Health
The Surprisingly Therapeutic Effects of Cold Water Immersion
Lessons from drowning survivors and Scandinavian swimmers.
Posted March 28, 2022 Reviewed by Lybi Ma
Key points
- Compelling case reports demonstrate it is possible to survive very cold underwater submersion for up to 66 minutes.
- The underlying physiological processes that aid survival in cold water drownings have implications for emotion regulation.
- Improvements in mood have been reported in response to cold water immersion of the face, cold water swimming, and cryotherapy.
In 2015, a 14-year-old Italian teenager named Michael was jumping into a cold canal in Milan with friends when his foot became trapped in underwater debris, and he failed to surface. Rescuers created a human chain to locate him in the murky waters, but by the time he was freed, he had been submerged for 42 minutes. He had no discernible pulse and appeared to be dead. However, emergency medical intervention saved his life, and after a month, he awakened in the hospital both alert and communicative, able to converse with his parents and inquire about his favorite sports team.
In March of the same year, 22-month-old Gardell Martin of Mifflinburg, Pennsylvania, survived at least 30 minutes of submersion in 34°F water after he fell into an icy creek while playing with his siblings early one evening. He was swept downstream and was finally caught in a branch a quarter-mile away. The toddler had no pulse and was not breathing at the time a neighbor pulled him from the water. CPR was continuously administered for one hour and 41 minutes until a pulse was finally detected.
It is estimated that up to 50 people contributed to his unlikely survival, with strong teamwork and extreme dedication. Incredibly, he regained consciousness and was able to return home safely within about five days. Although long-term effects of this kind of accident can potentially surface later, upon his return home the toddler appeared to be suffering no apparent neurological damage aside from some temporary balance issues; he was talking, playing, and relating to his family as usual.
How is this possible? In usual cases of drowning, brain damage occurs within four to six minutes of submersion, and death ensues within about 10 to 12 minutes.
One explanation is that loss of breath in very cold temperatures activates the marine mammal "diving response" in humans, a survival mechanism that slows the metabolic rate and reduces the need for oxygen. The heart rate decreases dramatically, and blood flow is directed to only the most essential biological operations. The colder the water and the younger the drowning victim, the better the chances of both survival and decreased neurological damage upon rescue.
The calming physiological response to cold water submersion likely helps explain the popular Scandinavian tradition of "winter swimming" in which people regularly immerse themselves in water that is 36-59°F, often in between recovery periods in the sauna and hot tub. It is believed that the shock of cold water releases both stress hormones and endorphins, and many winter swimmers find the practice to be a powerful natural antidepressant.
Cryotherapy clinics operate under the same principle, even more dramatically, although with the use of extremely cold gas rather than water submersion. Clients stand in a chamber of nitrogen gas that is cooled to -200 to -300°F for two to three minutes. Cryotherapy enthusiasts report a powerful endorphin release as well as the rapid circulation of oxygen-rich blood throughout the body during recovery that may have a fast-acting healing effect on damaged tissues. Cryotherapy has been shown in research to reduce symptoms of depression and anxiety and increase perceived quality of life (Rymaszewska & Ramsey, 2008; Rymaszewska et al., 2019).
One of Marsha Linehan's dialectical behavioral therapy distress tolerance coping skills involves the use of cold water to bring about physiological calm. She notes that immersing your face in a bowl of ice water (or putting a ziplock bag of cold water on your eyes and upper cheeks) and holding your breath for about 30 seconds can cause a cascade of biological responses that are emotionally regulating.
An Exercise for the Therapeutic Effects of Cold Water
Consider whether some version of "cold therapy" may be beneficial for you. If you are in a distressed state, safely submerging your face in cold water for half a minute or less may help calm you. More adventurous people might attempt a swim in cold water or a cryotherapy clinic visit. Obviously, you should talk with your doctor about any health concerns you may have.
References
Linehan, M.M. (2015). DBT skills training handouts and worksheets (2nd ed.). Guilford.
Rymaszewska, J., & Ramsey, D. (2008). Archives of Psychiatry and Psychotherapy, 10(2), 49-57.
Rymaszewska, J., Urbanska, K., Szczesniak, D., Pawlowski, T., Pieniawska-Smiech, K., Kokot, I., Pawlik-Sobecka, L., Placzkowska, S., Zablocka, A., & Stanczykiewicz, B. (2019). Psychiatria Polska, 53(5), 1053-1067.
