7 minute read
COPING WITH PANIC
Text & Images David F. Colvard, MD
David F. Colvard, MD, has been diving since 1971 and has over 1200 dives around the world. He is an active PADI Divemaster and a retired board-certified psychiatrist in Raleigh, North Carolina.
A twenty-eight-year-old male certified scuba diver with less than 30 open water dives back-rolled into clear springtime Bahamian waters. He gasped in the much cooler than expected water and soon surfaced. The attentive Divemaster noticed the diver was starting to panic and called off the dive. The diver was embarrassed and struggled to figure out what had happened.
A fifty-five-year-old male active divemaster with over 500 open water dives drowsily fumbled with his underwater camera equipment and struggled against slight nausea from anti-malarial pills and an empty stomach. The zodiac had launched early that morning through rough surf at Inhambane, Mozambique. After a wild 10-minute ride, the divers prepared for a negative buoyancy back-roll entry into a strong current. The vacationing diver tried to explain that his usual difficulty equalising middle ear pressures did not allow for rapid descents. The dive centre’s divemaster instructed the diver to leave the camera behind and get in before the current carried them past the reef. Soon after starting his descent in the cold water, he began to hyperventilate and failed to get control of his breathing despite the divemaster’s best efforts to calm him. They returned to the zodiac, drifted with the current and waited for the other divers to surface. After a hearty breakfast, he headed back into the rough seas on the zodiac and succeeded in controlling his breathing, but missed the reef due to his slow descent in the current.
Would you believe that both of these divers were one and the same? Yes, me!
The first aborted near-panic dive incident was a complete surprise to me. I had been diving since I was 18 years old, but not often. That evening, I searched my memory, trying to figure out why it had happened. Cold water on the face is a common trigger for anxiety and hyperventilation, but there had to be more.
Finally, I remembered something. Three years earlier, on my last dive in John Pennekamp Coral Reef State Park in the Florida Keys, my dive buddy and I had been cornered by a well-known territorial large barracuda. We hovered back to back, and he kept attacking us while we kicked him away. With our air starting to run low, he finally “allowed” us to escape back up to our small rented boat. I had not thought about it since then, but I felt the anxiety all over again. That was it! Having learned various techniques for treating post-traumatic stress as a psychiatry resident, I asked to borrow some scuba gear from the resort the next day. I waded into shallow water, calmed myself with diaphragmatic breathing, descended and relived the barracuda dive in my mind’s eye with guided imagery. The anxiety felt very real, but there were no barracudas nearby other than the one in my imagination. I relived the stressful barracuda dive repeatedly underwater until it no longer triggered anxiety. The rest of the week, I made several enjoyable dives while my wife snorkelled.
Fast forward almost 30 years, when a local dive shop asked if I could help a diver who wanted to scuba dive on her honeymoon in Hawaii. Her last dive in Mexico had been traumatic, and she was afraid, but determined. She was a young clinical psychology graduate student at a local university and sounded like an excellent candidate for a stress-reducing scuba refresher. We arranged to meet at a local pool a few days later, and I asked her to review training materials. She and I got into the shallow end of the pool with just masks and snorkels. When she put her face in the water, she almost shot up out of the pool in terror. We backed up and started with diaphragmatic breathing to reduce her anticipatory anxiety and gradually exposed her to the stressor of putting her face into and under the water. When she was comfortable with that, we put on our scuba gear and submerged in the shallow end of the pool to rehearse standard scuba skills, like flooding and clearing her mask. Within a few hours, she repeatedly ditched and donned her gear on the bottom of the diving well. Diving on her honeymoon in Hawaii went well with a divemaster as her dive buddy.
The Southern California Scuba Fatality Report (1965 - 1970), Los Angeles County Underwater Safety Committee, 1971, was one of the first reports examining the role of panic in recreational scuba fatalities. 1 It is recommended that all basic scuba students learn to recognise and cope with "speed breathing" and "regain control of his/her breathing before it is too late."
In 1980, Tom J Griffiths, Ed. D. produced and made available a two-hour audio program entitled Stress and Panic Management for Divers: Training Exercises for Controlling Diver Stress & Panic*. This is a “self-help” teaching tool that works. 2 It is designed for divers and may be used by students and instructors alike. The program is divided into four 30-minute segments. Each half-hour segment gives the listener just enough theory to understand the causes, symptoms, treatment, and prevention of diver stress. Relaxation skills and mental rehearsal exercises are introduced throughout the program. The audio files are available for free download on www. DivePsych. com.
In 1987, William Morgan reported in a survey of 254 recreational scuba divers that 64% of the females and 50% of the males had “panic or near-panic” episodes while diving on one or more occasions. 3 In 2000, my wife Lynn and I conducted an online survey of over 12,000 divers and found that 37% of the females and 24% of the males had “panic experience” while diving on one or more occasions. 4 The difference likely had to do with our more restrictive question. In our subsequent annual surveys, we found that neither certification level, number of yearly dives, nor trait anxiety prevented some certified divers from experiencing panic or nearpanic.
After hearing from countless divers over the years, I am convinced that it is not the certification level or diving experience or any of dozens of potential stressful events and conditions or trait anxiety in certified divers that lead to dive panic or near-panic. It is the level of anticipatory anxiety before the diver ever touches the water that is the best predictor of who will panic or experience near-panic. That brings us back to the 1971 Los Angeles County Underwater Safety recommendation: learn to recognise and control pre-panic “speed breathing”. You will also use less air and enjoy longer dives in God’s underwater creation. Psalm 107:24 5
REFERENCES
1. The Southern California Scuba Fatality Report (1965 - 1970), Los Angeles County Underwater Safety Committee, 1971.
2. Griffiths TJ, Steel DH, Vaccaro P, Allen R, Karpman M. The effects of relaxation and cognitive rehearsal on the anxiety levels and performance of scuba divers. Int J Sport Psych. 1985;16:113-119.
3. William P Morgan, Ed.D. Anxiety and panic in recreational scuba divers. Int J Sports Med. 1995;20:398-421.
4. Colvard DF, Colvard LY. A study of panic in recreational divers. The Undersea Journal. 2003; First Quarter:40-44.
5. Psalm 107:24. New International Version
