The Secrets to Solving White Coat Syndrome and Doctor Anxiety

By Dr. Nicole Cain ND, MA

What is Sanctuary Trauma and Could it be the Cause of your Anxiety?

Do you get anxious going to the doctor? Are you terrified they’re going to find something wrong? Does your blood pressure go up when there’s a white coat present? Do you avoid going to the doctor at all costs? Have you ever heard of Sanctuary Trauma? Do you have white coat syndrome?

Today you’re going to learn the secrets to solving white coat syndrome and doctor anxiety that no one else is talking about. We’ll uncover the actual reason you’re afraid of the doctor and you’re also going to learn three strategies to actually deal with doctor anxiety once and for all.

Imagine life feeling free to go to the doctor and not being afraid. How would your life change if you weren’t terrified of the next bit of bad news? What would you do differently if you were able to go to the doctor feeling strong, respected, confident and able to handle anything and everything that comes up?

That is possible. I am the very testimonial of that. And I’m going to share with you exactly what I’ve learned, for free, right now. Also stick around to the end because I’m going to share with you something pretty exciting. So, let’s get at it.

We have to start by defining two things: White Coat Syndrome and Sanctuary Trauma

White coat syndrome is where a patient experiences an anxiety response in the presence of a health care provider. Initially this was observed mostly in people whose blood pressure increased when a clinician in a white coat was doing their initial exam, but as the conversation around doctor-anxiety increases, this definition has broadened.

There are lots of reasons why going to the doctor may cause fear. Maybe it’s a fear of doctors, health anxiety and the fear of receiving bad news, or maybe it’s actually caused by something called Sanctuary Trauma. Which is what we’re going to focus on, today. Are you ready?

Have you ever heard of Sanctuary Trauma? Sanctuary Trauma is a form of trauma that happens in a place that should be safe, like a sanctuary. Traumas come in all shapes and sizes, but among the most difficult and painful are those that occur in places where we should be able to be vulnerable and protected. Let me share with you a story.

When I was 12 years old, I began to struggle with difficulties breathing when running and playing outside in the cold air and in the grass. My primary care doctor referred my family to a specialist who decided he needed to confirm without a doubt that I actually was reporting my difficulty breathing accurately. As such, he instructed I inhale a chemical that induces asthma and I started to suffocate. I remember sitting there looking over at him in his white coat, my parent compliantly stood off to the side while the doctor made notes and I panicked. Nodding that I was sufficiently asthmatic, he switched the chemical in the nebulizer and my bronchial airways opened.

This is an example of Sanctuary Trauma. As an adult, I look back at this experience and see this little 12-year-old me with such compassion and understand why she had such a distrust of the medical system for so many years. She had been frightened and powerless, and her mission was to give me power. Her way of giving me power was to create fear and skepticism of the medical community. Which in her own way has served me well, until it started to run my life. Make sense?

It doesn’t have to be dramatic in order to be traumatic.

Trauma is defined as anything that overwhelms the nervous system. And your beautiful and brilliant mind responds to an overwhelmed nervous system by creating an ego state, a part, and that part will do its very best to protect you from ever having to suffer again. But as you know, sometimes they take their job too seriously and push away all of our other parts: Confidence, self-control, and calm.

There are three solutions that you need to know in order to finally send white coat syndrome and doctor fear backstage where it belongs.

They are:

  1. Parts Work
  2. Role Reset
  3. Empowered Communication.

Let’s explore these a little more together.

1.   Parts Work

When we show up to the doctor, we are bringing with us our presenting self and all of our past selves. This is the foundation of a study that is called Parts Work. Parts work recognizes that all of our current experiences are impacted by our past experiences. Whether positive or negative, our life events result in our brains creating a lens through which we see and interact with the world. You may have also heard of this referred to as Ego State. Ego State was developed by psychotherapists John and Helen Watkins, in 1997. This was 10 years after Francine Shapiro developed EMDR (or eye movement desensitization therapy), and was taking the trauma world by storm with clinical trials on how groundbreaking her work was. Ego state therapy or what I call Parts Work marries beautifully to EMDR therapy.

