Integrating Stress Inoculation Training and Heart Rate Variability Biofeedback on Adult Recreational Scuba Divers in A Natural Dive Setting: A Preliminary Pre- /Post-Treatment Quasi-Experiment

Abstract

The purpose of this study was to explore mediating stress by integrating Stress Inoculation Training (SIT) (Meichenbaum, 1985) and Heart Rate Variability Biofeedback (HRVBF) training as an intervention for highly anxious or panicking recreational scuba divers with a history of intense anxiety or panic during dives. Typically, scuba diving stress that is poorly managed results in an increase of air consumption from the dive tank, an increase in mood disturbances, high anxiety or panic, low vigor, and poorly perceived generalized self-efficacy (Denoble, Marroni, & Vann, 2011). A review of the literature reveals theoretical and empirical evidence indicating that clinical psychology interventions are likely to help individuals better cope with the psychological and psychophysiological impacts of stress. However, few published studies have investigated the application of an integrated psychological and psychophysiological intervention to help recreational scuba divers moderate their diving air consumption, mood, and generalized self-efficacy.

This study's method consisted of a quasi-experimental pre/post single group psychotherapy intervention conducted in an open water diving environment with 9 recreational scuba diver participants. Participants received an integrated psychotherapy comprised of SIT and HRVBF training. To measure the treatment effects: air consumption, average airflow, and average heart rate were measured using the ScubaPro Galileo SOL/Luna dive computer; mood disturbance, anxiety, and vigor were measured using the Profile of Mood States (POMS) assessment (McNair, Lorr, & Droppleman, 1981); self-efficacy was measured using the Generalized Expectancy of Success Scale (GESS) assessment (Hale, Fiedler, & Cochran, 2006); all measures were compared pre and post treatment. The statistical analysis consisted of the paired t-Test and Cohen's d.

The results demonstrate a statistically significant change in all seven dependent variables for the participants. The results also demonstrate a large effect size across all seven variables. The study indicates that the combined interventions of SIT and HRVBF might be an effective psychophysiological treatment for anxiety and panic in recreational scuba divers.

The study is not able to reach a conclusion for a level of efficacy. A major recommendation for future research is to replicate this study with a randomized control trial design.