
THE UNDERWATER THERAPIST | RESEARCH + EDUCATION
Freediving and Mental Health
What the water may reveal about self-concept, emotional well-being, stress, connection, safety, and our capacity to adapt.
Begin readingElaine Hicks · Photograph: Ginny Roberts
01 / THE QUESTION
Calm is only part of the story.
Ask freedivers why they return to the water and sooner or later someone will use the word calm.
But calm does not adequately explain the relationship between freediving and mental health.
Mental health includes how we think, feel, relate, recover from stress, understand ourselves, experience challenge, and remain engaged with the people and activities that matter to us. Freediving brings many of these processes into unusually sharp focus.
In my exploratory mixed-methods research with freedivers, participants described changes extending well beyond relaxation: greater self-awareness, confidence, self-trust, positive emotion, resilience, and social connection.
Freediving is not an actual sanctioned mental health practice to treat specific conditions. But in my study, 42% of participants reported using freediving as part of a recovery program for mental or physical conditions. We do not know if it actually treats every mental-health condition, and we need more research to show the direct relationship between freediving, the dive response, and mental health recovery. But the patterns are compelling enough to ask a more interesting question.
What happens psychologically when we enter an environment that simultaneously asks us to manage stress, listen to the body, tolerate uncertainty, trust another person, make decisions under pressure, and discover what we are capable of?
That is where freediving and mental health begin to intersect.
02 / MENTAL HEALTH BELONGS TO EVERYONE
What Is Mental Health—and Why Should We Talk About It?
Mental health is often discussed only when something goes wrong: anxiety, depression, trauma, burnout, or another diagnosis.
But mental health belongs to everyone.
Mental health influences how we think, feel, make decisions, manage stress, relate to other people, experience ourselves, recover after difficulty, and participate in our lives.
In my book Behind the Mask: A Freediver’s Guide to Nervous System Regulation, Recovery & Resilience, I define mental health this way:
“Mental health is the capacity of the nervous system to respond flexibly to stress, recover after challenges, and remain connected to self and others in a meaningful way. It’s not a fixed trait—it’s a reflection of how well we can regulate, relate, and return to baseline across a range of experiences.”
—Elaine Hicks, Behind the Mask, 2025
Mental health is also emotional, psychological, and social well-being. It affects how we manage stress, make decisions, maintain relationships, recognize our needs, and respond when life becomes difficult.
Better mental health does not mean being calm all the time.
Sometimes mental health looks like resting.
Sometimes it looks like mobilizing.
Sometimes it means setting a boundary, asking for help, trying something difficult, changing direction, tolerating uncertainty, reconnecting after withdrawal, or recognizing that today’s capacity is different from yesterday’s.
Mental wellness is dynamic. It changes with our internal resources, environment, relationships, stress load, health, support, and lived experience.
“At its core, our mental health status is about capacity, not performance.”
—Elaine Hicks, Behind the Mask
Hicks, E. (2025). Behind the mask: A freediver’s guide to nervous system regulation, recovery & resilience. Somanautica Independent Press.
03 / NOTICE THE DIFFERENCE
Two Simple Questions Can Reveal a Lot About Mental Health
Am I safe?A cognitive assessment
Do I feel safe?An experience in the moment
They sound almost identical.
They are not.
“Am I safe?” asks for a cognitive assessment. We look at the situation, consider the available evidence, and decide whether an immediate threat exists.
“Do I feel safe?” asks something broader.
The answer can reveal what is happening emotionally, cognitively, physically, and relationally in the moment.
Someone may know they are safe while simultaneously experiencing racing thoughts, irritability, urgency, self-doubt, difficulty concentrating, numbness, muscular tension, fear, or a strong desire to leave.
Another person may recognize that they feel safe only when they remain useful, competent, productive, prepared, or in control.
Someone else may struggle to identify what they feel at all.
The difference between those two answers is not a diagnosis.
It is information.
That gap can tell us something about current stress load, anxiety, emotional awareness, attention, self-trust, perceived control, relationships, burnout, connection, and the ability to move between activation and recovery.
Mental health is not simply the absence of distress.
Our capacity to experience safety, connection, curiosity, pleasure, agency, flexibility, and engagement matters too.
04 / THE PERSON IN THE WATER
So, What Does Mental Health Have to Do With Freediving?
Quite a lot.
Freediving asks us to work with many of the same capacities involved in psychological well-being: self-awareness, attention, emotional regulation, stress adaptation, trust, agency, connection, recovery, and our beliefs about what we are capable of.
A diver brings their entire psychological landscape into the water: confidence and self-doubt, stress, previous experiences, expectations, relationships, coping patterns, perfectionism, curiosity, fear, resilience, and the stories they carry about themselves.
