Diving and Treatment of Aquaphobia in Cognitive Behavior Therapy: A Case Study

Case Report

Ann Depress Anxiety. 2014;1(1): 1005.

Diving and Treatment of Aquaphobia in Cognitive Behavior Therapy: A Case Study

Jérôme Palazzolo*

Department of Psychiatry, University Senghor, Egypt

*Corresponding author: Jérôme Palazzolo, Department of Psychiatry, University Senghor, 5 Quai des Deux Emmanuel, 06300 Nice, France, Alexandria, Egypt

Received: July 02, 2014; Accepted: Aug 06, 2014; Published: Aug 18, 2014

Abstract

Aquaphobia is a persistent and abnormal fear of water. It’s a specific phobia that involves a level of fear that is beyond the patient’s control or that may interfere with daily life. According to the National Institute of Mental Health, specific phobias normally develop in childhood. Approximately 19.2 million American adults suffer from some type of specific phobia.

The goal of Cognitive-Behavior Therapy (CBT) is to regain control of reactions to stress and stimuli, thus reducing the feeling of helplessness that often accompanies anxiety disorders. CBT works on the principle that the thoughts that produce and maintain anxiety can be recognized and altered using various techniques that change behavioural responses and eliminate the anxiety reaction.

Keywords: Aquaphobia; Anxiety; Cognitive behaviour therapy; Psychology; Systematic desensitization

How Phobias Can Ruin Someone’s Life

“I know all too well the symptoms of fear, wherever it comes from: trembling, rapid heartbeat, cold sweats, suffocation … even the paralysis that panic can cause. In a situation of fear, we are totally vulnerable, we do not control any of these feelings. We do not recognize ourselves. It often happens that we project our own fears on those who are close to us. Afterward, when the situation of fear disappears and when we become “normal” again, we do not know how to speak to them again, because a great sense of shame overcomes us.”

The fears that we feel in our daily life can ruin the best of times. We focus on fear, and everything else becomes secondary. Some people, like me, can even sometimes be obliged to organize their life around a whole system of uncontrollable fears, caused by phobias.

“Phobias”: the word is out!

This way of reacting is based on fear, and can severely impact one’s lifestyle. When this persistent fear gets more intense, and because there is an anxiety of being confronted with fearful situations, even going out becomes difficult.

When a phobia overcomes us, all the pleasures of life vanish. All these fears affect day-to-day living, and have the power to make the pleasant times of one’s existence, such as holidays, quite painful (anxiety of being in an unknown place, fear of being afraid...)

The way other people perceive us is also hard to endure, because they often make fun of the fearful person’s behavior-they get teased and laughed at.

The way other people perceive us is also hard to endure, because they often make fun of the fearful person’s behavior-they get teased and laughed at.

Phobias are a disorder which affects millions of people, but we are fortunate enough in being able to treat them. In spite of this however, the feeling of fear never disappears completely! Phobias may well just be part of the difficulty of living.

This is what Martine answered when we asked her to tell us about her fear of water (aquaphobia). We all have phobias. Does this mean we should consider consulting a doctor or taking medicine for it? Of course not. Treatment is only necessary when a phobia impacts the way we function, our behaviour, if it makes our life a misery. If this is the case, then diving, a leisure activity par excellence may well be a therapeutic tool.

According to the DSM (Diagnostic and Statistical Manual of Mental Disorders), a phobia is a “persistent and intense fear of unreasonable or excessive nature, caused by the presence or the anticipation of being confronted by a particular object or a specific situation.”

The exposure to a phobogenic stimulus almost systematically causes an immediate anxious reaction that can take the form of a panic attack, linked to the situation or facilitated by the situation.

The subject admits the excessive nature of his/her fear.

The phobogenic situation is avoided or experienced through an intensive anxiety or distress.

