Panic Triangle:

Why scuba divers panic,

and some ways to avoid it.

Dr Laura Walton
In a state of panic, the human being acts on instinct, generally
heading mindlessly for the nearest escape. A person in panic
cannot think clearly and their actions are not rational, because
their brain is operating on survival mode.

We can't breathe underwater without our equipment, and we

can't go immediately to the surface because of the effects of
pressure. Panic is a dangerous state for a scuba diver.

A study that reviewed snorkelling and diving

accidents over a 20 year period found that,
although reports rarely noted the
mental/behavioural state of the diver, in those
that did, panic was a feature in 68 percent.
Davis M, Warner M, Ward B. Snorkelling and scuba diving deaths in New Zealand, 1980-
2000. South Pacific Underwater Medicine Society (SPUMS) Journal 2002 June; 32: 70-80

And it is not as rare as you might think ...

Experience of panic and near-panic underwater

has been reported between 25 and 54 percent of
divers.  This means perhaps as many as
one diver in every buddy pair has panicked, or
almost panicked, at some stage during their diving.
Morgan, W. P. (1995). Anxiety and Panic in Recreational Scuba Divers. Sports Medicine,
20(6), 398–421. & Colvard DF, Colvard LY. A study of panic in recreational scuba divers.
Undersea J. 2003;Q1:40–4

So we need a way to understand

panic in scuba diving ...
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What is the Panic Triangle?
This is a theoretical model for the onset of panic in scuba divers,
based on review of the literature and direct, informal
observation.  It is a way we can understand, talk about and,
(most importantly) prevent divers panicking underwater.   A
peer-reviewed, and edited, article on this topic is published in
the Undersea and Hyperbaric Medicine Journal.  .

REFERENCE:
Undersea Hyperb Med. 2018 Sep-Oct;45:505-509.
The panic triangle: onset of panic in scuba divers

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If you have ever done any mandatory fire training, then you have
probably heard of the fire triangle model for how a fire starts
and burns.  The fire triangle states that three things are needed
for a fire: fuel/combustible materials, oxygen and heat. 

Similarly, if panic is the fire, then it takes three circumstances to

ignite it:
gap in readiness,
difficulty in regulation and
a trigger event.

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 the Panic Triangle

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The three sides of the panic triangle:

Readiness  - a gap between the actual demands of the dive and

the diver's current skills, equipment or preparedness.

Regulation - the diver's ability to regulate their emotions and

physical reactions, and also their ability to direct and sustain
attention.

Stressor - a thing that happens that may cause a diver to become

stressed, such as an external problem, or a distressing thought.

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The gap in READINESS
This is the fuel: the diver does not have the skills/equipment to
respond to the specific situation effectively. 

To have sufficient skill means having both the competence and

the confidence to take the correct actions to avoid or resolve a
problem and achieve an aim or objective.  Being faced with a
situation that we are unable to deal with leads to a perceived
lack of control which, if we feel threatened by the event,
triggers panic as a survival response to escape.  (But only if we
are aware of the threat.)  

Whether a diver lacks readiness very much depends on the

situation, for example, an open water diver is able to control
their buoyancy adequately.  On a reef at 10m, with 30 metre vis
and no current, their skills are sufficient. But if we change the
context by increasing the depth, going into a cave system or
wearing full tech kit .. then it is clear there will be some skills
deficits.  Similarly, even an experienced tech diver will
experience a deficit if entering a situation they were not
expecting, or an equipment failure that was not prepared for.

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The difficulty in REGULATION
This is the oxidising agent that can fan the flames.

Our bodies have really interesting physiological systems that

manage, and are affected by behaviour and can change to adapt
to our situation.  For simplicity, I talk about two processes,  the
“wind – up” and the “wind-down”.  Winds-up means that systems
up-regulate us towards high arousal, i.e. fight or flight, or freeze. 
Wind-down means that systems down-regulate to low arousal
e.g. rest and digest OR the “flop” response (death feigning).  

We can wind-up or down to the extent the system sort of short

circuits, in what’s called dissociation (lights are on, but nobody
home; rabbit in the headlight; thousand yard stare).  All have a
survival basis, but in diving switching off rational thinking and
letting these survival strategies run the show rarely ends well.  
 
Note: We all have what is called a “window of tolerance” for
emotional arousal, and some people’s are bigger than others.

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 The STRESSOR
This is the heat: the event that turns up the pressure.

The events that can be triggers are virtually

unlimited.  Common ones include:

equipment issues - e.g. leaking mask,

faulty mouth piece, burst o-ring
environmental hazards - e.g. dangerous
marine life, strong currents
physical stressors - e.g. overexertion, gas
density effects/narcosis
internal events - physical sensations,
thoughts (e.g. negative, anxious, paranoid)

If you are thinking, some of these things don’t bother me ... then
that is the triangle! If you perceive yourself as having the skill to
deal with them (readiness), or are not in an unhelpful state of
arousal (regulation) - then those things won't be a problem for
you.

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Panic is sparked!
When we have all three sides of the triangle happening at the
same time, then panic may be sparked. Psychological and
physiological processes mean the panic fuels itself, in a positive
feedback loop. The more stressed the person gets, the more
they panic, the less able they are to fix the problem, the worse
the problem seems, the more they panic, the more stressed ....

This means the person in panic is not able to think clearly to

address the issues. In diving this leads to specific risks, due to
the irrational actions a person makes when panicking.

Fortunately, like fire, we can reduce the risk by limiting the three
sides of the triangle.

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Prevent Panic
Avoid dives you are not yet ready for by
sticking to recommended limits and
evaluating conditions on the day.

Close the gap between your current level of

ability and the dives you want to do by
seeking appropriate training, practicing
effectively and gathering experience.

When working at the edges of your comfort

zone, for example different types of diving,
depth or site conditions, set up additional
safety measures (e.g. supervision, reduction
of unnecessary tasks and stressors).

Being with an instructor or buddy that you

trust makes a difference to regulation, so
consider who you want to dive with,
particularly when the dive is more
challenging for you.

Consider what aspects of the dive can be

changed to reduce the chance of
encountering stressors you are not yet
ready for, (e.g. shallower sites, less water
movement).

Build skills in self-regulation, this can

include developing proper breathing habits,
learning to respond effectively to anxious
thoughts and calming emotions to retain
clear thinking.

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What next?
We can never fully predict what a person will do under pressure, but
we can understand panic - what it is and why people go into that
state. We can reduce the risk of panic in diving by being fit-to-dive,
learning scuba skills and building our ability to self-regulate.

Learn more about diver Want to know more about

panic in the Prevent Panic the role of breathing in
in Scuba Diving course on self-regulation, take this
fittodive.org FREE 1 hour course.

Be fit-to-dive! Join the If anxiety, depression or

Facebook Group to share other mental health
information, inspiration concerns are an issue for
and motivation. you on the surface, then
seek advice and support.

Consider taking a break

from scuba diving until you
are fit-to-dive.

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