DRIVING ANXIETY

Book Review: Wish I Could Be There

2010-11-22T18:12:00.000-08:00

Wish I Could Be There: Notes from a Phobic Life by Allen Shawn is a mixture of lay science and psychology with a meandering memoir.

The author gives a nuanced and rather mannered account of his collection of general and specific phobias, predominantly agoraphobia--expressed in part by difficulty driving in some situations.

This book might give some people a little insight into the life of a phobic person. However the text is not well organised and doesn't really success as either a discussion of phobia or as a memoir.

New study into gender and anxiety

2010-09-03T11:04:00.000-07:00

Women suffer from anxiety, including specific phobia, at about twice the rate of men. Mohamed Kabbaj (Florida State University) has won a $1.8 million grant from the National Institute of Mental Health to look into these sex differences. He will be investigating, among other things, the role of testosterone and a gene designated zif268, or 'zif' for short.

Pedestrian Thinking

2010-07-22T13:06:00.000-07:00

"Unlike the street signs in most cities (including New Orleans) that are attached to poles and displayed high, these can’t be seen by drivers. These are designed for pedestrians, and perhaps bikers, using sidewalks. They reflect a time when planners were designing the city for people on foot." [from Sociological Images]

EXPERIMENTAL REPORT: Wanna drive?

2010-07-19T19:06:00.000-07:00

TITLE: Wanna drive? driving anxiety and fear in a New Zealand community sample
AUTHOR: Taylor, J & Paki, D.
JOURNAL: New Zealand Journal of Psychology, July 2008
ABSTRACT: "Driving anxiety can impact everyday functioning and is common following motor vehicle crashes. However, no research has investigated its general community prevalence, despite the consistent finding that driving anxiety is not always a function of a vehicle crash. The present study explored the frequency and characteristics of driving anxiety and fear in a general community convenience sample of 100 participants who completed a questionnaire about driving anxiety, avoidance behaviour, and types of driving-related cognitions. Most of the sample described no anxiety, fear, or avoidance in relation to driving. However, 8% reported moderate to extreme anxiety about driving, and 7% described moderate to extreme driving fear. Women reported more driving anxiety, fear, and avoidance than men. These results indicate the need for more formal methods of establishing prevalence to clearly ascertain the extent of population-based driving anxiety and fear and its effects, so that research can begin to focus on developing effective treatment approaches for those whose anxiety has a psychological and functional impact." [full text]

MY TAKE: This study is trying to find out how common driving anxiety is in the general public. Moderate to severe anxiety (significant enough to have a noticeable effect on their life) was found in 8% of the sample. I think that would have to be considered a pretty large proportion. As is usually the case driving anxiety was more common in women, although general trait anxiety was the same in both genders. The situations rated as most stressful were being tailgated, motorways, fog and heavy traffic.

EXPERIMENTAL REPORT: Driver stress and performance on a driving simulator

2010-07-15T18:46:00.000-07:00

TITLE: Driver stress and performance on a driving simulator
AUTHOR: Matthews, G., Dorn, L., Hoyes, T.W., Davies, D.R., Glendon, A.I., Taylor, R.G.
JOURNAL: Hum Factors. 1998 Mar;40(1):136-49.
ABSTRACT: "Effects of stress on driving performance can depend on the nature of driver's stress reactions and on the traffic environment. In an experimental study, we assessed multiple dimensions of vulnerability to driver stress by a questionnaire that was validated in previous field studies and related those dimensions to performance on a driving simulator. Results were broadly consistent with prediction. A dimension of habitual dislike of driving was associated with reduced control skills, greater caution, and disturbance of moods. A measure of aggressive driving predicted more frequent and more error-prone overtaking, which are effects attributed to the use of confrontive coping strategies in interaction with other vehicles. An alertness measure predicted speed of reaction to pedestrian hazards. This research has practical applications for system design, automated monitoring of driver performance, selection and assessment of drivers, and training."

MY TAKE ON IT: One thing that seems to be missing for discussion of driving phobia is the extent to which it is not purely irrational. This study shows that dislike of driving was associated with having poorer driving control skills making more frequent driving errors, caution when driving and stress. The suggestion is that stressed drivers might not have any more accidents, but this may be not because they have normal skill levels, but because the avoid taking risks.

