Hidden Depths - Psychology research of divers

Insight on Diving Psychology and Mental Health: Q&A with a Clinical Psychologist

Dr Laura Walton is a PADI Master Instructor and experienced Clinical Psychologist who specialises in working with divers. We caught up with Dr Walton to ask her some frequent questions and to gain her insights into diving psychology.

 This blog is part of a three-part series covering:

1.       Keeping calm underwater

2.      Psychology research of divers

3.      Psychology as you progress through your diving career.

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Can regular diving cause long-term changes to the brain and mental health?

From a psychological perspective, the long-term impact of recreational scuba diving is generally positive. The underwater environment offers a sense of tranquillity and peace that can help reduce stress and anxiety. Many divers describe a sense of oneness with nature and a heightened sense of mindfulness while diving, which can contribute to overall mental well-being. There have been several studies that show that scuba diving helps reduce stress and anxiety and improve overall mental well-being. Nearly 70% of divers report feeling more relaxed and less stressed after a dive.

There are risks to brain health due to an acute injury in an adverse event (e.g., rapid ascent, missed decompression, barotrauma, or DCI); however, there is not much evidence for problems due to long-term exposure to recreational scuba.

For commercial and technical diving, the risks are higher, though there is limited research on these topics. There is a study that suggests some changes and negative impact on the brain over a long time.  A review of scuba, technical, and saturation diving in 2023 highlights some specific risks, mainly HPNS, and concludes that more research is needed. Other researchers have noted temporary headaches and fatigue following saturation dives.

As a psychologist who works with divers experiencing trauma-related conditions (acute stress injury and post-traumatic stress), I would also suspect that these higher-risk diving activities are likely to increase the possibility of psychological trauma.

The nature of diving is such that it is carried out in an "Immediately Dangerous to Life or Health (IDLH) Environment."  Psychological trauma may result when what happens to us exceeds our capacity to cope. In such an environment, a small issue can generate an experience that is a threat to survival. Add to that the potential contributions of feeling powerless in relation to authority, limited autonomy over actions in a working environment, or pre-existing self-worth issues, and the impact of such events is increased and may accumulate over time, particularly if not addressed. In talking to saturation divers, I have heard several stories of workers who keep going through multiple adverse events without support and not wishing to burden families, eventually building into significant mental health issues and even suicide. 

Psychological trauma is a form of brain injury and one that is often overlooked in diving. In scuba diving, a 2010 study (which I describe in more detail here) found that significant numbers of divers who attended the hyperbaric chamber after an incident in recreational diving continued to report symptoms of psychological trauma for months after the event.  I am not aware of similar studies conducted on commercial diving, though I would suspect the numbers would be higher. 

It is important to note that while these risks exist, they can be managed with proper safety measures, training, and equipment. Regular check-ups with a healthcare professional, proper training, and adhering to safety guidelines can help mitigate these risks. It is also important for divers to listen to their bodies and take breaks when needed.

Ultimately, the answer is that it depends! It depends on the kind of diving that is done, the adequacy of systems for managing risk, and the availability of support. As a diver, and with knowledge of the research, personally I find the benefits of recreational scuba diving to wellbeing far outweigh the risks.

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What do you see as the next steps for exploring the psychology of divers?

There are so many opportunities to explore this area further and contribute to the understanding of the psychological aspects of diving. There is a lack of research in diving psychology and the provision of clinical services. With exploration of the oceans set to expand, for example, with projects like Deep for underwater habitation and the existing demands of the commercial diving sector, I can see a valuable role for diving psychology. 

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You can learn more about Dr Laura Walton and her work here: https://blog.padi.com/diving-careers-interview-padi-staff-instructor-clinical-psychologist-laura-walton/

If you would like to hear more from Dr Walton, her clinical psychology services, or courses, please visit www.fittodive.org

Stay tuned for her next blog on psychology as you progress through your diving career….

 

Keep Calm and Carry on... Diving. Clinical Psychologist tips on keeping calm underwater.

Insight on Diving Psychology and Mental Health: Q&A with a Clinical Psychologist

Dr Laura Walton is a PADI Master Instructor and experienced Clinical Psychologist who specialises in working with divers. We caught up with Dr Walton to ask her some frequent questions and to gain her insights into diving psychology.

 This blog is part of a three-part series covering:

1.       Keeping calm underwater

2.       Psychology research of divers

3.       Psychology as you progress through your diving career.

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Q: What sparked your interest in the psychology of divers?

My interest developed from the combination of my professional background in psychology and my personal passion for diving. I was always fascinated by the human mind and behaviour, which led me to pursue a career in psychology. My attention to the psychology of divers specifically was peaked when, as a diving professional, I noticed the significant psychological challenges that divers face, such as dealing with fear and anxiety, maintaining calm under pressure, and coping with the isolation and sensory deprivation that can occur during deep dives. I realised that psychology could be applied to help divers manage these challenges effectively. I am also intrigued by the potential for diving to be used as a form of therapy and its impact on wellbeing.

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Q: Do you have any tips on keeping calm underwater?

Approximately 33% of divers report feeling anxious or stressed during a dive.

