Scuba diving therapy

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Scuba diving therapy is a type of treatment that consists of a variety of scuba diving activities and exercises. Essential elements are increased body awareness, social bonding, and breathing techniques. The goal is to improve physical and psychological well-being. [1]

Contents

Description

Scuba diving is generally considered to be a high performance adventurous recreational activity that requires a multitude of safety precautions. The relatively risky sport or component of military service, has been established as a provisional element of therapy. Scuba diving has shown effectiveness as a therapeutic and rehabilitation process for veterans who had acquired traumatic physical and/or psychological injuries. [1] Scuba diving was shown to be a therapeutic process that can help people with various disabilities to reconnect with such activities while simultaneously focusing on the clear goal of coping with their impairment. [2] It can seem a very challenging activity for them but the apparent weightlessness in the water facilitates their experience. Even in extreme cases like with people in a wheelchair they regain a feeling of equalness in the water along with general mental improvements. Scuba diving therapy and rehabilitation relies on extensive stimulation of the entire human body. [2]   Benefits were also seen in the improvement of psychological aspects such as anxiety disorders, PTSD and an abatement in social dysfunction and depression. [1] [2]

Types

Recreational diving as therapy

As with other recreational activities, freediving and scuba-diving can provide immersive experiences that can help to reduce stress. [3] A study by Marlinge et al. (2019) has shown that scuba diving helped to promote relaxation which can lower levels of multiple stress markers like cortisol, copeptin and ischemia-modified albumin (IMA) levels. [4] Additionally, researchers from the Johns Hopkins University of Medicine found scuba diving to result in a significant improvement of PTSD symptoms, with a reduction of muscle spasticity by an average of 15%. [5]

Adaptive diving

Adaptive scuba diving is scuba diving by people with disabilities using techniques modified to allow the diver to participate as independently as their abilities allow. Learners are assessed according to their ability to perform each necessary skill-set. [6] Adaptations to procedures are made during training as applicable. It is possible that an adaptive diver may be certified at the same level as an able-bodied diver, but where this is not possible they may be certified to dive with a specially trained dive buddy or buddies who can provide necessary assistance for acceptable safety. [6]

Adaptive diving is an acceptably safe form of diving that helps people with amputations and other disabilities to dive as independently as reasonably practicable. The practical training is adjusted individually to suit each person. Through adaptive diving people can improve their body balance, and fine motor control in their hands. [7] Studies with veterans have shown that body balance after losing a leg can be improved with the help of adaptive diving. [7] The studies also report an improvement of 3.7 and 3.9 points [ clarification needed ] of the veterans anxiety and depression symptoms. [7] The improvements were shown with higher self confidence, emotional calm, goal and purpose. [7]

A diving service provider would generally need to provide extra diving support staff to ensure acceptable safety for an adaptive diver. A medical professional would be consulted to assess the diver's prospective abilities and suitability for training. Modified diving equipment is a common requirement. [8]

Adaptive diving equipment

The diving industry can support adaptive divers by developing specialized equipment to help manage various problems. These include access to the water, which can utilise chair lifts or wheelchair ramps, vehicle modifications for wheelchairs, hoists or cranes similar in principle to diving stages used by commercial divers, and lifting harness similar in principle to those used by surface supplied divers. [8]

Adaptive diving equipment includes specialized personal equipment, including protection of residual limbs and scar tissue, and propulsive equipment by way of customised fins for arms and legs, and inherently stable buoyancy control systems. [8]

Area of application

Scuba diving can decrease depression, anxiety, and post-traumatic stress disorder (PTSD) in military veterans and people who are dealing with similar mental illnesses. [7] Diving allows people to achieve a feeling of liberty, due to the concentration needed for the duration of the dive. This leads to an increase in mindfulness and a decrease in depression and anxiety levels. The risks that are involved in scuba diving may also lead to a decreased urge for control in life. This helps individuals reach acceptance of uncontrolled events. [7] Next to a decrease in stress and anxiety, veterans participating in scuba diving also reported improved levels of concentration and focus. [9]

