Experimenting anxiety, even only for a short period, is never pleasant. Even more when it is accompanied by its bad brother, panic, and even more when it is not experienced on land, but underwater. The reason why healthy subjects without a history or family history of anxiety or panic suddenly suffer from panic attacks underwater remains, to date, unknown. However, it is important to try to understand its mechanisms. Panic, in fact, although harmless on its nature, may be the most common cause of accidents among divers; as James Jones wrote in his novel Go to the Widowmaker: “The panic was the greatest danger, the enemy, the only danger that there was in diving”.
Although outside the scope of fiction, the experts in panic in diving Arthur Bachrach and Glen Egstrom, authors of the essay Stress and Performance in Diving, agree: “Most of us in diving research believe that panic is the overwhelming cause of the majority of injuries and fatalities in diving”. Any experienced divemaster or instructor can confirm these statements. That should not make us think that panic is an always lurking enemy, ready to strike anyone regardless of age, experience, sex or breed: thought dangerous, panic is usually preventable.
A recent study (Colvard et al., 2000) examined more than 12,000 divers who had experienced panic while diving with the aim to find out the generating reasons. The results were surprising. Respondents were offered a list of 43 possible causes of panic, such as “sharks”, “darkness”, “air hunger” and so on. The options were divided into three categories, relating to diving conditions, equipment problems, physical and/ or psychological problems. The divers were asked to assess which of these threats has been present during the panic attacks. Well, among all 43 possible threats, the three most selected boxes in each category were the last ones: “Other”. In short, the events triggering the panic reactions are not among objective causes of a problem of a justified situational anxiety. In most cases, the triggering reason was something trivial or routine, something that no one would see as a reason to panic in another moment.
Reading DAN’s annual reports on accidents and fatalities in diving, it evident that an astonishing number of dives could have been concluded easily if the diver had followed the bases of basic training. Just think of the rule “Do not hold your breath and not go up too fast”, of how many times have we read, studied, taught, practiced it, thinking that never and ever we would do such an error. Yet, anyone can be in panic, a panic attack is as voluntary as a heart attack. The panic is not cowardice, it is not lack of courage, but an involuntary reaction to a massive secretion of adrenaline into the bloodstream by order of the sympathetic nervous system, which, facing a huge threat, causes the heart rate, body temperature and blood sugar quickly and dramatically rise. “Butterflies” start flying in your stomach or a sense of nausea appears. You start sweating. Skin becomes red or pale. Your breath becomes faster, less deep and dyspnoeic (or irregular). You experience the phenomenon known as “perceptual narrowing”, during which the field of vision lost can restrict peripheral vision, achieving an effect similar to looking at the world through a tube.
The worst thing is that you feel more and more agitated and you cannot think clearly. It follows that your attention becomes focused on the problem, so that the right solution for that situation seems to fade away and no longer exist. With a real panic attack in progress, there is very little that the rational part of the brain can do to stop it quickly, be cause the body takes several minutes to absorb the adrenalin, and the risk to take the wrong actions increases. The good news is that despite the mystery that surrounds it, panic can almost always be prevented. It is showed by a clue, at first sight insignificant, reported in the above-mentioned study. Although the results provided by divers on the plausible causes of their panic attacks seemed unrelated and apparently so scattered that it was impossible to draw a logical, statistical or epidemiological conclusion, all tended to agree that they had started to hyperventilate just before the panic attack began. It is worth mentioning that hyperventilation (rapid breathing, shallow, irregular) is a classic sign of anxiety.
Anxiety is an accumulation of daily stress that goes as far as the generation point of an unconscious fear of not being able to solve problems; from this arises a feeling of powerlessness which amplifies the uncertainty, worry, fatigue, frustration and fear that are still part of everyday life. It is therefore likely that this is what happens to the diver who, like most of us, is stressed even before entering the water. There may be memories of a difficult or frightening dive – the diver is concerned about this. Perhaps the diving conditions are unusually difficult. Or maybe he went to bed late the night before, found traffic in the morning and had to run to catch up with the diving boat. Or he cannot get that damn office problem out of his head. Or the instructor, who then should change method, is getting him nervous, taunting him, insulting him. Or the students are particularly unruly and refuse to follow directives.
At the time when he enters the water, the diver is troubled, angry, less able to react in a consistent and ready way: so he can easily be the object of fear. Breathing is more difficult than normal, he uses the BC more than usual, and when something unexpected happens, even harmless (like the mask that comes off or the fin that remains entangled) he begins to hyperventilate, but the air seems never enough. The feeling of “air hunger” and the risk of suffocation increase. Panic is at hand. Of course one should not assume that all divers who remain stuck in morning traffic will have a panic attack: people, as human beings different from one another and unique, deal with stress and everyday worries in different ways. Some are more vulnerable than others to stress and are therefore more vulnerable to panic. Yet no one, as mentioned, is immune to panic, because our individual threshold of panic may also change from day to day.
Although it may seem scary, this should reassure the reader that a panic attack is rarely sudden during a dive – in most cases, stress has been working for hours and sometimes even days. At the end the straw breaks the camel and the diver feels overwhelmed: the fear of failure triggers panic. Think of a juggler with three plates in the air, then four, then five. Finally, one more element is too many, and the exhibition ends with a shower of shards of pottery and an explosion. The cause of loss of control is not the sixth plate in itself, but simply having too many plates in the air. Similarly, anything can trigger panic and make it explode, but it can easily be prevented “by removing some plates”, or reducing stress and psychological pressure when we are under water and refusing to take care of all unnecessary burdens and responsibilities that not compete.
One of the best ways to reduce and avoid stress is to establish a series of breaks in the day of the dive: rest, focus on the situation and think about what you are going to do next. If you are stressed when you get at the meeting point, once parked, possibly before moving the equipment, take a break for a minute or two and relax. When the equipment is on board, but before you get dressed, take a break. When you are in the water, but before you dive, break. And so on throughout the dive. There are at least three good reasons why frequent breaks reduce
stress and help to prevent panic. First, regular breaks reduce fatigue; rest promotes the lowering of the level of adrenaline, the slowing of the heartbeat, a slower and deeper breathing, and the level
of carbon dioxide in solution in blood turns to normal.
Secondly, the breaks are a chance to enjoy a moment of mental rest and without stress to slow the rush of the events with which we are obliged to keep up, paying then more attention to new needs that arise. Finally, frequent breaks are an opportunity to think about the next task and how to do it. The next step is to dress up? Before you jump in the suit, take a break and mentally organize the steps to follow, one after the other, mentally scroll the list of requirements. Try to visualise the problems that can occur and their solutions: the psychology of sport, has proved that visualisation is a powerful weapon against anxiety, stress and panic.
Breaks may also be an opportunity to keep your breathing under control. Breathing with the chest wall, and not with diaphragm, is an intensive energy action because we use the wrong muscles. Breathing with the diaphragm is rather the natural way of breathing, induces a state of relaxation and is fundamental to keep breathing under control: hyperventilation is in fact a well known cause of anxiety and panic. In conclusion, when you do not feel good it’s better not to dive.
When you have a feeling of nausea and just do not want to dive for some reason you cannot identify, it is better not to. Do not let peer pressure push you beyond your limits because you would begin your dive already stressed and more susceptible to panic. If anyone does not understand and insists in making you feel embarrassed, accusing a sudden otalgy or pretending to fail in compensating is always a great escape!
WORDS by Andreas Aceranti dr. and Simonetta Vernocchi dr.
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