Anxiety Management

[jvanostrand]

I met Peter Murray at Peacock Spring last week and I thought I'd exercise my SB account and ask about managing anxiety.

It was the same week in Peacock and at about the farthest penetration of my young cave diving career that I experienced anxiety. It was enough anxiety that my breathing changed and a small additional issue might have sent it out of control. What went through my head was "if my breathing gets out of control I'll be in trouble" and that made it worse. I managed to calm down by going to my "happy place". I realized during cave training that the lights-out-line-follow was very relaxing. I okayed the line and was calm in about a minute. I was worried about anxiety on the next dives but also a little more confident that I could manage it if it did appear again.

I've noticed that hypercapnia seems to be a factor. I've had dives where I've kept up with a buddy who's pace is just a tad faster and after 20 or 30 minutes I notice my breathing is a little too fast and my anxiety level seems higher too. I've learned to notice when this happens and slow down or take breaks.

I've also noticed that distractions are good. This dive was through large dusty tunnels which are, in a way, kind of boring. Had there been lots of turns or restrictions I wouldn't have had time to think about worrying things. On later dives I did things like calculate gas consumption rate and speed and estimate exit times and pressures.

I recall some discussion during cave training about anxiety, range anxiety, gas anxiety, etc. I think we talked about avoiding it but I don't recall anything about how to manage it once it appears.

After the dive I mentioned the event and my buddies admitted to having points during dives where they've felt anxious. So it seems common.

Clearly the first step is to avoid anxiety. There are things one can do that help avoid anxiety, like having confidence in one's gear, diving a good plan, using a p-valve, having suitable thermal protection, more experience, etc. But even with those in place anxiety can still happen.

I'd like to hear people's thoughts and experiences about a few ideas.

1. Did your cave training discuss anxiety? Did it talk about how to avoid it? Did it talk about how to manage it once it appears? If it doesn't should it and how?

2. Is this something that divers are wary of talking about? Should it be discussed more?

3. Do others find that hypercapnia is a factor? What other factors are relevant?

4. What do you do when anxiety appears?

 

[boulderjohn]

I have been cave certified for a number of years now, but I live in Colorado, far from any caves, so I only have about 80 cave dives or so (have to look it up) scattered over those years. That makes me something of a perpetual early stage cave diver.

1. Did your cave training discuss anxiety? Did it talk about how to avoid it? Did it talk about how to manage it once it appears? If it doesn't should it and how?
If we talked about it, I don't remember it.

2. Is this something that divers are wary of talking about? Should it be discussed more?
I guess it might be, especially if you are doing something like cave diving, in which as a newer diver you will naturally assume everyone around you is an expert. You might be reluctant to reveal anxieties.

3. Do others find that hypercapnia is a factor? What other factors are relevant?
Yes, I believe hypercapnia is a factor in probably most anxiety situations and all panic situations. As carbon dioxide builds up because of improper breathing techniques, you will begin to feel anxiety build. It is a natural bodily reaction--if I hold my hand over your nose and mouth, that growing panic that will eventually cause you to struggle with everything you've got to get free is a physiological reaction to hypercapnia, not a need for oxygen.

4. What do you do when anxiety appears?
I have only had any anxiety in a cave dive (once I was done wondering what the instructor was gong to do to me) one time, so i will begin by explaining why I don't think I ever feel anxiety, then explain that one time.

As a perpetual early stage cave diver, I know my limits and don't push them. I enter every dive fully confident that I have the skill and the equipment to do the dive I have planned. I have trained for emergencies, and I know I will be able to follow that training. I have never (with the exception I am about to describe) been in a situation in which I had the remotest doubt that I could exit just by continuing the dive plan. I think doing that kind of diving until you feel the confidence to extend your limits gradually will greatly limit any anxiety.

