FIT TO DIVE

Following a traumatic event, it is not unusual to experience a range of issues including stress, tension, numbing, switching off, sleep disturbance, anxiety & panic. This can be part of normal processing and will often improve. Opinions vary on how soon trauma-focused therapy should be offered. On the one hand, naturally-processing does occur and many people will feel better with talking to friends and some rest. On the other, this can also risk the trauma being avoided, unprocessed and getting stuck. It then stays in the nervous system, potentially triggered by events that connect to the original trauma. Repeat triggering increases the risk of retraumatization and also generalising to other situations. A bit like if you have a broken leg and keep walking on it. Interestingly,r ecent research with EMDR has been showing that shorter, earlier interventions have been helpful. Psychological assessment and formulation (1 to 2 sessions) can make a big difference in understanding and processing what has happened. There are also options for ways to cope that support people to respond to their experience in more helpful ways.

Guilt, shame and blame are common responses when something goes wrong. This is likely more intense where someone was injured or died in a diving incident you were part of. Sometimes what happened can link back to older traumas and things we do not like about ourselves, and this tends to awaken old shame, guilt or fear. Often this is the case when someone cannot let go. It may also be that mistakes were made, and evidence that you or your team/group were at fault. This adds more pressure and can make it harder to move on. However, it is also useful to be aware that guilt and shame are often part of the post-trauma profile, even when someone did all they could. Either way, if you find guilt and self-blame are weighing on you, it would be advisable to seek support. Therapy can help you to process what happened, and reflect on the reality of the situation. It can also help move past holding on to guilt to learning from what happened and making changes.

Heading to the bar or having a few drinks post-dive is part of diving for many people. So meeting up for a few drinks, to get back to normal and forget about what happened may be tempting. There are several reasons that it may not be the best idea though. During a stressful event, the brain processes information differently. You may even have noticed thoughts that you just could not deal with at the time because you were too busy being rescued or rescuing someone. At the time, it may have got shoved into the temporary storage of your nervous system. After the event it needs to be processed: thoughts, feelings, emotions, actions, images sorted out and filled away in memory. Alcohol tends to prevent that processing because it numbs. It can slow down the healing process. In addition, trauma affects emotions, you may feel angry, guilty, anxious .... alcohol can exacerbate that. There is also a risk of drinking to excess, and potential for further stressful events arising from that. Consider getting together with buddies or club, if that feels right, but without the drinks.

The honest answer is that it depends. It depends on what your current issue is and how it has developed. It depends on how much support you have. It depends on how much stress you are currently under. It depends on your coping style and the strategies you use to respond to psychological pain. It depends on what you do. Everyone is different. Some people may have fully processed and integrated the event several days after it happens, some people may take weeks or months. For some, it may not even seem like a concern at all, and then turn up years later when something similar happens.

The answer varies and depends on lots of other factors such as: other sources of stress in your life, severity and complexity of the incident; how you interpreted the event; how much support you have available. National guidelines suggest that for single incident traumas, 8 - 12 sessions is the norm. If there are multiple traumas, then more time is needed. EMDR tends to be faster than CBT, though both are effective. Often 1-3 sessions of EMDR can make a significant improvement. It also depends on how entrenched the issue is, and whether secondary traumas have occurred (for example due to panic episodes or repeat incidents when diving). There is also some evidence for preventative approaches, which support people immediately or soon (within first month) of an accident.

Research shows that therapy is effective when provided by remote videocall. In some cases, it can be more effective than therapy within the same room. There are some advantages to remote therapy: convenience, less travel time, being more comfortable in your own environment, having more control over the process, feeling less inhibited etc. Since the pandemic in 2020, many therapist were pushed into adopting remote therapy. This has lead to the opportunity for gathering data for research. EMDR, which was previously under-researched with regard to online methods, has been found to be effective. There are also therapy tools via online platforms dedicated to providing EMDR.

Sometimes it can be hard to talk to friends and family if they can't connect to your experience of diving. Some may not be able to understand what the upsetting part was, because they have never experienced anything similar. Many may hold the belief that all diving is dangerous and unintentionally respond with distress. Perhaps they tell you not to dive, and then expect that this would fix the issue. People find it hard to connect with something they do not have experience of. Try using an analogy like driving. In some ways, when a dive goes wrong it's a bit like a car crash or near miss. The driver may be physically hurt, or not. Either way, they could experience post-trauma or stress injury. They may have trouble sleeping, panic episodes, anxiety etc. They may be nervous of driving again, ... or perhaps not. Maybe they set off for a drive and it's only when a reminder of the accident happens that the trauma is triggered. After a while, they may feel low, even get depressed because they are worried they will not be able to drive: something that was an important part of their life and identity. When divers have issues following an incident, it's quite similar, re-read the above and remove the "r" from driving.

First, understand that you have been injured. If you are struggling after a traumatic event then you may have sustained a stress injury. This injury affects the nervous system (the brain and the nerves that control most of our body, hold our thoughts and create emotions!) Unlike broken bones, cuts and bruises, these types of injuries can not be seen. Second, know that people heal from these injuries all of the time. The feeling of being stuck and fear that it won't get better is actually part of the injury. Third, seek help, talk to someone: a supportive friend, doctor, therapist or one of the helplines listed above.

There is not a lot of research, so we do not really know. It may be a bit similar to road traffic accidents, where we know that something like 10 to 30 percent of people involved experience post-trauma issues. There was a study published in 2010 that spent two years following every diver who was treated at the hyperbaric chamber in Orkney. they found "A significant minority of diving accident victims (between 25% and 50%) continued to suffer from the psychological impact of the accident, some for over a year." So it is possible that post-trauma issues after diving injury are relatively common. If you are struggling after such an event, you are certainly not alone.