Panika!

Glede na to da je potapljačev najhujši sovražnik panika in pa tudi najbolj smrtnonosen, bi predlagal da gdo poišče kakšen lušten članek o tej temi, ki bo pomagal našim mlajšim članom to nevarnost pravi čas prepoznati.

Starejši člani smo se z paniko srečali tako ali drugače verjetno vsi in bi v splošni debati znali povedati o tem marsikatero zgodbo, ki pa se je na srečo nas vsek končala srečno.

Na žalost je v angleščini...

How common is panic among scuba divers?

Dr. Morgan: More than half of the scuba divers in our study reported that they had experienced panic or near-panic episodes on one or more occasions.

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How big of a factor is panic in diving fatalities?

Dr. Morgan: The cause of death in more than 60 percent of scuba diving fatalities is listed as drowning, usually caused by such specific problems as lack of air, entanglement (in fishing nets, rope or kelp), air embolism, narcosis — and panic.

However, when "lack of air" is given as the causal explanation, often other sources of air are available via buddy breathing or a pony bottle. Also, air embolism, a common cause of diving fatalities, may result from rapid ascent due to panic, and the inability to free oneself from rope, nets or kelp may also be caused by a panic response. Diving authorities generally agree that panic behavior is responsible for many of the diving accidents and fatalities that occur in recreational scuba divers.

Since 1970, the number of annual U.S. scuba diving fatalities has varied from a low of 66 to a high of 147. However, the total number of active scuba divers is unknown; estimates range from 1.5 million to 3.5 million in the United States alone. Therefore, valid estimates of risk using traditional methods are not possible. Fatality estimates range from a low of 2 or 3 per 100,000 to 6 to 9 per 100,000, depending on the number of fatalities and estimations of the number of active divers in a given year.

Moreover, most studies of diver fatalities define a diver as someone certified as a diver. This is problematic because some individuals (1) scuba dive, but have not been certified, (2) are certified and never dive, and (3) may hold as many as 25 advanced level certifications, with the result that such a diver would be treated statistically as 25 divers. And, risk estimates in this activity have not considered the fact that someone who dives once in a given year is treated statistically in the same way as a diver who makes several hundred dives.

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Is the tendency to panic restricted to novice or beginning divers?

Dr. Morgan: No. Scuba divers with many years of experience sometimes experience panic for no apparent reason. One theory is that panic may occur in such cases because divers lose sight of familiar objects and experience a form of sensory deprivation. This problem has been labeled the "blue orb syndrome." However, in the case of inexperienced divers, there is usually an objective basis — for example, loss of air — for panic responses.

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What exactly is "panic behavior" by a diver?

Dr. Morgan: In simple terms, panic behavior is when a diver behaves in an irrational manner. An objective, observable stimulus is usually responsible for this inappropriate behavior, such as the sudden appearance of a shark, loss of visibility, loss of air, entrapment in a kelp bed and so on. A diver might develop problems with his or her regulator and, because of the lack of air, perform a rapid ascent with resulting air embolism. This action would be judged as a panic response because the diver might have access to a pony bottle, or other divers might be present who could share their air supply and perform a gradual ascent. Eyewitnesses have reported accounts of divers removing their regulators while diving, an action thought to be caused by a perception of inadequate air.

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Are anxiety and panic problems discussed in scuba diving instructional materials?

Dr. Morgan: No. Terms like "anxiety" and "stress" don't appear in the index of many books commonly used by national certifying bodies involved in scuba training. Panic, along with the problems that can occur in scuba diving as a consequence of panic, isn’t even addressed in these training manuals.

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How do men and women compare on the incidence of panic behavior while diving?

Dr. Morgan: Surveys indicate that more men than women take part in scuba diving. One recent study of 245 scuba divers revealed that 71 percent of the respondents were men, and 29 percent were women. The incidence of panic was significantly higher in women (64%) as compared to men (50%). However, a greater percentage of the men (48%) than women (35%) perceived the events as life-threatening.

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Can individuals with high anxiety be trained in techniques that will reduce the risks of panic?

