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The New Clinical Discipline: Diving Psychology

There’s a growing awareness that like ear barotrauma or DCI, divers can also be subject to mental and emotional traumas—whether it’s overcoming a newbie’s fear of mask clearing, or coping with the aftermath of a CO2 hit that nearly cost a wreck diver her life. Welcome to the emerging new discipline of “Diving Psychology!” Clinical psychologist and scuba instructor Laura Walton ventures a diagnosis of what’s going on.

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by Laura Walton
Header photo by SJ Alice Bennett.

“It can be optimistically stated that world literature provides an increasing number of reports connected with the mental functioning of divers and, to a certain extent, the new psychological disciplinediving psychologyhas become more established.” Dorota Niewiedział et al, Psychological Aspects of Diving in Selected Theoretical and Research Perspectives

“I feel like someone handed me gold!” This was one of the first reactions I got when I began to provide psychological support to scuba divers a couple of years ago. The comment was from a professional diver, who was experiencing some specific anxieties while diving, and who expressed relief upon finding someone who understood what they had been struggling with for a long time. It has been a continuing theme among my clients.

Communication is key. Underwater, on land and in your own head. Photo by Peter Gaertner.

Commonly, the divers I see have gotten entangled in an increasingly knotty issue, and all their efforts to escape are only making things worse. On top of that, they have often been unwilling or unable to talk to fellow divers about the issue, and when they do, the answers are not always helpful.  

Photo courtesy of GUE Archives.

If you were a runner, and your foot was injured, would you continue to run on it? A high proportion of the people I work with have kept limping on, sometimes for hundreds of dives. When we have physical injuries, these cause pain and send clear signals that we need to do something about the issue. But with psychological issues, we do not always respond to the signs, and there is often more of a pressure to keep going. This is especially the case for professional or technical divers: How do you tell your boss or your buddies that you feel like you are going to lose control underwater? People understandably fear losing their jobs or being rejected from their group of divers.

In some cases, taking a break is appropriate. But a lot of the people I speak to are highly controlled in their behaviour: It is not always about panic. Sometimes divers are just feeling very worn out by irritating, repetitive mental blocks or unwanted reactions. In fact, most of the people I have worked with are highly safety-conscious divers who find ways to mitigate risks. Unfortunately, this ability to keep going often is causing more issues. The classic reason for this is that fighting with stress or anxiety creates ever-increasing tension. By finding inventive ways to fight, suppress, or otherwise hide these issues, the diver unwittingly entrenches them.  

Taking a break and reaching out for a helping hand is okay. Photo by Jesper Kjøller.

The Need For A Diving Doc

Numbers are small, but there does seem to be a clear need for psychological support for divers, especially regarding anxiety and post-trauma reactions following distressing dives. What is wrong with a non-diving psychologist? Well, for a start, most non-divers know almost nothing about the physics and physiology of diving. Few psychologists would be able to tell you what a recompression chamber is and hardly any have an awareness of the medical treatment of decompression illness and arterial gas embolism/cerebral arterial gas embolism (AGE/CAGE).  

If you were unlucky enough to have gone through a diving accident, then a non-diving psychologist would have little concept of what the treatment had entailed. Even when the diver seeking help has not been involved in an actual incident, their concept of what the issues are is limited. In most cases, the diver would need to spend time explaining why their fear of losing control and making a fast ascent is a significant risk, even for a recreational diver. Much of the session could be taken up with the diver providing definitions for words like “drop-off”, “off-gas” and “decompression stop.”  

The time and effort required by the diver to bridge the gap would be significant.  This vocabulary issue drains resources, but that’s not the only problem. The words we use generate shared meaning and connection; it’s hard to connect with someone who cannot see or feel what you are trying to explain to them. Diving has its own language, and speaking that language is a necessary part of working with our unique community.  

Feelings matter underwater. Photo by Peter Gaertner.

There are also clear signs that direct experience of the underwater environment is clinically important. For example, when divers are addressing anxiety or apprehension, part of the work would often be to set appropriate dives to reduce psychological avoidance and increase confidence. A non-diving psychologist is limited in perspective on (1) the actual risk of the activities being set and (2) ensuring the tasks are pitched at the right level of challenge to help the diver overcome the issue safely. In fact, many of my psychology colleagues react with fear or awe at the thought of scuba diving, so their comprehension of risk is unhelpfully skewed. Furthermore, perception and acceptance of risks varies greatly in divers; a recreational holiday diving enthusiast and an elite technical diver have obvious differences when you live in the diving world. 



What sort of help may divers benefit from?

Diving psychology can help and support divers in their efforts to address a range of behavioral concerns that are problematic in their diving. A recent review highlighted the need for anxiety and post-trauma treatment—which could potentially play a role in assessing a diver’s fitness to dive when experiencing psychological issues—and interventions to support a safe return to diving. There are evidence-based psychological approaches to help people who experience difficulties following a distressing or traumatic incident. A diving psychologist could  adapt these approaches for diving contexts, since they would have an understanding of the nature of underwater emergencies such as running out-of-gas, entrapment/entanglement, being left at sea, unplanned/rapid ascent, and being injured in or witnessing a serious accident: essentially, the issues we see listed in accident and incident reports.  

At the end of the day, diving leads us to a deeper sense of joy and deeper understanding of ourselves. Photo by Alexandra Graziano.

Fortunately, these incidents are rare. More commonly, divers have developed specific fears and phobias, or problematic recurrent anxiety that is a frustrating feature of their dives. In addition, sometimes issues that divers are struggling with underwater turn out to be a compartmentalized presentation of a wider concern, such as burnout, depression, or other forms of stress.  It’s not unusual for someone to seek help with an issue that is showing up under the surface only to find that it links to the rest of their life.  

