A novel technique that uses a beta blocker to interfere with memory reconsolidation shows promise in the treatment of adjustment disorder following romantic betrayal, according to new research published in the Journal of Affective Disorders.
Adjustment disorder is a condition that can occur in response to a significant life event or change. While it is normal to feel some degree of anxiety or distress in such situations, people with adjustment disorder experience more intense and long-lasting symptoms that interfere with their ability to cope. These may include difficulty sleeping, depressed mood, social withdrawal, and difficulty concentrating. In severe cases, adjustment disorder can lead to self-harm or suicidal thoughts.
“There is no recognized empirically-based treatment for adjustment disorders,” said study author Alain Brunet, a clinical psychologist and psychiatry professor at McGill University. “This is an oddity. We were interested in determining if the good clinical results we had obtained in treating PTSD with Reconsolidation Therapy applied to a broader set of trauma-like conditions, hence our interest for adjustment disorder.”
“Romantic Betrayal (a form of adjustment disorder) seemed like an interesting topic to study because, first, it is very distressing. Second, it is one of the most common reason why individuals seek professional help. Finally, there is very little help available for romantically betrayed individuals who do not wish to return with their partner.”
Propranolol is a beta blocker that is often prescribed for high blood pressure, migraines, and certain anxiety disorders. But the drug has also been shown to weaken the emotional tone of memories by blocking adrenergic pathways.
“Reconsolidation Therapy consist in recalling a bad memory under the influence of propranolol with the help of a trained therapist,” Brunet explained. “This treatment approach is a translational treatment stemming from the research in neuroscience which stipulates that a recalled memory needs to be saved again to long-term memory storage in order to persist. Interfering with the storage process will yield a degraded (less emotional) memory.”
In the new study, Brunet and his colleagues recruited adults who met the DSM-5 criteria for adjustment disorder. The participants had all experienced a romantic betrayal event, such as infidelity, that occurred during a monogamous long-term relationship.
The researchers asked the participants to write a first-person narrative of their romantic betrayal/abandonment event. The participants were told to focus on the most emotionally provocative aspects of the event and to include stress-related reactions, such as feeling tense, trembling, and sweating. During treatment sessions, the participants ingested propranolol before reading their narrative out loud once. Fifty-five participants completed at least one treatment session, while 48 completed all five sessions.
To assess clinically significant symptoms, the participants completed a widely used questionnaire known as the Impact of Event Scale — Revised (IES-R) before, during, and after the treatment phase. The researchers observed a large drop in IES-R scores immediately following the first treatment. The declines in IES-R scores continued over the course of the treatment phase. Thirty-five participants who completed a follow-up survey provided evidence that the improvements in symptom endured up to 4 months.
“Our study suggests that Reconsolidation Therapy works with adjustment disorder, in that it is clearly superior to a wait-list group (subjects were their own control),” Brunet told PsyPost. “The magnitude of the pre-post treatment improvement compares to results we obtained in our PTSD research.”
Brunet said he was surprised by how high the IES-R scores were prior to treatment. “Looking at the severity of symptoms, were surprised at how painful adjustment disorder can be,” the researcher explained. “Adjustment disorder is no ‘wimpy’ disorder. This is clearly a misconception.”
The study utilized a within-subjects open-label design, which limits the ability to draw strong conclusions about causality. However, the findings provide an important foundation for future research. “In spite of its moderate size, the study is important in that it provides the treatment ‘effect sizes’ required to launch a placebo-controlled randomized controlled trial,” Brunet said.
The study, “Treatment of adjustment disorder stemming from romantic betrayal using memory reactivation under propranolol: A open-label interrupted time series trial“, was authored by Michelle Lonergan, Daniel Saumier, Sereena Pigeon, Pierre E. Etienne, and Alain Brunet.