Drug Therapy (AQA A-Level Psychology): Revision Notes
Drug Therapy
Drug therapy represents a physiological approach to managing stress by directly targeting the body's stress response systems. This method involves using chemicals that affect brain functioning or other body systems, particularly those that control neurotransmitter levels. Two main categories of drugs are commonly prescribed for stress management: benzodiazepines and beta blockers.
Benzodiazepines (BZs)
Benzodiazepines are anxiety-reducing medications that work by lessening the physiological arousal associated with stress. These medications target the brain's natural inhibitory systems to create a calming effect throughout the nervous system.
Common examples of benzodiazepines include diazepam (Valium) and alprazolam (Xanax), which are frequently prescribed in the UK for managing acute anxiety episodes.
How benzodiazepines work
The mechanism centres around GABA (gamma-aminobutyric acid), the brain's primary inhibitory neurotransmitter. Under normal circumstances, GABA binds to receptors on post-synaptic neurons, opening channels that allow chloride ions to enter the cell. This process inhibits neural activity by making it less likely that signals will be transmitted between neurons.
BZs enhance this natural process by combining with GABA receptors without blocking them. When both GABA and benzodiazepines bind to the receptor, the chloride channels remain open for longer periods, allowing more chloride ions to enter. This creates a stronger inhibitory effect, reducing overall activity throughout the central nervous system and consequently decreasing anxiety levels.
Worked Example: GABA Enhancement Process
Step 1: GABA naturally binds to receptors on neurons
- Opens chloride channels briefly
- Some chloride ions enter the cell
- Mild inhibitory effect occurs
Step 2: Benzodiazepine combines with GABA at the receptor
- Chloride channels stay open much longer
- Many more chloride ions flood into the cell
- Much stronger inhibitory effect achieved
Step 3: Result
- Overall neural activity decreases significantly
- Anxiety symptoms are reduced
Beta blockers
Beta blockers operate differently by targeting the sympathetic nervous system rather than the brain directly. These medications are particularly effective for managing the physical symptoms of stress, such as increased heart rate and blood pressure, without affecting mental processes.
How beta blockers work
The stress response involves the release of adrenaline and noradrenaline as part of the sympathomedullary pathway. These hormones circulate through the bloodstream and bind to beta-adrenergic receptors located throughout the cardiovascular system, particularly in the heart and blood vessels. This binding process accounts for the typical physical stress symptoms: rapid heartbeat, elevated blood pressure, and increased cardiac output.
Beta blockers work by blocking these beta-adrenergic receptors, preventing adrenaline and noradrenaline from stimulating them. This intervention slows heart rate, reduces blood pressure, and causes the heart to pump less intensely, thereby reducing its oxygen requirements.
An important advantage of beta blockers is that they reduce anxiety without affecting consciousness or cognitive function, since they don't operate directly on the brain. This makes them particularly suitable for individuals who need to remain alert whilst managing stress symptoms, such as performers, musicians, or surgeons.
Evaluation
The effectiveness and limitations of drug therapy for stress management have been extensively researched, revealing both significant benefits and important concerns that must be carefully considered.
Research evidence for effectiveness
The effectiveness of both drug types has been demonstrated through rigorous scientific testing. The gold standard for evaluating drug effectiveness is the double-blind placebo-controlled trial, where neither participants nor researchers know who receives the active medication versus an inactive placebo.
Research by David Baldwin and colleagues (2013) provided strong evidence that BZs are more effective than placebo for treating acute anxiety. However, the review noted that some other drug classes show greater effectiveness than BZs, and the dependency risk means they may not be the first-choice treatment for many individuals.
Beta blockers have also shown consistent effectiveness in research. Desmond Kelly's (1980) review demonstrated that beta blockers were effective for treating everyday anxieties, including public speaking nerves, exam stress, and even anxiety related to civil disturbances. The drugs proved particularly useful for people with social anxiety disorder, where fear of public speaking is a major stressor.
Research consistently shows beta blockers effectively treat physical stress symptoms and may be even more useful when combined with other drugs like BZs, providing comprehensive stress management.
Limitations and concerns
While drug therapies show clear effectiveness, several significant limitations must be carefully considered before prescribing these medications.
Side effects
Both drug categories carry notable side effects that must be considered. BZs commonly cause drowsiness, weight gain, and respiratory problems. More concerning are paradoxical reactions - outcomes opposite to those expected from treatment, including criminal behaviour, impulsive actions, and uncontrollable emotional responses such as excessive weeping.
Beta blockers can reduce heart rate and blood pressure excessively in some patients, making them unsuitable for people with diabetes or severe depression. When side effects occur, patients face the dilemma of either stopping beneficial treatment or enduring potentially damaging effects.
Dependency issues
Dependency presents a major concern with BZs. Users develop tolerance, requiring increasing doses to achieve the same therapeutic effects. Additionally, withdrawal symptoms occur when stopping the medication, including anxiety, depressed mood, sleep disturbances, headaches, and muscular aches.
According to Heather Ashton (2005), withdrawal can be managed with appropriate psychological support, and BZs should ideally be prescribed for only two to four weeks. However, some doctors continue prescribing them for months or years, potentially creating dependency problems more severe than the original stress symptoms.
Treating symptoms rather than causes
A fundamental limitation of drug therapy is that it addresses symptoms rather than underlying causes. Both BZs and beta blockers focus on anxiety reduction, providing short-term relief from acute stress symptoms. However, this approach doesn't address the root causes of chronic stress, and combined with dependency risks, may not be the most appropriate long-term treatment strategy.
For chronic stressors, psychological therapies that address underlying issues may prove more beneficial than medications that simply mask symptoms.
Key Points to Remember:
- Drug therapy uses chemicals to modify brain or body system functioning, primarily affecting neurotransmitter levels in stress management
- Benzodiazepines enhance GABA's inhibitory effects in the central nervous system, reducing overall neural activity and anxiety
- Beta blockers prevent adrenaline and noradrenaline from stimulating cardiovascular receptors, reducing physical stress symptoms without affecting cognitive function
- Research evidence supports the effectiveness of both drug types, though other treatments may be more appropriate for some individuals
- Major limitations include side effects, dependency risks, and the focus on symptom management rather than addressing underlying causes of stress