Dr. Morgan: Apparently not. The use of interventions based on procedures such as biofeedback, hypnosis, imagery and relaxation in an effort to reduce anxiety responses in scuba divers exposed to various stressors have not been effective. Research has shown, for example, that hypnosis is effective in relaxing scuba divers, but it can also have the undesired effect of increasing their heat loss. Furthermore, relaxation is known to lead to increased anxiety and panic attacks in some "high anxious" individuals. This phenomenon is known as relaxation-induced anxiety (RIA). Individuals with a history of high anxiety and panic episodes should probably be identified and counseled during scuba training classes regarding the potential risks associated with this in diving.

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Are certain diving activities more likely to lead to panic episodes?

Dr. Morgan: Yes. Diver panic is usually caused by such objective stresses as equipment malfunctioning, sudden loss of visibility, entrapment (for example, by seaweed or nets), threatening marine life like sharks, loss of orientation during a cave, ice or wreck dive, and so on. Therefore, diving with faulty or inappropriate equipment, or performing high-risk dives will have greater potential for panic episodes. However, it should also be noted that the problems resulting from high-risk dives can be prevented or minimized with appropriate training and cautionary actions.

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Can we predict whether someone will experience panic while scuba diving?

Dr. Morgan: Yes. The psychological variable known as trait anxiety is regarded as a stable or enduring feature of personality, whereas state anxiety is situational or transitory. Individuals who score high on trait anxiety are more likely to have increased state anxiety and therefore panic during scuba activities.

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Should some people be discouraged from scuba diving?

Dr. Morgan: Yes. It is clear that individuals who score high on measures of trait anxiety are potentially at a greater risk than those scoring in the normal range on this psychological variable. Of course, individuals with certain medical problems probably also shouldn’t scuba dive.

pa še to...pa že pa opet v engliš...


Stress, anxiety and panic

Most divers will experience enough stress at some time in their diving lives to feel anxiety before, during or after a dive. For some, this will reach an intensity that makes normal functioning difficult or impossible and this is the state we call panic. According to some diving psychologists, such as Bachrach and Egstrom (1987), panic is the leading cause of diving fatalities. Panic can result from a gradual accumulation of anxiety evoking events (cold, tiredness, unfamiliarity with equipment etc.), or from a single event that the diver feels unable to handle (regulator free flow, loss of a mask etc.). Edmonds (1986) pointed out that fear alone, without the addition of any other stress, can cause death. Panic is more likely to happen when diving at a new site or in more extreme conditions than the diver is used to.

For some people, a gradual accumulation of stressful life events can take them closer to their panic threshold. If you are interested in a seeing a list of typical life events, with an estimate of their typical stress value, click here.

This should also be distinguished from the chronic (long lasting) condition of panic disorder. Psychologists define panic in a specific way that is somewhat different to the way divers use the word. They define it as an intense fear of losing control or dying. According to the Recreational Scuba Training Council (1998), a panic disorder is an absolute contraindication to scuba diving. This was modified in 2001 to acknowledge that if the panic disorder is being treated, the individual may be able to dive. However, there is evidence from the study by Colvard and Colvard (2003) that divers who have experienced panic attacks unrelated to diving are about twice as likely to experience panic while diving, compared to those with no history of panic attacks. They also report a gender difference, with females more likely to panic while diving than males.

The main signs and symptoms of panic are:

Respiratory changes: Changes in the breathing rate and pattern. In a panic attack, shortness of breath is common and the diver may feel that they cannot get enough air into their lungs.
Cardiovascular changes: Changes can include tachycardia (rapid heart rate) and arrhythmias (irregular heart beat). The diver may experience heart 'palpitations', a feeling of heaviness or chest pain.
Gastrointestinal changes: The GI system may become more active, with symptoms ranging from 'butterflies in the stomach' to nausea, vomiting and diarrhoea.
Genitourinary changes: Changes in the GU system include increased urination or the sensation of needing to urinate and tingling sensations.
Musculoskeletal changes: Muscular tension, headache and tremor are common symptoms.
Vocalisation changes: Tremor in the voice, a high-pitched voice or 'frozen' vocalisations are the main signs.
Other possible changes include an increase in sweating, a feeling of choking, chills or hot flushes and fear of losing control.
Panic can lead to death in several ways. If the diver is breathing rapidly and shallowly, insufficient oxygen reaches the lungs, causing hypoxia and the build up of excess CO2. The diver thus tries to breathe even faster and may expel the regulator because they feel it is preventing them from getting enough air. Some divers in this situation bolt for the surface and expose themselves to the risks of decompression sickness. Hypoxia can also lead to loss of consciousness. The increase in heart rate and sympathetic nervous system activity can cause a heart attack in someone with a weak heart.