And freediving can make those patterns difficult to hide.
A diver may objectively know:
- I am with a competent buddy.
- The conditions are appropriate.
- I have done this depth before.
- I can turn whenever I want.
Yet internally:
- My stomach is tight.
- I feel pressure to perform.
- I do not want to disappoint my instructor.
- I cannot stop watching the line.
- I suddenly do not trust my body.
- I want to prove something.
The dive may not have created those patterns.
Freediving may simply make them easier to see.
The water does not only ask how we THINK we are doing.
It gives us another opportunity to notice how we are actually doing.
05 / SIX CONNECTED DOMAINS
Where Freediving and Mental Health Meet
Self-awareness
Recognizing emotion, bodily sensation, stress, readiness, and internal change.
Stress + adaptation
Learning to experience challenge while retaining flexibility and choice.
Self-concept
Developing confidence, self-trust, bravery, adaptability, and a different sense of personal capability.
Attention + presence
Learning to notice what matters, redirect attention, and remain engaged in the present task.
Connection + trust
Buddy relationships, belonging, interpersonal support, mutual safety, and co-regulation.
Positive emotion + engagement
Awe, joy, curiosity, contentment, play, meaning, exploration, and participation in life.
06 / BEYOND SYMPTOM REDUCTION
What Does Better Mental Health Actually Look Like?
When we discuss freediving and mental health, it is easy to organize the conversation around anxiety, depression, trauma, or whether someone feels calmer after diving.
But mental health is larger than symptom reduction.

It also includes our ability to:
- recognize what we are feeling;
- recover after stress;
- remain engaged when something becomes difficult;
- trust ourselves to make decisions;
- experience curiosity, pleasure, awe, and connection;
- ask for help;
- set boundaries;
- make mistakes without turning them into evidence of personal failure;
- recognize limits without interpreting limits as weakness;
- and return to participation after difficult experiences.
These changes influence self-concept, relationships, emotional regulation, confidence, problem-solving, and engagement with life.
Sometimes the most meaningful shift is not:
“I feel less anxious.”
It is:
“I trust myself more.”
“I know what my body is telling me.”
“I can experience discomfort without automatically assuming I am in danger.”
“I can ask for support.”
“I can stop without shame.”
“I can try again.”
9 Ways Freediving is Like Therapy-and One Major Way it is Different
By Elaine Hicks, LCSW Freedive instructor @theunderwatertherapist
I am a therapist, specifically a licensed clinical social worker. In addition to my profession, I am also a freediving instructor. Freediving is a sport in which you dive in a pool, lake, or ocean with a single breath. This activity requires trust in your body and mind to navigate the underwater world. While freediving has received some negative press lately, many documentaries only show one aspect of freediving: competition diving.
The truth is that there is another side to freediving, known as recreational fun diving, which has gained popularity worldwide. The typical freediver I encounter is a woman in her 40s who can reach depths of up to 20 meters (66 feet) and possesses impressive breath-holding abilities.
This time spent away from work, family, and relationship responsibilities provides an opportunity for self-care and helps to restore a sense of autonomy, serenity, and peace.
So, what if I told you freediving is like therapy? No, seriously. Imagine your mind as the ocean, the dive as your therapeutic journey, and your body’s instincts as your inner therapist guiding you through the waters. In my work, folks often say that freediving is their therapy. It’s a time to get away from the digital world, find quiet, let the brain's chatter settle, and breathe easily as they fin around the surface. Spending time in a relaxed-state body provides the necessary respite from the stressors of daily life.

Freediving is 60% Self-Regulation. The Rest is Relaxation.
Freediving, with its emphasis on breath control, attention and awareness to self, and a sense of surrendering to self, is almost exactly what I teach in therapy through different skill sets such as self-regulation.
Self-regulation is the insight and awareness to recognize dysregulation through physiological cues–this is called interoception. That is learning how to listen to the body and nervous system by sensing the nervous system. It is the capacity to change or inhibit thoughts, emotions, and impulses.
Then, by utilizing specific tools and techniques, we can return the autonomic nervous system to a regulated state. This is exactly what we do in freediving. If you can self-regulate, you can relax. And you can do anything in a relaxed state-body.
Once my clients have grasped this, we move on to the breathwork aspects of relaxation. When we can do this with more ease in freediving, we settle into beautiful, serene dives.
The Most Powerful Protective Response
Freediving gives us access, every time we dive, to the most powerful protective response all mammals have–the mammalian dive response. It’s an autonomic response or reflex that sets a virtuous healing cycle in place. It starts with a lowered heart rate, a shift in attention and awareness, slowed breath, or more regular breathing, and the op tempo of the body slows down.