Review (in progress)

2010-05-15T06:31:00.000-07:00

Driving anxiety (also called driving phobia) is more common than many people realise, including those suffering from the condition who often suffer in silence or experience considerabel ridicule. Driving anxiety is a "situational phobia" distinguished mainly by the symptoms of fear or anxiety in relation to driving and avoidance of driving either in general or under certain circumstances (such as one freeways).

The role of instigating events

Motor vehicle accident
It may occur as a result of a motor vehicle accident (Mayou, 2002; Vingilis, 1996). After an accident about half of drivers reduce their driving behavior, but the effect is generally temporary (Rajalin & Summala, 1997).

No instigating event
There is a tendency to assume psychological disorders have an instigating event, or to assume an events immediately prior to the onset fo severe symptoms are causal. However many psychological conditions are known to occur without any obvious precipitating conflict, trauma or significant experience. For example: 45% of hoarders do not report any stressful life event before the onset of their maladaptive behavior (Grisham et al, 2006). Many people develop driving anxiety despite never experiencing a motor vehicle accident (Taylor et al, 2000; Taylor & Deane, 1999). At this time driving anxiety is still commony assumed to be a learned fear but this assumotion is being considerably undermined as more data is collected (see Poulton & Menzies, 2002). It is possble that diving phobia has more of a evolutionary/biological basis, like the fear of spiders.

Predisposing Factors

Gender
Suffers of driving anxiety are more likely to me female than male (e.g. Levinson, 1989; Taylor & Paki, 2008).

Vestibular Function
It has been suggested that individuals with impaired vestibular (inner ear) function might be more likely to develop phobias sich as driving anxiety, due to their increased likelihood if experiencing feelings such as vertigo, nausea and disorientation (Levinson, 1989)

Measuring driving anxiety
Driving situations can be safely reprodiced using 'virtual reality' and simulators (Matthews et al, 1998). And driving anxiety can be measured in a range of ways including verbal reports and physiological responses including heart rate, skin conductivity and salivary cortisol (Alpers et al, 2003).

Treating driving anxiety
There are three general approaches to treatment: Pavlovian, psychoanalysis, and cognitive therapy.

Pavlovian approaches required controlled exposure to the stressful situation. As real driving situation can be uncontrolled and dangerous, virtual reality is being explored as an alternative (Wald & Turner, 2007; Mühlberger, 2007). Virtual relaity is defined as a computer generated environment that a person can interact with (Gorini & Riva, 2008).

References

Alpers GW et al 2003 Salivary cortisol response during exposure treatment in driving phobics. Psychosomatic Medicine 65:679-687.
Grisham JR Frost RO Steketee G Kim HJ Hood S 2006 Age of onset of compulsive hoarding' Journal of Anxiety Disorders 20 675-686.
Mühlberger A, Bülthoff HH, Wiedemann G, Pauli P 2007 Virtual reality for the psychophysiological assessment of phobic fear: responses during virtual tunnel driving. Psychological Assessment 19 340-6.
Poulton, R & menzies, R.G. (2002). Non-associative fear aquisition: a review of the evidence for retrospective and longitudinal research. Behaviour Research and Therapy 40, 127-149.

OBSERVATIONAL REPORT: A cerebellar-vestibular explanation for fears/phobias

2010-05-14T15:50:00.000-07:00

The vestibular system consists of three semi-circular canals filled with liquid and two "otoliths" that are located in the inner ear. These structure tell us how we are positioned and space and allow us to judge how we are moving through space. Malfunctions of the vestibular system can cause vertigo, nausea, dizziness and inability to balance. Levinson suggests that vestibular disfunction may predispose people to develop many kinds of phobia.

