Scuba diving therapy is a type of treatment that consists of a variety ofscuba diving activities and exercises. Essential elements are increased bodyawareness, social bonding, and breathing techniques. The goal is to improve physical and psychologicalwell-being.[1]
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 ofmilitary service, has been established as a provisional element oftherapy. Scuba diving has shown effectiveness as a therapeutic andrehabilitation process forveterans who had acquired traumatic physical and/or psychological injuries.[1] Scuba diving was shown to be a therapeutic process that can help people with variousdisabilities 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 asanxiety disorders,PTSD and an abatement insocial dysfunction anddepression.[1][2]
As with other recreational activities,freediving and scuba-diving can provide immersive experiences that can help to reducestress.[3] A study by Marlinge et al. (2019) has shown that scuba diving helped to promoterelaxation which can lower levels of multiple stress markers likecortisol,copeptin andischemia-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 ofmuscle spasticity by an average of 15%.[5]
Adaptive scuba diving isscuba 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 withamputations 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 finemotor 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 higherself 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]
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]
Scuba diving can decrease depression,anxiety, andpost-traumatic stress disorder (PTSD) in military veterans and people who are dealing with similarmental 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 inmindfulness 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] InNorway, for example, it is applied to people who have lost their vision, suffer frommultiple sclerosis oramputees. 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 astraumatic brain injuries orPost 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 ofanxiety andchronic stress disorders, by increasing mindfulness and a sense of relaxation.[12] Scuba interventions have been organized for people withneurological andneurodevelopmental disorders, such asautism spectrum disorder.[13]
Therapeutic scuba programmes are delivered by local or international organisations which have an interest in supporting thephysical andpsychiatric rehabilitation and recovery of people with physical ormental health conditions.[14]
Diving therapy is applied in different countries, ranging fromMalaysia to theBahamas, and theUK.[10][15][16]
Scuba diving has proven to help with physical, mental and social issues. For people withphysical 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 ofself assessment can rise and levels ofdepression can significantly decrease. This can be explained by the reduced weight experienced in water, that accommodates people withdisabilities 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 theirmuscle strength.[2] Diving can give individuals a feeling ofaccomplishment and therefore an increase in the level ofcontentment.[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 fromchronic 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 suchmental 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 inmindfulness 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]
Many mental or physical health issues make it unsafe for a patient to undergo scuba treatment, as it requires processes such asthinking, concentration, orproblem-solving.[14] Before starting the therapy, amedical professional should evaluate the fitness-to-dive state of the patient.[14]
Specificpsychiatric 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 andcharities have started fundraising to make the therapy more accessible to lower-income patients.[2]
Scuba diving requires specializedequipment to ensure safety andcomfort 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 as anAdaptive Support Diver is provided byPADI, 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 orOpen Water Diver certification and currentEmergency First Response primary and secondary care certification. Adequate buoyancy control and trim skills are also recommended.[17]
