Mark Gould Beta Blocker Discussion

[royjohn]

Rick,

<<I think some of you guys are missing the point. It's not that Propanalol is a treatment for anxiety. It's a treatment for conditions that anxiety exacerbates.>>

Right, as is any form of lifestyle modification, meditation, hypnosis, relaxation, exercise, what have you...they are treatments just as powerful and just as legitimate as any medicine or drug.

<<That is not bad psychology--nothing in my current performance life approaches the stress of performance I have mastered in the past, or that I deal with routinely in my professional life.>>

Not to put you on the couch in front of everyone, but what you're saying above is that the stress by objective measures or measured by your logical mind is less, but it might be more, given how you feel about a tremor once it has happened once in a performance situation. After that it is hard not to anticipate it and that is very stressful, as you describe.

<<Those who disparage it have never sat on stage unable to play at all, when the music in front of them is something they can play 100 times out of 100 in the practice room.>>

I think here we're getting close to claiming that your doctor can't treat your heart until he has a heart attack, or that a psychologist can't comment on anxiety attacks before having them. Fallacious reasoning and it implies that folks who would counsel against medicine or drugs (all medicines are "drugs," no?) are heartless. Well, I myself have had anxiety attacks and they are not fun. I have also had tremors on occasion, although I haven't been diagnosed with essential tremor. I have also had migraines and depression. So I think I know what stress related to my body not performing is.

<<All the things that psychs talk about vis a vis relaxation are great. But if there is a physical ailment, why wouldn't a person seek a medical solution? Isn't that what medicine is for? (I did NOT say "drugs".)>>

Here you are trivializing any form of relaxation training or meditation as not a treatment, yet the treatment effects attributed to these are very strong and equal to many medicines or drugs or greater. Various lifestyle and behavioral treatments are a medical solutions. They just require more from the patient than tilting back the head and swallowing.

Further, if you will look into the treatment of essential tremor, you will find that the cause is unknown and the diagnosis is a wastebasket used when there isn't any Parkinsons or another recognized ailment and yet there is a tremor which is worse during use. Stress (subjective stress, that is) worsens it, as does caffeine use, alcohol use, cured meats and various toxins and probably poor muscle tone. Treatments do include various relaxation and stress reduction approaches as well as lifestyle changes (eating less cured meat??) in addition to and instead of medicines. Physical therapy has also proved helpful, and that would make sense, since tremors are more in evidence as we age and presumably most of us lose muscle tone.

I'm not trying to get anyone to do anything that they don't want to do. It's easy enough to get your beta-blockers if you want them and easy enough to find people who are very happy with you doing this and very sympathetic to you. I've very happy for folks who are better, however they accomplish that, and beta-blockers are certainly far from the most toxic drug you could take. I do take exception to fuzzy thinking and defensiveness when someone points out that there are non-drug approaches to treatment of a common problem such as this. And to the trivialization of non-drug treatments and the characterization of "psychs" as heartless and unfeeling...
roy"who has had enough of the personalization and faulty logic in this discussion"john

[Donn]

<<Those who disparage it have never sat on stage unable to play at all, when the music in front of them is something they can play 100 times out of 100 in the practice room.>>

I think here we're getting close to claiming that your doctor can't treat your heart until he has a heart attack, or that a psychologist can't comment on anxiety attacks before having them

I think the present example of "those who disparage" is this Mark Gould character, who I'm guessing is not a psychologist.

I do take exception to fuzzy thinking and defensiveness when someone points out that there are non-drug approaches to treatment of a common problem such as this

Who's defensive?

What I'm hearing is "this pharmaceutical remedy worked for me." Is there a problem with that?

[royjohn]

Donn,

You state:
<<What I'm hearing is "this pharmaceutical remedy worked for me." Is there a problem with that?>>

As for me, no, I don't have a problem with that and I so state in my post:
<<I'm not trying to get anyone to do anything that they don't want to do. It's easy enough to get your beta-blockers if you want them and easy enough to find people who are very happy with you doing this and very sympathetic to you. I've very happy for folks who are better, however they accomplish that, and beta-blockers are certainly far from the most toxic drug you could take.>>

If all you are hearing is "this pharmaceutical remedy worked for me" I think you are not reading very well. I'll try not to rehash all of what I have already said. The problem for me comes when folks go beyond "this worked for me" to "you're wrong and don't know what you're talking about."And [paraphrasing] relaxation techniques are nice, but they aren't really treatment." Or 'you just don't understand until you've sat where I'm sitting." I have an earned doctorate in psychology and practiced for 30+ years, sometimes in the offices of primary care physicians. I've had anxiety attacks, too. The arguments against what I said are weak, I think, and I detailed why.

roy"who wishes people would read what I write and respond to that"john

[Donn]

The problem for me comes when folks go beyond "this worked for me" to "you're wrong and don't know what you're talking about."And [paraphrasing] relaxation techniques are nice, but they aren't really treatment." Or 'you just don't understand until you've sat where I'm sitting."
...
roy"who wishes people would read what I write and respond to that"john

If only you would extend the same courtesy, is what I'm saying.

