Intended for healthcare professionals


Near drowning: self therapy in situ

BMJ 2000; 321 doi: (Published 23 December 2000) Cite this as: BMJ 2000;321:1604
  1. Graham Ness (, clinical lecturer in forensic psychiatrya⇓,
  2. Norman Macaskill, consultant psychotherapistb
  1. a. School of Health and Related Research, University of Sheffield, Sheffield S1 4DA
  2. b. Leeds Community Mental Health Trust, Leeds LS6 4QB
  1. Correspondence to: G Ness

Post-traumatic stress disorder is a common problem, developing in 15-24% of people who are exposed to traumatic events. 1 2 General population surveys have suggested that 1 in 12 adults has experienced post-traumatic stress disorder, the commonest causes being violence (39.5%) and an unexpected bereavement (31.3%).3 Control studies have shown that cognitive behavioural interventions and antidepressant drugs are moderately effective treatments for fully developed post-traumatic stress disorder.4 Early psychological debriefing to prevent the development of post-traumatic stress disorder has had mixed results.5

Previous stress inoculation training might help in such situations that might cause post-traumatic stress,6 but little work has been done to evaluate the effectiveness of teaching cognitive behavioural coping strategies to people at risk of trauma. In this brief paper we report the experience of a trained cognitive behaviour therapist working in a post-traumatic stress clinic who was exposed to the trauma of being trapped underwater and near drowning. During this experience he was able to use a variety of cognitive coping strategies. He did not later develop post-traumatic stress disorder but did experience an alteration of his assumptions about risks of trauma in general and an increase in the strength of his spiritual values.

Case summary

I was pleased to be getting a day off to go on a “boys'” sailing adventure on Lake Windermere. My previous experience of the lake had been of visiting lakeside cake and gift shops with my wife and 2 year old daughter, but now I was going sailing with a general practitioner friend of similar age (39), Peter.

Though the wind seemed disappointingly light, I was excited to be on an 18 foot yacht, having sailed before only in dinghies. I love water, being a strong swimmer and a sports diver. We made slow progress down the lake because …

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