Challenge your Fears

Dear Dr. Hurd,

I am afraid of blood pressure measurements. It all started three years ago when I had a panic attack. My blood pressure was high, and the emergency medical team mistook it for a heart attack and sent me to the emergency room in an ambulance. Since then, I’ve been fearful of having my blood pressure taken, whether in a doctor’s office or by myself. How can I get over this fear? I try to “let go,” but just thinking about it sends me into a tizzy. Help!

Dr. Hurd replies,

You’re probably looking for a method or technique — maybe a few words to say — to “make the fear go away.” Unfortunately, it doesn’t work like that. We all have fears of certain things, and many of us have very strong fears (known as phobias). You’re aware of what your phobia is, and you describe it well. In fact, it’s referred to as “white coat syndrome,” where just the sight of the doctor or nurse makes your blood pressure skyrocket. There’s no magic answer, but I do have some guidance to offer: Start by making a commitment to overcome this fear. Without that commitment, your life will, at least in part, become paralyzed by your refusal to challenge what you already know to be an irrational fear.

Your fright is “associational.” In other words, you’re not really afraid of blood pressure measurements themselves. You’re afraid of being told that you’re having a heart attack. Well, who isn’t? But you survived that, and by your own admission, you were never in danger. Let’s say it again: You’re afraid of a situation in which you were never in danger. You just thought you were. The EMTs made an error. That’s not particularly reassuring, but human judgment isn’t perfect. The good news is that they erred on the side of caution. They risked upsetting you rather than failing to get you to the proper facility during (what they believed was) a heart attack. Yes, it might have been easier on you emotionally had they not overreacted, but wasn’t that better than if they just didn’t care?

People who have panic attacks are afraid of the attacks. Panic disorder is, in essence, a “fear of fear”; fear of the symptoms you’ll be having while afraid. But there are steps you can take during a panic attack, and it might even help to consult a skilled psychotherapist. In these cases, the central issue is control. “I’m afraid of losing control, and I’m afraid of the emotional/physical reaction I’ll have while being afraid of losing control.” But it’s important to remind yourself that you’re not in danger during these anxious moments; you’re just very uncomfortable. (Discomfort is survivable.) Begin by buying a good consumer-level blood pressure monitor and practice in the privacy of your home. High quality devices are not expensive, and your doctor can recommend a good brand. This will lead to more accurate measurements than the ones you get when you’re confronted with the “white coats.”

The point of insisting you make a commitment is an “if-then” proposition. IF you want to better deal with your fear, THEN you will have to spend some time in the setting of your fear. IF you continue to avoid the feared situation, you’ll never have to face it, but THEN you’ll never really know your true blood pressure. Are you prepared to take that risk?

So you actually have a choice between ignoring your blood pressure (pretty risky), and making a commitment to face your fear in spite of the temporary discomfort. The rational choice may seem obvious, but because of your fear and panic, you’re not rational on this issue. For you, it’s a dilemma. But it’s a dilemma you can resolve, for better or for worse. It’s your choice. Nobody can do it for you.

People who have to overcome a fear of flying, for example, have trained themselves to say, “It’s really my fear that bothers me. It’s not anything about the plane. There are hundreds of thousands of uneventful flights every day.” People who experience panic when crossing bridges (but still have to cross them) learn to say to themselves, “I’m more afraid of the fear (and how I will feel when it comes on) than I am about this bridge that has been standing for fifty years.” People struggling with other kinds of phobias can apply the same line of reasoning. When you’re afraid of something, and you know the fear is irrational, then what’s really bothering you is the anticipation of the physical and emotional discomfort that comes with the fear. So it’s OK to tell yourself that it’s all in your head, because, in fact, it is.