TITLE: A cerebellar-vestibular explanation for fears/phobias: hypothesis and study
AUTHOR: Levinson HN
JOURNAL: Perceptual and Motor Skills. 1989 Feb;68(1):67-84.
ABSTRACT: "To clarify and test the cerebellar-vestibular (CV) basis of fears/phobias, responses of 4000 learning disabled children, adolescents, and adults with neurological and electronystagmographic (ENG) evidence of CV-dysfunction were analyzed for anxiety-related symptoms. Of this sample, 64.6% indicated fears/phobias; females were significantly more predisposed; mixed-handedness was significantly related to fears of heights and reduced vestibular response or asymmetric vestibular functioning. Also, adults had a higher incidence of the specific fears/phobias characterizing agoraphobia than children and adolescents. Analysis of factors reported as triggering the fears/phobias led to (1) a classification and theory of fears/phobias, obsessions/compulsions, and related anxiety symptoms based on realistic or traumatic, neurotic, and CV- or other CNS-based mechanisms rather than on DSM-III--R surface descriptions; (2) an understanding of the relationships between mitral valve prolapse, agoraphobia and panic episodes, as well as depression; and (3) new insights into differential diagnosis and selective treatment." [full text]

The sample used in this study are not a normal cross-section of the population, but a large group of learning disabled individuals--a group where vestibular problems are more common. And the study does not have a control group which greatly limits the conclusions that can be drawn.

However it is interesting to note that anti-motion sickness medications which help stabilise the vestibular system and improve its function, seemed to help this group with their phobias.

riving anxiety was reported by 4.9% of the adults in the group, and 2% of the overall group (including children and adolescents who are less likely to be driving). The paper assesses phobias and vestibular function but does not seem to (be able to?) assess the correlation between the two and so is ultimately more suggestive than informative. However there does seem to be some grounds for suggesting that vestibular disfunction may be a predisposing factor for developing phobias including driving anxiety.

EXPERIMENTAL REPORT: Salivary cortisol response during exposure treatment in driving phobics

2010-05-13T16:00:00.000-07:00

Whenever a person become alert and ready to react they are experiencing "stress" (all so called the fight-or-flight response). A range of responses occur including physiological stress responses that prepare the body for strenuous activity. The following study measured one aspect of this physiological response, cortisol in saliva. Cortisol (shown right) is released by a part of the adrenal gland and its main function to to increase blood sugar

TITLE: Salivary cortisol response during exposure treatment in driving phobics
AUTHOR: Alpers GW et al
JOURNAL: Psychosomatic Medicine 65:679-687 (2003)
ABSTRACT: "OBJECTIVE: Extensive research on the hypothalamic-pituitary-adrenal (HPA) axis response to stress has not clarified whether that axis is activated by phobic anxiety. We addressed this issue by measuring cortisol in situational phobics during exposure treatment. METHODS: Salivary cortisol was measured in 11 driving phobics before and during three exposure sessions involving driving on crowded limited-access highways and compared with levels measured in 13 healthy controls before and during two sessions of driving on the same highways. For each subject, data collected in the same time period on a comparison nondriving day served as an individual baseline from which cortisol response scores were calculated. RESULTS: Cortisol levels of driving phobics and controls did not differ on the comparison day. Phobics also had normal cortisol response scores on awakening on the mornings of the exposures but these were already increased 1 hour before coming to the treatment sessions. Phobics had significantly greater cortisol response scores during driving exposure and during quiet sitting periods before and afterward. These greater responses generally paralleled increases in self-reported anxiety. At the first exposure session, effect sizes for differences in cortisol response scores between the two groups were large. Initial exposure to driving in the first session evoked the largest responses. CONCLUSION: The data demonstrate that the HPA axis can be strongly activated by exposure to, and anticipation of, a phobic situation." [abstract and full text]

TAKE HOME MESSAGE: People with a driving phobia suffer measurable physiological stress which starts in anticipation of the driving session and lasts for some time afterwards.

D'uh.

I'm sorry, but anyone suffering from a phobia can feel for themselves the racing heart rate, sweaty palms and all the classic symptoms of a physiological stress response. So even after reading the introduction to this paper (which outlined previous studies that had question the existence of a full stress response as part of phobic anxiety) I am having some trouble seeing this as a matter that was in an serious doubt. Inconsistent results are most likely caused by the fact that accurately measuring cortisol is a relative skilled task. Also cortisol is an good measure or stress experience over the course of minutes or hours, and people experiencing chronic stress might not show normal responses.

