effects were recorded . The data were analyzed with a 2-way analysis of variance for unbalanced data . RESULTS A total of 73 surgical cases were performed ; the surgeons were administered propranolol for 40 cases and placebo for 33 . As judged by the resident surgeon , there was a highly significant effect of propranolol in decreasing anxiety ( P = .0058 ) , reducing surgical tremor overall ( P < .0001 ) , and reducing tremor while placing the first 3 sutures following lens extraction ( P < .0001 ) . There was no treatment-by-surgeon interaction for any of the measures . Complications and difficulty of the case , as judged by both the resident and attending surgeons , were not significantly different in the propranolol versus placebo groups ( P > .05 ) . There were no side effects reported or observed in any of the surgeons . CONCLUSIONS Propranolol , 40 mg , administered 1 hour prior to surgery , significantly decreases tremor and anxiety in the surgeon without untoward effects to the surgeon and the patient . However , it is unknown whether decreased tremor and anxiety improved surgical outcome In a double-blind crossover study the beta-adrenergic blocking drug propranolol hydrochloride reduced symptoms in 17 of 26 patients with chronic anxiety disorders . Both somatic and psychic symptoms improved as judged by patient and observer ratings . The most frequent side effects ( dizziness , fatigue , and insomnia ) were difficult to distinguish from anxiety symptoms and were , for the most part , mild . The therapeutic and side effects observed suggested CNS activity of the drug . Although propranolol is of benefit to patients with anxiety , its efficacy , compared with that of other antianxiety drugs , has not been established Abstract Thirty-eight patients agreed to participate in a preliminary crossover trial comparing imipramine to propranolol for the treatment of panic disorder and agoraphobia with panic attacks .  An independent blind assessor was used as well as several st and ard rating scales . There was no placebo group . Twenty-three patients completed a trial of both drugs . Approximately half of the patients lost their panic attacks completely , both on imipramine and propranolol . Other patients were partially , but not completely improved . The implication s and limitations of this finding and others are discussed Fifty-five patients completed a 5-week double-blind study comparing alprazolam , propranolol , and placebo in the treatment of panic disorder and agoraphobia with panic attacks . There was no concomitant behavioral treatment . Patient and therapist rating scales included Sheehan 's Panic and Anxiety Attack Scales , the Marks-Sheehan Phobia Scale , the Hamilton Anxiety Scale , the Hamilton Depression Scale , and the Side Effects Checklist . The results generally support the efficacy of alprazolam , but not propranolol , in the treatment of panic disorder and agoraphobia with panic attacks . The significance of the results are discussed , as well as a number of the unique aspects of our procedures and patient population The purpose of the present study was to compare the effects of oral premedication with ketohemidone 5 mg , lorazepam 1 mg , propranolol 40 mg or placebo , given about an hour prior to anaesthesia , in a prospect i ve r and omized double‐blind fashion . One hundred and twenty ASA I female patients scheduled for elective laparos‐copy were r and omly prescribed one of the study drugs . Patient evaluation of anxiety , nurse evaluation of premedication , induction and postoperative course were studied . Ninety‐three of the 120 patients ( 78 % ) experienced no change or a decrease in anxiety , regardless of type of active drug or placebo administered . Eighty‐eight of the patients ( 73 % ) were considered adequately premedicated by the nurse observer , with no differences between the groups . Pre induction pulse rate , blood pressure and amount of induction agent needed was also similar between the four groups of patients . No major differences could be seen during the postoperative course . We found no major effects of any of the active drugs studied compared to placebo . Routine use of small doses of oral premedication one hour before elective surgery among low anxiety patients could probably be omitted The efficacy of oxprenolol ( Trasicor ) and propranolol in controlling anxiety was compared in a double-blind study of patients with anxiety and tension .  Efficacy was assessed by the investigator with the aid of a psychiatric rating scale consisting of 19 items , bythe patients using visual analogue scales , and by the investigator 's and the patients ' over-all assessment s. Tolerance to the drugs was evaluated by over-all assessment and by means of a checklist of signs and symptoms which emerged during treatment . Little difference in the efficacy of the two drugs was observed . Both were effective in the treatment of anxiety and tension . In general , oxprenolol was significantly better tolerated than propranolol . Evidence of the intrinsic sympathomimetic activity of oxprenolol emerged during the course of the study or , alternatively , evidence that propranolol had a greater cardiac-depressant effect The beta-adrenergic blocker propranolol given within hours of a psychologically traumatic event reduces physiologic responses during subsequent mental imagery of the event . Here we tested the effect of propranolol given after the retrieval of memories of past traumatic events . Subjects with chronic post-traumatic stress