Training

Keeping calm in an underwater emergency starts a long time before the adverse event occurs. The first step is to undergo comprehensive diving training that is appropriate for the diving you are doing. This will equip you with the necessary skills and knowledge to manage a variety of underwater emergencies. It is important to familiarise yourself with your equipment, understand the potential risks and challenges you may encounter, and learn how to respond effectively. People do not panic because they think it is a good idea! We panic as a byproduct of the innate survival processes that are triggered when we do not see a solution or perceive ourselves as unable to cope with the situation. We can consider psychological factors such as emotion regulation and mindset. Visualising potential problems or emergency scenarios and your responses can help you react more effectively when faced with a real-life situation.

Mindfulness 

Mindfulness (or other attention training techniques) and breathing exercises can also be beneficial in managing stress and maintaining calm. It has been shown in studies that teaching novice divers to breathe deeply and mentally rehearse skills can reduce anxiety and improve performance.

Social Environment

Trust and connection are powerful processes for humans, and they are essential in regulating emotional and behavioural responses. Before any emergency occurs, it is possible to create psychologically safe teams where issues of risk can be addressed and managed. 

Debrief 

Lastly, a related point is that it is important to debrief after diving activities, whether they went well or there were minor issues. Reflecting on what happened, how you responded, and what you could do differently next time is a valuable part of learning and improving your emergency response and preventing major incidents. If you find that you are struggling with anxiety or other emotional reactions following an underwater emergency, consider seeking support from a mental health professional who understands the unique challenges of diving.

The traditional way of answering this question, while useful, misses a lot. It is often said that in the event of an emergency, remember the diving mantra:

Stop, breathe, think, and act

·         Stop any movement to conserve air and reduce the risk of panic.

·         Breathe slowly and deeply to help calm your nervous system and clear your mind.

·         Think about what you need to do based on your training and the situation at hand.

·         Then, act on your plan, making sure to communicate with your dive buddy or surface support if possible.

This is all good advice; however, it is impossible for a brain in fight or flight to carry this out. Looking at habits, psychological health, and systems for preventing and responding to failure is more effective. For example, do not wait for an emergency to practice pausing. You can practice pausing at multiple points during a dive. 

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You can learn more about Dr Walton and her work here: https://blog.padi.com/diving-careers-interview-padi-staff-instructor-clinical-psychologist-laura-walton/

If you would like to hear more from Dr Walton, her clinical psychology services, or courses, please visit www.fittodive.org

Stay tuned for her next blog on psychology research surrounding divers….

5 tips to Control your Blood Pressure, and avoid White Coat Hypertension...

As part of the H.S.E. Commercial Diver Medical, your blood pressure is checked. High blood pressure is an early warning sign of developing problems with your blood vessels, and leads to an increased risk of heart attack and strokes if it is not controlled.

Your blood pressure check is designed so that we can pick up on this early warning sign, and do something about it, before it affects your health in the long term, and before it leads to a diving emergency. By the age of 65 most people will need to take some medication to control their blood pressure, but sometimes high blood pressure is found much earlier.

If you're found to have high blood pressure, we may ask you to visit your GP for further tests (eg. blood tests) and to consider starting medication.

It can be controlled with simple lifestyle changes before starting medication. Most medications used for treating blood pressure are OK to taken when diving, but some are not, so if you are in doubt ask your Approved Medical Examiner of Divers (AMED). We can liaise with your GP to help guide them.

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White Coat Hypertension

This is the very common experience of finding that your blood pressure is higher when you are stressed, when sitting in the doctor (or nurses') room. These 5 tips will help you keep your blood pressure as low as possible during your appointment:

Tip 1: Avoid salt

Particularly for the 48 hours before your appointment, avoid any salty food or snacks (crisps, salted nuts). Keeping an eye on your food labels to buy "no added salt" or "low sodium" alternatives. In the long term, consider using other herbs and spices to your food instead of salt.

Tip 2: Avoid Alcohol

Regular alcohol intake >14 units a week (6 pints) or repeated binge drinking will increase your blood pressure. Limiting your alcohol all year round to below 14 units is advisable for lots of health reasons, but avoiding alcohol in the week leading up to your medical will particularly help your keep your blood pressure low during your appointment.

Tip 3: Consider missing the morning coffee

This one catches people out a lot. You may be traveling after a night shift, and driving to your appointment, and so you might normally drink a coffee or caffeinated drink to keep you alert. However, along with keeping you alert, it will also increase your blood pressure.

Tip 4: Relax

Avoid stress, and plan a relaxing morning before your appointment. Plan your journey with plenty of time to avoid putting yourself in any unnecessary stressful situations. Consider asking for a lift from a friend or family member.

When your blood pressure is being taken, focus your mind on what you can control, positive memories from the last year and remember to take long big deep breaths when your blood pressure is being taken. Don't focus your mind on the "what if's" and any future plans such as transport home, and the next job.

Tip 5: Take your medication

If you are on medication for your blood pressure already, remember to take your medication that morning before coming to your appointment. Remember to tell us what medication you are taking (you may want to bring a prescription or the box with you).

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Summary

Having a diagnosis of high blood pressure (or Hypertension) does not stop you from diving if it is controlled with lifestyle changes or the correct medication. We can work with you and your GP to control your blood pressure and keep you safe at work.

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Safe Diving