No worries: How to avoid a panic attack in the swim

Open water swimming can be a challenge for many triathletes, especially beginners. A look at some tips and tricks that will make your open water training and racing much easier.

by Theresa Wallace and Rick Hellard

“I am from a very warm country, so I spent the night before the race visualizing the swim. Perhaps I thought about it too much. When the race started, I was able to swim for about five minutes, but felt colder and colder. Then I started shivering and hyperventilating and couldn’t breathe. So I hung onto a kayak and the volunteers comforted me, but when I tried to swim again, I just couldn’t.”

That’s how 39-year-old Dr. Dina Altayeb describes her most serious panic attack. It happened in 2007, during a half Ironman near Cranbrook, B.C. As an Ironman who lives in Saudi Arabia, but trains and competes in Canada, Altayeb is unusual, but her panic attacks certainly aren’t. Many triathletes say they’ve had panic attacks or felt extremely anxious about the swim portion of a triathlon. For Altayeb, cold water triggers her anxiety. For some, especially novices, it’s the fish, weeds, mass starts, the possibility of swimming off-course, or the whole open-water swim experience. For others, it’s a potent mix of performance pressures combined with unpredictable swim conditions.

In a 2004 study of Ironman athletes by Montreal triathlete Karine Grand’Maison, 22 per cent of those surveyed reported being anxious about the swim. They described, in graphic terms, their fears of drowning or of being hit by other swimmers. Anxiety about the swim was the second biggest race-day worry after a more general concern about “not having a good day.”

The symptoms of a panic attack usually include at least four of the following: feelings of shortness of breath, smothering, choking or hyperventilation; tightness or pain in the chest; a pounding or racing heartbeat; feelings of extreme fatigue; a dry mouth; trembling; lightheadedness, dizziness and mental confusion; a feeling of disassociation from one’s body; a feeling of impending doom; and/or, a desire to flee the current situation. Panic attacks are often most intense shortly after they begin, and usually last no more than a few minutes. To complicate matters, a triathlete having a panic attack may not recognize the sensations he or she is feeling are caused by anxiety or fear.

If you think you’ve had a panic attack, you should make an appointment to get thoroughly checked out by your medical practitioner. Panic attack symptoms, triggered by the release of adrenaline as part of the fight-or-flight response, can be similar to symptoms of certain medical conditions – an irregular heartbeat, low blood sugar, a drug reaction, a seizure, exercise-induced asthma or cold urticaria (a rare allergy to cold), for example. Symptoms of swimming induced pulmonary edema (SIPE), associated with maximal exertion in cold water, are also very similar to panic attack symptoms, but SIPE usually involves pink frothy spit-up as a result of plasma crossing the lung capillary membranes into the air sacs of the lungs.

Dr. Stacey Rosenfeld, who heads a team of five psychologists on duty at the New York City Triathlon to help participants with their swim anxieties, says that before the race they use cognitive-behavioral techniques to help competitors develop plans for scenarios they fear. She explains that panic attacks can strike right out of the blue, but understanding they’re caused by anxiety is half the battle. “Learning how to talk yourself down with positive self-statements such as ‘I am just anxious, and that’s understandable’ can help a lot. Seeking contact with others, either to distract yourself or for actual help with your panic, is also helpful. In many cases, simply talking about your anxiety will cause it to diminish.”

Dina Altayeb has done just that as part of her strategy to feel more comfortable in the sometimes glacial-fed water at triathlons in western Canada. She says talking to her coaches and sharing her concerns with other triathletes has helped immeasurably. “Realizing I’m not alone and that even some pros get the same anxious feelings at the beginning of the swim in a triathlon, makes all the difference.” Altayeb now has a routine for entering cold water that starts with standing knee-deep and splashing the water with her hands; the whole immersion process takes about 15 minutes, but works well.

Paul Anderson, technical director for the inaugural Viterra Calgary Ironman 70.3, suggests the most important steps you can take to prevent a panic attack during the swim portion of a tri are to be physically and mentally prepared for that particular race, which includes having a good mental picture of the swim course and your race strategy. Calgary 70.3 race director Cheryl Lowery adds that if you find yourself losing confidence during the swim, remember your mind is a powerful tool. “You are, or hope to be,an Ironman. You can do this. Let your mind relax and your body will follow.”

Heating up your wetsuit:

Based on the premise that the warmer you are when you hit the water the less impact cold water will have, organizers of the inaugural Calgary 70.3 Ironman suggested participants warm up their wetsuits about five minutes before entering Ghost Lake.