It’s not unusual for someone to seek help with an issue that is showing up under the surface only to find that it links to the rest of their life.  

Divers frequently note how important it is that when consulting medical doctors, we seek out ones who understand  diving, because if they don’t, their advice can be incorrect or misleading. It is the same in clinical psychology, and there is an apparent need to support divers when needed. Diving Psychology is emerging as a niche specialty, one that can help divers understand and cope their concerns, return safely to the water, and get more out of their diving.

…and the mask is off. Photo by SJ Alice Bennett.

Special thanks to SJ Alice Bennett for the dive therapy pics! You can find more of her work here.

References

  • *Dorota Niewiedział et al., (2018).  Psychological Aspects of Diving in Selected Theoretical and Research Perspectives. Polish Hyperbaric Research 62(1):43-54
  • Walton, L. (2018). The panic triangle: onset of panic in scuba divers. Undersea and hyperbaric medicine, 45(5), 505-509.

Additional Resources:


Laura Walton is a clinical psychologist and scuba diving instructor bringing together psychology and scuba diving to help people with their diving. She provides specialist psychological services for scuba divers and accessible courses. Laura has been guiding and teaching scuba diving in the UK since 2012, and is currently a PADI IDC Staff Instructor at The Fifth Point Diving Centre, Blyth, UK.

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Our Most Read Stories of 2020

Dive into our most read stories of 2020. Can cameras kill? What about those peculiar GUE rebreathers? Gradient factors anyone? Was it a world record dive? Find out.

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Header photo by Sean Romanowski

Greetings Tekkies,

This December marks the second full year of publishing InDepth, and what a crazy year it’s been. With the pandemic still raging throughout most of the world, it has been a most challenging year for the diving industry, as I’m sure you’re aware. I would like to take this opportunity to thank you, our readers for your continuing interest and support, and also thank our thoughtful contributors who make the blog possible.

Over the last year, we published nearly 100 InDepth stories covering the latest developments in exploration, technology, training, conservation, diving science & medicine, image making and technical diving culture. We also added select translations into Chinese, Italian, and Spanish . In doing so, I believe that we have grown our coverage in terms of breadth, depth and sophistication. Call it, a geeky labor of love!

In addition, we’ve added some depth-full sponsors to the mix, that have made it possible to grow and sustain InDepth. Our special thanks to DAN Europe, Dive Rite, Divesoft, Fourth Element, Halcyon, The Human Diver, and Shearwater Research. May your brands continue to flourish! 

Similar to 2019, we celebrate the coming new year with our Most Read Stories from 2020/2019. If you like what you read, please SUBSCRIBE, it’s free! That will ensure you’ll get our latest stories and content delivered to your inbox. Here’s to a hopefully wet and most excellent 2021!

—Michael Menduno/M2


Photo by Natalie Gibb

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Cave explorer, photographer and instructor Natalie L Gibb wants to make “taking pictures” the sixth rule accident analysis. How can toting a camera underground get you into trouble? Take a breath, clip off your camera, and say cheese, Gibb will explain.

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2. The Thinking Behind GUEs Closed Circuit Rebreather Configuration 

GUE is known for taking its own holistic approach to gear configuration. Here GUE board member and Instructor Trainer Richard Lundgren explains the reasoning behind its unique closed-circuit rebreather configuration. It’s all about the gas!

Photo by Joakim Hjelm.

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World-recognized decompression physiologist and cave explorer David Doolette explains the new evidence-based findings on “deep stops,” and shares how and why he sets his own gradient factors. His recommendations may give you pause to stop (shallower).

Image courtesy of DeeperBlue.com.

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Isobaric counterdiffusion is one of those geeky, esoteric subjects that some tech programs deem of minor relevance, while others regard it as a distinct operational concern. Divers Alert Network’s Reilly Fogarty examines the physiological underpinnings of ICD, some of the key research behind it, and discusses its application to tech diving.

Photo courtesy of Michal Guba.

7. Deepest Freshwater Flooded Abyss in the World 

The efforts to explore and map Hranice Abyss, located in Hranice (Přerov District) in the Czech Republic span more a century. Currently, the monstrous chasm is known to reach 384 m/1260 ft deep. Explorer and member of the Czech Speleological Society Michal Guba has the deets.

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Tech diver and doctoral student, Payal Razdan, offers an in-depth review of the options available to women tech divers for handling the call of nature.

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9. Situational Awareness and Decision Making In Diving

Situational awareness is critical to diving safety, right? But how much of your mental capacity should be devoted to situational monitoring, e.g., How deep am I? How much gas do I have? Where is my buddy? Where is my boat? More importantly, how does one develop that capacity? Here GUE Instructor Trainer Guy Shockey, who is also a human factors or non-technical skills instructor, explores the nature and importance of situational awareness, and what you can do to up your game.

10. Examining Early Technical Diving Deaths

The early days of technical diving were marred by an alarming number of fatalities that threatened the viability of this emerging form of diving. Here InDepth editor-in-chief Michael Menduno presents the original accident analyses of 44 incidents that resulted in 39 fatalities and 12 injuries, as reported in aquaCORPS Journal and technicalDIVER in the early to mid 1990s.

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Just when you thought you’ve seen it all, along comes underground picture-maker SJ Alice Bennett, who is shedding new light on the dark, moody, twisting karst passageways that form what explorer Jill Heinerth calls “the veins of Mother Earth.” If you’re ready for a new perspective on the ‘doing of cave diving,’ switch on your primary and dive right in.


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