White coat syndrome is when someone without hypertension shows a high blood
pressure reading when they go to the doctor's. When in actual fact they don't
have high blood pressure when they're in a familiar or normal setting such as at
home or at work. Now this poses a problem for the doctor because they can only go
by the numbers that they see in the doctor's office and if you're nervous
every time you go there and your blood pressure's high they're the numbers that
they're going to see. Now I just did a video about white-coat syndrome and for
most of you the techniques in there work really well in stopping you from being
quite so nervous while at the doctor's office. However there's a small
proportion of people for whom these techniques may not work and that's
because we have to delve a little deeper into your thinking. So that's what this
video is going to be about today. Hello my name is Clare and welcome to
Generation Calm where you can learn to reduce your stress and anxiety naturally
in your own time so that your mind and body feel great. I would love to be able
to wave a magic wand and help you reduce your blood pressure when you're at the
doctor's, but you, like everybody else, is a complex human being with a rich and
varied history. This means that somewhere in your past you may have made a
connection between a doctor's office and something to be fearful of. Let me
explain. Here's Tracey, she had a bad experience at a doctor's office. About
three years ago she was having a stressful time. She was going through a
divorce, she had a toddler at home she was going through a stressful time at
work as well. She had a panic attack while waiting at the doctor's in the
waiting room, During the doctor's appointment she couldn't wait to get out
of there and of course when she when they took her blood pressure
it was sky-high. And now three years later she still gets nervous when she's
going to the doctor. She thinks about it for days beforehand and she's
particularly worried about getting a panic attack again in public.
And so of course when she gets there at the doctor's the nurse takes her blood
pressure and it's high every time because she's nervous. She's learned to
associate going to the doctors with a fearful experience because panic attacks
are really awful and she doesn't want that to happen again. But she's made that
association now between the doctors and feeling awful and something to be
fearful of. Now let me show you another example. Here's Simon, he's in his forties
and he has no problem going to doctors appointments with other people if it's
another person's doctor's appointment. So he can quite happily take his son to see
the pediatrician and he doesn't get anxious at all. So he's not made an
association between the doctor's office and being scared. But as soon as the
appointments are for him he starts to worry. He starts to get anxious and his
blood pressure goes up and so when the nurse takes his blood pressure it's high
again/ This is an indication that he's worried about his health. He's actually
worried ... he's thinking in the future what does this appointment mean? And so that's
causing him to get nervous and that's causing his blood pressure to (raise) to
rise. Now if you recognize yourself in either of these people, either Tracey or
Simon, then the breathing techniques alone are not going to work. Now in the
case of Tracy she's kind of formed almost a type of phobia response in
which case let's look at it from the point of view of how you would treat a
phobia. In order to overcome this type of white coat syndrome we would start to
look at, in CBT, encouraging Tracy to hang out at a doctor's office more often.
Now you might find this a little strange but in order to overcome a fear you have
to face it and not just face it once but face it over and over again until you
get to the point where your anxiety comes up but it also comes down, and that
happens. Actually over time in this case Tracey is
scared of going to the doctor's office so she's going to hang out little by
little little bit at a time in places that remind her of her doctor's office.
And she'll wait in the waiting room or ... you know, if you speak to the doctor's
office they will probably be more than willing to allow you to kind of hang out
in their waiting area or wherever it wherever it is over time. Tracey will find
that she no longer gets this fear response or if she does it's over really
quickly so that when she does go to the doctors and has the blood pressure
checked it won't be as high anymore because she's overcome that fear
response of going to the doctors. Now for Simon of course it's not a fear response.
It's not any kind of phobia, he's not scared of going to a hospital or a
doctor's. He's only scared when it's an appointment for him so treating it like
a phobia isn't going to be as helpful. In this case we need to examine Simon's
thoughts. What are the thoughts that are popping into Simon's head when he has to
visit the doctors? What's on his mind when he's sitting in the waiting room?