Panic also prevents the diver from thinking in a cool, rational way. If the situation calls for rational thought, if the diver is tangled in a line or has an equipment malfunction for example, panic can prevent the kind of reasoning that is needed to solve the problem and will often make it worse.

Divers can prevent panic in a number of ways:

Improving physical fitness. Divers who are fit have more resources that they can use to combat cold, fatigue etc.
Improving knowledge of diving. Knowing the real risks of diving prevents unrealistic fears from taking over. For example, many novice or trainee divers ask me if we are likely to encounter sharks on a dive and how dangerous they are. It usually helps them to know that the chances of being bitten by a shark are less than the chances of being stung to death by bees. If divers were worried by truly risky situations, they would be far more likely to panic when they get behind the wheel of a car. Driving a car is far more likely to lead to danger than a shark encounter.
Practising emergency responses. One of the most useful things that divers can do to prevent panic is to practice emergency response techniques, such as buddy breathing ascents, until they become automatic. For one thing it saves valuable time because in a real emergency you don't have to spend as much time thinking of every step. For another thing, the confidence of knowing you can handle emergencies makes panic a less likely response. You can help yourself even when you are out of the water by thinking what you would do if confronted with specific emergencies. What would you do if your buddy grabbed your regulator and bolted for the surface, for example?
Knowing your limits. When you know what kind of dives you are trained and competent to carry out, you are less likely to get into emergency situations.
Improving psychological fitness. Spigolon and Dell'oro (1985) have proposed that autogenic training can be useful to divers. This involves learning techniques that break the negative circle that goes from difficult situation to anxiety to panic. A diver who, when confronted by difficulties, can direct himself to "Relax - Breathe easily - Think" will be in a better frame of mind to help himself and/or others.
A simple way of doing this is to include deliberate pauses at important points in a dive. This will improve your diving and reduce stress. At each major transition point - before donning gear or entering the water; at the surface and before descending; when arriving at the bottom and before ascending; at the safety stop; and finally when arriving on the surface or before leaving the water:
- Pause.
- Check yourself, your gear, your buddy and the environment.
- Take time to allow your body and mind to adjust to where you are and what you are doing.
- Compare instruments and communicate with your buddy as needed.
Use appropriate equipment. If you know that you will be diving under potentially difficult conditions, it can be very reassuring to know that you have the appropriate equipment. For example, if you will be drift diving in choppy conditions so that the boat captain may find it difficult to locate you after the dive, it can be reassuring to carry a signalling device, such as a tall surface marker buoy, so that you are visible even from a long way away.
Know, and have confidence in, your buddy. Divers on holiday may know very little about their buddy, his skills and his ability to cope with difficulties. I have come across buddies who wandered off on their own, who didn't know basic signals, who had health problems they hadn't mentioned to anyone, who seemed to have forgotten everything they learned on their Open Water course etc. Make sure that you have a buddy that you can rely on and have confidence in.
In the mid 1970s, I read a journal article about the difference between experienced and inexperienced sky divers. Experienced sky divers were not only less anxious than the inexperienced, they also felt the anxiety at a different time. Experienced sky divers felt anxiety some hours before the jump and were calm at the time of the jump, while inexperienced sky divers felt maximum anxiety at the point of the jump itself. If I can track down the reference I will put it here because it was an interesting result.

I encourage as many divers who can, to take their training on to the point where they can help other divers in emergencies - the PADI Rescue Diver or the SSI Stress and Rescue certification are good courses. BSAC includes rescue skills at the Sport Diver level.

Supposing the worst happens and you get involved in a dive incident where you, your dive buddy or someone in your group has a dive emergency, you may have some reactions you weren't expecting. Life threatening incidents can be upsetting, overwhelming, even terrifying. Someone involved may experience Post Traumatic Stress Disorder (PTSD).

najša sen še to...je v slovenščini, ampak je o paniki nasplošno...

Panična motnja
Vpisal: Hister Caprae
05. 08. 2006
"Začelo se je pred desetimi leti. Sedel sem na seminarju v hotelu in ta stvar je prišla kot strela z jasnega. Počutil sem se, kot da umiram."

