What Makes Scuba Divers Panic?

Panic Triangle: Why scuba divers panic, and some ways to avoid it.

Dr Laura Walton In a state of panic, the human being acts on instinct, generally heading mindlessly for the nearest escape. A person in panic cannot think clearly and their actions are not rational, because their brain is operating on survival mode.

We can't breathe underwater without our equipment, and we can't go immediately to the surface because of the effects of pressure. Panic is a dangerous state for a scuba diver.

A study that reviewed snorkelling and diving accidents over a 20 year period found that, although reports rarely noted the mental/behavioural state of the diver, in those that did, panic was a feature in 68 percent. Davis M, Warner M, Ward B. Snorkelling an d scuba diving deaths in New Zealand, 1980- 2000. South Pacific Underwater Medicine Society (SPUMS) Journal 2002 June; 32: 70-80

And it is not as rare as you might think ... Experience of panic and near-panic underwater has been reported between 25 and 54 percent of divers. This means perhaps as many as one diver in every buddy pair has panicked, or almost panicked, at some stage during their diving. Morgan, W. P. (1995). Anxiety and Panic in Recreational Scuba Divers. Sports Medicine, 20(6), 398–421. & Colvard DF, Colvard LY. A study of panic in recreational scuba divers. Undersea J. 2003;Q1:40–4

So we need a way to understand panic in scuba diving ... 2 PANIC TRIANGLE © Laura Walton 2019 | scubapsyche.com What is the Panic Triangle?

This is a theoretical model for the onset of panic in scuba divers, based on review of the literature and direct, informal observation. It is a way we can understand, talk about and, (most importantly) prevent divers panicking underwater. A peer-reviewed, and edited, article on this topic is published in the Undersea and Hyperbaric Medicine Journal. .

REFERENCE: Undersea Hyperb Med. 2018 Sep-Oct;45:505-509. The panic triangle: onset of panic in scuba divers

3 PANIC TRIANGLE © Laura Walton 2019 | scubapsyche.com If you have ever done any mandatory fire training, then you have probably heard of the fire triangle model for how a fire starts and burns. The fire triangle states that three things are needed for a fire: fuel/combustible materials, oxygen and heat.

Similarly, if panic is the fire, then it takes three circumstances to ignite it: gap in readiness, difficulty in regulation and a trigger event.

4 PANIC TRIANGLE © Laura Walton 2019 | scubapsyche.com the Panic Triangle

5 PANIC TRIANGLE © Laura Walton 2019 | scubapsyche.com The three sides of the panic triangle:

Readiness - a gap between the actual demands of the dive and the diver's current skills, equipment or preparedness.

Regulation - the diver's ability to regulate their emotions and physical reactions, and also their ability to direct and sustain attention.

Stressor - a thing that happens that may cause a diver to become stressed, such as an external problem, or a distressing thought.

6 PANIC TRIANGLE © Laura Walton 2019 | scubapsyche.com The gap in READINESS This is the fuel: the diver does not have the skills/equipment to respond to the specific situation effectively.

To have sufficient skill means having both the competence and the confidence to take the correct actions to avoid or resolve a problem and achieve an aim or objective. Being faced with a situation that we are unable to deal with leads to a perceived lack of control which, if we feel threatened by the event, triggers panic as a survival response to escape. (But only if we are aware of the threat.)

Whether a diver lacks readiness very much depends on the situation, for example, an open water diver is able to control their buoyancy adequately. On a reef at 10m, with 30 metre vis and no current, their skills are sufficient. But if we change the context by increasing the depth, going into a cave system or wearing full tech kit .. then it is clear there will be some skills deficits. Similarly, even an experienced tech diver will experience a deficit if entering a situation they were not expecting, or an equipment failure that was not prepared for.

7 PANIC TRIANGLE © Laura Walton 2019 | scubapsyche.com The difficulty in REGULATION This is the oxidising agent that can fan the flames.

Our bodies have really interesting physiological systems that manage, and are affected by behaviour and can change to adapt to our situation. For simplicity, I talk about two processes, the “wind – up” and the “wind-down”. Winds-up means that systems up-regulate us towards high arousal, i.e. fight or flight, or freeze. Wind-down means that systems down-regulate to low arousal e.g. rest and digest OR the “flop” response (death feigning).

We can wind-up or down to the extent the system sort of short circuits, in what’s called dissociation (lights are on, but nobody home; rabbit in the headlight; thousand yard stare). All have a survival basis, but in diving switching off rational thinking and letting these survival strategies run the show rarely ends well.

Note: We all have what is called a “window of tolerance” for emotional arousal, and some people’s are bigger than others.

8 PANIC TRIANGLE © Laura Walton 2019 | scubapsyche.com The STRESSOR This is the heat: the event that turns up the pressure.

The events that can be triggers are virtually unlimited. Common ones include:

equipment issues - e.g. leaking mask, faulty mouth piece, burst o-ring environmental hazards - e.g. dangerous marine life, strong currents physical stressors - e.g. overexertion, gas density effects/narcosis internal events - physical sensations, thoughts (e.g. negative, anxious, paranoid)

If you are thinking, some of these things don’t bother me ... then that is the triangle! If you perceive yourself as having the skill to deal with them (readiness), or are not in an unhelpful state of arousal (regulation) - then those things won't be a problem for you.

9 PANIC TRIANGLE © Laura Walton 2019 | scubapsyche.com Panic is sparked! When we have all three sides of the triangle happening at the same time, then panic may be sparked. Psychological and physiological processes mean the panic fuels itself, in a positive feedback loop. The more stressed the person gets, the more they panic, the less able they are to fix the problem, the worse the problem seems, the more they panic, the more stressed ....

This means the person in panic is not able to think clearly to address the issues. In diving this leads to specific risks, due to the irrational actions a person makes when panicking.

Fortunately, like fire, we can reduce the risk by limiting the three sides of the triangle.

Avoid dives you are not yet ready for by sticking to recommended limits and evaluating conditions on the day.

Close the gap between your current level of ability and the dives you want to do by seeking appropriate training, practicing effectively and gathering experience.

When working at the edges of your comfort zone, for example different types of diving, depth or site conditions, set up additional safety measures (e.g. supervision, reduction of unnecessary tasks and stressors).

Being with an instructor or buddy that you trust makes a difference to regulation, so consider who you want to dive with, particularly when the dive is more challenging for you.

Consider what aspects of the dive can be changed to reduce the chance of encountering stressors you are not yet ready for, (e.g. shallower sites, less water movement).

Build skills in self-regulation, this can include developing proper breathing habits, learning to respond effectively to anxious thoughts and calming emotions to retain clear thinking.

11 PANIC TRIANGLE © Laura Walton 2019 | scubapsyche.com What next? We can never fully predict what a person will do under pressure, but we can understand panic - what it is and why people go into that state. We can reduce the risk of panic in diving by being fit-to-dive, learning scuba skills and building our ability to self-regulate.

Want to know more about Learn more about the the role of breathing in topics above on the self-regulation, take this Prevent Panic program. FREE 1 hour course. Sign-up for updates.

https://learn.scubapsyche.com/cou http://eepurl.com/glyYGH rses/what-is-deep-breathing

Be fit-to-dive! Join the If anxiety, depression or Facebook Group to share other mental health information, inspiration concerns are an issue for and motivation. you on the surface, then seek advice and support.

Consider taking a break from scuba diving until you are fit-to-dive.