A pill to beat fear?
27 March 2006
by Michael Hopkin

Hormone treatment could help people to overcome phobias.

Does the prospect of public speaking make you panic? Do you run for the hills at the mere mention of spiders? Help could be at hand: researchers have come up with a way to ease the crippling symptoms of phobia.

The treatment, developed by a Swiss-led research team, could one day help sufferers to face their fear simply by popping a pill before facing a stressful situation.

The researchers hope that it may even have permanent effects, by helping phobics deal with the daunting prospect of undergoing therapy in which they come face to face with their fears.

Hormone therapy
The remedy contains a human hormone called cortisol, which the body produces naturally in times of stress or fear to help subdue the panic response. Previous studies have shown that increased levels of cortisol help us to blank out painful memories and emotions, allowing us to deal more effectively with stressful situations.

Researchers led by Dominique de Quervain of the University of Zurich studied whether artificially increasing levels of cortisol can help phobics overcome the paralysing fear that they feel when faced with the source of their anxiety.

They tested 40 people with social phobia and 20 with a fear of spiders. They gave half of them cortisol and then, an hour later, forced the volunteers to give a presentation and undergo an impromptu maths test, or to view a picture of a large spider. Participants who took cortisol reported significantly less fear, on a scale of 0 to 10, than those given a placebo. The results appear in Proceedings of the National Academy of Sciences1.

The next step will be to repeat the trial using a larger group of people, says de Quervain, and to combine it with behavioural techniques.

Feel the fear
Psychologists do not know exactly what causes severe phobias, de Quervain says. Phobics may have naturally low cortisol levels, which means that the first time they encounter a spider, or have to stand in front of an audience, they develop an intense fear that then preys on their mind. And if natural cortisol defences are low, this could prevent someone forming non-panicked reactions on subsequent exposure.

Traditionally, severe phobias are treated using behavioural therapy, in which a patient gradually embraces their fear. An arachnophobe, for example, might begin by looking at pictures of spiders, before graduating to seeing or handling the real thing.

Cortisol might help people to overcome their initial fears when embarking on such treatment and increase the proportion of patients who stay with the course, the researchers suggest. "Perhaps they will learn faster that the stimulus is not fearful," says de Quervain.

The hormone, which has a wide range of effects on both brain and body, is already used to treat chronic conditions such as arthritis. Side effects of daily use include changes in blood pressure and metabolism, and the risk of diabetes. There are also fears that extended exposure to increased cortisol levels can affect long-term memory.

The cortisol dose needed to set someone on the road to beating their phobia will hopefully be small and infrequent; a kick-start for therapy rather than a long-term medication, says de Quervain. "This will never be a daily pill," he says. "But it could be used in combination with behavioural therapy."

1Soravia L. M., et al. Proc. Natl Acad Sci. USA, 103. 5585 - 5590 (2006).