A Driving Instructor's Blog

Pills in a blister packThis article was last updated in 2018, but it’s become popular again recently.

At the time of the original, I had recently seen a forum post from someone who had failed their driving test five times, and who said that the whole test business was too stressful and that they were ready to give up. The poster said that they fretted over the test for weeks beforehand, and the repeated failures were 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 her heart 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. So I read up on the subject.

At the time this happened to Clare, I’d naïvely 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 as the years passed I came to realise that a fair number of pupils get ‘butterflies’ so bad that they are physically sick on test day – literally vomiting – and that is not par for the course. I’ve had those 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’s precise words) while out on their test, suffer a complete meltdown and can’t continue. This is not ‘butterflies’, and it is not ‘test day nerves’. It’s people with genuine issues.

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, she’d been a bag of nerves on her tests – it even transpired that she was nervous on lessons, but tests made it a hundred times worse. But after she started taking the tablets she passed on her next attempt. It was a real eye-opener for me. From that moment on, if I ever suspected someone was suffering from crippling nerves, I would advise them to speak to their GP. In many cases this resulted in them being given beta-blockers. There was a marked effect every single time – with some bordering on the miraculous.

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. Propanolol is usually the one they issue. When I read up on it 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 will be able to make the call on whether you can have them or not.

Beta-blockers are not ‘zonk-out’ pills that make you sleepy. No one knows the precise mechanism by which they can be used to treat anxiety, but I explain it this way.

Imagine that you’re sitting at home, feet up, chilling out with a beer or whatever. Your anxiety level (i.e. ‘nerves’) might look something like this.

Normal nerves when calm and chilled

Assuming you don’t have any issues, if you’re confronted with a situation of some sort which stresses you out a bit, your nerves might react like this to the stressful situation.

Normal nerves with a stressful situation

This is perfectly normal – anyone is going to get stressed when confronted by a stressful situation. However, some people have a chilled stress level which looks like this.

People already stressed

It might not be like it at home (though sometimes it is), but even going on a driving lesson is likely to send it in this direction. The problem then is that the test (and sometimes, even driving lessons) can send it to this when additional stress is added.

Extra stress in an already stressed personThis is into meltdown territory. At the very least, the person experiencing it is going to find concentrating difficult, especially on their driving test – and that is likely to lead to mistakes.

What beta-blockers do is effectively make this.

People already stressedMuch closer to this.

Normal nerves when calm and chilled

Maybe not as low as this, but much more like it. And that means any additional stress doesn’t lead to overload the way it does in an already stressed person.

One of the best stories I have concerns a 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 aren’t natural drivers, and who were going to find things difficult no matter what. 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 – in one instance, even muttering to herself.

I’d already talked to her about beta-blockers, and when she’d gone to see her 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. But she went back to her GP a couple of months later – 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 think of learning to drive on a 0-100 scale, to begin with she was about 10-20 and getting no better. Beta-blockers suddenly took her to 40-50 over a couple of months. Then she fell pregnant again, and had to stop taking them, but 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.

Initially, her nerves had created a shell through which nothing new could pass. Beta-blockers cracked the shell wide open, and new information flooded in. When she stopped taking them, the shell closed and we were back to square one in the sense learning new stuff was difficult – but the extra she’d learned before was still there!

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.

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