Not long ago my buddy and I planned to do a circuit in a cave in Mexico. It was a well known circuit, but neither of us had ever done it before. My buddy was cave certified, but he had far less experience than I. We knew our gas usage well, and based on what we read about the depth and length of the circuit, we were very confident we had enough gas. Everything went as planned. We put in the jump line to complete the circuit, and we headed off. It was quite a beautiful cave and i was enjoying the scenery quite a bit. As is true in many Mexican caves, though, the line was not well marked. There were no comfortable markers with numbers telling you how far you were from anything. There were pretty much no markers at all. We reached thirds, and i had not seen any markers indicating that we were passed the halfway point in the circuit. Had I missed something? According to our preparation, our shortest exit should have been ahead of us--but was it? With no arrows in sight, how could I be sure? We pushed on, and I began to grow concerned. Were we pushing deeper into the cave (instead of exiting it) without realizing it? I had read stories of confusing markings in Mexican caves causing errors leading to deaths, and I had even written one of those stories.

I was greatly relieved to see my jump line ahead, and we eventually reached the exit pretty much as planned, with nearly half our gas intact. My anxiety during the dive was simply due to my unfamiliarity with the cave and the lack of expected cues on the line. We had planned the dive well within our abilities, but that unfamiliarity brought on doubt and anxiety.

 

[kensuf]

I met Peter Murray at Peacock Spring last week and I thought I'd exercise my SB account and ask about managing anxiety.

It was the same week in Peacock and at about the farthest penetration of my young cave diving career that I experienced anxiety. It was enough anxiety that my breathing changed and a small additional issue might have sent it out of control. What went through my head was "if my breathing gets out of control I'll be in trouble" and that made it worse. I managed to calm down by going to my "happy place". I realized during cave training that the lights-out-line-follow was very relaxing. I okayed the line and was calm in about a minute. I was worried about anxiety on the next dives but also a little more confident that I could manage it if it did appear again.

I've noticed that hypercapnia seems to be a factor. I've had dives where I've kept up with a buddy who's pace is just a tad faster and after 20 or 30 minutes I notice my breathing is a little too fast and my anxiety level seems higher too. I've learned to notice when this happens and slow down or take breaks.

I've also noticed that distractions are good. This dive was through large dusty tunnels which are, in a way, kind of boring. Had there been lots of turns or restrictions I wouldn't have had time to think about worrying things. On later dives I did things like calculate gas consumption rate and speed and estimate exit times and pressures.

I recall some discussion during cave training about anxiety, range anxiety, gas anxiety, etc. I think we talked about avoiding it but I don't recall anything about how to manage it once it appears.

After the dive I mentioned the event and my buddies admitted to having points during dives where they've felt anxious. So it seems common.

Clearly the first step is to avoid anxiety. There are things one can do that help avoid anxiety, like having confidence in one's gear, diving a good plan, using a p-valve, having suitable thermal protection, more experience, etc. But even with those in place anxiety can still happen.

I'd like to hear people's thoughts and experiences about a few ideas.

1. Did your cave training discuss anxiety? Did it talk about how to avoid it? Did it talk about how to manage it once it appears? If it doesn't should it and how?

2. Is this something that divers are wary of talking about? Should it be discussed more?

3. Do others find that hypercapnia is a factor? What other factors are relevant?

4. What do you do when anxiety appears?

So I can understand having a bit of anxiety when you meet Pete Murray . But let me be serious for a minute and talk about your specific concern.

Anxiety is not uncommon, and a little bit of stress is good for you. But the problem with being under a lot of anxiety is that when someone is "on the edge," anything that causes the fit to hit the shan may lead to panic. You don't want to panic -- that's when your brain shuts down and bad things happen from there. The accident files are filled with cases where a trigger event caused a cascading series of other events to escalate and snowball out of control.

Slowly building up your experience through progressive penetration is one of the easiest ways to prevent/reduce/minimize anxiety.

Now..

1. Did my cave training discuss anxiety? I'm 99% sure it did, but I took those courses over 20 years ago. The courses I teach do discuss recognizing anxiety, stress, and panic in yourself and your teammates, and some of the best ways to manage those feelings. I spend a substantial amount of time discussing the psychological aspects of stress, but all of the methods to avoid panic can be summarized in a simple sentence, "Listen when you hear the voice in your head whispering to you rather than waiting for that voice to start screaming at you."