REVIEW ARTICLE: Virtual Reality in Anxiety Disorders by Gorini, A & Riva, G

2010-05-08T15:49:00.000-07:00

Virtual reality is a method for exposing phobic drivers to the situations they fear under controlled, interactive and safe conditions. The paper described below explains how virtual reality is used in the treatment of a range of phobias and provides a good background before tackling the more detailed experimental papers relating to the use of virtual reality in treating driving phobia (such as Ward & Taylor, 2000). Free full text of this review article is available online.

TITLE: Virtual reality in anxiety disorders: the past and present
AUTHOR: Gorini, A & Riva, G
JOURNAL: Expert Reviews of Neurotherapeutics, 2008, 8, 215-33.
ABSTRACT: "One of the most effective treatments of anxiety is exposure therapy: a person is exposed to specific feared situations or objects that trigger anxiety. This exposure process may be done through actual exposure, with visualization, by imagination or using virtual reality (VR), that provides users with computer simulated environments with and within which they can interact. VR is made possible by the capability of computers to synthesize a 3D graphical environment from numerical data. Furthermore, because input devices sense the subject's reactions and motions, the computer can modify the synthetic environment accordingly, creating the illusion of interacting with, and thus being immersed within the environment. Starting from 1995, different experimental studies have been conducted in order to investigate the effect of VR exposure in the treatment of subclinical fears and anxiety disorders. This review will discuss their outcome and provide guidelines for the use of VR exposure for the treatment of anxious patients." [PUBMED abstract, Full Text pdf]

SUMMARY/TAKE HOME MESSAGE:
This article provides a good overview of the theoretical purpose of virtual reality treatemnt for phobias, the equipment and procedures used, and research to date. There is relatively breif coverage of driving phobia, specifically:

"Driving phobia, defined as a specific phobia, situational type in Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV, is characterized by intense and persistent fear of driving, which increases as a person anticipates or is exposed to driving stimuli. People with driving phobia acknowledge that their fears are excessive or unreasonable, yet are unable to drive, or tolerate driving with considerable distress. The inability to drive results in a major loss of mobility and independence, which interferes with daily activities.

Currently, the only three studies we have found in literature suggest that VRET may be a quite promising intervention for treating driving phobia, but obviously, more controlled trials and follow-up evaluations are necessary to support these preliminary findings" (p218).

The studies referred to are:
* Wald J. Efficacy of virtual reality exposure therapy for driving phobia: a multiple
baseline across-subjects design. Behav. Ther. 35, 621–635 (2004).
* Wald J, Taylor S. Efficacy of virtual reality exposure therapy to treat driving phobia: a case report. J. Behav. Ther. Exp. Psychiatry 31(3–4), 249–257 (2000).
* Walshe DG, Lewis EJ, Kim SI, O’Sullivan K, Wiederhold BK. Exploring the use of computer games and virtual reality in exposure therapy for fear of driving following a motor vehicle accident. Cyberpsychol. Behav. 6(3), 329–334 (2003).

Inconsiderate stores

2010-01-24T18:10:00.001-08:00

One side effect of having an ambiguous relationship with automobiles is that you spend more time getting around by other methods--including your feet. On a routine short walk to the local bookstore I saw evidence of the increasing car-centrism of our society.

As I walk past the Marriott hotel I see that the path from the street to the from door is immaculately cleared, as is the carpark in its entirety. The footpath along the road, however, is snow covered and has been for days. In fact it is easier to walk along the outside edge of the carpark then on the path (although if you do so while walking your dog, a security guard will evict you from the grounds).

As I cross the overpass I see that the roadway is in perfect condition. The pavement, however, is completely covered in slick ice. The Wildberry eatery has also not shoveled the public pavement directly outside their building, although the pathway from the carpark to their front door is carefully cleared.

I suppose the logic is that, on some basis, pedestrian traffic does not count. We are not numerous enough, rich enough, or afforded enough alternatives. We aren't customers worth considering or caring for. But pedestrian, especially pedestrains with long memories and cold feet can be very contrary. Marriot and Wildberry go on my list of places not to shop.