Since this adaptation fosters a survival mechanism and the adaptations shift from threat-seeking to connection and relaxation, it takes us into our parasympathetic nervous system, or “rest and digest.” In freediving, this is known as the dive response.
It becomes something freedivers seek out unintentionally. It probably accounts for why we feel so good after diving. In therapy, you learn about your stress response and how these aspects of your typical reactions to tension and stress in your day-to-day life create a mobilization response, and then learn adaptive coping strategies to mitigate stress. The mechanisms of intentionally entering into a “rest and digest” state, or the parasympathetic nervous system, take folks from being in a state of mobilization to relaxation, again creating beneficial conditions for healing.
Awareness and Breath: The Foundation of Every Dive
Mastering your attention and breath is crucial in both therapy and freediving. In therapy, breathwork helps you stay grounded, calm, and present. Freediving is similar–that one final breath has to sustain you through your dive. Learning to control your breath is like learning to control your thoughts and emotions; it’s about finding your center and calm amidst the chaos.
This is where things can get tricky for some folks, but the learning process grows you meaningfully. As you keep practicing, you learn what you are capable of and what you can overcome. Think about it this way: if you just keep going, take the next breath, try the next dive, and go just a bit deeper each time, you build up a series of successes. You chose your hard. It’s like that in therapy; you chose to be there. Building attention works the same way. In freediving, attention is almost effortless, and I call it a back door approach to becoming fully attentive and aware of one’s self. And who doesn’t like looking at fish?
Before a dive, freedivers relax their bodies and calm their minds with a specific breathing technique to get centered, regulated, and relaxed. Similarly, in therapy, breathwork exercises help you self-regulate, which means you can manage anxiety and stay focused.
The Dive Plan
The moment you start your descent in a dive session, it is akin to the beginning of a therapy session. You’re diving down a preselected or set-out plan. In therapy, we have a treatment plan. In freediving, we have a dive plan that lays out the depth, the time, safety protocols, and the roles of the divers. The plan is necessary to explore your experiences or the ocean. Both require courage, patience, and a willingness to confront whatever lies beneath the surface.
As you descend, you feel the pressure increasing, much like the emotional pressure you feel when delving into deep-seated issues in therapy. But with each kick and equalization, you learn to adapt, to manage the pressure, and to keep moving forward. It’s about flowing through the discomfort. This is when you discover your levels of grit and determination.
When a student and I surface from a dive and after they complete their recovery breaths and surface protocol, it’s amazing to see the unmitigated joy from someone making a goal; it’s also equally amazing to see some faces crumple into tears for the same reason. It happens much the same in therapy. I have joked with other freedive instructors that you are a therapist if you have a freediving float and a line for training. While we are decompressing from the dive, emotions and old mental scripts show up and we can release them in the water. Good work happens on the dive float.
The Journey: It’s Not Just About Depth
Freediving is not just about reaching the bottom or about depth. It’s about the journey, the exploration. In therapy, the process of self-discovery is similar. You navigate through memories, emotions, and thoughts like a freediver navigating underwater caves and coral reefs.
Each session or dive reveals something new, something unexpected. Even facing fears, like encountering different ocean challenges with currents and waves, parallels confronting intense memories in therapy. Understanding how to interact with these fears helps reduce the impact of triggers and a “feelings flashback” and helps us develop advanced coping skills.
In therapy and freediving, you learn to embrace the unknown, be present in the moment, and trust your instincts. It’s a different type of self-control, where you allow yourself to be guided by your body’s signals. Whether swimming with fish or in your thoughts, the journey is where the magic happens.
Surface Intervals: Processing and Reflecting
After each dive, freedivers must spend time at the surface, allowing their bodies to recover and physiologically process the experience. Similarly, in therapy, the days between sessions are your surface intervals. These are the times when you reflect on the insights gained, process your emotions, and prepare for the next dive into your psyche.
Surface intervals are crucial for both freedivers and therapy-goers. They provide the necessary pause to let everything sink in, to catch your breath, and to integrate the experiences. During these intervals, you rest, consider what you have learned, and prepare for the next go-round.

Elaine Hicks at the surface beside a freediving buoy. Recovery Breaths: Finding Your Balance
After a dive, freedivers take recovery breaths to stabilize themselves. In therapy, recovery breaths are when you find your balance after processing or talking. Whether through vagus nerve work, grounding exercises, or simply taking a moment to breathe, these practices help you regain your equilibrium.