2. I'm sure there are divers that are wary about talking about their own personal anxieties and fear. That's because of ego. However, you're doing yourself and your buddies a disservice when you let your ego get in the way of common sense. Yes, I think it should be discussed openly and freely.

3. CO2 is bad stuff. I know whenever I am pushing really hard CO2 can increase my narcosis, anxiety, and just feeling of doom and dread. There are both physical factors (thermal comfort, work-load, depth, visibility, properly fitting and functioning gear, etc) and psychological factors (new cave, new buddy, new tunnel, just being in a cave, time pressure due to: distance - time it will take to exit, amount of air it will take to exit, NDL limits/decompression obligation/ceiling, etc).

4. Stop. Breathe. Think. Breathe. Take action. If the anxiety is getting to be too much, I'm not opposed to pulling out the thumb and calling it a day.

FWIW -- A bit of anxiety is quite common. I remember distinctly the first time I ever saw a 1000' arrow I thought to myself "holy crap, if I were to die here it'll be hard to get my body out." A guy that I used to dive with, who held a few distance world records at one time or another, once told me that he was terrified his first 50-70 cave dives but that after he had around 100 under his belt he felt more comfortable. Build your experience slowly and enjoy the journey.

Great thread, great questions.

Ken

 

[The Chairman]

It's my non-medical opinion that co2 plays a huge role in a number of accidents. Skip breathing and other attempts to reduce SAC can really increase residual co2 and the resultant anxiety.

 

[PfcAJ]

I think what you experienced was a good thing. You hit a psychological limit. Some people don't have that, and that can result in going too far too fast. A little apprehension will keep you alive.

What's likely to happen moving forward is you'll gain more confidence in your equipment, procedures, buddies, and most importantly, yourself. Your sphere of 'what's comfortable' will expand.

Also, take ownership of your dive. If your buddy is moving at a clip that's a bit much, tell 'em to slow down. No shame in that.

 

[karstdvr]

I've also noticed that distractions are good. This dive was through large dusty tunnels which are, in a way, kind of boring. Had there been lots of turns or restrictions I wouldn't have had time to think about worrying things. On later dives I did things like calculate gas consumption rate and speed and estimate exit times and pressures.

Kudos to you for bringing up this subject,because people don't want to admit it, or deny it, and as people have eluded to,panic ensues.

Not to be mean,but if you are looking for distractions, doing calculations etc during a dive, you are no longer an active part of a team, and really should be thumbing the dive, and exiting. If you are having to go to those extremes to mitigate anxiety, then the more your penetration increases,so will the anxiety and feeling of impending doom. You have to ask yourself,at that point if something goes wrong will I be an active participant in addressing the emergency, and helping the team to exit safely.

One means of addressing anxiety is progressively increasing the stress until it decreases. For example if someone is afraid of spiders then they will look at pictures until the anxiety decreases, then 10 feet away from a live specimen, then 5 feet, then 1 foot etc (you get what I mean),but this is a gradual thing.

Progressive penetration is a good thing in cave diving because it allows learning of the cave,but will help reduce anxiety because you are repeating the same section of cave before adding more,but that is done in small increments.

I wish you good luck, and hope you can progress at your own rate. Cave diving can be so goal driven,but ignore those landmark dives, and concentrate on yourself and the team.

---------- Post added January 4th, 2016 at 06:04 AM ----------

It's my non-medical opinion that co2 plays a huge role in a number of accidents. Skip breathing and other attempts to reduce SAC can really increase residual co2 and the resultant anxiety.

You are correct,hypercarbia plays a role. That being said,anxiety is a state that all of us have for proper reasons,but some have a disorder that makes the anxiety more. There are people who will get sweaty palms, nervousness, elevated breathing, elevated heart rate etc by just having to put on dive gear, and they haven't done anything to build up CO2. Human defense mechanisms are wonderful things,but we can't rationalize all anxiety issues due to CO2 build up,but we have to acknowledge that some people have anxiety, and this must be addressed before penetrating a cave,which is the worst place to deal with an anxiety attack. I think the key is go slow, take your time, and listen to the little man in your head.

