Understanding Diver PANIC
By John R. Yarbrough,
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
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 Associations 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
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
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
perceives the threat and reacts by
natural fight or flight responses to
getting you ready for fight or flight.
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 persons
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,
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 Scotts 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 dont 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
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.
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 divers mouth in an effort to become an active
get air, or in bolting for the surface. for m if the
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 rescuers regulator,
sudden inability to communicate unaware that he or
coherently. (See sidebar). she is also
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 divers regulator professional dive schools.
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.
or feeling that you cant get enough
air). Its 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
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 equipments 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 dont go
(being detached from oneself, as if all alone.
observing events from above or
outside of ones body). Have a dive buddy to stay in your
14. .ear of losing control or of zone.
15. Intense fear of drowning, or So be an alert diver and dive to
sudden fear that you are about to your plan.
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. Parkers precriptions for life