Recovery breaths are about finding your footing, ensuring you’re stable and ready to face the world again. It’s a crucial part of freediving and therapy, reminding you that it’s okay to take a moment, breathe, and find your balance.
You aren't alone
In freediving, having a dive buddy is essential. The number one rule in freediving is to never dive alone. In session, your therapist guides you through the process. They help you navigate the tricky parts of your subconscious, ensuring you don’t get lost or have a negative mental encounter.
Your dive buddy is there for safety and support, much like your therapist in your emotional journey. They help you explore safely. It’s a cooperative relationship to ensure everyone on the dive team has fun while ensuring everyone is safe. The relationship is a crucial aspect of freediving.
Decompression: Easing Back into Reality
Just as freedivers ascend with proper propulsion and use specific protocols to avoid the bends, easing back into the surface, doing specific recovery breathing, and passing a neuro check, “I’m okay!” therapy requires a gentle decompression. After diving deep into your emotions, you can’t just leap back into daily life. You need time to transition and let the insights settle.
Therapists often use the last few minutes of the session to help you decompress, discussing lighter topics or planning practical steps for the week ahead. This is your chance to adjust from deep introspection to the everyday grind, ensuring you don’t experience an emotional version of the bends. They might even ask you if you plan to get into the ocean over the weekend.
THE MAJOR WAY FREEDIVING IS DIFFERENT FROM THERAPY
There isn’t Much Talking
Even though I am a therapist and feel honored to spend time with folks on their healing journey, what I adore about freediving is that there isn’t that much talking. You don’t have to talk to process and heal. Aside from the “I’m OK” and communicating the dive plan, this is one of the times in life when you can just “be” and let the body do its job of healing both mentally with active rest and distracted focus. This is a huge draw for many folks to freediving. It’s a time when the silence is safe.
The nervous system breathes a sigh of relief. This is partly due to the dive response. Again, this pathway to healing is one thing normal office therapy cannot yet offer. It’s almost like the ocean sounds: hearing yourself breathe, a decreased heart rate and cold-face immersion bypass those chattering parts of the brain and give us peace and equanimity.
It’s worth noting that staying in this regulated state can decrease the intensity of the symptoms associated with post-traumatic stress, quite literally the other protective response (mobilization).
Whether you’re exploring the ocean or your life’s experiences, freediving and therapy share a profound connection. Both require courage, patience, and the right amount of breathwork. You never know what treasures you’ll find beneath the waves. And remember, whether it’s the ocean or your mind, it’s all about the journey. Consider this, how has freediving changed your life?
08 / THE DISTINCTION MATTERS
And the One Way Freediving Is Completely Different From Therapy
Freediving is not psychotherapy.
A dive buddy is not a therapist simply because they provide support.
A freediving instructor does not become a mental-health professional because a student has an emotional experience in the water.
Freediving should not replace psychotherapy, psychiatric care, medication, or other evidence-based mental-health treatment when those services are needed.
Mental-health treatment has clinical goals, ethical obligations, informed consent, assessment, professional scope, confidentiality requirements, and therapeutic boundaries that recreational or instructional freediving does not.
The comparison matters because freediving can engage capacities also strengthened in therapy:
- self-awareness
- agency
- emotional flexibility
- stress tolerance
- trust
- connection
- self-efficacy
- positive emotion
- and recovery after challenge.
Freediving can be restorative without pretending to be clinical treatment.
That distinction protects both the diver and the value of the experience.
09 / EXPLORATORY RESEARCH
What Freedivers Reported
- 85%
- reported improvements in self-concept, including confidence, self-awareness, bravery, adaptability, and emotional resilience.
- 97%
- reported positive emotional experiences following freediving, including calm, joy, contentment, awe, and emotional relief.
- 74%
- reported stronger social connection through freediving, including belonging, buddy relationships, trust, inclusion, and support.
- 85.7%
- described the dive buddy as important to creating a relaxed and safe diving experience.
These findings come from Elaine Hicks’ exploratory mixed-methods research with freedivers. The study examined self-concept, positive emotion, social connection, stress, and lived psychological experience.
The findings are self-reported and should not be interpreted as proving that freediving causes these outcomes or treats mental-health disorders.
Instead, the findings identify recurring psychological experiences worthy of continued research.
Source: Elaine Hicks’s exploratory mixed-methods freediving research. Manuscripts are works in progress; no peer-reviewed publication status is claimed here.
Read Elaine’s essay about the research10 / ROOM FOR THE WHOLE EXPERIENCE
Freediving Can Be a Regulator—and a Revealer
Freediving does not affect everyone in the same way.
For some people, underwater stillness feels restorative.
