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Diving Medicine

The Mind Games of Diving

By Dr. David Sawatzky


Diving is an activity with some degree of real risk.  You can get hurt while diving and you can die.  You should have some degree of anxiety and apprehension when you are diving.  This ‘appropriate’ level of arousal is reasonable, normal, healthy and actually reduces your risk of getting hurt, injured or dying.

Arousal or stress levels is an interesting topic.  As your level of arousal increases, your performance can increase.  When you first wake up, your performance is relatively poor (turning off the alarm can be challenging!)  Once you have showered and had breakfast your performance is better.  As you are driving to work someone almost crashes into you.  Suddenly your level of arousal is elevated and you are far more aware of the cars around you.  Your performance climbs another notch.

Then the kids start fighting, the dog in the car starts barking and you realize you have forgotten a very important presentation at home.  Your level of stress now rises to the point where your performance declines.  If your level of stress continues to increase you will reach a point where you are unable to function.  The key is to find the level of arousal/stress that results in maximum performance.

In diving, we face the same problem.  If we are so ‘cool, relaxed and at peace’ that we are not paying attention to our depth, time, orientation, location, gas supply, partner, etc. we are at high risk of having an accident.  However, if we are so anxious or stressed that we cannot keep track of these critical tasks, we are also at high risk of having an accident.  When I was doing a lot of very challenging diving I had a rule:  If I ever thought of anything during the dive, other than the dive, I aborted the dive.  You have to focus on the dive to remain safe.

Unfounded Stress: Phobias

When our level of stress and anxiety/fear is more than is appropriate for the situation, it is called a phobia.  A phobia can be defined as “any objectively unfounded or morbid dread or fear”.  For example, if I came face to face with a large great white shark while diving, I might experience a great deal of fear.  This fear would be completely reasonable and not a phobia.  However, if I refused to go swimming in a swimming pool because I was terrified of being eaten by a great white shark, it would be unreasonable and a phobia (assuming that there was not a great white shark in the pool!)

Phobias are so common that we have special words to describe various kinds.  For example, everyone knows that ‘claustrophobia’ is fear of enclosed spaces and ‘arachnophobia’ is fear of spiders (fear of snakes is called ‘ophidiophobia’).  There are over 200 different words in English to describe specific phobias.  Virtually all of us have at least one unreasonable fear so there must be some reason that they are so common.

Psychologists have several explanations.  Psychoanalytic theory believes that every problem is a result of your relationship with your mother or the way that you were toilet trained.  Behaviour or learning theory believes that a person learns the phobic reaction and the mechanism is most likely ‘generalization’.  


Generalization is an absolutely necessary process, whereby we take things we have learned in one situation and apply them to a different condition.  For example, you were initially taught how to dive in one specific type of gear setup in one fashion.  As you gain experience you apply this knowledge to diving different gear configured in different ways.

When the changes in gear configuration are large (going from back mounted to side mounted tanks) it is a good idea to take another course as you are quite likely to make mistakes trying to apply your previous knowledge and experience to a very different situation.  In the same way, moving into a new kind of gear (closed circuit rebreather) or new kind of diving (cave or wreck penetration) requires enough new knowledge and skills that you need additional training to be safe.

But let’s return to anxiety/fear and see how generalization can cause them to become inappropriate.  If on the dive after I came face to face with a large great white shark, I encounter a large barracuda, I may have the same fear response.  The next dive I may have the same response to a large fish and on the next dive the same response to a minnow.  Having the same fear upon coming face to face with a minnow as to a large great white shark is ‘objectively unfounded’ and therefore a phobia.  The perfectly reasonable fear when meeting a large shark had generalized to a completely unreasonable fear upon seeing a minnow.  The fear may even generalize to the possibility of meeting a fish in a swimming pool.

Every scary experience has the possibility to generalize to inappropriate situations but usually it does not.  There are three common ways in which phobias develop.  One is avoidance.  Not diving in places where great white sharks are commonly encountered would be reasonable avoidance behaviour.  Avoiding situations similar to where the fear was experienced would reduce the anxiety.  Not diving anyplace in the ocean because you might encounter a shark would be unreasonable.  Giving up diving totally as a result of the fear would be completely unreasonable.  The phobia is growing and developing as we make these transitions due to avoidant behaviour.

Another way phobias can develop is due to ‘modeling’.  A speaker may give a presentation at a meeting about a terrifying experience that they had while diving.  If they do a realistic enough presentation some of the people in the audience will experience significant fear and anxiety to the situation being described, even though they did not experience the event!  If that fear and anxiety is allowed to grow and generalize the person can develop a phobia.

At the same time, it is very important that we have the ability to learn to fear things that we have never experienced.  Anyone who has raised a child will know this.  You want to be able to teach your children to be afraid of heights/falling, you want to teach them to be afraid of fire, hydro wires, etc. without them ever being hurt or injured due to these things.  The important point is that the fear/anxiety/caution has to be appropriate to the danger.

The third way phobias can develop is ‘operant conditioning’.  In this situation the person’s initial fear response is supported and reinforced by others.  For example, if you take up diving but your parents/spouse are very unhappy about this, they will reinforce any decision you make to reduce or to eliminate your diving.  Therefore, when you ‘give in’ to your fear and stop diving, they will provide lots of support for this decision and course of action.  This can easily result in a phobia.

I have spent most of my life working for the military and as I write this it has become clear to me that Post Traumatic Stress Disorder (PTSD) has many similarities to phobias.  So how do we prevent and/or treat phobias?  

Falling off the horse

Everyone has heard the phrase, “If you fall off a horse, get right back on”.  In general, this is good advice.  If you have a scary experience, as soon as possible return to the same situation and control the anxiety.    You will have ‘mastered’ your fear and prevented the fear from growing and generalizing.  In combat stress, it is critical to return the person to active combat as quickly as possible to allow them to deal with their fear and reduce the risk of PTSD.  If you have a scary dive, as soon as possible try to repeat the dive under controlled conditions so that you can overlay the scary memory with a completely normal memory in the same situation.  Obviously, you have to be able to control the anxiety and fear on the repeat dive or the stress/anxiety will get worse.

Treating a phobia (or PTSD) involves gradual, progressive exposure to situations similar to the initial event while learning to control the anxiety/fear response.  Several techniques work: breathing control, relaxation, biofeedback, etc.  What you are really doing is achieving systematic desensitization.  This approach is highly successful, as long as the person controls their anxiety/fear.  Sometimes you can do this on your own, sometimes with the assistance of friends and sometimes professional help will be required.  If you are willing to persevere virtually any unreasonable fear can be controlled and eliminated.  However, a lot of time and effort are sometimes required, the process is not fun, and many people chose to live with their phobias, avoiding the situation, rather than learning to control them.  Many people quit diving because of fear.

When you meet someone with a phobia, your response will have a significant impact on what they do.  If you tease, ridicule or express any negative reaction to their phobia, they will almost certainly avoid you and the phobic situation in the future.  Conversely, if you grab them and say, “You can beat this!” and force them into a situation where they are unable to control the fear and anxiety, you will have made the phobia even worse.  

The best response would be to acknowledge their anxiety and fear (it is real).  Let them know that you understand (we all have some unreasonable fears).  At the same time, let them know that if they want to invest the time and effort required they will be able to control and get over their anxiety and fear.

Phobias are encountered in a very large number of situations that have nothing to do with diving.  Two very common examples would be fear of heights and fear of public speaking.  As with diving phobias, these other phobias can be overcome with graduated desensitization.

In the next column I will continue looking at mind games and diving.

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