By Dr. Stefano Casali
Implosive techniques (flooding)
Implosive techniques [21] tend to overload the pupil with a series of anxiety-provoking stimuli, with the idea that the subject can quickly get used to the stressor. Although it is not advisable to put the aspirant in difficulty to prove his degree of panic reaction, eg. tearing off the mask or the ballast, showing him a negative and highly anxious scenario can be useful, even if with obvious limitations.
Cognitive-behavioral techniques
These therapeutic methods emphasize the reorganization of thoughts, perceptions, attitudes and behaviors that produce anxiety in the person. Under the direction of a therapist, subjects explore the antecedents of their anxiety (for example, equipment failure, loss of dive buddy and other stressors) and learn other ways of thinking to decrease or eliminate these concerns. Divers can learn specific techniques to stop these distressing thoughts before they reach the point of becoming overwhelming anxiety.
An interesting and extremely simple technique is called "stopping thought" and it is no longer complicated to wear an elastic band on your wrist. When an intrusive and worrying thought begins, the pupil can snap the rubber band against his wrist. This pungent and slightly painful sensation immediately draws the attention that was taken into a thought that produces anxiety. At that time, then, the diver tells himself "Stop". With time and a little practice, these techniques achieve remarkable results in reducing anxiety.
The "Stop - Breathe - Think - Act" technique
There are many potentially stressful situations that can occur during a dive. The manuals of the most serious educational agencies propose a kind of rational cognitive therapy [22] aimed at making the diver recognize the onset of panic and provide him with the tools to regain control in a stressful situation, which is based on the cognitive schema:
Stop - Breathe - Think - Act.
I will present some examples that can exemplify this type of conduct:
1. Carlo immerses himself and finds himself hindered by passing through a bed of long algae at a depth of about 15 meters. When he tries to strike more strongly to free himself, he finds himself stuck more deeply. She has an anxious reaction "I'm stranded. What happened? I can't get away from here! Oh my God! I wrapped myself in this stuff!" After each attempt to free himself, Carlo finds himself more blocked. He begins to hyperventilate and consumes the air quickly. He is not sure if the algae have twisted around his body or on the tank. At some point he decides to take off the BCD and the tank and makes an emergency ascent risking to drown. The onset of panic attack must instead involve the following sequence. STOP: "I got caught in the algae. I feel like I can't move. I stop and imagine how to get out of it." BREATHE: "I must control my breath. I take slow, deep breaths while I think of this. I should still have 100 bars of air to breathe in the tank." THINK: "Since I can't move I have two possibilities: try with the knife to cut what stops me or try to take off my jacket and tank". ACT: Carlo slides his right hand along his leg and takes the knife. Slowly and carefully he begins to cut all the algae he can see or hear at the waist. Making slight rotational movements continues to cut ever wider areas. In a few minutes he can turn around completely and cut the remaining algae around his ankles. Here he puts the knife back and begins a slow ascent towards the surface.