1. No one said you don't know what you're talking about.
2. Your "paraphrase" above? he didn't say that at all. Why put words in his mouth?
3. "Those who disparage it have never sat on stage unable to play at all" was about the guy in the video (and in previous iterations discussions, some of our own colleagues.) OK, I can't read "Rick Denney"''s mind, but you don't have to assume it's directed at you or any psychologist.

For someone reading this at home, it looks like the only direct resistance you actually got was from bloke, and the two of you couldn't really find a specific point of disagreement. Past that ... maybe someone's been editing their posts or something?

[hup_d_dup]

I have an earned doctorate in psychology and practiced for 30+ years, sometimes in the offices of primary care physicians.

This is often a fall-back position when the arguments are not convincing in and of themselves.

(Sorry to say, I have also been guilty of this)

Hup

[Ken Crawford]

For those with extreme performance anxiety issues, propanolol is awesome. If you don't agree, you're wrong. The end.

[Donn]

as well as for other high-pressure events, such as speeches and legal testimonies

From what I could dig up, not very much research on this, but from the few experiments mentioned, it doesn't look like they're very reliable way to evade a polygraph test.

[royjohn]

Donn,

Comments in your quoted text:

1. No one said you don't know what you're talking about.

Looking at what was written, you're right. But the language was dismissive, IMHO

2. Your "paraphrase" above? he didn't say that at all. Why put words in his mouth?

One of the phrases I was referring to is this:

<<All the things that psychs talk about vis a vis relaxation are great. But if there is a physical ailment, why wouldn't a person seek a medical solution? Isn't that what medicine is for? (I did NOT say "drugs".)>>

To me this pretty clearly implies that "all the things that psychs talk about vis a vis relaxation" are not really medical treatment. If so, someone should tell the health insurance companies, since they are paying for them.

3. "Those who disparage it have never sat on stage unable to play at all" was about the guy in the video (and in previous iterations discussions, some of our own colleagues.) OK, I can't read "Rick Denney"''s mind, but you don't have to assume it's directed at you or any psychologist.

Here I think you're right, as I didn't really disparage any medical treatment. Must have been that other guy. The "you don't know what it's like" line got me, I have to admit it. As an argument for a selected form of treatment, though, it is a weak one. I didn't disparage, but I did perhaps oppose. So IDK maybe it was me...

To those who don't like credentials, let me say that I have looked a bit at the literature, and that's why I have written as I did. One can present one's credentials when the argument is weak or when it's not.

There are pluses and minuses to any form of treatment and I think we all too often forget that. I do tend to be one of those people who take an extreme position and feel that medical drugs are often a crutch for evading responsibility. Millions in the US take blood pressure meds when it would make more sense to lose weight and get into the gym and get in shape. Ditto for your meds for ED. Propounding such views is not likely to make you popular, however right you are.
roy"who is going to crawl back under his rock now"john

[Donn]

Millions in the US take blood pressure meds when it would make more sense to lose weight and get into the gym and get in shape.

This case can be made on various practical grounds. Against those meds, for getting in shape, both. Plenty to go on there, with no need for an abstract philosophical question of drugs vs. alternatives. Is that true for beta blockers - practical grounds? If so, we haven't touched on it much.

when i look into the beta blocker discussion, i keep running into these...

Athletic competitions revolve around a question of fairness that isn't very relevant to the arts. I don't listen to you to thrill to your accomplishment as my musical hero, I want to hear the best possible music you can deliver, period. It's up to you to decide how to do that, I don't care, don't really care what you're like or anything. Everyone knows a long list of all-star jazzers who did illegal drugs, Sidney Bechet was not a real nice guy unless you get the story from his autobiography, and none of that matters even a tiny bit.

[windshieldbug]

...with a low dosage of the b.b. medicine suppressing the fight/flight reaction and allowing for a clear/accurate head and clear/accurate communication

The bloke you are talking with knows his stuff.
He merely was being candid, and I say good on him!
I know SEVERAL people in FULL-TIME orchestras who couldn't survive daily without the stuff (probably as a result of at least one bad encounter with a conductor, else why would one pick this as an occupation with that kind of reaction). No names, but they have a doctor's supervision now, although it probably didn't start that way.Music is not, nor never has been a drug tested sport (with the possible exception of BBB), so it hardly matters what are accepted substances.

