Are there ways to effectively control white coat syndrome?

[Kingdawson]

So i've suffered from white coat syndrome for a long time now. It started in 2011 when my dad passed away and I have found no effective way to calm myself down when i'm checking my BP in the doctors office. I can feel my heart beat...I need to urinate every 2 mins....and my BP reading Is always high.
My doc made me check it 3 times a day for 2 weeks at home and it was fine (rough average 125/70). How come every time it's done in an official capacity (ie docs, work) it jumps up and is there anything I could do to calm myself down in these situations.

[MyNameIsTerry]

Breathing is important in trying to slow your heart rate and lower blood pressure. Look for techniques that change your breathing.

Also, intently focusing on an object is useful in steering your mind away from thoughts and to examining the object.

[Kingdawson]

Yes I notice my pulse is also really high as well when i'm in those situations.

[AndrewCanada]

Try combining breathing techniques with the five thinking hats.

Think of

5 things you can see
4 things you can feel
3 things you can feel
2 things you can smell
1 good thing about yourself

This is mainly intended to ground you in the present moment.

I also have white coat syndrome, but thankfully my blood pressure tends to be good even when I'm anxious. The main thing I notice is a spike in heart rate. Regulating my breathing combined with the thinking hats can really help. What also has helped me was bringing my wife into the office with me. If you have a partner, or if you feel comfortable bringing a friend or other family member, that might help you.

[MyNameIsTerry]

Yes I notice my pulse is also really high as well when i'm in those situations.

It will be. Getting anxious puts a strain on the body and it shows in blood pressure.

Exercise lifts your blood pressure but as your body reduces this heightened state your blood pressure returns to normal. Hence anything that aims to slow the pulse, slow breathing, etc reduces BP.

If your GP wants to check your BP outside of clinical settings they can also fit a 24 hour monitor to perform the ambulatory test which is a standard I diagnosing high blood pressure anyway. This test came in in to reduce over prescribing of blood pressure medications due to white coat syndrome influencing results.

So your GP is probably asking you get some readings to determine if your BP is ok outside the surgery as a quicker way than a monitor if they don't suspect high BP needing medication?

As the cuffs inflate it can be a trigger for anxiety but the more you do these tests the more this tends to go away like most things in anxiety as we become more confident about them through exposure. If you employ techniques like distraction and those Andrew mentions you will hopefully find them easier to get through.

These are at least quick things to try. The usual therapy, Mindfulness, reducing overall anxiety levels, working on multiple areas of lack of confidence (or triggering situations), etc will all help too but are part of the longer term approach to recovery.

[Kingdawson]

It will be. Getting anxious puts a strain on the body and it shows in blood pressure.

Exercise lifts your blood pressure but as your body reduces this heightened state your blood pressure returns to normal. Hence anything that aims to slow the pulse, slow breathing, etc reduces BP.

If your GP wants to check your BP outside of clinical settings they can also fit a 24 hour monitor to perform the ambulatory test which is a standard I diagnosing high blood pressure anyway. This test came in in to reduce over prescribing of blood pressure medications due to white coat syndrome influencing results.

So your GP is probably asking you get some readings to determine if your BP is ok outside the surgery as a quicker way than a monitor if they don't suspect high BP needing medication?

As the cuffs inflate it can be a trigger for anxiety but the more you do these tests the more this tends to go away like most things in anxiety as we become more confident about them through exposure. If you employ techniques like distraction and those Andrew mentions you will hopefully find them easier to get through.

These are at least quick things to try. The usual therapy, Mindfulness, reducing overall anxiety levels, working on multiple areas of lack of confidence (or triggering situations), etc will all help too but are part of the longer term approach to recovery.

Exactly right mate. He did the 2 week test thing after hearing that i've had these high readings for a long time and was happy I didn't need a 24 hour monitor as he identified white coat syndrome as the issue. Said if I get the same readings at home then the next step is 24 hour monitor but he was confident it would be normal...and he was right.
The cuffs thing is a really good point actually because it actually tends to be high even at home for the first reading and then it goes back to normal. I was literally checking it 10 times or so a day in that 2 week period and always the same pattern. I just can control nerves (I know it's that because I also need to urinate very often when i'm at my GP .....even today at work when they said they was checking BP I needed to.urinate almost immediately and din't feel comfortable at all.

I want to control this because it's really annoyong and it actually makes me feel down after getting these readings even though I know why. It makes me feel like i'm not controlling my anxiety well.

[lofwyr]

Close your eyes, draw in deep breaths through your nose, hold, exhale slower than you breathed in. I have to monitor my BP at home per doctor's orders, and I have done all of the experiments to keep it low. I can shave a ton off with deep, meditative breathing.

[Kingdawson]

Cheers for advice guys.