"Zame je napad panike skoraj nasilna izkušnja. Počutim se, kot da se mi meša. Kot da izgubljam nadzor na zelo skrajen način. Srce mi močno razbija, stvari se zdijo neresnične in obdaja me občutek bližajoče se pogube."

“Med enim in drugim napadom obstaja nekakšna grožnja in strah, da se ti bo ponovilo. Bežanje tem občutkom panike je lahko pohabljajoče.”

Ljudje s panično motnjo imajo občutke terorja, ki udari nenadno in se ponavlja brez opozorila. Ne morejo napovedati, kdaj se bo zgodil napad in mnogi razvijejo intenzivno anksioznost med eno in drugo epizodo, skrbi jih, kdaj ga bodo naslednjič doživeli. V tem času nad njimi visi neprestana skrb, da se lahko vsak trenutek pojavi nov napad.

Med napadom panike vam srce močno razbija, potite se, čutite šibkost, omedlevico ali vrtoglavico. V dlaneh imate mravljince ali otopelost, oblije vas lahko hladno ali vroče. Lahko imate bolečine v prsih, zadušljivo vam je, dobite občutek nerealnosti, strah pred prihajajočo pogubo ali izgubo kontrole. Čisto zares lahko mislite, da doživljate srčni napad ali kap, da se vam meša in da ste na robu smrti. Napad se lahko pojavi kadarkoli, celo med popoldanskim dremanjem.

Simptomi napada panike:


Razbijanje srca
Bolečine v prsih
Omotičnost in vrtoglavica
Slabost ter želodčne težave
Rdečica ali mrzel pot
Težko dihanje, sopenje, občutek zadušljivosti ali davljenja
Mravljinci ali otopelost v dlaneh, stopalih, rokah, nogah
Tresenje ali trepetanje, trzajoče mišice
Občutki neresničnosti
Teror
Občutek, da nimate kontrole nad dogajanjem ali da se vam meša
Strah pred smrtjo
Potenje
Strah pred tem, da bi znoreli
Kaj je panični napad?

Lahko ga opišemo samo kot vsestransko čustveno moro. Nekateri ljudje s panično motnjo se počutijo kakor v naraščajočem krogu katastrofe in pogube. Imajo občutek, da se jim bo “prav v tem trenutku” zgodilo nekaj slabega.

Drugi se počutijo kot da bi doživljali srčni napad, saj jim srce tolče na vso moč. Srčne palpitacije jih prepričajo, da bodo doživeli srčni napad. Spet drugi se počutijo, da bodo izgubili nadzor nad samim seboj in napravili nekaj ponižujočega pred drugimi ljudmi. Nekateri tako hitro dihajo in hlastajo za zrakom, da hiperventilirajo in se počutijo, kot da se bodo zadušili zaradi pomanjkanja kisika.

Napad panike traja več dolgih minut in je eno najhujših stanj, kar jih oseba lahko izkusi. V nekaterih primerih napadi trajajo daljše obdobje ali pa se ponavljajo v zelo kratkih presledkih.

Posledice takšnega napada so zelo boleče. Običajno oseba občuti depresijo in nemoč. Najhujši strah je, da se bodo napadi vedno znova ponavljali in to napravi življenje pretežko, da bi ga prenašali.

Panike ne prinese nujno okoliščina, ki bi jo prepoznali. Za osebo ostaja skrivnost, zakaj se je pojavil napad. Napadi pridejo kot strela z jasnega, lahko pa jih izzove pretiran stres ali druge negativne okoliščine življenja.

Osnovna dejstva o napadih panike

“Izgubljam nadzor...”
“Zdi se mi, da bom znorel...”
“Zagotovo imam srčni napad...”
“Dušim se in ne morem dihati...”
“Prišlo je iznenada. Občutil sem val strahu, enega za drugim in izdal me je želodec. Slišal sem svoje srce razbijati tako glasno, pomislil sem, da mi bo ušlo iz prsi. V nogah sem začutil ostre bolečine. Postalo me je tako strah, da nisem mogel zajeti zraka. Kaj se mi je dogajalo? Srčni napad? Sem umiral?”

Napadi panike so zelo resnični, mučni in čustveno uničujoči. Veliko ljudi ob prvem napadu panike konča na urgenci... Ali pri zdravnikih - pripravljeni slišati najhujše novice o svojem zdravju.

