By Andy Davis. Scuba Tech Philippines, Copyright 2011
I'm not a psychologist, but I have noticed some trends when it comes to diver reaction to incident stress, and how those trends can be, to a greater or lesser degree, influenced by the effectiveness of scuba training.
Panic is a major danger to scuba divers, because most safe diving practices are often counter-intuitive to natural instinct. A diver in a panicked state will revert to instinctive self-preservation rather than the controlled implementation of effective solutions. This situation results in most, otherwise avoidable, scuba diving fatalities and injuries.
Most people have heard of the 'fight or flight' response, otherwise known as the 'acute stress response'. Whilst underwater, when confronted with an acute fear of drowning, there is very little opportunity for the 'fight' element (short of attacking a fellow diver to secure their air supply etc). Thus, the 'flight' response is nearly always dominant when divers exceed their psychological capacity for rational response.
To understand diver panic, it is beneficial to consider the factors that can lead to it. In general, I believe there are two types of 'panic' commonly evident in divers:
1) 'Hair-trigger' panic. i.e. the diver doesn't attempt to seek a solution or enact any rational trained response, resorting immediately to the irrational 'flight' response.
2) 'No-resolution' panic. i.e. the diver tries, but fails, to identify a resolution to an incident or fails to properly implement a known solution. Thus, they feel they are "out of options" and that sense of helplessness causes them to react instinctively and flee to the surface. An initial response for rational self-preservation prevails, but is unsuccessful in outcome, inevitably leading the diver to resort to an irrational 'flight' response.
The first situation is really about comfort zone and reaction to stress - the factors that cause stress and the individuals' threshold for the acute stress response. Every individual enters a different environment/situation with a unique comfort zone for the conditions they will psychologically endure before a panic 'fight-or-flight' reaction occurs. Likewise, they also have a unique tolerance for subduing that reaction based on their personal ability to suppress an instinctive panic response. The scuba instructor has a limited capacity to influence these factors. The second situation is much more within the scuba instructors capacity to influence. This deals with effectiveness and relevance of the training provided.
Comfort Zone. Most diving students start training with a small comfort zone underwater, but that comfort zone increases with experience, at varying rates unique to individuals. Whilst the comfort zone remains small, even the most minor problems can trigger instinctive self-preservation responses that are contrary to safe conduct underwater (primarily, fleeing to the surface).
It is the job of the instructor to preserve the student's safety until they gain sufficient comfort and familiarity within the underwater environment to the extent that they can psychologically deal with any reasonably foreseeable problems. Short-duration, minimum requirement certification courses can be the antithesis of this responsibility - and this leads to many student divers being certified before their comfort zones have sufficiently expanded to provide the necessary psychological tolerances. Emphasising how the importance of applying personal limits to diving, in addition to agency recommended limits, is also a critical step in helping the student balance their comfort zone against their capability.
Comfort zone (and associated physical limits) must be based on a worse-case scenario, determined by the foreseeable problems that can be encountered, rather than any notion that a dive will proceed under ideal circumstances. In short, students shouldn't be certified until they can deal with foreseeable problems, relevant to the dives they will conduct, with physical and psychological ease.
Reaction to Stress. Regardless of the scope of an individual's comfort zone, there are natural variances in how a person reacts to being outside of that comfort zone. Some people have more capacity to deal with stress than others. This dictates the point at which stress leads them into an irrational acute stress response. Whilst stress management can be taught within the syllabus of scuba training, that knowledge alone can have little impact on an individual's actual psychological ability to deal with stressors. Developing a more robust coping method is well outside the scope and confines of even the most in-depth scuba training course - and firmly within the realms of long-term medicinal psychology.
If a scuba student has a 'hair-trigger' acute stress reaction, there is little that a scuba instructor can do to provide any assurance of safety should problems occur on subsequent dives. No amount of training and preparation can benefit a diver whose psychological make-up determines that they will rapidly enter a panic-state and fail to apply that training or problem solving when they encounter a stressful problem. It should be noted that some scuba training syllabus (i.e. military, technical and 'pro'-level recreational) include an element of psychological 'stress testing'. These activities might increase a divers' comfort and familiarity with stress situations, but ultimately do little to actually influence their psychological threshold to panic. In essence, they widen the scope of a person's comfort zone, but do not impact on the reactions that occur when the limits of that comfort zone are exceeded.