The use of diving in therapy, specifically scuba diving, is applied to a wide range of disorders. The therapeutic effects range from psychological to physiological. [10] In Norway, for example, it is applied to people who have lost their vision, suffer from multiple sclerosis or amputees. The aim is to increase their sensory awareness and promote the strengthening of confidence. [10]

Military veterans may undergo therapeutic diving, when they suffer from physiological or psychological impairments, such as traumatic brain injuries or Post Traumatic Stress Disorder (PTSD). [10] Scuba diving has the potential to benefit veterans with PTSD, as they respond less to conventional treatments than the non-military populations. [11]

Diving therapy is advantageous for milder types of anxiety and chronic stress disorders, by increasing mindfulness and a sense of relaxation. [12] Scuba interventions have been organized for people with neurological and neurodevelopmental disorders, such as autism spectrum disorder. [13]

Therapeutic scuba programmes are delivered by local or international organisations which have an interest in supporting the physical and psychiatric rehabilitation and recovery of people with physical or mental health conditions. [14]

Diving therapy is applied in different countries, ranging from Malaysia to the Bahamas, and the UK. [10] [15] [16]

Effectiveness

Scuba diving has proven to help with physical, mental and social issues. For people with physical disabilities, scuba diving can help improve their self-perception. [2] Through positive experiences and mastering the partly challenging techniques that are required in scuba diving, levels of self assessment can rise and levels of depression can significantly decrease. This can be explained by the reduced weight experienced in water, that accommodates people with disabilities to participate in physical activities. This allows the feeling of the disability to be diminished since individuals are not limited under water and they are even able to enhance their movement and improve their muscle strength. [2] Diving can give individuals a feeling of accomplishment and therefore an increase in the level of contentment. [7] Studies have also shown scuba diving therapy to help with social interactions and relationships: Participants noted that scuba diving has helped them to regulate their mood and made them less irritable in daily life. [9] For some, even just thinking back to the dive can have a calming and relaxing effect. Apart from this, scuba diving can also have physical treatment effects. For instance, training to breathe under water can heal people suffering from chronic obstructive pulmonary disease by increasing the peak and endurance exercise capacities. [2]

Scuba diving can decrease depression, anxiety and PTSD in military veterans and people that are dealing with such mental illnesses. [7] Diving allows patients to achieve a feeling of liberty, due to the concentration needed for the duration of the dive. This leads to an increase in mindfulness and a decrease in depression and anxiety levels. The risks that are involved in scuba diving may also lead to a decreased urge of control in life. This helps individuals achieve acceptance of uncontrolled events. [7]

Next to a decrease in stress and anxiety, veterans participating in scuba diving also reported improved levels of concentration and focus. [9]

Limitations

Many mental or physical health issues make it unsafe for a patient to undergo scuba treatment, as it requires processes such as thinking, concentration, or problem-solving. [14] Before starting the therapy, a medical professional should evaluate the fitness-to-dive state of the patient. [14]

Specific psychiatric medications are not compatible with diving, and scuba therapy is not recommended when they are used. [14]

Higher costs are associated with scuba dive therapy, so the therapy is limited to patients who are able to finance it. Several organizations and charities have started fundraising to make the therapy more accessible to lower-income patients. [2]

Scuba diving requires specialized equipment to ensure safety and comfort of the divers underwater. This leads to limitations due to the availability and cost of obtaining such equipment. [14]

Trained professionals are needed to supervise therapy dives to ensure safety. [14]

Training

Training as an Adaptive Support Diver is provided by PADI, with the claimed goal of increasing awareness of diver's varying abilities and techniques applicable when diving with a buddy with a disability. The specialty training has prerequisites of Freediver or Open Water Diver certification and current Emergency First Response primary and secondary care certification. Adequate buoyancy control and trim skills are also recommended. [17]

See also

Related Research Articles

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event and can include triggers such as misophonia. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones generally with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples of distressing events include violence, rape, or a terrorist attack.