Ko ne slišijo, da so bili v stanju, ki bi jih življenjsko ogrožalo (kot npr. srčni napad), lahko to še poveča njihovo napetost in frustracijo: “... Če sem fizično zdrav, kaj se mi je potemtakem zgodilo? Doživel sem nekaj tako grozljivega, da ne znam niti razložiti. Kaj se mi torej dogaja?”

Če osebi s paniko ni postavljena prava diagnoza, si jo lahko zdravniki podajajo več let, brez da bi začutila kakršnokoli olajšanje. Namesto tega je stanje vedno hujše za trpečega, saj mu nihče ne zna povedati kje tiči njegov problem in mu seveda ne zna pomagati.

Ker so simptomi panike tako zelo resnični, je anksioznost zelo travmatična in za osebo, ki to doživlja, čisto nova in čudna izkušnja. Panični napad je zato ena najhujših izkušenj kar jih je. Poleg samega napada, vedno obstaja huda negotovost: “ Kdaj se mi bo to ponovilo?” Nekateri ljudje se tako boje novega napada panike, posebno v javnosti, da se potegnejo v tako imenovane “varne cone”, običajno domove, katere redkokdaj zapustijo. To stanje imenujemo agorafobija. Vedite, da oseba z agorafobijo ne uživa v svojem življenju, ki je tako omejeno. Zanjo to pomeni depresivno in bedno životarjenje. Na dom jih veže neprenehen strah pred novimi napad panike.

Pojavnost in razsežnost

Panična motnja prizadene vsaj 1,6 odstotka (ameriške) populacije in je dvakrat pogostejša pri ženskah kot pri moških. Lahko se pojavi pri katerikoli starosti - pri otrocih ali ostarelih - najpogosteje pa se pojavi pri mladih odraslih. Vendar pa vsak, ki je doživel napad panike, ne razvije panične motnje - npr. veliko ljudi doživi samo enega, brez ponovitev. Za tiste, ki imajo panično motnjo, pa je pomembno, da poiščejo terapijo. Če ostane nezdravljena, je ta motnja lahko uničujoča.

Panično motnjo velikokrat spremljajo še druga stanja, kot sta depresija in alkoholizem. Lahko se razrastejo fobije, ki se razvijejo na krajih in situacijah, kjer se je zgodil panični napad. Na primer, če se vam je napad pripetil v dvigalu, lahko razvijete strah pred dvigali in se jim pričnete izogibati.

Življenja nekaterih ljudi postanejo izjemno omejena – izogibajo se običajnih, vsakdanjih aktivnosti kot je nakupovanje živil, vožnja in v nekaterih primerih celo zapuščanje hiše. Ali pa so se sposobni soočati s situacijo, ki se je bojijo, samo če jih spremlja partner ali druga zaupna oseba. V bistvu se izogibajo kakršnekoli situacije, v kateri mislijo, da se bodo počutili nemočne, če se panični napad pojavi. Ko življenje postane tako omejeno zaradi te motnje, kar se zgodi eni tretjini ljudi s panično motnjo, imenujemo stanje agorafobija. Nagnjenost k panični motnji in agorafobiji je dedno in se ponavlja v družini. Zgodnja terapija pri panični motnji pa velikokrat ustavi napredovanje k agorafobiji.

Zdravljenje

Na žalost veliko ljudi ne poišče pomoči pri paniki, agorafobiji in z anksioznostjo povezanih težavah. To je še posebno tragično, ker sta panika in aknsioznost ozdravljivi in ljudje se zelo dobro odzivajo na relativno kratkoročne terapije. Te motnje spadajo celo med najbolj ozdravljive psihološke težave! Obstaja veliko metod, ki nam pomagajo premagati tovrstne probleme.

V veliki večini primerov je torej stanje uspešno ozdravljivo. Menijo celo, da primerna terapija, ki jo izvaja dober terapevt, pomaga okrog 90 odstotkom oseb s panično motnjo.

