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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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The Price of Helium is Up in the Air

With helium prices on the rise, and limited or no availability in some regions, we decided to conduct a survey of global GUE instructors and dive centers to get a reading on their pain thresholds. We feel your pain—especially you OC divers! InDEPTH editor Ashley Stewart then reached out to the helium industry’s go-to-guy Phil Kornbluth for a prognosis. Here’s what we found out.

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Helium Technical Diving

By Ashley Stewart. Header image by SJ Alice Bennett.

Helium is one of the most abundant elements in the universe, but here on Earth, it’s the only element considered a nonrenewable resource. The colorless, odorless, and tasteless inert gas is generated deep underground through the natural radioactive decay of elements such as uranium and thorium in a process that takes many millennia. Once it reaches the Earth’s surface, helium is quickly released into the atmosphere—where it’s deemed too expensive to recover—and rises until it ultimately escapes into outer space. 

Luckily for divers who rely on the non-narcotic and lightweight gas for deep diving (not to mention anyone who needs an MRI scan or who uses virtually any electronic device), some helium mixes with natural gas underground and can be recovered through drilling and refinement.

Yet the world’s helium supply depends primarily on just 15 liquid helium production facilities around the globe, making the industry uniquely prone to supply chain disruptions, which this year caused the industry’s fourth prolonged shortage since 2006. The shortage has caused many technical dive shops around the world to raise prices, limit fills, or stop selling trimix altogether, according to an InDEPTH survey of GUE instructors and affiliated dive centers.

Longtime helium industry consultant Phil Kornbluth, however, expects the shortage will begin to ease gradually now through the end of the year, and for supply to increase significantly in the future.

Photo courtesy of Extreme Exposure

While a majority of the world’s helium is produced in just a few countries, a new gas processing plant in Siberia is expected to produce as much as 60 million cubic meters of helium per year, about as much as the US—the world’s largest helium producer—was able to produce in 2020. The Siberian plant ran for three weeks in September, but experienced major disruptions over the past year, including a fire in October and an explosion in January, that delayed its planned opening until at least 2023.

Meanwhile, according to Kornbluth, the U.S. Bureau of Land Management in Texas closed down from mid-January to early June due to safety, staff, and equipment issues, wiping out at least 10% of the market supply. The plant reopened in June and is back to normal production as of July 10. The supply of helium was further reduced as two of Qatar’s three plants closed down for planned maintenance, a fire paused production at a plant in Kansas, and the war in Ukraine reduced production of one Algerian plant.

With the exception of the plant in Siberia, Kornbluth said virtually all of the recent disruptions to the helium supply chain have been resolved and should yield some relief. And the future looks promising. Once the Siberian plant is online, it’s expected to eventually boost the world’s helium supply by one-third. While sanctions against Russia could prevent some buyers from purchasing the country’s helium, Kornbluth expects there will be plenty of demand from countries that as of now are not participating, like China, Korea, Taiwan, and India, though there could be delays if those countries have to purchase the expensive, specialized cryogenic containers required to transport bulk liquid helium. “Sanctions are unlikely to keep the helium out of the market,” Kornbluth said.

Meanwhile, there are at least 30 startup companies exploring for helium, and there are other projects in the pipeline including in the U.S., Canada, Qatar, Tanzania, and South Africa. “Yes, we’re in a shortage and, yes, it’s been pretty bad, but it should start improving,” Kornbluth told InDEPTH. “The world is not running out of helium anytime soon.” 

THE SURVEY:

To find out how the helium shortage is affecting divers, InDEPTH surveyed Global Underwater Explorers’ (GUE) instructors and dive centers and received 40 responses from around the world. 

The survey’s highest reported helium price was in Bonaire—a Dutch island in the Caribbean that imports its helium from the Netherlands—where helium costs as much as US$0.14 Liter(L)/$4.00 cubic foot (cf) and is expected to rise. At that price, a set of trimix 18/45 (18% O2, 45% He) in double HP100s (similar to D12s) would cost around $360.00 and trimix 15/55 would cost $440.00.

