Understanding Diver PANIC

By John R. Yarbrough, Ph.D Panic refers to a sudden and often unpredictable onset of intense, sometimes blinding, fearfulness or terror, usually associated with feelings of impending Photo William M. Mercadante doom.

W e associate panic with a associated with a specific phobia, knowing when of if the symptoms number of physiological symptoms, such as a fear of sharks or a fear of will recur. such as shortness of breath, a feeling ‘going too deep’ (called of ‘not getting enough air,’ bathophobia). In these instances, Cognitive and Physiological palpitations, chest pain and fear of divers most likely avoid placing Symptoms of Panic losing control. Panic symptoms themselves in such situations so as At one time or another, everyone usually build to a crescendo in 10 to minimise the chances of an experiences mild symptoms of minutes or less. episode. anxiety. Perhaps the most common and familiar form is performance According to the DSM-IV (the Situationally predisposed panic anxiety or ‘stage fright.’ People may American Psychiatric Association’s attacks usually occur in the presence feel apprehensive or embarrassed Diagnostic and Statistical Manual of of a trigger: they do not always occur that all eyes are focused on them, Mental Illness, 4th edition), people in every situation, however, or they waiting for them to demonstrate a experience three major types of might not occur immediately. 0or particular skill. Often apparent in panic attack: example, an apprehensive novice dive training, this occurs when may make two successful dives to 10 students are observed practicing • Situationally bound, or cued attacks; metes, but has an overwhelming skills such as clearing a flooded mask. • Situationally predisposed attacks; & need to bolt to the surface on the Panic is at the far end of the anxiety third. • Spontaneous attacks. continuum: it can be intense and overwhelming, overriding rational 0inally, a spontaneous panic attack Situationally bound (or cued panic thought. is not associated with any particular attacks) happen immediately after trigger and occurs ‘out of the blue.’ exposure to, or in anticipation of, a Due to their unique environment, This is perhaps the most frightening situational cue or trigger such as divers may actually predispose type of attack and possibly one of seeing a shark or crossing the magical themselves to panic, especially in the more dangerous kinds. No one 18-metre mark into a ‘deep dive.’ This emergency situations. The natural can predict the onset of panic form of panic is most often human responses to an symptoms, and there is no way of overwhelming sense of anxiety - the

Alert Diver, SEAP 16 this time more deliberately, but without effect. You immediately feel that you are out of air, and the thought flashes through your mind that you are going to drown.

Before your training kicks in and you reach for your octopus or back-up air supply, or before you signal to your buddy that you are out of air and take his or her octopus, your first impulse is to get out of the situation as quickly as possible. Your inclination is to hold your breath, believing you are conserving at least a partial lungful of air and kick for the surface.

Unexpected is a significant factor here, for if you are expecting an emergency you can often look at it more clinically: i.e., responding to the situation rather than simply reacting.

Note: this example of the malfunctioning regulator applies to any level of diver. It is merely an assumption that veteran divers do not experience any symptoms in similar situations. Practice and over- learning play important roles in how experienced divers respond in unexpected, emergency situations. This is one of the reasons that military divers train continuously and in various stressful situations. Photo William M. Mercadante

Panic and perceives the threat and reacts by natural ‘fight or flight’ responses to Personality actors which we are predisposed - are getting you ready for ‘fight or flight.’ unsuited for coping with problems Your heartbeat accelerates and Several personality factors encountered in the marine perception narrows, blood is diverted contribute to a person’s environment. from your internal organs to your predisposition to panic. Anxiety- limbs. Oxygen demand increases. prone individuals may set 0or example, your regulator This happens automatically and themselves up for panic by doing unexpectedly malfunctions at 20 involuntarily; you can do nothing to many things, including: metres. Your body immediately prevent it. You again try to inhale,