[royjohn]

bloke,

A short excerpt from a 1988 NYTG article on beta blockers. Since then there
have been studies on mood alteration by beta blockers (it did occur) and the
effects of exercise on said mood alteration. These are mood altering. In some
the alteration will be helpful, but in others, perhaps not.

" In an editorial accompanying the paper, Dr. Edward Frolich of the Alton Ochsner Medical Foundation in New Orleans commended the researchers for questioning what he calls the myths that developed around beta blockers.

"But he cautioned that the study was small and ''one should not make generalized and sweeping statements.'' The drugs may cause depression and mental dullness in some individual patients, he said, even if they do not cause these side effects in most."

[royjohn]

For myself, as already state, it is fine for folks to use whatever works for them. I hope they understand the pros and cons of it, whether it's meditation or "medicine," "mood altering chemicals" or "drugs" or prayer.

Beta blockers are mood altering chemicals. What else would they be with the ability to block anxiety? They are "medicines" and also could be called "drugs."

At a one time dose of 10-20mg, the side effects or negative effects are likely to be slim to none, but everyone is different.

Same would be true for a glass of wine or two, or a few tokes off a mary jane reefer. Or 5 or 10mg of Valium or 0.25mg to 0.5mg of Xanax.

You can become dependent on such to do what might be otherwise done. This could be just fine if the effort to accomplish such without the drug was extremely time consuming and effortful.

Ya pays ya money and takes ya choice.

[Donn]

the only time i have a concern about their musical use is during competitions or auditions.

If I put musicians through a competition in order to hire one, I'd want to hire one that knows how to deal with whatever issues he or she may have. An audition is a type of competition, but for a specific purpose and not for the sake of competition, not at all like an athletic event, chess game etc. If as I gather some people think, there's a chance that it's a two-edged sword and it takes something out of performance, then ideally that will show up in the audition as well.

[Donn]

I am not likely to hire an executive, anyway. They're always getting in the way, and when they aren't, they're out playing golf, or doing something that's going to bring ruin down on them and you.

[southtubist]

I was probably raised very differently from most of the people on this forum. I was raised to never acknowledge fear or weakness, and as a result I've never really had stage fright. I've always viewed stage fright as cowardice. I mean, what is there to really fear? The audience isn't going to physically rip you to pieces and eat your liver! I might feel slightly apprehensive (like in this one concert where I had to play a ppp G above middle C), but not nervous. If anything I tend to forget about those feelings when I'm playing, especially when playing hard music. Honestly the audience probably won't notice your mistake (particularly if you're a tuba player), and if someone does notice, should you even care?

As far as physiological responses, I believe that physical fitness will help make a player more resilient. I personally enjoy endurance exercises and am currently getting into triathlons. Rock climbing is also really fun. . . I started hunting at a young age, so I learned to not shake when an adrenaline rush hits. Shaking would cause me to miss my shot. My chops only shake when I'm extremely fatigued, just like all my other muscles.

Most of the "mechanical" aspects of playing should be automatic (from practice) so that the player only has to think about their sound and the music. Of course, things don't always work that well in practice. . .

[Donn]

I'm hardly ever all that nervous either. Also, I'm a skinny man, 6'2'' and only 160 lbs. I'm that way because I was raised right and eat a wholesome, plant based diet.

Really, it doesn't matter a bit what I eat, I couldn't gain more than about 8 lbs to save my life. There are plenty of other people like me, but alas our example is not particularly illuminating to those who struggle with weight problems.

[windshieldbug]

I was raised right too, but somewhere along the way I seem to have gone left. Now I'm at a loss.

[hup_d_dup]

I was raised to never acknowledge fear or weakness, and as a result I've never really had stage fright. I've always viewed stage fright as cowardice. .

You are a hero!

I will vote for you if you run for president!

We can be great again!

Hup

[ghmerrill]

just a tangential comment health.
Never confuse "public" health with YOUR health.

I'd go a little stronger on this. Never confuse "public health" with health. I'd also go even further and say "don't confuse it with science", but then I'd have to explain exactly what I mean by this, and that would get too lengthy and technical.