For others, the same quiet can bring anxiety, performance pressure, self-criticism, loneliness, sensory discomfort, or old protective patterns into sharper focus.
That does not make the experience a failure.
It means the relationship between freediving and mental health is more complex than “the ocean makes people calm.”
The same environment can offer peace and challenge.
The same breath-hold can create confidence or uncertainty.
The same buddy relationship can support trust—or reveal its absence.
The same stillness can feel safe to one person and unfamiliar to another.
This is why trauma-informed, psychologically aware freediving matters.
The goal is not to force a particular emotional state.
The goal is to create enough safety, choice, awareness, and support for the diver to recognize what is happening and respond appropriately.
11 / WHAT BECOMES POSSIBLE
Maybe Calm Was Never the Most Important Benefit
When freedivers tell me that diving makes them calm, I believe them.
But I am increasingly less interested in whether freediving makes people calm.
I am more interested in what happens around that calm.
What happens when someone notices fear and remains curious?
What happens when discomfort no longer automatically means danger?
What happens when someone who never asks for help allows a buddy to support them?
What happens when a person accustomed to self-doubt discovers competence?
What happens when someone recognizes that they are safe but does not yet feel safe?
What happens when those two answers finally begin to match?
Perhaps freediving’s psychological value is not that it removes stress.
Perhaps freediving creates an environment where people repeatedly encounter stress, emotion, attention, choice, trust, connection, capability, positive emotion, and recovery—and have an opportunity to experience themselves differently within them.
Sometimes the result is calm.
Sometimes it is courage.
Sometimes it is connection.
Sometimes it is realizing that the body has been communicating for a very long time.
And sometimes the most important discovery is simply:
I am safe.
And now, I can feel it too.

12 / ELAINE HICKS, LCSW, CSAC
Clinical insight. Research. Time in the water.
Elaine Hicks is a licensed clinical social worker, certified substance use counselor, freediving instructor, researcher, educator, and author of Behind the Mask.
As The Underwater Therapist, her work brings together freediving and psychology, trauma-informed freediving, nervous system literacy, and psychological well-being.
The mammalian dive response (MDR) is part of the physiology of breath-holding and immersion. Its oxygen-conserving changes involve both sympathetic and parasympathetic activity. That physiology informs questions about experience; it does not establish a treatment effect or tell us whether a person feels safe.
Read the physiology review ↗13 / COMMON QUESTIONS
Freediving and mental health, in plain language.
What is the relationship between freediving and mental health?
Freediving brings attention to capacities involved in psychological well-being: self-awareness, stress adaptation, self-concept, attention, connection, trust, and positive emotion. Elaine Hicks’s work explores these relationships through research, clinical insight, and lived experience.
Can freediving improve mental health?
Participants in Elaine’s exploratory research reported improvements in self-concept, positive emotion, and social connection. These self-reported experiences suggest questions worth investigating; they do not prove that freediving causes improvements or treats a mental-health disorder.
Is freediving therapy?
Freediving is not psychotherapy. It can engage capacities that therapy also seeks to strengthen, but diving does not carry the clinical assessment, treatment goals, confidentiality, and professional boundaries of mental-health care. It should not replace appropriate treatment.
Why can freediving feel calming?
Immersion, focused attention, silence, physical activity, supportive relationships, and recovery may all contribute to a person’s experience. The mammalian dive response conserves oxygen, but physiology alone does not explain emotional calm, and Elaine’s survey did not isolate a cause.
Can freediving trigger anxiety?
Yes. Breath-holding, uncertainty, sensory discomfort, performance pressure, or a strained buddy relationship can bring anxiety into focus. The goal is to recognize the experience and preserve appropriate safety, choice, pacing, and support, rather than force calm.
How does freediving affect self-concept?
Divers in Elaine’s research described greater confidence, self-awareness, self-trust, bravery, adaptability, and emotional resilience. These are reported experiences, not guaranteed outcomes, and psychological benefit is not defined by depth or performance.
Why does the buddy relationship matter in freediving?
A competent buddy is central to freediving safety. Reliable attention, communication, and reciprocal support also make trust tangible. In Elaine’s exploratory research, 85.7% described the buddy as important to a relaxed and safe diving experience.
What does “Am I safe?” versus “Do I feel safe?” mean?
“Am I safe?” considers the situation and available evidence. “Do I feel safe?” explores the emotional, cognitive, physical, and relational experience of that situation. A difference between the answers is information, not a diagnosis.
14 / CONTINUE EXPLORING
Start where your question takes you.
Hicks, E. (2025). Behind the mask: A freediver’s guide to nervous system regulation, recovery & resilience. Somanautica Independent Press.