Let me share with you an example: Have you ever felt anxious, or sad, or maybe even sick but had no words to express why? It’s just the way your body felt, right? We know there is a strong mind-body connection, but what do we do if we can’t seem to access the words to take us from the body to the mind where we can process and understand why we feel the way we feel.

As you can imagine, this is where talk therapy (cognitive behavioral therapy) really falls short. The counselor asks you if how you feel is logical and how to change the thoughts, and you just shrug. Talk therapy leans on logic, and sometimes our emotions and sensations are not logical.

This is where Ego State therapy can save the day. Ego state therapy, or parts work, creates a linguistic bridge from the way you feel in your emotions or body, to the logical centers of your brain, so that you can heal. In other words, Parts Work gives words to your experience.

So, let’s say that I go to the doctor. I’m sitting on the cold sterile examination bed, which is covered with crisp white paper looking at posters of all the health issues that could be wrong with me. The doctor comes in, and part of me remembers white coat = being forced to inhale chemical that caused suffocation. That part associates doctors with danger. In an attempt to protect me and get me out of that dangerous situation, that part evokes a fear response. My cortisol and adrenaline levels rise, causing me to feel my heart beating faster, my body temperature rises, I start to sweat, poised to run, my muscles are trembling and when the doctor checks my blood pressure and she finds that it is increased, and now I’m afraid that there’s something wrong with me causing my blood pressure to go up, and on and on and on. Does any of this sound familiar?

As you’re seeing, underlying parts that have endured negative situations with doctors, will continue to inform you of their experiences even years down the road, causing white coat syndrome.

Their goals are to protect you.

Just like hearing the growl of a hungry tiger in the woods protected our ancestors from becoming lunch, the growl of fear and anxiety is trying to remind you, “Hey, this is reminding me of something scary, and I’m going to need you to listen up.”

While your parts are well-intended, they are also uninformed of the here and now, and this is because of how your brain stores trauma. Think about it this way: If you learned that growling tigers equals danger, it is more advantageous for your brain to interpret it as current danger so that you continue to be afraid of growling tigers or at least anything that resembles a growling tiger. This is as opposed to your brain hearing the growl-like sound and only associating it with the past.

What this means is that your brain does not timestamp trauma. You have to do that.

In the Anxiety Breakthrough Program, you will learn how to identify the part that is hijacking your present, and timestamp the trauma, and free yourself from the shackles of past events clouding your present.

You will learn the skills to heal the inner powerless child, and take back your life. Being anxious does not change the present or the future, but it will change your EXPERIENCE of the now.

Which would you rather? Avoid and dread the doctor at all costs and go in only when you absolutely have to, and spend your days anticipating the worst? Or would you rather do the work, send anxiety backstage, heal your parts, and take back your power? Imagine how this would change your life!

Remember, you have resources now that you didn’t have when you were little. It’s time to send anxiety back to its rightful place as a warning signal, not the star of the show. It’s time for you to step into center stage and own your strength. It’s in there. It’s just been backstage. It’s been waiting and now it’s time to let it show up for you in a real way.

And remember, sometimes scary or negative events do not have a linguistic bridge, which means you may not be able to logically remember or think of a past event that is impacting your current experience. That is the nature of trauma. This is the magic of Parts Work. So even and especially if you can’t put your finger on any events that might be making you feel doctor anxiety or have white coat syndrome, this step is profoundly important.

2.   Role Reset

When it comes to the second secret to overcoming doctor anxiety and white coat syndrome, and taking back your power, it is absolutely necessary to remember who’s the boss. (Hint, it’s you!)

Remember the doctor is your customer, you (or your insurance) are paying THEM to take care of you. We have to shift the power dynamic here.

Yes, your doctor likely knows more than you do about how to take blood pressure and run tests and do differential diagnosis. But you are the expert at your body, your experience, your history, and your needs. It’s time to take back your power and approach the medical encounter with your doctor with equal authority. By changing the dynamic from hierarchal, to collaborative, you will be taking leaps towards freeing yourself from the delusion that your doctor’s assessment is the end-all-be-all.

In my story, it was clear I had asthma. I struggled to breathe when I was playing outside in the grass, my doctor had the choice to chemically induce an asthma attack, and sit there and take notes while I suffocated, or that doctor could have approached the diagnosis differently. The treatment would not have changed, but my experience sure would have.