The responsibility of the instructor in this instance is to build an awareness of each student's psychological thresholds and recognise that not everyone has the psychological capacity to be a safe scuba diver or to progress to more demanding levels of diving. A strong ethical bias in this respect should lead to the instructor withholding certification for those students who fail to demonstrate sufficient capability to withstand stress underwater.
Solutions and Resolutions. Debilitating stress responses can occur when a person perceives that they don't have a solution to the problems they encounter. Regardless of experience, comfort zone or personal stress management capacity, any individual can revert back to an instinctive 'fight-or-flight' reaction when they perceive that they have no alternatives for self-preservation. This is an issue that can be dealt with via effective training. The responsibility of the scuba instructor is to provide students with a pre-determined series of solutions to foreseeable problems, thus negating any panic-inducing perception of helplessness should an stressful incident occur. These solutions have to be developed beyond the level of purely theoretical understanding, as mental acuity will be depreciated under stress. The aim is to reduce the necessity to problem-solve when under stress, this reducing the likelihood of a diver hitting a mental 'dead-end' of potential resolutions. If they are to be relied upon, critical incident solutions should be developed and ingrained as instinctive reactions. The use of repetition and realism in training have a major impact on the ingraining of these reactions. Again, short-duration, minimum standards training courses are an antithesis to this development.
Problem Solving. It should be recognised that not every feasible problem can be addressed through the development of ingrained, automatic responses. Variance in incident factors can equally lead students into a sense of helplessness if they perceive that their pre-designated ingrained responses are not ideally applicable to problems encountered. In addition to ingraining pre-set incident responses, the scuba instructor has a responsibility to develop students with a wider capacity for problem solving under variable circumstances. This can be achieved by varying the scope of training drills - providing a wider variety of situations for the students to practice skill implementation within, increasing the realism of training scenarios and combining simulated problems so that a 'textbook' response is insufficient.
If training drills are only conducted in clear-cut, easily definable sequences, then the diver will only develop the capacity to utilise those skills within clear-cut, easily definable circumstances. Whilst individual divers will possess different natural capacities to improvise and problem solve, the instructor can be pro-active in developing this capacity as a skill. Neglecting the development of this essentially reduces student safety to the base-line of their genetic pre-disposition for problem solving. The ability to maintain a flexible approach, improvise and apply existing skills under novel circumstances to achieve a safe outcome is beneficial for all divers.
However, it must be recognised that any personal capacity to problem-solve is ultimately determined by the individuals' reaction to, and threshold for, tolerable stress, as previously mentioned. In short, the ability to problem solve is the preserve of divers who have the psychological capacity to resist instinctive, acute stress reaction and apply intelligence and rational thinking under stress. An instructor can develop this as a skill, but cannot develop the divers' psychological traits that determine whether they can utilise the skill under stress. Psychological stress thresholds will always determine whether skills can be applied.
So, what can a scuba instructor achieve in training that will help prevent diver panic?
Firstly, the instructor can develop a divers' comfort zone. They can increase the scope of situations where the diver can operate without stress. If a diver is not stressed, then they will not progress into an acute stress reaction ('fight or flight'). Delaying the onset of stress can include developing familiarity with a wider range of diving conditions, activities and, of course, developing familiarity with potentially encountered problems under realistic conditions. It should also include giving prudent guidance to divers about their capabilities relative to their activities - the setting of 'limits'.
Secondly, the instructor can provide divers with effective resolutions to foreseeable problems; developing instinctive and ingrained responses to problems that the diver might be likely to face. The instructor can develop the divers' capacity to implement those resolutions on a more flexible basis, Not only giving divers effective survival tools, but teaching how to use them. Awareness of, and capacity to implement, such resolutions allows divers to mitigate stress and prevent the onset of an acute stress response.
Thirdly, the instructor can help a student gain more awareness of their psychological capacities for dealing with stress. If a diver develops a realistic and honest self-appreciation of their psychological thresholds and reactions, then they are better equipped to make sound and prudent decisions about the diving conditions that they might choose to subject themselves to. In the most extreme circumstances of 'hair-trigger' acute stress response tendency, this could include guiding the student to abandon scuba diving as a potential hobby. Not every problem can be rectified by the hard-work, motivation and diligence of the scuba instructor.
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