17 • having the additional stress of • Do you perceive an increase in your After this thought stopping, redirect diving in a new and unfamiliar place; heart rate? your mind to some other thought, • trying to dive too deep; • Do you suddenly feel tired, such as the head-to-toe equipment • attempting to dive a profile to stressed, anxious? check. This technique serves two which they are unaccustomed; or purposes: it defuses the anxiety, and • Do you have a ‘bad feeling’ about • task-loading themselves to the it reassures you that all equipment is the situation or dive? point that they are accounted for and thoroughly overwhelmed. checked and now re- checked. This affords you an Persons already suffering extra margin of safety and from an anxiety disorder, confidence to continue. It such as obsessive- also simply helps you to slow compulsive disorder, post- down and to concentrate on traumatic stress disorder something other than your (especially if the initial anxiety. trauma was marine-related) or a specific phobia, such as If this does not work nyctophobia (a fear of quickly, make a controlled darkness) or pnigophobia ascent toward the surface. (fear of not being able to Sometimes just moving up breathe) may be even more into shallower water can prone to full-blown panic help. If you do feel the need attacks. to surface, however, donÕt forget to make a safety stop. Note also that some medical There have been stories of conditions may predispose divers who have panicked certain individuals to panic. once at the surface, suddenly It has been suggested that believing that they would asthma, mitral valve immediately get decom- prolapse and thyroid disease pression illness by missing or may be contributing factors. cutting short their safety Use of cocaine, stops. Some, hoping to amphetamines or caffeine, Photo William M. Mercadante recompress, have even and withdrawal from alcohol compounded the problem by or other central nervous trying to descend while in a system depressants can precipitatePhoto a William M. Mercadante near-panic state. In his book The Gift of 0ear, Gavin panic attack as well. DeBecker discusses why we may feel Some individuals believe that in apprehensive, adding that too often order to understand panic you must Managing Panic In Yourself we cognitively override these experience it firsthand. Recall the One of the most important things feelings, ignoring the warnings our scene from Ridley Scott’s 1997 film you can do toward managing anxiety bodies give us until we reach the G.I. Jane, when Navy S.E.A.L. is being aware of your internal state. point where irrationality and panic trainees were blindfolded and water Occasionally, run through a mental is imminent. Remember, it is never poured into their faces. The checklist: too late to abort a dive. command master chief instructed his crew: “You need to know what it If you feel anxious, actively and feels like to drown in order to avoid forcefully tell yourself to STOP!

Alert Diver, SEAP 18 panic and perhaps gain those few a situation only takes a few seconds, increased degree of comfort and seconds that just may save your life.” but it could actually provide you with more freedom to enjoy the dive. that moment or two it takes to avoid While some extremists may embrace full-blown panic. Are you in adequate physical and this concept of fear management, it mental condition for diving? Have is not practical in you been out too late conventional dive training. partying and now have a Instead, one might consider hangover? Do you feel a technique called cognitive drowsy from the rehearsal, which consists of antihistamine you just playing ‘What if?’ took for sinus problems or seasickness? Do you feel Ask Yourself Hard queasy from the boat ride Questions through unexpectedly “What would I do if _____ rough seas? happens?” 0or example: “What would I do if my Is your training adequate buddy suddenly snatched my for the situation? How regulator from my mouth and experienced are you at began fighting toward the making night dives, dives surface?” “What would I do below 18 metres, or in if my weight belt caught on overhead environments? a piece of wreckage? Or my Have you acquired - and panicked buddy grabbed the do you practice - the inflator on my BC and I skills for self-aid or the suddenly found myself in an skills to assist or rescue uncontrolled ascent?” or another diver? “What would I do if I became entangled in kelp?” What is your task load? Are you attempting to Photo William M. Mercadante Mentally walk yourself take photographs, count through an emergency. fish, stay off the reef, Rehearse a mnemonic for an watch your less- action: e.g., ‘SA0E: Slow Ascent 0or Ask yourself whether you are experienced dive partner and keep an Exit.’ This is especially effective if prepared for the dive. Is your eye on your gauges all at the same you are already in a similar, but equipment serviced and operating time? presently non-threatening situation. correctly? Do you have a redundant Think about how to respond to a air supply, such as a pony bottle or What about environmental factors? diving emergency while you are Spare Airª system? Do you carry a What about currents, visibility and making a pool dive or hanging at your knife or shears to free yourself from temperature? Are you wearing safety stop. It provides you with a accidental entanglements? Some enough thermal protection for the mental template of how you could divers see equipment such as back- dive? Water temperatures below 20 respond in an actual emergency. up signaling devices or a small BCD degrees C place significant stress on flashlight on a daytime dive as the body, and cold stresses have been But don’t obsess about a situation unnecessary. Others see these small cited as a major reason for drop-out to the point of making yourself items as crucial to their psychological among military divers. overly anxious: mentally rehearsing safety net, allowing them an