“We have enough to support both open circuit and CCR, but in the near future, if the situation remains, we may be forced to supply only CCR divers,” Bonaire-based GUE instructor German “Mr. G.” Arango told InDEPTH. “We have enough for 2022, but 2023 is hard to predict.”

Not far behind Bonaire was the Philippines, where helium costs around US$0.13 L/$3.68 cf—if you can even get it. Based on the responses to our survey, Asia is experiencing the greatest shortages. Supply is unavailable in some parts of the Philippines, limited in South Korea, and unavailable for diving purposes in Japan as suppliers are prioritizing helium in the country for medical uses, according to four instructors from the region. In Australia, it’s relatively easy to obtain.

Four US-based instructors reported that helium prices are increasing significantly and supply is decreasing. Helium remains “very limited” in Florida and prices in Seattle increased to $2.50 from $1.50 per cubic foot ($0.09 L from about $0.05 L) in the past six months, and there was a period when the region couldn’t get helium as suppliers were prioritizing medical uses. In Los Angeles, prices have reached as high as $2.80 cf (nearly $0.10 L) and one instructor reported helium is only available for hospitals and medical purposes, even for long-term gas company clients who are grandfathered in. Another Los Angeles-based instructor said direct purchases of helium had been limited to one T bottle per month, down from three. 

“Currently, we are only providing trimix fills for our CCR communities,” GUE instructor Steven Millington said. “Possibly this will change, but the current direction for active technical divers is CCR. I agree (and already see) that open circuit technical diving in some regions will go the way of the dinosaur.”

In Western Europe, helium is becoming more difficult and expensive to acquire, 10 instructors in the region told us. Instructors in the United Kingdom, Spain, Italy, and Germany reported longer wait times, high price increases, and limited supply. 

Meanwhile, Northern Europe appears to be a bright spot on the map with comparatively reasonable prices and general availability. In Norway, two instructors reported helium is easy to obtain, with no lead time from suppliers. Likewise in Sweden and Finland, though one Finnish instructor told us that in the past year prices have increased significantly.

Three instructors in Northern Africa and the Middle East said helium is easy to get, but is becoming more expensive. The price of Sofnolime used in rebreathers is increasing in Egypt as helium becomes more expensive and more difficult to obtain. Lebanon has minimal lead times, but helium is among the most expensive in all of the responses we received at US$0.10 L/$2.83 cf.

Helium is generally easy to obtain in Mexico, though prices are increasing dramatically and instructors are starting to see delays. In Brazil, prices in São Paulo quadrupled in the past 12 months and by 30% in Curitiba. Suppliers there aren’t accepting new customers and existing customers are having difficulty obtaining supply. Supply is mostly constrained in Canada, with the exception of one outlier: an instructor who has a longstanding account with the gas company and pays less than US$ 0.035 L/$1.00 cf. “I have been hearing of helium shortage every year for the last decade,” instructor Michael Pinault of Brockville Ontario told InDEPTH, “but I have never not been able to purchase it.”

Many instructors around the world said that helium shortages and skyrocketing prices are, no surprise, fueling a shift to CCR for individual divers and exploration projects. “CCR is saving our exploration projects,” GUE instructor Mario Arena, who runs exploration projects in Europe, said. “These projects would be impossible without it.”

Please let us know what helium prices and availability are in your area: InDEPTH Reader Helium survey

Additional Resources

US Geological Survey: Helium Data Sheet: Mineral Commodity Summaries 2021

NPR: The World Is Constantly Running Out Of Helium. Here’s Why It Matters (2019)

The Diver Medic: The Future of Helium is Up in the Air,” Everything you wanted to know about helium, but were too busy analyzing your gas to ask—talk by InDEPTH chief Michael Menduno


InDepth Managing Editor Ashley Stewart is a Seattle-based journalist and tech diver. Ashley started diving with Global Underwater Explorers and writing for InDepth in 2021. She is a GUE Tech 2 and CCR1 diver and on her way to becoming an instructor. In her day job, Ashley is an investigative journalist reporting on technology companies. She can be reached at: ashley@gue.com


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