One more question....is the frequent need to urinate when in the gp's linked to the high blood pressure and pulse? I guess i want to understand what exactly is happening inside my body during these situations.

[Shadowhawk]

Cheers for advice guys.

One more question....is the frequent need to urinate when in the gp's linked to the high blood pressure and pulse? I guess i want to understand what exactly is happening inside my body during these situations.

Frequent urination can certainly be driven by the onset of anxiety or panic attacks (i would know, happens to me). On a good day, with no issues, i can go hours without peeing. On a bad day, especially when I have a particularly bad stress out, i can pee twice an hour. There are lots of physiological reasons (but as we say, lets not google that.. ;) ), but yes, it is common.

[Kingdawson]

Frequent urination can certainly be driven by the onset of anxiety or panic attacks (i would know, happens to me). On a good day, with no issues, i can go hours without peeing. On a bad day, especially when I have a particularly bad stress out, i can pee twice an hour. There are lots of physiological reasons (but as we say, lets not google that.. ;) ), but yes, it is common.

Yep I only need to go often when i'm in the docs or when i'm gonna give a presentation for work etc eItc. Just wanted to know the science behind it and what the link is with having a high pulse in these situations as well. Yesterday I didn't need to go for 4 or so hours but as soon as i heard "blood pressure test" i have yo go almost immediately and around 3 times in an hour. I felt a weird feeling in my stomach as well.....all went back to normal when It was done but I always get this feeling when i'm nervous.

[Shadowhawk]

Yep I only need to go often when i'm in the docs or when i'm gonna give a presentation for work etc eItc. Just wanted to know the science behind it and what the link is with having a high pulse in these situations as well. Yesterday I didn't need to go for 4 or so hours but as soon as i heard "blood pressure test" i have yo go almost immediately and around 3 times in an hour. I felt a weird feeling in my stomach as well.....all went back to normal when It was done but I always get this feeling when i'm nervous.

So, from what i understand, 3 main causes:
- Muscle tension: When you are anxious or nervous, people have a tendency to tighten muscles, especially abs and legs. These muscle contractions put increased pressure on the bladder, increasing the urge to go. When you feel the urge, try to focus on your belly; you will likely notice your muscles are tighter than you realized.

- Stress response: When stressed, your body will produce additional hormones (including adrenaline, cortisol, norepinephrine, and others) in response (the fight or flight response). While preparing your to respond to a perceived threat, these chemical also alter bodily functions, and (in the interest of your question) can cause you to limit digestion and excrete excess water. The pulse and BP spike come from these hormones as well (your blood system constricts ina response to prevent bleeding from damage, while your heart rate increase in anticipation of the extra oxygen needed to respond.

- Stress response hyperstimulation: This tends to follow prolonged stress and anxiety, and is the body's continued (over)recation to stress, even when the obvious mental worry has passed. The body has, at least temporarily, changed its physiology, and will be more sensitive to new stressors, while still missbehaving due to previous changes. In addition to having to go more, this is where many of our stress induced aches and pains come from.

[Kingdawson]

So, from what i understand, 3 main causes:
- Muscle tension: When you are anxious or nervous, people have a tendency to tighten muscles, especially abs and legs. These muscle contractions put increased pressure on the bladder, increasing the urge to go. When you feel the urge, try to focus on your belly; you will likely notice your muscles are tighter than you realized.

- Stress response: When stressed, your body will produce additional hormones (including adrenaline, cortisol, norepinephrine, and others) in response (the fight or flight response). While preparing your to respond to a perceived threat, these chemical also alter bodily functions, and (in the interest of your question) can cause you to limit digestion and excrete excess water. The pulse and BP spike come from these hormones as well (your blood system constricts ina response to prevent bleeding from damage, while your heart rate increase in anticipation of the extra oxygen needed to respond.

- Stress response hyperstimulation: This tends to follow prolonged stress and anxiety, and is the body's continued (over)recation to stress, even when the obvious mental worry has passed. The body has, at least temporarily, changed its physiology, and will be more sensitive to new stressors, while still missbehaving due to previous changes. In addition to having to go more, this is where many of our stress induced aches and pains come from.

What a brilliant post. Very much appreciated.

[MyNameIsTerry]

And the trigger to the stress response comes back to learned behaviour. You learn to fear something, a trigger, and all that "data" is stored & potentiated. You create core beliefs.

As you work to change from fearing a situation you mothball these core beliefs by adjusting them to better or previous ones or creating new ones based on the same mechanism of learning.

The trouble is, the fear system is based on needing to stay. It takes longer to unpick than to create. Negative reactions are assumed and the Amygdala in question looks for them. It doesn't expect or value anything positive/negative with as much as strength. You undermine the fear, pull the rug out from under it, it becomes irrelevant.