Do instructions modify effects of beta-adrenoceptor blockade on anxiety?

To study the interaction between physiological and cognitive factors in anxiety, 44 subjects with public speaking anxiety were allocated to four different groups. Two groups received either beta-adrenoceptor blockade (100 mg of atenolol) or placebo orthogonally crossed with an instruction that heart rate would decrease or an instruction that did not mention cardiovascular effects. During the delivery of a speech, measures of heart rate, systolic and diastolic blood pressures, and self-reported anxiety were obtained. All variables increased during an anticipation period before speech, and heart rate, systolic blood pressure, and self-reported anxiety increased further during speech. Regardless of instructions, atenolol decreased heart rate and systolic blood pressure during both anticipation and speech, whereas no differences were found in self-reported anxiety. This lack of a relationship was seen in spite of the correctly perceived heart rate reduction in the atenolol-treated group receiving an instruction that heart rate would decrease. Cardiac aware subjects, according to the Autonomic Perception Questionnaire, showed higher levels of heart rate and self-reported anxiety at rest than did cardiac unaware subjects. During speech, even though heart rate was similar in atenolol treated groups, self-reported anxiety was higher in cardiac aware than in cardiac unaware subjects. The lack of a relationship between heart rate and self-reported anxiety is discussed in terms of primary and secondary emotions. It is suggested that the perception of external rather than internal cues determines situationally elicited anxiety.