By Dr. Stefano Casali
Premise
A recent study has shown that over half of the experienced divers interviewed experienced a panic attack at least once [1]. Statistics from DAN (Divers Alert Network) [2] and the University of Rhode Island [3] argue that panic was responsible for 20-30 percent of fatalities in diving and is probably the leading cause of death in diving activities. In a panic situation, the diver has only one thing in mind: to reach the surface as quickly as possible; in such circumstances he forgets to breathe normally, with the result of a possible arterial gas embolism. Zeidner [4] points out that the early stages of many forms of stress can be associated with anxiety and underlines how the fear of incurring an accident is part of the latter. This fear can be real or symbolic. According to Zeidner the main features of this type of anxiety are:
A. The individual perceives his own situation as threatening, difficult or demanding;
B. The individual considers his ability to cope with this situation as insufficient;
C. The individual focuses on the negative consequences that will result from his failure (to solve problems), rather than focusing on finding possible solutions to his difficulties.
Persistent anxiety over a long period of time can degenerate into a state of panic. Anxiety, however, always refers to an excessive sense of apprehension and fear. Characterized by physiological symptoms, sometimes of a neurovegetative type, it can produce both physical and psychological symptoms. Anxiety can determine doubts about the nature and reality of the threat as well as doubts related to oneself regarding the ability to face the situation. Physical symptoms can vary greatly, from sweating of the hands and tachycardia of the medium forms to psychomotor agitation, emotional paralysis or the onset of a panic attack or phobic reaction. The difference is only a technical fact.
Anxiety serves a specific purpose: it is an alarm to a threat, which has a survival value. Escape is the most typical behavioral response to fear. Occasionally, however, direct action is necessary (fighting instead of escaping) and a physiological activation can sometimes provoke a heroic reaction, such as attacking a shark or jumping into the cold waters of a river to save a dog that is about to drown. Some studies have shown that an average level of anxiety guarantees optimal performance in certain situations. People who experience mild to moderate anxiety have an "arousal" rating that allows them a better performance level than people who do not feel anxiety. An average level sometimes causes an increase in motivation to focus on one's goals. An excess, on the other hand, tends to make the individual focus on himself and his fears, moving him away from his goals. A low level of anxiety can help the diver be more cautious. An excessive state of anxiety can lead to that reduced cognitive and perceptive dimension, in which the concentration and the attention of the diver can move on inner fears making him neglect important aspects, such as the slow ascent towards the surface. Panic, on the other hand, can be a signal when a stimulus presents itself or it can arise spontaneously if it occurs in the absence of a triggering element (apart, perhaps, a simple thought or an idea); in comparison with the "attack or flight" of anxiety, the signs and symptoms of panic are more pronounced. The panic attack has a sudden onset, reaches a symptomatic peak very quickly (10 minutes or less from the onset), vanishes within 60 minutes and is often accompanied by a sense of imminent catastrophe and the urgency to leave. The symptoms of panic are much more debilitating than the anxiety crisis; rational thought is suspended and people can get stuck, for example they remain fixed in a position or react in an unpredictable way or in such a way as to put themselves in danger [5].
