Psychological Issues in Diving (Part II)
Posted By Divers Alert Network on 14 May 2003
By Ernest Campbell, M.D., FACS
Editors' Note: This is the second of three articles addressing psychological issues and their relationship to scuba diving. The first discussed depression and manic depression; this article looks at anxieties, phobias, panic and narcolepsy; and the third installment addresses schizophrenia, marijuana and alcohol use. Each section examines causes, symptoms, advice about diving and medications used for a particular disorder or habit.
Anxiety
Anxiety is a normal human emotion we all experience when we face threatening or difficult situations. Associated with the secretion of catecholamines (adrenalin), fear or anxiety can help us avoid dangerous situations or get out of them. It can make us alert and it can spur us to deal with a threat or other problem rather than simply avoiding it (i.e., the "fight or flight" reaction). However, if feelings of foreboding become too strong or last too long, they can hold us back from many normal activities.
In abnormal situations, anxiety is manifested by apprehension and dread, though it cannot be attached to a clearly identifiable stimulus. Anxiety can be accompanied by worried feelings, tiredness, tension, restlessness, loss of concentration, irritability and insomnia. The physical effects of anxiety can range from irregular heartbeat, sweating, muscle tension and pain, heavy, rapid breathing, dizziness, faintness, indigestion and diarrhea, and they're produced by the effects of increased adrenalin.
People who are experiencing extreme anxiety can often mistake these signs and symptoms for evidence of serious physical illness, and worry about this can aggravate the symptoms.
A more intense form of anxiety is panic, a sudden, unexpected but powerful surge of fear. Panic can cause a wholesale flight from the immediate situation, a reaction that is especially dangerous for scuba divers. A diver who experiences panic at depth is subject to near-drowning, lung overexpansion injuries and death.
In susceptible people a heightened awareness of potential but definite dangers, complicated by a normal anxiety of being underwater, can cause a phobic anxiety state. The diver may then develop an actual fear of descending into the water. Some divers experience this while learning to dive, but other stronger motivating factors — finishing the class, spousal, parental or peer approval, an unwillingness to appear fearful to anyone else — can temporarily override their fears.
An overreactive anxiety state usually occurs in response to a mishap, such as a dive mask flooding with water. This may cause the diver to panic unnecessarily and behave irrationally. Often, this results in emergency ascents with the attendant dangers, frantic grabs for air supplies and lack of concern for the safety of others. This reaction is seen more often in those divers who have an above-normal tendency toward anxiety.
Phobias
A phobia is an objectively unfounded fear, an anxiety about particular situations or things that are not dangerous and which most people do not find troublesome. People with phobias have the intense signs of anxiety — e.g., irregular heartbeat, sweating, dizziness, etc., described above.
Phobias arise only from time to time, however, in particularly frightening situations. At other times, those who experience phobias don't feel anxious. If you have a phobia of dogs, you'll feel OK if there are no dogs around; if you are scared of heights, you're OK at ground level; and if you can't face social situations, you will feel calm when there are no other persons around.
A phobia will lead sufferers to avoid situations they know will provoke anxiety, but this will actually worsen the phobia as time goes on. It can also mean that the phobic person's life becomes increasingly dominated by the precautions taken to avoid the situation feared. Phobic individuals usually know that no real danger exists; they may note that they feel silly about their fears, but, still, they cannot control them. Notably, a phobia is more likely to fade away if it began after a distressing or traumatic event.
About one in every 10 persons will have troublesome anxiety or phobia at some point in life. However, most will never ask for treatment. Some divers have true claustrophobia, preventing their immersion into water or their entry into a recompression chamber. This syndrome may surface only during certain times of stress and diminished visibility, such as in murky water, during night diving or during prolonged diving.
This has no one cure, but treatments such as exposure therapy (see the website: http://phobialist.com/treat.html) expose the individual to the situation most feared. The two most popular forms of this therapy are "slow desensitization" and "flooding." Flooding is a rapid and more intense form of desensitization, without the relaxation techniques used in slow desensitization.
Through these treatments, phobia sufferers receive direct exposure to the fear until the anxiety subsides. One can imagine such direct exposure or can actually confront the phobia's trigger, the latter a dangerous method of treatment in the underwater setting.
An agoraphobic reaction in diving, often called blue orb or blue dome syndrome (see website: http://www.gulftel.com/~scubadoc/bluorb.htm), is what a phobic diver can experience when he or she loses contact with both the bottom and the surface and becomes spatially disoriented.
Sensory deprivation — e.g., limited visibility, murkiness, loss of spatial orientation — can also cause illusions, particularly when visibility is impaired. Anxiety associated with this environment can cause heightened suggestibility and result in mistaking fish, other divers and objects for sharks or other threatening entities.
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