The pre-race instructions were:

Take a large disposable bottle of hot water with you on race day. Protect this bottle from getting cold by placing it in the middle of your gear bag. Bring the bottle to the swim start. Make sure the water is not so hot that it will burn you. Pour this water down the neck of your wetsuit. The warm water will reduce the surge of cold water into your wetsuit when you enter the water. Dispose of your water bottle in the trash cans near the swim start.

Preventing panic attacks:

• Have challenging but not impossible race-day goals.
• Practice swimming in race conditions. In the pool, swim in close contact with others in your lane. Practice swimming at the race venue if possible.
• Use visualization to rehearse what you’ll do in stressful situations – when you get bumped or miss a breath or swallow water, for example.
• On race day, do a good dry-land warm-up, making sure your heart rate visits the zone it will be in when you race and warming up your shoulders and arms for the swim.
• Take your time entering the water. If the water is cold (lower than 65 degrees), splash it on your face before putting your head in the water. Start with an easy stroke close to shore.
• Do at least 5 to 10 minutes of swimming as a warm-up.
• When your wave is called, position yourself off to the side or near the back, away from traffic.
• Once the race starts, swim at a moderate pace and gradually increase your speed.
• Find a friendly pair of feet to draft behind.

Cold-water swimming:

Tips for training and racing in cold water:

• If you know the water on race day is going to be cold, practice swimming in cold water, but use common sense. Other than bragging rights, is there really anything to be gained from open-water training in water that’s so frigid you’re spending all of your energy fighting off hypothermia?
• Wear a wetsuit that fits. (Wetsuit fitting can be tricky, so either buy your wetsuit from a triathlete retailer who knows the product, or take someone knowledgeable shopping with you.)
• Put the wetsuit on properly. Pull it up high on your body so it’s not pressing down on your shoulders or constricting your arms or chest.
• Log some serious hours before race day swimming in your wetsuit.
• If cold water entering your ears makes you feel dizzy, wear earplugs.
• In a race, wear a neoprene bathing cap under your race cap.
• On race-day morning, stay bundled up as long as possible to conserve your body heat.
• Take your time entering the water. To get used to the cold, try walking in until you are waist-deep, then put your face in the water and blow bubbles.
• Do at least a five-minute warm-up in the water a few minutes before your race, but don’t get in the water too far in advance of your wave.
• When the race starts, kick your feet a little more vigorously than usual. Cold water can make blood leave the extremities, and a steady kick may help you warm up more quickly.

Swimming buoy:

Swimming around buoy markers can be a source of anxiety for some triathletes because contact with other participants is almost inevitable. One of the only ways to guarantee you’re not going to get whacked on the head rounding a buoy is to get there first. For the rest of us, here are some tips:

• Expect to get bumped. When you are, assume it wasn’t done intentionally. Don’t take it personally.
• Sight often as you approach the buoy. Be aware of your surroundings so you won’t be surprised by anything or anybody.
• Try not to be beside anyone going into the turn. Either lead or follow.
• Stay wide of the buoy marker. A bigger arc helps avoid physical contact and means you’re turning less sharply, so what you lose by swimming a few extra metres you make up by maintaining a more natural stroke pattern that can help keep your speed up.
• Accelerate out of the corner and hold the effort for about 20 seconds.

If you feel like you’re going to have a panic attack:

• Slow down.
• Try to think only positive thoughts. Fight against negative thinking.
• Take deep breaths. Try to get your breathing under control and your heart rate down.
• Switch to an easier stroke such as heads-up breaststroke.
• If conditions allow, flip over onto your back and float. (This is not always possible in the middle of an open-water race, but will be easier if you have started near the back or off to the side.)
• If you are still having trouble, signal or find your way over to a race official in a kayak or zodiac. They’ll be happy to let you hang off the side to regroup.

Send in your hints:

Some triathletes say not knowing where they are in the middle of the swim is their biggest worry and they wish the buoy markers at races had elevated flags on top to make sighting easier and swimming off-course less likely. Do you have any suggestions for race organizers? Or do you have any tips that aren’t included here on how to prevent panic attacks? We’d like to hear from you. Please write to us at kevin@triathlonmagazine.ca.

Theresa Wallace is a freelance writer based in Ottawa. Rick Hellard is a triathlon coach in Ottawa, race co-director of the Mike Collingwood Memorial Triathlon at Meech Lake, Quebec and a former pro.