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Pill 'builds capacity but doesn't fix' basic problem.

SEVERAL IMPORTANT ISSUES are covered by the work by Dr. Soeter and her colleagues, John T. Walkup, MD, said in an interview.

Traditionally, exposure therapy has been used to treat fear, phobias, and anxiety, he said. The approach embedded in the use of propranolol--while powerful--does not do much to eliminate the underlying fear. Instead, it trains people to function in the face of fear or worry. "It essentially builds capacity but doesn't fix the basic problem," he said.

Humans have the capacity to rework memories of situations based on a prompt and a specific time frame, Dr. Walkup said. "Essentially, we remember things the way we remember them, but if the memory prompt occurs and there is new information, we can rewrite the memory in a fundamental way. So if you were to observe a situation and then at a later time were to see a video of the same situation, you would rework your memory to accommodate the new information (reconsolidating update).

"What is interesting about this study is that a medication can accomplish this process, and essentially an exposure task on medication can rewrite the experience in the brain so that basic fear memory is erased."

The research has important implications for both treating anxiety disorders from a pharmacologic point of view and in the way in which therapy might be implemented.

"That is, by systemically prompting those fears and then implementing exposure tasks within the window of brain plasticity, one may make current therapy of anxiety more effective."

Dr. Walkup, an expert in the treatment of anxiety disorders, is chair of the department of psychiatry at Ann and Robert H. Lurie Children's Hospital of Chicago.

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Title Annotation:VIEW ON THE NEWS
Publication:Clinical Psychiatry News
Date:Feb 1, 2019
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