Avoidance, anxious anticipation or suffering in the dreaded situation severely interfere with the person’s daily life, their professional activities or his/her social activities or their relations with others, or the fact of suffering from this phobia is accompanied by an important feeling of pain. >>

In practice, the very thought of being in water is enough to distress Martine. She admits that this fear is excessive, but it is beyond her control. The patient is conscious of abnormal nature of her disorder, which forces her to reorganise some situations she needs to face in her daily life.

Let’s now see how Martine was helped to overcome her fear of water thanks to diving.

Treatment

CBT (Cognitive Behaviour Therapy) is the most effective way to treat simple phobias. This is the most widely accepted method of psychological treatment, recognized by the whole scientific community. CBT is based on techniques that are modified slowly over time in response to research works that evaluate its effectiveness.

Cognitive behaviour therapies, as their name indicates, are effective on any inappropriate behaviour in daily life. (For example: Martine lives on the Mediterranean coast. She would take her children to the beach in summer but she wouldn’t let them go into the water .Because if something happened, she couldn’t jump into the water to save them. Even when some water splashed over her, she started gasping, her heart started racing and she would break out in a cold sweat, thinking that she was going to die. Therefore, she was obliged to stay away from the water and to take quick showers taking care not to get her face wet. )

CBT also acts on thoughts (cognitions) associated with these inappropriate behaviours (in the case of Martine: “If I find myself in the water, I’m going to drown”, “If there is water on my face, I’m going to inhale some and choke”, etc.).

It is a matter of altering an inappropriate behaviour so that the person may improve their state of mind as fast as possible (inappropriate acts are fought and removed, appropriate acts are encouraged and reinforced).

Martine’s story

Martine, aged 43, is a personal assistant in Cannes. She has been widowed for three years, lives in Nice and couldn’t stand getting wet: the mere idea of being splashed worried her intensely, which led to avoidance behaviour (she never went to the beach, she couldn’t bring herself to take her kids to the swimming-pool) that made life very complicated for her.

The beginning of her disorders goes back to March 2004, when her husband suddenly passed away from a heart attack while he was swimming in the sea. Martine explained that her husband had eating disorders with frequent bouts of bulimia; however, no psychological treatment had ever been requested.

On the day of his death, he phoned his wife, and told her he had a bout of bulimia and suggested that they meet at the beach after her work because he felt distressed. Martine’s husband died of a heart attack while he was swimming towards her.

Following this tragic episode, Martine consulted her general practitioner and underwent a treatment with relaxation and was off work for one month with a nervous breakdown. She suffered during this period from very invalidating insomnia, continuous fatigue and depressive thoughts (she thought of death throughout the day). In the course of the following months, while she had gone back to work, Martine fell victim to intense anxiety, called panic attacks, which were characterized by an acceleration of breath, thoracic oppression, palpitations, cold sweats, muscle contraction and dizziness. The fear of dying was the strongest feeling at these times; it came with both physical and mental agitation, in search of a person that could help her.

Martine avoided going swimming, fearing her anxiety about water might again cause panic attacks. When necessary, her 20-yearold eldest son living with her took responsibility for going to the swimming pool or to the beach with his two 10-year-old sisters. When Martine took a shower, she avoided getting her face wet and washed as fast as possible.

Aim

Martine suffered from a typical fear of water (aqua phobia). Let’s now to define more closely what was making Martine suffers: it is called a “functional analysis” of the anxiety disorder. Therefore, we are going to summarize all the recorded information on a diagram called “SECCA model”, a French model of functional analysis used in CBT. SECCA means:

These are the results of the analysis of Martine’s phobia, using the SECCA model:
[Figure 1]

Psychotherapeutic Treatment

We started by giving Martine information on her phobia making it as unthreatening as possible and showing her that she has a wellknown disorder which can be treated in a series of sessions using the behavioural cognitive approach.

We informed Martine about the main principles of BCA and the practical aspects, especially about the systematic desensitization techniques.

We explained to Martine, step by step, the way the therapy was going to be done.

We asked her to begin to watch herself carefully in each situation she finds challenging and leads her to an avoidance. We also suggested that in those situations she rate her anxiety on a scale of 0 to 10.