While I can’t change what happened to me as a child, I can change how I make choices as an adult.

As an adult, I have personal power now to pick the doctor I want to see, someone who has good bedside manner, a philosophy that resonates with my own, and who is willing to work collaboratively and with respect. I get to decide to do the tests I feel are best for me, and to decline others.

As a child I did not have that power, and maybe you didn’t either. So now is the time. Take back your power. If you have a doctor who is unkind, who has treated you with disrespect, who does not honor your autonomy over your body, fire them. You’re worth finding the right fit. Especially in a society where telehealth has opened the doors to accessibility to doctors outside of our own community borders. Your options are now better than they ever have been. Don’t settle. It’s time for a role reset, with you taking center stage and your doctor or medical team being your co-stars.

3.   Empowered Communication Skills

The last step is Empowered Communication Skills. These are described in The House of Boundaries exercise as the CABLE Criteria. The CABLE criteria is a mnemonic for what is considered necessary in order for you to engage in a relationship with someone, both personally and professionally.

C: Communication – Your doctor needs to take time to communicate with you about what they are doing, and why. Communication also includes non-verbal communication. Is your doctor multitasking while talking with you? Are they typing on their computer and staring at the screen? Are they even facing you during your visit? I’ve heard stories of patients going into their doctor’s office and never once seeing the front of their doctor’s body because they are facing their desk against the wall and typing notes. You deserve someone who can communicate with you and who uses non-verbal communication to connect with you and show you that they care.

A: Awareness – The person has to be aware of others needs as well as their own. This rules out individuals with a narcissistic tendency whose emotional energy was focusing on their own needs only.

B: Boundaries – Boundaries are absolutely necessary. In my childhood story, the doctor wanted to run a test, and had my adult self been there I would have questioned that doctor and said “absolutely not, not happening” and a doctor who respected boundaries would have respected that. Sometimes we put up a boundary because we need more information and so if you are feeling resistant to moving forward with a recommendation, a good boundary is to gather more information. Your doctor should take the time to hear you, respect you, and talk about your feelings.

L: Listening – You deserve to be heard. You deserve to be respected. No matter your age, you deserve your doctor to talk with you. When it comes to your health, it is important for your doctor to listen carefully and hear you. Not only because it’s good bedside manner, but also, in order to correctly assess your health and do the right testing, your doctor needs to LISTEN to you.

E- Empathy – Empathy is the action of understanding, being aware of, relating to, or even vicariously experiencing the feelings, thoughts and experiences of others. Empathy lives hand-in-hand with compassion and respect.

If you have doctor anxiety or white coat syndrome, the ACT Method teaches us to look at our social cast of characters. These are the people around you. Your community, your family, AND your health care providers. While doing the work and healing your own psychological characters, your parts, your traumas, and your internal experiences, it is also important to take an audit of your health care providers. Using the CABLE criteria to select your health care team will create a foundation where you can successfully implement a role reset, and pursue the healing that you deserve.

In today’s blog, we learned about the secrets of why you may struggle with white coat syndrome and introduced concepts from the Anxiety Breakthrough Program: Psychological Cast of Characters which explores topics of our how past parts have created a lens through which we perceive our present, and we also explored sanctuary trauma, and garnered wisdom from the Social Cast of Characters in creating boundaries for yourself so that you are able to create a clinical team of practitioners who you trust and can work collaboratively with. Lastly, we discussed the topic of role reversal, which is a call to change the experience of health care as a hierarchical model, to a collaborative model. Your doctor gets to be the medical expert, and you get to be the expert of YOU.

I’ve been there. From the 12-year-old girl, to the person I am today. I get it. I hear you. I honor you. With one foot in the clinical psychology world, and the other in the naturopathic medicine and integrative medicine world, I’ve got your back. I’ve changed my life, and have helped thousands of others change theirs.

You’re worth it.


Dr. Nicole

This article is for educational purposes only and is not intended as medical advice. Whenever considering changing your protocol whether it includes a change of medications, supplements, diet or lifestyle, always speak with your primary care physician first.

Dr. Nicole Cain is an advocate for empowering people around the world to help themselves via her educational free resources, online courses, and membership group. You can receive the tools you need to find the root cause of your symptoms and feel healthy again.