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Understanding Diver PANIC

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					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
number of physiological symptoms,
                                         associated with a specific phobia,
                                         such as a fear of sharks or a fear of
                                                                                 knowing when of if the symptoms
                                                                                 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. .or         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.                                   continuum: it can be intense and
• Spontaneous attacks.
                                                                                 overwhelming, overriding rational
                                         .inally, a spontaneous panic attack     thought.
Situationally bound (or cued panic
                                         is not associated with any particular
attacks) happen immediately after
                                         trigger and occurs ‘out of the blue.’   Due to their unique environment,
exposure to, or in anticipation of, a
                                         This is perhaps the most frightening    divers may actually predispose
situational cue or trigger such as
                                         type of attack and possibly one of      themselves to panic, especially in
seeing a shark or crossing the magical
                                         the more dangerous kinds. No one        emergency situations. The natural
18-metre mark into a ‘deep dive.’ This
                                         can predict the onset of panic          human     responses      to      an
form of panic is most often
                                         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
                                getting you ready for ‘fight or flight.’
                                                                           Personality .actors
which we are predisposed - are
                                Your heartbeat accelerates and
unsuited for coping with problems                                          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
.or 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
diving in a new and unfamiliar place;
                                        • Do you perceive an increase in your After this thought stopping, redirect
                                        heart rate?                           your mind to some other thought,
• trying to dive too deep;                                                    such as the head-to-toe equipment
                                        • Do you suddenly feel tired,
• 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        the situation or dive?
                                                                              it reassures you that all equipment is
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 precipitate a William M. Mercadante
                                 Photo                                        near-panic state.
                                       In his book The Gift of .ear, Gavin
panic attack as well.
                                       DeBecker discusses why we may feel
                                                                          Some individuals believe that in
                                       apprehensive, adding that too often
Managing Panic In Yourself                                                order to understand panic you must
                                       we cognitively override these
One of the most important things feelings, ignoring the warnings our      experience it firsthand. Recall the
you can do toward managing anxiety bodies give us until we reach the      scene from Ridley Scott’s 1997 film
is being aware of your internal state. point where irrationality and panicG.I. Jane, when Navy S.E.A.L.
Occasionally, run through a mental is imminent. Remember, it is never     trainees were blindfolded and water
checklist:                                                                poured into their faces. The
                                       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?” .or 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                  take photographs, count
Mentally walk yourself
through an emergency.                                                                     fish, stay off the reef,
Rehearse a mnemonic for an                                                                watch       your   less-
action: e.g., ‘SA.E: Slow Ascent .or     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,
.or 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.    for m 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)
holding on rapid ascent).                     palpitations (rapid fluttering or
                                                                                        Diving is safe if you follow the
2. Sudden inability to communicate or         throbbing of the heart).
follow commands.                              2. Diaphoresis, or excessive                           rules
3. Wide-eyed, fearful facial expression (as   sweating.                                    Which are easily learnt in
seen through the mask).                       3. Dry mouth.
4. Clutching for another diver’s regulator                                                 professional dive schools.
                                              4. Tremulousness.
or octopus.                                   5. Paraesthesias (sensation of
5. Bolting for the surface (most
                                                                                        Knowing your limits as to how
                                              numbness or tingling).                          you will dive,
common) or other irrational behavior.
                                              6. Chills or hot flashes.
6. Withdrawal, trance-like state or
                                              7. Dyspnoea (shortness of breath         Lets you explore, relax, stay alive.
catatonia.
                                              or feeling that you can’t get enough
                                              air).                                    It’s only when rules are broke or
At the surface:
1. Head held back and out of the water,       8. Sensation of choking.                             get bent
gasping for breath (often with the mask       9. Chest pain, or feeling that a tight
                                              band is about the chest.                  That things go wrong to cause
off).
2. Ar ms 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. .eeling dizzy, light-headed, or
have the BC inflated and is still wearing                                                   It may suddenly fail with
                                              as if you are about to faint.
weights while trying to keep his or her                                                         disastrous effect.
                                              13. .eeling 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. .ear 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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