Car-mares

2010-01-07T17:59:00.000-08:00

One of the weird things I had always thought was part of having a driving phobia is my driving nightmares. The exact appearance of the dream varies but I am in a car and driving. Then somehow I either lose the ability to break, or the car starts to accelerate beyond my control. I try desperately to make turns and stay on the road, but inevitably crash, and wake with a start.

But a recent XKCD comic made me wonder whether having dreams like this is really pretty normal, whether you have driving anxiety or not.

What surviving drivers learn from a fatal road accident

2009-12-03T16:03:00.000-08:00

AUTHOR: Rajalin S & Summala H
JOURNAL: Accident Analysis and Prevention 1997; 29: 277-283.

ABSTRACT: "The effects of involvement in a fatal accident on surviving drivers' subsequent driving behavior were studied. The quantity (mileage) and quality of driving (offences in driver records) of 245 surviving drivers were compared in three-year periods before and after the accident. A random sample of 253 drivers from the driver register were additionally used as controls. The data showed that about half of the car drivers decreased their driving, with greater reductions being associated with more serious injuries. However, the total number of convictions did not reduce but even showed a tendency to increase in proportion to the amount of driving. The proportion of car drivers with post-crash offences was approximately constant (27-32%) independent of any change in mileage. The data suggest that professional heavy-vehicle drivers incurred fewer convictions during the post-crash period in comparison to car drivers. Thirty-seven surviving drivers were further interviewed on the duration and specificity of the effects. With the exception of three drivers, all said that the fatal accident had affected their driving behavior, but only for a relatively short time. Most commonly, the drivers reported that the effect was limited to those circumstances and situations which led to the accident and did not generalize to safer driving practices. This study suggests that car drivers, if not seriously injured, typically return to their 'normal' driving within a few months, while heavy-vehicle drivers show a tendency towards more cautious behavior after a fatal crash in terms of violations, presumably due to the continuous reinforcement which the latter receive in their work community." [abstract]

SUMMARY/TAKE HOME MESSAGE: About 20% of driving involved in an accident where there was a fatalities permanently reduce or cease their driving behavior. Drivers who believed their own error caused the accident were more severely affected.

Psychiatric consequences of motor vehicle accidents

2009-05-02T17:35:00.000-07:00

AUTHOR: Mayou RA
JOURNAL: Psychiatry in the Medically Ill 2002; 25: 27-41.

ABSTRACT: "Psychiatric complaints are frequent following motor vehicle accidents and may be major predictors of persistent pain and other complaints. Outcomes are not related closely to the nature or severity of any medical injury. Psychiatric problems often are unrecognized and untreated. There is a need for more behaviorally inferred routine care, early recognition of complications, and the use of psychological and pharmacological interventions."

SUMMARY/TAKE HOME MESSAGE: Motor vehicle accidents are relatively common and frequently have serious mental health consequences including driving-related phobia.

EXPERIMENTAL REPORT: Virtual Reality for the Psychophysiological Assessment of Phobic Fear: Responses During Virtual Tunnel Driving

2009-05-01T13:03:00.000-07:00

PEER-REVIEWED

AUTHORS: Mühlberger, A., Bülthoff, H.H., Wiedemann, G., Pauli, P.
JOURNAL: Psychological Assessment 2007; 19: 340-346.

ABSTRACT: "An overall assessment of phobic fear requires not only a verbal self-report of fear but also an assessment of behavioral and physiological responses. Virtual reality can be used to simulate realistic (phobic) situations and therefore should be useful for inducing emotions in a controlled, standardized way. Verbal and physiological fear reactions were examined in 15 highly tunnel-fearful and 15 matched control participants in 3 virtual driving scenarios: an open environment, a partially open tunnel (gallery), and a closed tunnel. Highly tunnel-fearful participants were characterized by elevated fear responses specifically during tunnel drives as reflected in verbal fear ratings, heart rate reactions, and startle responses. Heart rate and fear ratings differentiated highly tunnel-fearful from control participants with an accuracy of 88% and 93%, respectively. Results indicate that virtual environments are valuable tools for the assessment of fear reactions and should be used in future experimental research."

