A Driving Instructor's Blog

Pills in a blister packI recently saw a forum post from someone who has failed their driving test five times, and who says that the whole test business is too stressful and that they’re ready to give up. The poster says that they fret over the test for weeks beforehand, and that the repeated failures are affecting them deeply.

Many years ago – and I’d not been an instructor for very long – one of my then pupils (let’s call her Clare), who had previously failed two tests, told me she’d been to her doctor and he’d prescribed beta-blockers. I knew what they were normally used for and asked her if she was OK. She told me they weren’t for her heart, and that her doctor had prescribed them to help her with her driving nerves.

Being a naïve new instructor, I’d simply assumed that everyone would be like me, and that “getting butterflies” was par for the course. For most people it is par for the course, but over the years I’ve discovered that a fair number of pupils get it so bad that they are physically sick on test day – literally vomiting – and that is not normal. I’ve had others who start shaking when we arrive at the test centre (or who just break down) and can’t go through with it. And I’ve had a couple who, after committing a non-serious fault (the examiner told me that) while out on their test, suffer a break down and can’t continue. This is not “butterflies”, and anyone who dismisses it merely as “test day nerves” is talking out of their backside.

The effect on Clare was dramatic. She was already a good driver, but she improved even more as a result of a growing confidence. Previously – and I hadn’t cottoned on – she’d been a bag of nerves on her tests, but after she started taking the tablets she passed on her next attempt. From then on, if I ever suspected someone was suffering from crippling nerves, I would advise them to speak to their GP. If beta-blockers were prescribed to them, there was a marked effect every time – with some bordering on the miraculous. I can only remember one person out of many dozens for whom they seemingly did nothing.

Although beta-blockers are intended to treat heart conditions associated with angina and heart attacks, doctors often prescribe them “off-label” (i.e. not for their licensed purpose) for anxiety. The one they usually prescribe is propanolol. When I read up on the subject it turned out that actors and musicians commonly use them to ward off the effects of stage fright or the jitters when playing instruments. They’re banned in athletics because they give archers and marksmen an unfair advantage (steadier hands than without them) in competition.

Beta-blockers are a prescription-only medicine, and should only be taken if specifically prescribed to you by your doctor for this specific purpose. You must not get them from someone else, as there might be a medical reason you can’t have them, and the dosage might be different. One pupil wasn’t allowed them when she was in the early stages of pregnancy, for example, and was prescribed a lower dose while she was breastfeeding. Another had problems with his blood pressure and wasn’t given them. Another was already taking medication for anxiety and the doctor switched her to beta-blockers instead (which also helped as she was less tired with them), but another was already on anxiety medication and wasn’t given them because her existing medication was stronger. Only your GP knows your medical history and is able to make the call on whether you can have them or not.

Beta-blockers are not “zonk-out” pills. No one knows the precise mechanism by which they can be used to treat anxiety, but one way of looking at it is to consider what someone is like when they get anxious or nervous. Terms like “jangling nerves” sum it up. When I’m explaining it to pupils, I use the example of static hiss on a radio – as the hiss gets louder and louder (representing “nerves”) the music in the background (what they need to be concentrating on) becomes less and less distinguishable, even though it is still there. Eventually, it can be completely drowned out, and that’s what happens to pupils’ concentration if the nerves are hissing or jangling too loudly.

Beta-blockers reduce or even eliminate that background hiss.

Concentration and awareness of what is happening all around is vital when driving. Nerves act like a distraction, negatively impacting concentration and so reducing awareness. In the early stages of learning a certain level of anxiety and nerves is completely normal, and that’s why beginners often make mistakes. It’s later on – in cases where the jangling nerves don’t go away – that people can become discouraged.

One method I use to find out what’s happening with established pupils is to do some scaling to find out what they’re feeling. When I’m scaling pupils, I’ll set up the scale with something like this as we’re sitting parked up in a quiet location:

Imagine you have an inner pressure dial that goes from 0 to 100. Imagine now that you’re sitting at home, feet up, watching TV with a can of beer or a cup of tea. That’s ‘0’ on the dial. Then imagine you have an important job interview tomorrow, and you’ve got to do a presentation to a room full of people you don’t know. You’ve not been well, so you haven’t prepared for it properly, and getting the job depends on how well the presentation goes. That’s ‘100’ on the dial. Now, on that same scale of 0 to 100, what is the dial reading right now?

Most pupils will say something like ‘10’ or ‘20’. A fair number will say maybe ‘30’ or ‘40’. But every now and then, someone will come out with ‘70’ or more – and when that pupil has had maybe 20 or 30 lessons… well, that’s when my beta-blocker stories get an airing.

One of the best stories concerns the pupil who was initially breastfeeding. She’d been taking lessons for a long time before she came to me and wasn’t getting anywhere. She turned out to be one of those people who isn’t a natural driver, and she was going to find things difficult no matter who she was learning with, and no matter how many lessons she’d had previously. It didn’t matter what we covered on a lesson, or how much progress appeared to have been made, because by the next lesson she’d be doing things exactly the way she always did. Every stop was likely to throw me through the windscreen if I wasn’t ready for it, and she was like a cat on hot bricks with every action or movement. Driving in a straight line was fine as long as we didn’t have to stop – if we did, you could see the wheels in her head start to go round, the possibilities start to multiply, and chances were she’d try and turn left or right instead for no reason whatsoever. She was like a guitar string that had been tightened to breaking point when she was in the driver’s seat, and some days were especially bad. I saw her walking down the street a couple of times, and she was always in a massive hurry and looking flustered.

I’d already talked to her about beta-blockers, and when she’d gone to see the doctor – not her regular GP, who was away – she’d been told she couldn’t have them because she was breastfeeding, so we soldiered on for a month or two more. But then she went back to her GP – this time, her regular one – and asked again about using beta-blockers. He told her she could have them, but at a reduced dose.

The effect was astounding. All of a sudden, she was actually learning things, and they were sticking between lessons. If you represent the process of learning to drive on a 0-100 scale, she was at about 10-20% and getting no higher. Beta-blockers suddenly allowed this to climb to 40-50% over a couple of months. Then, disaster! She fell pregnant again and had to stop taking them.

The remarkable thing was that her driving stabilised where it had got to – it didn’t fall back – and we were in a much better position to move forward. Unfortunately, she then had a few family crises all in quick succession and had to put her lessons on hold.

The way I describe it, she was initially enclosed in a shell created by her “nerves”, and nothing new could get through – it was just deflected. Then, with the beta-blockers, the shell was cracked open and information was able to get through so that learning took place. When she stopped the medication, the shell closed up again, but what had previously got through stayed there.

Many of the others have marvelled at “how calm” they feel when they start taking them. One of my current pupils has gone from being stuck on a low plateau since she started last year to being likely taking her test in the summer – and it was definitely down to the beta-blockers.

You see, some pupils don’t like the idea of “relying” on medicine. But as the first example shows, you don’t have to. The medicine appears to allow confidence to develop, and that brings the overall “nerves” down so that the medicine isn’t needed permanently.

So, in a nutshell, if you really are having a problem with anxiety or “nerves” when you’re driving, a trip to your GP might be worth considering.

(2 views today)
Share