Anxiety: Is It a Contraindication to Diving?

Anxiety is a mental health condition that refers to an overwhelming sense of apprehension or fearfulness. Marked by physiological signs, anxiety can produce both psychological and physical symptoms.

Anxiety can cause uncertainty about the nature and reality of threats as well as self-doubt about one’s capacity to deal with situations. Physical symptoms of anxiety can vary widely, from the damp palms and quickened heartbeat associated with mild apprehension to the crippling, paralyzed feelings of a full-blown panic attack or phobic reaction.


Symptoms of anxiety can vary from person to person, situation to situation, and even day to day. Signs include:

  • Dilated pupils
  • Increased heart rate and blood pressure
  • Constricted peripheral blood vessels
  • Blood flow diverted to the skeletal muscles
  • Rapid breathing
  • Increased perspiration

Some people who suffer from anxiety can experience severe panic attacks or debilitating physical symptoms. These may include:

  • Shortness of breath
  • Palpitations
  • Chest pain
  • Dizziness or vertigo
  • Hot or cold flashes

Implications in Diving

The ocean can be a major stressor for some people. As stress increases, a diver’s ability to recognize and respond properly diminishes.4 In a demanding situation it is critical that a diver be able to recognize and break out of the escalating cycle of stress before it reaches the level of panic. Divers may exhibit some specific symptoms and behaviors, including:

  • Rapid breathing or hyperventilation
  • Muscle tension
  • “White knuckle” grip
  • “Wild-eyed” look or avoiding eye contact
  • Irritability or distractibility
  • “Escape to the surface” behavior
  • Stalling, e.g., taking too long to don equipment or enter the water
  • Imaginary equipment or ear problems
  • Being overly talkative or becoming withdrawn
  • Contact maintenance, e.g., clutching the swim ladder or anchor line

Dive professionals are taught to recognize signs and symptoms of stress, both in themselves and in students and new divers. In many cases, identifying and removing a particular stressor can help alleviate anxieties. However, there will be instances in which recreational divers remain apprehensive, and the reason(s) may not be readily apparent. Depending on divers’ motivations for continuing to dive and their willingness to work toward a resolution of their anxieties, there are psychological techniques that can be useful in overcoming these problems. Mild anxiety does not have to be a contraindication to recreational diving. Dive professionals learn to intervene before that stress becomes excessive and results in exhaustion, panic or a dive accident or fatality.

Common Stressors in Diving Include:

  • Time pressure — Dive tables limit the time that can be spent at various depths. Planning and staying within no-decompression limits provides a significant source of stress, especially when accompanied by task-loading.
  • Task-loading — This involves doing or managing too many things at once. An example is a scuba diver attempting to hold a light and camera while navigating in an overhead environment. It is easy to focus on one task to the exclusion of others when that task is complicated or particularly demanding. This is known as perceptual narrowing.
  • Pushing limits — Diving beyond physical limitations or pushing oneself too hard, either physically or mentally.
  • Environmental conditions — These include unfamiliar dive sites, currents and surface conditions and diving in cold water, reduced visibility or at night.
  • Lack of readiness — Too little preparation or training for a particular dive can be a major stressor.
  • Equipment considerations — Diving with new or unfamiliar equipment, or diving with equipment (a drysuit, for example) in which one is insufficiently experienced or trained.
  • Diving for the wrong reason — This includes peer pressure, diving beyond safe limits “just for the thrill,” diving when you are uncomfortable or ill (seasick or hungover), diving because a friend is diving, diving to save face or diving due to fear of being left out.

Practice and additional training can help reduce anxiety. Instructors sometimes overlook the importance of patience and repeated practice in making students comfortable in the open water. Some students will need additional time and practice or require one-on-one instruction in particular areas. It should be emphasized that it is always acceptable to sit out a dive for any reason.

Medical Conditions

Certain medical conditions can produce feelings of anxiety: anemia, mitral valve prolapse (a cardiac condition), premenstrual symptoms, menopausal symptoms, diabetes, hypoglycemia (an abnormally low level of blood glucose), thyroid and parathyroid disorders, asthma and some systemic infections.5 Along with other stressors, one or more of these could amount to a potent and dangerous combination.

Overcoming Anxiety

There are ways to treat and overcome anxiety. Work with your health care provider to see what options are available. Treatment may include medication or working with a licensed professional or a combination of the two. An understanding of the mechanisms of anxiety help you understand how possible treatments and techniques might work.

John R. Yarbrough, Ph.D.


1 Barlow, David H. (1988). Anxiety and its Disorders: The Nature and Treatment of Anxiety and Panic. New York: Guilford Press.

2 Professional Association of Diving Instructors. (1999). The PADI Divemaster Manual. Rancho Santa Margarita, CA: PADI.

3 Smith (1979) as discussed in Gilliam, Bret. (1995). Deep Diving: An Advanced Guide to Physiology, Procedures and Systems. San Diego: Watersport Publishing.

4 Hardy, William, Jr. (1997). Psychiatric Physician Assistant Protocol: A Handbook for Mid-Level Psychiatric Practitioners. Tyler, TX: William Hardy, MS, PA-C.

5 DuPont, Robert L. (1987). Phobia: A Comprehensive Summary of Modern Treatments. NY: Brunner-Mazel.

6 Gilliam, Bret. (1995). Deep Diving: An Advanced Guide to Physiology, Procedures and Systems. San Diego: Watersport Publishing.

7 Maultsby, Maxie C., Jr. (1984). Rational Behavior Therapy. Englewood Cliffs, NJ: Prentice-Hall.