SUMMARY: Most treatments for phobia involve some kind of counter conditioning. That is being placed in the feared situation, usually starting with low intensity, and replacing feelings of fear with feelings of relaxation. As the authors note, placing driving in a feared situation such as driving in a tunnel, is neither easy nor particularly safe.

This study further developed a virtual reality system as a fully controlled and safe substitute for real driving. The study shows that those with a specific fear of driving in tunnels did become more fearful during periods of simulation of tunnel driving, but not during open driving (there was also a control group that did not become afraid at all). this suggests that virtual reality systems may, in the future, have a useful role in treating driving phobias.

Fearfulness was measured from self-report, but also heart rate, and skin conductivity. Self report was the most useful measure, followed by heart rate with which it was moderately correlated. Skin conductivity was, well a bit rubbish all round.

MY THOUGHTS: This is all very nice... but can we move along with using it for actual treatments?

Mühlberger, A., Bülthoff, H., Wiedemann, G., & Pauli, P. (2007). Virtual reality for the psychophysiological assessment of phobic fear: Responses during virtual tunnel driving. Psychological Assessment, 19 (3), 340-346 DOI: 10.1037/1040-3590.19.3.340

See also:
Efficacy of virtual reality exposure therapy to treat driving phobia: a case report

New Url

2009-04-30T15:02:00.000-07:00

Please update your bookmarks to http://www.drivinganxiety.info

I apologise for the downtime; it took a little while to get the domain, host and blog host to all play well together.

It will take just a little longer to settle fully into this new theme and get everything linked up and looking pretty....

But I hope that once that is done this site will be a lot more functional, and I have a lot more great information to add to it.

Discomfort, affects and coping strategies in driving activity

2009-02-28T15:11:00.000-08:00

AUTHORS: Cahour, B
JOURNAL: Proceedings of the 15th European conference on Cognitive ergonomics: the ergonomics of cool interaction, 2008

ABSTRACT: "Psychological comfort/discomfort is a global feeling constructed from the affective states which are lived by the users during the activity. This empirical study is about discomfort and emotions lived during all sorts of driving situations, and it is based on "explicitation interviews" and questionnaires. The analysis allowed us to specify the categories of uncomfortable situations during driving and their level of discomfort, to develop the underlying cognitive and social sources of discomfort (need of multiple attention; impossible anticipation; loss of control and feeling of un-ability; social image and relation), and to look at how people cope with the disagreeable situations, specifying the different types of coping modes (internal coping, external coping, avoidance)." [Full text available here (pdf)]

SUMMARY: This study is based on hour long interviews with 18 participants from a range of age groups. It is a general examination of experiences that cause negative emotions during driving. It was found that the most commonly experienced emotions were "tension and fear", followed by anger and then all other feelings. The sources of these feelings seem to be the need to attend to multiple aspects of a situation, of failures to see or anticipate events, feelings of being out of control or unskilled and the interference and opinions of other people. Coping strategies fall into three main groups: trying to change ones own thoughts or behavior, trying to change the situation, and avoidance of situations such as driving in certain areas. "It seems that older people are more often avoiding uncomfortable situations of driving..."

MY THOUGHTS: While not specifically about driving anxiety this paper gives a good background to the causes and outcomes of negative feelings whilst driving.

Béatrice Cahour (2008). Discomfort, affects and coping strategies in driving activity ACM International Conference Proceeding Series, 369

Why am I so afraid of driving?

2009-02-27T15:28:00.000-08:00

POPULAR PRESS
AUTHORS: Fox, S.
PUBLICATION: The Times (London), 1999.

SUMMARY: A journalist account of suffering from spontaneous driving anxiety and seeking help for it.

"...I was horrified at how out of proportion my fears had become."

"It was a relief to sit with Professor Ehlers who, without be judgmental, was able to explain what happened to me."

"Professor Ehler divides driving phobics into three categories. Post-traumic stress disorder follows an accident ... another group .. suffer from panic disorder ... someone with a driving phobia."