Kognitivna-vedenjska terapija (KVT) je relativno nova metoda zdravljenja panike in agorafobije, ki se je pokazala za uspešno. Namesto zastarelih metod analize se terapevti, ki izvajajo KVT, osredotočijo na trenutno paniko ter načine, kako jo izničiti. Zato so KVT poimenovali kar “kako naj” terapijo. Se pravi, osredotoča se na “kako naj” premagamo misli in občutke, ki vodijo v začarani krog anksioznosti in panike.

Ljudje, ki doživljajo paniko in agorafobijo niso “nori” ali “zmešani” in ne potrebujejo dolgotrajnih terapij. Sestanki s terapevtom so odvisni od resnosti in velikosti problema ter pripravljenosti pacienta za aktivno sodelovanje pri terapiji.

Ko je oseba s panično motnjo motivirana za izvajanje in preizkušanje novih tehnik, dejansko spreminja način odzivanja možganov. Ko spremenimo način odzivanja naših možganov, se anksioznost in panika krčita in krčita, dokler končno ne prenehata povzročati težav.

Kognitivno-vedenjski pristop uči paciente kako gledati na panične situacije drugače in predstavi poti, kako zmanjšati anksioznost npr. z dihalnimi vajami ali tehnikami preusmeritve pozornosti. še ena tehnika, ki jo uporabljajo v kognitivni-vedenjski terapiji, imenovana terapija izpostavljanja, lahko pomaga omiliti fobije, ki izvirajo iz panične motnje. Pri terapiji izpostavljanja so ljudje zelo počasi izpostavljeni strah zbujajočim situacijam, dokler ne postanejo neobčutljivi zanje.

Nekateri ljudje občutijo največje olajšanje od panične motnje, če jemljejo določena predpisana zdravila. Zdravila, kot tudi kognitivna-vedenjska terapija, pomagajo preprečiti napade panike ali zmanjšati njihovo pogostost in resnost. Kot varni in učinkoviti pri panični motnji, sta se izkazali dve zdravili, antidepresivi in benzediazepini.

Panična motnja: fizične (somatske) spremembe/menjave simptomov

Problem, ki zelo zbega večino ljudi s panično motnjo, je nagnjenost fizičnih simptomov panike, da se spreminjajo, zamenjajo skozi čas. Vsaka oseba ima drugačno sestavo simptomov, čeprav je veliko takih, ki so skupni vsem. Kar osebe zelo zbega, je sprememba fizičnih simptomov, celo med terapijo.

To je še toliko hujše za osebo, ki ne razume, kaj se z njo dogaja. Npr. oseba, ki jo zaradi panične motnje pesti nenehna slabost, prične s terapijo. Uspe ji nekoliko zajeziti napade panike, slabost izgine - vendar jo nadomestijo glavoboli, osebo pa je strah, da ima tumor na možganih!

Takšno dogajanje je v resnici pozitivno. Ko se oseba popolnoma in celovito zaveda, da je slabost samo simptom, ki jo možgani povezujejo s strahom in paniko, simptom izgine. Nadomesti ga drugačen simptom - karkoli se nam pač zdi drugačno ali nenavadno. Potem se proces prične znova: Katastrofalna napačna razlaga - napihovanje fizičnih simptomov - in preveliko posvečanje pozornosti tem simptomom. In kakor vemo, več pozornosti kot namenjamo takšnim simptomom, večji so in hujši postanejo.

Oseba, ki razume, da se te menjave lahko zgodijo, je pri tej igri v prednosti. Panika je zelo zvijačna- pestila vas bo, dokler ji boste dovolili. S terapijo se hitro naučimo pričakovati menjavo simptomov in sprejemati to kot pozitiven dogodek. Veliki simptom je izginil, pojavil se je nov. Ta nov simptom prepoznamo in se naučimo, kako mu lahko posvečamo čimmanj pozornosti. Katerikoli od teh novih simptomov je, kot rezultat, manj intenziven in dramatičen. Krajši kot je čas, da prepoznate menjavo simptomov in da vas panika poskuša ukaniti, hitreje in lažje se boste spoprijeli in končno odpravili simptom.

Ko izginejo napadi panike in se prične menjava simptomov, je oseba na dobri poti, da popolnoma ozdravi. Menjava simptomov je pozitiven element, ki vam, če ga pravilno dojamete, znak da ste na pravi poti do okrevanja.

Viri:

1. http://www.anxietynetwork.com/hnote.html#hnote1
2. “Anxiety disorders: desetletje možganov” - NIMH