Public health is about policy, and statements about, and guidelines for, a broad population (the "public"). Sometimes it's very good, and so is the science that supports it. Sometimes it's not, and neither is the "science" on which it rests. Some years ago, a couple of independently researched and written papers by statisticians were published demonstrating that in approximately 80% of published and peer-reviewed epidemiological studies there were fundamental methodological errors. Unfortunately, many people don't have the training to make their own evaluations in some complex health and treatment situations. More unfortunately, neither do some physicians -- or maybe they're just too busy trying to cram the most 15-minute exams into the day. But it's always worth a try, and always worth learning as much as you can and skeptically evaluating reports, studies, and recommendations being offered to you. If you have open and clear discussions with your doctor(s), and push him/her/them to provide you with answers that seem consistent, complete, and sensible, then you have a better chance of achieving a positive, rather than a negative, result -- and sometimes avoiding a real disaster.

[Rick Denney]

I was probably raised very differently from most of the people on this forum. I was raised to never acknowledge fear or weakness, and as a result I've never really had stage fright. I've always viewed stage fright as cowardice. I mean, what is there to really fear? The audience isn't going to physically rip you to pieces and eat your liver! I might feel slightly apprehensive (like in this one concert where I had to play a ppp G above middle C), but not nervous. If anything I tend to forget about those feelings when I'm playing, especially when playing hard music. Honestly the audience probably won't notice your mistake (particularly if you're a tuba player), and if someone does notice, should you even care?

As far as physiological responses, I believe that physical fitness will help make a player more resilient. I personally enjoy endurance exercises and am currently getting into triathlons. Rock climbing is also really fun. . . I started hunting at a young age, so I learned to not shake when an adrenaline rush hits. Shaking would cause me to miss my shot. My chops only shake when I'm extremely fatigued, just like all my other muscles.

Most of the "mechanical" aspects of playing should be automatic (from practice) so that the player only has to think about their sound and the music. Of course, things don't always work that well in practice. . .

With all due respect...

The conductor will notice, and for professionals, it could be career-ending, or at least lead to additional stress being applied, which will just make things worse. I'm not a pro, but I still care about what the conductor thinks. I also care about what my colleagues on stage think, and about what I think. I care about the musical product, and I don't want to be the person that undermines the best performance that the ensemble can deliver. I'm an amateur and no paycheck rides on it. In fact, when I have played professionally, I never had this problem, because I was younger and usually playing music composed with my abilities in consideration. As an amateur, though, I'm now stretched to my limit with music that challenges me to improve.

I have played when I was physically fit, and I have played when I was less so. I have found no correlation between my physical fitness an my playing, and no correlation between fitness and the effects of adrenalin on my essential tremor. I was extremely fit, by the way, when those symptoms first appeared--I had completed an Ironman triathlon within the previous year. Over the 15 years since then, the symptoms have gotten worse, but I've also gotten older. Despite the essential tremor, however, my playing has improved both technically and musically. Not spending 15 hours a week training is perhaps part of the reason. Life is hard to balance and good health is important. But deep athletic fitness does not make musicians better, except it may help them with hauling the tuba around or avoiding a backache from carrying or holding it.

Also, it's quite easy to suggest that people who suffer from these issues just don't practice enough. Well, hell, none of us practice enough, do we? I'm a hobbyist on the tuba, but I still take it seriously. That seriousness does not, however, mean I can set aside the many other responsibilities of life to pursue it. (That's the main reason I don't post much on Tubenet any more--I work much harder now than ever, and have many more responsibilities in other aspects of life than I used to.) So, I do my best, just as we all do. But my essential tremor problem does not get better with practice. More practice would make be a better musician, perhaps; a better technician, certainly. But it is extremely frustrating to have all that practice invalidated by a physiological condition that does not afflict me during practice. If that has never happened to you, then blessings upon your house. Perhaps you should consider what you might do if it did. Once all those techniques that have worked for you in the past no longer worked, would you 1.) consider a beta blocker, or 2.) stop playing tuba? I do not believe this is a false choice.

To Mr. John: I detect quite a bit of defensiveness in your responses. I don't mean to disparage the tools in your toolbox (recognizing that as a clinical psychologist, those are the only tools you have). But I have tried many of them. Essential tremor is a physiological problem that is exacerbated by adrenalin. I might learn to control adrenalin release, up to a point, by the methods you espouse, but at what cost? Is that cost greater or lesser than the negligible risk (your word) of taking 10mg of Propanolol once in a while?? How many therapy sessions would I need, that my insurance company would have to pay for, with someone such as yourself, to get the same result? Is that a better deal for me (and my time is precious) or my insurance company than that tiny dose of Propanalol?

But if you think my language dismisses the methods you are suggesting, perhaps your words are equally dismissive. Please consider that. I suspect that before I'm ready to give up playing the tuba, I will be doing it all, because the alternative is to be forced to stop playing.

Rick "not taking the easy way out" Denney