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Dr. Michael
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience:  Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
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Hi, My name isXXXXX have severe anxiety about blood pressure

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My name isXXXXX have severe anxiety about blood pressure issues. I am 56 years old. The anxiety is very severe when taking my blood pressure. My face gets hot and bp can get very high. I am on meds for the bp and also for bipolar. I had a complete physical a month age, including an ekg and everything except for low vitamin d was fine. I am on vitamin d supplements, as my doctor prescribed. It is to the point where it gets high even when I think about it a lot and I can get scared just looking at a bp cuff, even if at home measuring. Doctors have frightened me and my primary care doctor recently said "I don't just want your bp better, I want it perfect"..OMG, what a thing to say and she knows me well. My psych doctor has not prescribed an anxiety med as of yet and when I mentioned it recently, did not agree. I am so afraid of them giving me too much bp med because I know and can feel it go down when I am relaxed. Face gets much cooler. I have also tried relaxation exercises but oftentimes can't do them, as I am too anxious. Any suggestions would be greatly appreciated. Thanks Grace
Hello. I believe I can be of help to you with this issue.

You really do have severe anxiety, obviously because it is bubbling over into your concerns about your health in a major way. We call these problems 'somatoform disorders' as a family.

To answer your question properly, I want you to construe your BP testing issue or problem as a learned or conditioned fear or phobia which probably isn't hard for you to do. Now, if you understand you have a phobia, the question I want to ask you is, "How would you help a child who is afraid of the water and won't take a bath, get over their fear and feel o.k. about taking a bath? I want you to solve this puzzle and then we'll talk again about an approach that makes solid theoretical sense, o.k.?

Also, have you ever had a really good trial of therapy involving cognitive behavioral therapy or acceptance and commitment therapy, with a clinical or counseling psychologist with health expertise (clinical health psychologist)?
Customer: replied 5 years ago.

Hi again Dr. Michael,

Yes, I do understand that this is a phobia. As for the child in the bath, I would make the water temperature very comfortable. I would ask the child if he wanted music or a favorite toy. I would let him talk out his fears, if he wanted to. If I could see that he was relaxing, I would leave and go to another close room, where he could talk to me for a short time and gradually increase the time, as long as he was comfortable. I would try to gently coax him to give it a little more time, if he wanted to come right out, but would never be demanding or too pushy. I have been in therapy forever lol, not quite sure about the therapies that you suggested. Thanks, Grace

The vast majority of therapists and therapies can't help someone with serious anxiety disorders. Most therapists really don't know how to help because generic 'therapy' or 'counseling' skills most learn, or the level of training and formal supervision they receive in the therapies I mentioned above isn't very extensive. So I'm not surprised you haven't been helped. And as you know, medication has apparently, not been a great answer.

Well, you did a great job in this 'assignment about the water phobia. What you included are a couple of key ingredients we would use to help you cope with this health-related anxiety, and many others you would have. First, is the principle of gradual and nonthreatening exposure to what the child fears. So you would probably fill the bathtub with only a tiny bit of water, and have them play with toys that floated in the tub, perhaps while standing or sitting outside of the tub---you would make it fun or at least relaxing and nonthreatening. So what we would do in this first step with you is also, nonthreatening exposure to what you fear---simply have you acquire a blood pressure cuff from a health equipment rental store or buy one for yourself, and have you handle it and maybe put it on and just wear it for short periods of time while watching TV or eating a meal. You would have the understanding that no one, not even you would pump it up and take your blood pressure reading.

With the child, you would make it fun and distracting and this is what we'd have you do in wearing the cuff. Next, we would have the child get into the tub to play with the toys with only 1/4 inch of water or so, correct? And with you, we would put a bit of air pressure into the cuff but cover over the reading dial so no one would read the numbers and there would be no stethoscope component. And next, we'd add water to the bathtub and with you, we'd repeatedly pump up and deflate the cuff, without reading it. All the while, you'd be trained to meditate and think about other thoughts or watch a distracting event. We might have you actually focus on your thoughts and feelings about the cuff while it was pumped up and talk about it, which would desensitize you to wearing it. Eventually, you'd allow your reading to be taken without as much anxiety and fear. Now what your doctor said about getting a perfect blood pressure reading is nonsense because there is a RANGE of readings that are normal and he/she knows this. There is no perfect reading. There are extreme out-of-range readings and these are the only ones doctors really worry about. So you need a half-way normal range reading is all!!!

I'm going to pause here and let you comment on this general approach to overcoming fears. It DOES work of course, and you know this because you'd use the very same methods you intuitively know to be 'right' to help a child get over her water phobia.

What do you think?
Customer: replied 5 years ago.

I think this is great, Dr. Michael,

Many years ago, about 20, I did have a therapist have me go to my md's waiting room, when I didn't have an appointment. I had an md in the same building and read magazines in his waiting room. His office had been told that I would be doing this. Your idea of doing it at home and slowly is wonderful. It might take me a little while to get used to it, but I feel that it would help alot. As for the child in the bath, it definitely would be better to increase the water level, the same way that I would increase the cuff pressure. You are very helpfull. Thank you so much, Grace


Yes, this is called fading in the stimulus that the person is afraid of---never want to do it to the point they have an anxiety attack or panic response but do it gradually and it will work in the way we've outlined here.

Let me know if i can be of further help. Please click on the green Accept button at the bottom of the screen. Thanks. My best to you!
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