Habituation of the cold shock response is inhibited by repeated anxiety: Implications for safety behaviour on accidental cold water immersions

INTRODUCTION: Accidental cold-water immersion (CWI) triggers the life-threatening cold shock response (CSR) which is a precursor to sudden death on immersion. One practical means of reducing the CSR is to induce an habituation by undergoing repeated short CWIs. Habituation of the CSR is known to be partially reversed by the concomitant experience of acute anxiety, raising the possibility that repeated anxiety could prevent CSR habituation; we tested this hypothesis.

METHOD: Sixteen participants (12 male, 4 female) completed seven, seven-minute immersions in to cold water (15°C). Immersion one acted as a control (CON1). During immersions two to five, which would ordinarily induce an habituation, anxiety levels were repeatedly increased (CWI-ANXrep) by deception and a demanding mathematical task. Immersions six and seven were counter-balanced with another high anxiety condition (CWI-ANXrep) or a further control (CON2). Anxiety (20cm visual analogue scale) and cardiorespiratory responses (cardiac frequency [fc], respiratory frequency [fR], tidal volume [VT], minute ventilation [V̇E]) were measured. Comparisons were made between experimental immersions (CON1, final CWI-ANXrep, CON2), across habituation immersions and with data from a previous study.

RESULTS: Anxiety levels were sustained at a similar level throughout the experimental and habituation immersions (mean [SD] CON1: 7.0 [4.0] cm; CON2: 5.8 [5.2] cm cf CWI-ANXrep: 7.3 [5.5] cm; p>0.05). This culminated in failure of the CSR to habituate even when anxiety levels were not manipulated (i.e. CON2). These data were different (p<0.05) to previous studies where anxiety levels were allowed to fall across habituation immersions and the CSR consequently habituated.

DISCUSSION: Repeated anxiety prevented CSR habituation. A protective strategy that includes inducing habituation for those at risk should include techniques to lower anxiety associated with the immersion event or habituation may not be beneficial in the emergency scenario.