 

[The Chairman]

My point wasn't that co2 is the only vector for anxiety, so please don't ascribe something to me that I didn't post. However, one of the significant side effects of hypercapnia is increased anxiety and that can be rather pronounced, if not dramatic. In a healthy person, chemoreceptors in our medula oblongata monitor levels of co2 in order to regulate our respiration. The guy panting after running that 100 yd dash is doing so to get rid of the excess co2. If he feels he can't get enough air, his anxiety will increase until his co2 abates to a tolerable level. Introduce a pharyngospasm with a single drop of water and you really have a lot of anxiety.

Skip breathing, or artificially regulating your respiration is an easy way to build up high levels of co2. While it appears that some may develop a tolerance to the increased levels it doesn't render them impervious, especially when their threshold has been reached. If you want to improve your SAC, hit the pool or some other cardio. FWIW, I'm not saying that the OP is even doing this. I'm simply pointing out that this vector does exist and divers would be wise to take co2 into account.

 

[karstdvr]

My point wasn't that co2 is the only vector for anxiety, so please don't ascribe something to me that I didn't post.

I wouldn't, you brought up a valid point. What I am trying to say is in scuba diving we are taught about dead air spaces and CO2 build up, and some people will rationalize as that as their cause of anxiety, without really realizing that they have anxiety as a medical disorder. One I would say has a more harmful effect and less chance of mitigating as the other.

 

[Nasser]

I have definitely had my share of anxiety during wreck and cave penetrations and I think it's actually much more common than we realize. In my training this was discussed as a psychological factor and the approaches on how to deal with it as well as the signal for "let's get the F out of here" were reviewed and agreed upon. Having said, that I feel that this should be given more attention in Advanced Wreck and Cave courses and elaborated on in texts. After all, letting things get out of hand and not knowing when to call the dive could literally turn fatal if one hits the panic button.

From my personal experience I believe that the practice of meditation and focus on the breath is of immeasurable help in addressing anxiety. By being able to train the mind to observe yourself "from the outside looking in" objectively, you allow yourself to act upon a situation with more control rather than react blindly. It helps you to bring yourself into the present and focus on your breathing with heightened awareness which in turn helps in controlling your breathing rate and CO2 buildup.

It's a bit difficult to really explain how well it can work and perhaps may come off as a little "new age" to some, but I believe training the mind is one of the most powerful things one can do to improve the quality of your diving and life in general. It's something to definitely look into if you are undertaking these kinds of dives and grappling with anxiety. It has really helped me and I enjoy wreck and cave dives so much more knowing that I am more in control of how my mind works and am able to act accordingly - which BTW also means knowing when to call the dive and exit calmly.

 

[sebach]

Not long ago my buddy and I planned to do a circuit in a cave in Mexico. It was a well known circuit, but neither of us had ever done it before. My buddy was cave certified, but he had far less experience than I. We knew our gas usage well, and based on what we read about the depth and length of the circuit, we were very confident we had enough gas. Everything went as planned. We put in the jump line to complete the circuit, and we headed off. It was quite a beautiful cave and i was enjoying the scenery quite a bit. As is true in many Mexican caves, though, the line was not well marked. There were no comfortable markers with numbers telling you how far you were from anything. There were pretty much no markers at all. We reached thirds, and i had not seen any markers indicating that we were passed the halfway point in the circuit. Had I missed something? According to our preparation, our shortest exit should have been ahead of us--but was it? With no arrows in sight, how could I be sure? We pushed on, and I began to grow concerned. Were we pushing deeper into the cave (instead of exiting it) without realizing it? I had read stories of confusing markings in Mexican caves causing errors leading to deaths, and I had even written one of those stories.

I was greatly relieved to see my jump line ahead, and we eventually reached the exit pretty much as planned, with nearly half our gas intact. My anxiety during the dive was simply due to my unfamiliarity with the cave and the lack of expected cues on the line. We had planned the dive well within our abilities, but that unfamiliarity brought on doubt and anxiety.

I might have unsderstood you incorrectly, but are you telling us that you went farther than your thirds on a circuit, without personal recent knowledge of the end of the circuit, relying of the (un)present markers and your recollection of the topography based only on your preparation?