19 How well do you know your dive During the PADI Rescue Diver or collective safety, entangling the buddy? A hot topic in terms of safety SSI Stress and Rescue certification rescuer or dragging the rescuer along and liability, some divers have begun courses (see their program manuals) while ascending. pushing for a solo diving or at the divemaster and instructor certification. How do you know what levels, advanced divers are trained At the surface, the diver may try to the random guy on the boat will do to recognise and deal with these push off of another diver in an once his feet hit the water, much less situations. attempt to get further out of the how he will react in a stressful or water; the diver may hold the rescuer emergency situation? Panic may take other, more under or cause other injuries to those unexpected forms, e.g., sudden attempting to assist. Again, 0or that matter, how do you know withdrawal or catatonia, an instruction in diver rescue and the that the younger divemaster, with involuntary ‘freezing,’ or inability to actual practice of skills can be only a hundred or so dives, is any move or otherwise respond. invaluable in such situations. more experienced at handling (Underwater, it may be difficult to unfamiliar situations than you, an distinguish this from a petit mal One rule of thumb in attempting to advanced open-water diver with only seizure, which may also be an manage panic in others is one or two specialties, but with more emergency, but of a different sort.) paramount: take care of yourself than 1,000 logged dives? This leads If the diver is slightly negatively first. You cannot assist another if to the next topic. buoyant, catatonia may result in a you are in trouble or incapacitated. slow sinking; the diver may slip If you do try to help and get in Managing Panic in Others below a depth below which a safe trouble as well, you have just created The subjective physiological rescue is difficult. A number of these a second emergency situation for symptoms of panic include racing accidents have occurred over the someone else to manage. heartbeat, and feelings of unreality. years, although whether they resulted These are very real symptoms, but from panic may never be known for Diving prepared means you can help they are not readily apparent to an sure. yourself and others. observer. Note that a Active panic may be easy to ‘passive’ panic- recognise. This is often seen as a like catatonia may diver trying to tear the regulator from just as quickly another diver’s mouth in an effort to become an active get air, or in bolting for the surface. form if the individual Other outward signs of suddenly snaps overwhelming anxiety include: from this state of • a ‘panicked’, ‘wild-eyed stare’ (as withdrawal. This one instructor put it: ‘your eyeballs often happens touching the lenses of your mask’); when the diver is • rapid, shallow, inefficient breathing; approached by a buddy or rescuer. • hyperventilation (or sometimes At this point, a breath-holding on rapid ascent); diver may grab the • flailing with the arms and legs or a rescuer’s regulator, sudden inability to communicate unaware that he or coherently. (See sidebar). she is also jeopardising their

Alert Diver, SEAP 20 OBJECTIVE SIGNS O PANIC SYMPTOMS O PANIC IN DIVERS A Poetic Thought from At depth: Dr. John Parker 1. Rapid, shallow breathing or 1. Tachycardia (increased heart hyperventilation (or sometimes breath- rate), pounding heart, or (from DAN Doc) palpitations (rapid fluttering or holding on rapid ascent). Diving is safe if you follow the throbbing of the heart). 2. Sudden inability to communicate or rules follow commands. 2. Diaphoresis, or excessive 3. Wide-eyed, fearful facial expression (as sweating. Which are easily learnt in seen through the mask). 3. Dry mouth. professional dive schools. 4. Clutching for another diver’s regulator 4. Tremulousness. or octopus. 5. Paraesthesias (sensation of Knowing your limits as to how 5. Bolting for the surface (most numbness or tingling). common) or other irrational behavior. you will dive, 6. Chills or hot flashes. 6. Withdrawal, trance-like state or 7. Dyspnoea (shortness of breath catatonia. Lets you explore, relax, stay alive. or feeling that you can’t get enough air). It’s only when rules are broke or At the surface: get bent 1. Head held back and out of the water, 8. Sensation of choking. 9. Chest pain, or feeling that a tight gasping for breath (often with the mask That things go wrong to cause off). band is about the chest. 2. Arms flailing frantically, as if 10. Nausea, vomiting, or accidents, attempting to push self out of the water. abdominal distress. 3. Inability to speak or call for help due 11. A feeling of, or actually losing Or if equipment’s ignored or not to gasping for breath. bowel or bladder control. pre-dive checked, 4. The panicked diver often does not 12. 0eeling dizzy, light-headed, or It may suddenly fail with have the BC inflated and is still wearing as if you are about to faint. disastrous effect. weights while trying to keep his or her 13. 0eeling of unreality head above the water. (derealisation) or depersonalisation And when you do dive don’t go (being detached from oneself, as if all alone. observing events from above or outside of one’s body). Have a dive buddy to stay in your 14. 0ear of losing control or of zone. ‘going crazy.’ 15. Intense fear of drowning, or So be an alert diver and dive to sudden fear that you are about to your plan. die. If ever in doubt, then always call ABOUT THE AUTHOR DAN. DAN Member John Yarbrough is a psychotherapist with the University of Texas Medical Branch at You can read more of Galveston. He has been diving since Dr. Parker’s ‘precriptions for life’ 1984. at www..the poetrydoctor.com.au

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