What's on his mind when he's first made the appointment to go. What's on his mind
when he has a reading of high blood pressure at the doctors. These thoughts
will give a clue as to why Simon's blood pressure is spiking while he's at the
doctor's. Now of course everybody's different and their thoughts are going
to be different, your experiences in life are different. But it's very likely that
you're going to be scared and it's something to do with your health and
your future. Very likely it is a catastrophic thought that what if I'm
going to be told I have cancer? How am I going to be there for my family and you
start projecting yourself into the future and you start worrying about
these thoughts that are popping into your head. In both of these scenarios the
blood pressure spikes because the thoughts make you nervous and
nerves increases your blood pressure. Now in Tracy's case she's worried she's
gonna get another panic attack and in Simon's case he's worried about his
future health and what that might mean and he's probably thinking oh this is
gonna mean an impending death and how are the family going to cope. Now you
can't become fearless you can't stop thoughts but you can manage how you
respond to your thoughts so that it doesn't stop you from doing things and
so that it doesn't make your blood pressure spike when you go to the
doctor's. Doctors offices are neither good or bad places the key is to figure
out what thoughts you're having about doctors offices. So here are some
examples of thoughts you might be having The doctor is going to give me bad news.
I haven't been to the doctors in a long time they're gonna be annoyed I didn't
take the last medicine they prescribed me. He's gonna say I have cancer. The last
time I came here they sent me straight to hospital. What if I have a
panic attack again? If my blood pressure is high they're gonna give me
medication for the rest of my life. So do you see that no matter how much you use
breathing exercises to bring down your blood pressure as soon as you have that
thought your blood pressure is going to go right back up again? And it happens
instantaneously as soon as you have that thought your blood pressure's up again.
So you're fighting a losing battle with using breathing techniques because it
will work but then you have the thought again. Now remember the majority of your
thoughts that while they're just thoughts they're not real they're not
factual. They're opinions, they're thoughts you don't know for sure that the test
results are going to prove that you have cancer. It's not a fact that you're going
to have a panic attack again. But once that thought has gone into your mind
then your body responds as if that is a fact. So my first suggestion is to start
noticing your thoughts. Merely noticing them is enough sometimes. Now Thich
Nhat Hanh, the Buddhist monk and author calls it Radio non-stop thinking. Radio NST. And
that's because we all do it. We've all got these thoughts running around in our
heads. Sometimes they're nurturing thoughts, sometimes they're critical
thoughts and sometimes they're just downright negative. But it's always best
to write them down so you get them out of your head onto paper and somehow they
seem less threatening that way. Now you're not going to be able to remove
negative thoughts so you can just stop battling them right now, but you can
learn how to respond to them in a different way and writing them down will
be the first step for that. Now tip number two is that being stressed in
your everyday life is going to cause you to have more negative thoughts. You'll
see things in less than rosy glasses so try to pay attention to your stress
levels and do what you can to keep them down. That means sleeping well, eating
well, moving your body, have more breaks, get outside more. All the things that you
know is sensible and will help reduce your stress in your day to day life.
Number three talk to your doctor or anyone else that you trust about your
fears. Getting it out in the open makes everything so much better. It's a
relief to talk about these things. Most of time we don't talk about it because
we're embarrassed we're scared to share these things. Well don't be. It's time to
tell someone about it. Being open helps to relieve the stress you're feeling
inside. Tip number four you're not going to like this but spend more time in
clinical places. Hang out at waiting rooms even random ones just hang out
there. Take your time get to realize you know, it's different it's different to
our everyday life unless you're a doctor or a nurse.
Spend time in a clinical setting on a regular basis it's just not that natural
for us. You know the sounds are different the smells are different. So just if you can
hang out in clinical places. And then lastly, talk to your doctor about White
Coat Syndrome. I don't know if you've already spoken to them about it yet or
not, but talking about it and bringing it out into the open will open up that
conversation with them. And hopefully it will lead to you having 24-hour blood
pressure monitoring because that's really the only surefire way to figure
the real results out. And I'm just gonna end this with a little story about
myself because over this summer I was getting a lot of palpitations. And of
course you know I'd never had them before and I knew I wasn't anxious so I
thought well this must be a terrible sign I'm having some kind of heart
problem and obviously it's gonna mean impending death for me. Of course I was I
was scared. These negative thoughts just made me feel terrible. I went to the
doctors, had the echocardiogram had the 24-hour holter that I needed to wear and
it ruled out anything serious which which felt like such a relief. But the
difference was then I still get the palpitations but now that I know is not
something serious I'm just much much more relaxed about it and I don't notice
the palpitations as much now. Even though I'm still having them. So
the way you think about things makes a huge difference. I believe your thoughts
are the missing link in white coat syndrome. Don't go silent,
don't try and ignore them. Notice them, write them down and then you can see if
they're having an effect on you.