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is a recommended treatment for post-traumatic stress disorder (PTSD), but remains controversial within the psychological community. It was devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories such as PTSD.

<span class="mw-page-title-main">Yoga as therapy</span> Yoga in the use of physical and mental therapy

Yoga as therapy is the use of yoga as exercise, consisting mainly of postures called asanas, as a gentle form of exercise and relaxation applied specifically with the intention of improving health. This form of yoga is widely practised in classes, and may involve meditation, imagery, breath work (pranayama) and calming music as well as postural yoga.

Post-concussion syndrome (PCS), also known as persisting symptoms after concussion, is a set of symptoms that may continue for weeks, months, or years after a concussion. PCS is medically classified as a mild traumatic brain injury (TBI). About 35% of people with concussion experience persistent or prolonged symptoms 3 to 6 months after injury. Prolonged concussion is defined as having concussion symptoms for over four weeks following the first accident in youth and for weeks or months in adults.

Virtual reality therapy (VRT), also known as virtual reality immersion therapy (VRIT), simulation for therapy (SFT), virtual reality exposure therapy (VRET), and computerized CBT (CCBT), is the use of virtual reality technology for psychological or occupational therapy and in affecting virtual rehabilitation. Patients receiving virtual reality therapy navigate through digitally created environments and complete specially designed tasks often tailored to treat a specific ailment; and is designed to isolate the user from their surrounding sensory inputs and give the illusion of immersion inside a computer-generated, interactive virtual environment. This technology has a demonstrated clinical benefit as an adjunctive analgesic during burn wound dressing and other painful medical procedures. Technology can range from a simple PC and keyboard setup, to a modern virtual reality headset. It is widely used as an alternative form of exposure therapy, in which patients interact with harmless virtual representations of traumatic stimuli in order to reduce fear responses. It has proven to be especially effective at treating PTSD, and shows considerable promise in treating a variety of neurological and physical conditions. Virtual reality therapy has also been used to help stroke patients regain muscle control, to treat other disorders such as body dysmorphia, and to improve social skills in those diagnosed with autism.

<span class="mw-page-title-main">Animal-assisted therapy</span> Alternative or complementary type of therapy

Animal-assisted therapy (AAT) is an alternative or complementary type of therapy that includes the use of animals in a treatment. The goal of this animal-assisted intervention is to improve a patient's social, emotional, or cognitive functioning. Studies have documented some positive effects of the therapy on subjective self-rating scales and on objective physiological measures such as blood pressure and hormone levels.

Somatic psychology or, more precisely, "somatic clinical psychotherapy" is a form of psychotherapy that focuses on somatic experience, including therapeutic and holistic approaches to the body. It seeks to explore and heal mental and physical injury and trauma through body awareness and movement. Wilhelm Reich was first to try to develop a clear psychodynamic approach that included the body.

<span class="mw-page-title-main">Psychological intervention</span>

In applied psychology, interventions are actions performed to bring about change in people. A wide range of intervention strategies exist and they are directed towards various types of issues. Most generally, it means any activities used to modify behavior, emotional state, or feelings. Psychological interventions have many different applications and the most common use is for the treatment of mental disorders, most commonly using psychotherapy. The ultimate goal behind these interventions is not only to alleviate symptoms but also to target the root cause of mental disorders.

Exposure therapy is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the patient to the anxiety source or its context. Doing so is thought to help them overcome their anxiety or distress. Numerous studies have demonstrated its effectiveness in the treatment of disorders such as generalized anxiety disorder (GAD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and specific phobias.

Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous. Additional procedures include processing of the trauma memory and breathing retraining.

