Pharmacotherapy for performance anxiety disorders: Occasionally useful but typically contraindicated

Pharmacotherapy is an effective part of treatment for most anxiety disorders, but not for specific phobia or performance anxiety. In them it is contraindicated, because it interferes with the effectiveness of exposure therapies and the extinction of fear responses. Interference with exposure-extinction is a drug side effect that should rarely if ever be tolerated in treating them. This article reviews the many indications for pharmacotherapy in treating most anxiety disorders and contrasts its usefulness in treatment of anxiety disorders with its relatively rare usefulness in treating specific phobias and performance anxiety. In both the latter disorders, benzodiazepines interfere with exposure and generally are best avoided, although temporary use, with safeguards, can sometimes be helpful for a specific phobia. The recent discovery that D-cycloserine (DCS) facilitates exposure and the extinction of anxiety offers promise that it could in the future be usefully and broadly employed to catalyze and enhance exposure therapies.