"Professor Ehlers ... "I would hope that your anxiety could be dealt with in 12 to 15 sessions...."
MY THOUGHTS: So this article neither explains what causes the anxiety, nor goes even as far as beginning to treat it.

TAKE HOME MESSAGE: Why call an article "why am I so scared of driving?" and then not provide any kind of answer? A phobia diagnosis describes that you are afraid--it does not explain why.

Psychosocial sequelae of motor vehicle collisions: a follow-up study

2009-02-01T13:17:00.000-08:00

AUTHORS: Vingilis E, Larkin E, Stoduto G, Parkinson-Heyes A, McLellan B.
JOURNAL: Accident; Analysis and Prevention, 1996

ABSTRACT: One-hundred-and-forty-nine motor vehicle collision trauma victims were interviewed one year after discharge from a Regional Trauma Unit. Follow-up data indicated major post trauma problems such depression, anxiety, family stress, financial problems and driving fears. Almost 40% reported drinking driving after the crash with a greater proportion of alcohol (blood alcohol content) positive drivers engaging in drinking driving than blood alcohol content negative drivers. Notably, almost 16% of the blood alcohol content positive and 13% of the blood alcohol content negative reported involvement in another crash in the year since discharge.. [Abstract here; Keywords: Canada; Trauma; Motor vehicle injuries; Alcohol; Sequelae; Psychosocial ]

SUMMARY: A Canadian study of 149 people who suffered injuries (requiring hospital treatment) from a car crash found that 25-50% had post-traumatic problems as a result. One third experienced driving anxiety and 1/4 fear of cars. After one year 16% had not resumed driving. Driving who had no blood alcohol at the time of their crash were more likely to develop fear of driving and take longer to resume driving.

MY THOUGHTS: The consequences of traumatic crashes are often diverse and serious, often including severe driving anxiety.

TAKE HOME MESSAGE: It seems driving anxiety is a relatively common result of a driving accident resulting in trauma. Although it is not clear what proportion of people suffering from driving anxiety develop it as a result of a crash.

Phobic drivers go to class to learn mastery of fear

2009-01-31T13:25:00.000-08:00

POPULAR PRESS
AUTHOR: Glenn Ruffenach
PUBLICATION: The Wall Street Journal, 1990

ABSTRACT: N/A.

SUMMARY: A journalist account of Charles Melville's group treatment course for driving anxiety. Interesting quotes:

"Fears links to driving may be the most common."

"Heredity seems to be part of the problem, but no one is immune...."

"Most of the nine seated around Mr. Melville had their first attach while driving. It occurred for no apparent reason."

"Mr. Melville ... says such attacks are often an "accumulation of life stresses"."

The treatment seems to be primarily systematic desensitization.

MY THOUGHTS: If driving anxiety has genetic (biological) input, occurred spontaneously (no initiating assocation with an unconditioned stressor), and in response to generalised stress (operant conditioning?)--why is the treatment based on the idea of Pavlovian conditioning?

TAKE HOME MESSAGE: The article concentrates on one participant who recovered fully... but what happened to the other nine? This is why I generally focus on peer-reviewed scientific reports.

What does driving and riding avoidance scale (DRAS) measure?

2009-01-30T17:45:00.000-08:00

AUTHORS: Taylor JE & Sullman MJM
JOURNAL: Journal of Anxiety Disorders, 2008

ABSTRACT: Driving anxiety can have a significant impact on everyday functioning and usually results in some kind of avoidance behaviour. The Driving and Riding Avoidance Scale (DRAS; Stewart, A. E., & St. Peter, C. C. (2004). Driving and riding avoidance following motor vehicle crashes in a non-clinical sample: psychometric properties of a new measure. Behaviour Research and Therapy, 42, 859–879) shows promise in the self-report assessment of the degree of such avoidance. The present study investigated the psychometric properties of the DRAS in a sample of 301 university students. Internal consistency for the DRAS was 0.89 and temporal stability over two months was 0.71. The factor structure of the DRAS supported the use of the general and traffic avoidance subscales but not the weather and riding avoidance subscales in the present non-clinical sample. However, a significant limitation of the DRAS is that it does not assess the reasons for driving avoidance, and is therefore not a measure of avoidance that is due to driving anxiety. Some items may be rated highly for practical reasons, such as avoidance because of increasing fuel and other costs associated with driving. Modified instructions for the DRAS should ensure that it measures anxiety-related avoidance behaviour. [Abstract here; Keywords: Driving and Riding Avoidance Scale; Avoidance; Measurement; Assessment]