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

<span class="mw-page-title-main">Fitness to dive</span> Medical fitness to function underwater

Fitness to dive refers to the medical and physical suitability of a diver to function safely in an underwater environment using diving equipment and related procedures. Depending on the circumstances, it may be established with a signed statement by the diver that they do not have any of the listed disqualifying conditions. The diver must be able to fulfill the ordinary physical requirements of diving as per the detailed medical examination by a physician registered as a medical examiner of divers following a procedural checklist. A legal document of fitness to dive issued by the medical examiner is also necessary.

Operational stress injury or OSI is a non-clinical, non-medical term referring to a persistent psychological difficulty caused by traumatic experiences or prolonged high stress or fatigue during service as a military member or first responder. The term does not replace any individual diagnoses or disorders, but rather describes a category of mental health concerns linked to the particular challenges that these military members or first responders encounter in their service. There is not yet a single fixed definition. The term was first conceptualized within the Canadian Armed Forces to help foster understanding of the broader mental health challenges faced by military members who have been impacted by traumatic experiences and who face difficulty as a result. OSI encompasses a number of the diagnoses found in the Diagnostic and Statistical Manual of Mental Disorders (DSM) classification system, with the common thread being a linkage to the operational experiences of the afflicted. The term has gained traction outside of the military community as an appropriate way to describe similar challenges suffered by those whose work regularly exposes them to trauma, particularly front line emergency first responders such as but not limited to police, firefighters, paramedics, correctional officers, and emergency dispatchers. The term, at present mostly used within Canada, is increasingly significant in the development of legislation, policy, treatments and benefits in the military and first responder communities.

Trauma-sensitive yoga is yoga as exercise, adapted from 2002 onwards for work with individuals affected by psychological trauma. Its goal is to help trauma survivors to develop a greater sense of mind-body connection, to ease their physiological experiences of trauma, to gain a greater sense of ownership over their bodies, and to augment their overall well-being. However, a 2019 systematic review found that the studies to date were not sufficiently robustly designed to provide strong evidence of yoga's effectiveness as a therapy; it called for further research.

MDMA-assisted psychotherapy is the use of prescribed doses of MDMA as an adjunct to psychotherapy sessions. Research suggests that MDMA-assisted psychotherapy for post-traumatic stress disorder (PTSD), including Complex PTSD, might improve treatment effectiveness. In 2017, a Phase II clinical trial led to "breakthrough therapy" designation by the US Food and Drug Administration (FDA) for potential use as a treatment for PTSD.

Being exposed to traumatic events such as war, violence, disasters, loss, injury or illness can cause trauma. Additionally, the most common diagnostic instruments such as the ICD-11 and the DSM-5 expand on this definition of trauma to include perceived threat to death, injury, or sexual violence to self or a loved one. Even after the situation has passed, the experience can bring up a sense of vulnerability, hopelessness, anger and fear.

Psychological trauma in adultswho are older, is the overall prevalence and occurrence of trauma symptoms within the older adult population.. This should not be confused with geriatric trauma. Although there is a 90% likelihood of an older adult experiencing a traumatic event, there is a lack of research on trauma in older adult populations. This makes research trends on the complex interaction between traumatic symptom presentation and considerations specifically related to the older adult population difficult to pinpoint. This article reviews the existing literature and briefly introduces various ways, apart from the occurrence of elder abuse, that psychological trauma impacts the older adult population.

References

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  11. ↑ Walker, Petra Ann; Kampman, Hanna (2022-11-20). ""It didn't bring back the old me but helped me on the path to the new me": exploring posttraumatic growth in British veterans with PTSD". Disability and Rehabilitation. 44 (24): 7455–7463. doi:10.1080/09638288.2021.1995056. ISSN   0963-8288. PMID   34714191. S2CID   240154445. Archived from the original on 2024-03-02. Retrieved 2023-05-14.
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  16. ↑ Russell, Mark 'Crowley' (2018-07-17). "New study confirms therapeutic benefits of scuba diving". DIVE Magazine. Archived from the original on 2023-05-14. Retrieved 2023-05-14.
  17. ↑ "Adaptive Support Diver". www.padi.com. Archived from the original on 2 January 2024. Retrieved 2 March 2024.
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