disorder described their traumatic event during a script preparation session and then received a one-day dose of propranolol ( n=9 ) or placebo ( n=10 ) , r and omized and double-blind . A week later , they engaged in script-driven mental imagery of their traumatic event while heart rate , skin conductance , and left corrugator electromyogram were measured . Physiologic responses were significantly smaller in the subjects who had received post-reactivation propranolol a week earlier . Propranolol given after reactivation of the memory of a past traumatic event reduces physiologic responding during subsequent mental imagery of the event in a similar manner to propranolol given shortly after the occurrence of a traumatic event To determine which symptoms characterized isoproterenol-induced panic attacks , we analyzed the presence of panic attacks in 54 panic disorder patients who panicked , 24 patients who did not panic , and 37 controls who did not panic during isoproterenol infusions .  The increases over the baseline of the symptoms shortness of breath and fear of going crazy were highly associated with panicking patients when compared to nonpanicking patients and nonpanicking controls . The increases of the symptoms trembling and shaking , generally nervous , and fear of going crazy were highly associated with patients when compared to controls . The possibility of a cognitive theory of panic attacks is discussed Abstract Propranolol , a β-adrenergic blocking agent , is useful in the treatment of heroin addiction . It prevents the euphoric effects of heroin ; in addicts from whom heroin is withdrawn it eliminates , or much reduces , the distressing and enduring residual craving for the narcotic ; and it is a non-narcotic , non-addicting , and relatively safe drug that is effective when given orally in small doses . Propranolol taken in the usual amounts does not help in the management of the acute physical withdrawal symptoms . Two cases are described in which heroin , self-administered after the use of propranolol , actually precipitated , without accompanying euphoric effects , major symptoms of withdrawal . In one case the symptoms occurred after a single oral dose of propranolol 10 mg . given for the first time in the course of a double-blind trial of this medication , and persisted for twenty-four hours despite further use of heroin . In the other case , they were subsequently reactivated for twenty-four hours by further medications with propranolol ; the adverse reaction led to a request for continued treatment with propranolol as a prophylactic against recurrent use of heroin The response to diazepam and propranolol hydrochloride was compared in 21 patients who ( with one exception ) met DSM-III criteria for panic disorder and agoraphobia . Each drug was administered for two weeks in double-blind fashion according to a crossover design . The response to diazepam was significantly superior on all measures . By observer rating , 18 patients showed at least moderate improvement with diazepam compared with seven receiving propranolol .  Panic attacks and phobic symptoms responded to diazepam , but not to propranolol . The results suggest that benzodiazepines constitute effective short-term treatment for these newly defined disorders BACKGROUND This study compared the efficacy and tolerability of paroxetine with placebo in the treatment of panic disorder . METHOD After three weeks of placebo , patients received 12 weeks of treatment with paroxetine ( 20 , 40 , or 60 mg ) or placebo , and finally two weeks of placebo . Dosages were adjusted according to efficacy and tolerability . St and ardised cognitive therapy was given to all patients . The primary measure of outcome was reduction in the number of panic attacks . RESULTS Analysis of the results showed statistically significant differences in favour of paroxetine between the two treatment groups in two out of the three primary measures of outcome , i.e. 50 % reduction in total number of panic attacks and number of panic attacks reduced to one or zero over the study period . For the third measure of outcome , the mean change in the total number of attacks from baseline , there was a positive trend in favour of paroxetine . The results of the primary measures of outcome were strongly supported by the results of the secondary efficacy measures of outcome . In addition , paroxetine , at all doses , was very well tolerated . CONCLUSION Paroxetine plus cognitive therapy was significantly more effective than placebo plus cognitive therapy in the treatment of panic disorder
target: These meta-analyses found no statistically significant differences between the efficacy of propranolol and benzodiazepines regarding the short-term treatment of panic disorder with or without agoraphobia .
  Also , no evidence was found for effects of propranolol on PTSD symptom severity through inhibition of memory reconsolidation .
  In conclusion , the quality of evidence for the efficacy of propranolol at present is insufficient to support the routine use of propranolol in the treatment of any of the anxiety disorders
background: The effects of propranolol in the treatment of anxiety disorders have not been systematic ally evaluated previously .
  The aim was to conduct a systematic review and meta- analysis of r and omised controlled trials , addressing the efficacy of oral propranolol versus placebo or other medication as a treatment for alleviating either state or trait anxiety in patients suffering from anxiety disorders .