SUMMARY: The DRAS is a twenty question survey taken by people with driving anxiety which is intended to measure how much they avoid driving or riding in cars. However surveys depend on people reporting accurately. This study of undergraduates (mean age 24 years). There was no effect of gender. The test was administered twice, two-months apart, and results changed significantly over this time. The participants showed low level of avoidance.

MY THOUGHTS: Undergraduates may be the most studies subject other than the albino rat, but that has more to do with convenience than validity. DRAS can be used equally with a history of motor vehicle crash experience or not--but may also respond to cause other than driving anxiety. But this is basically yet another study concluding that there is a need for more studies.

TAKE HOME MESSAGE: In a practical sense, limited.

J TAYLOR, M SULLMAN (2008). What does the Driving and Riding Avoidance Scale (DRAS) measure? Journal of Anxiety Disorders DOI: 10.1016/j.janxdis.2008.10.006

Young drivers: the driving behaviour of men and women

2008-12-31T19:55:00.000-08:00

AUTHORS: Gylfason HM, Porisdottir R & Peerson M

ABSTRACT: None. [Full text available here (pdf)]

SUMMARY: A survey of 1782 Icelandic students at the high school and undergraduate level. There was a broad focus but in relation to driving anxiety the findings were that females had a lower "willingness to drive" and scored higher of a driving anxiety scale with questions such as "I avoid driving routes with access lanes into streets with fast traffic". Women also scored lower on a joyriding scale. Despite these reported difference young men and women drive at similar speeds.

MY THOUGHTS: This really just confirms that driving anxiety is higher in women not only as a severe condition, but in milder forms.

TAKE HOME MESSAGE: None.

Measuring emotions in traffic

2008-09-14T15:59:00.000-07:00

AUTHORS: Mesken, J.
CONFERENCE: Towards Safer Road Traffic in Southern Europe, 2002

ABSTRACT: In this paper, three categories of methods to measure emotions are reviewed and possible applications for traffic research are discussed. Of the three measurement categories - overt behaviour, physiological measures and self-reported behaviour - examples are given of past use of these measures in traffic research. Also, implications for further research are discussed. [Full text available here (pdf)]

SUMMARY: This paper discusses the measurement of driver emotion.

MY THOUGHTS: This paper discusses how very little is known about how to measure, and so understand, the emotions of the drivers. The interactions between emotion, motivation and action are discussed. Many subjects were covered but elements relating to driving anxiety, in brief, are:
* Emotions can negatively effect driving behaviors. Specifically: "anxiety narrows attentional focus." Driving is a complex task and overly narrowed focus can be dangerous.
* However, positive moods can be equally dangerous as they increase risk taking.
* Therefore it is important to measure both the emotions and the performance of the task (driving).
* There are various types of measurement that can be taken to appreciate the emotion of a driver, including: behavior, physiology and spoken reports. In general it is a good idea to take at least two measures and where possible more when trying to understand a driving situation.

TAKE HOME MESSAGE: In many cases where driving anxiety is being treated the potential for impaired ability and so legitimate danger during driving seems to be overlooked, and there is a tendency to rely exclusively in verbal report as a measure. This report is a useful reminder to step back to try to capture more about the situation in order to understand it better.

Mesken, J. (2002). Measuring emotion in traffic ESF Congress: 'Towards Safer Road Traffic in Southern Europe'

Efficacy of virtual reality exposure therapy to treat driving phobia: a case report

2008-07-17T17:10:00.000-07:00

AUTHORS: Wald J, Taylor S
JOURNAL: Journal of Behavior Therapy and Experimental Psychiatry 2000, 31, 249-257

ABSTRACT: An AB case design was used to examine the efficacy of virtual reality exposure therapy (VRET) in treating driving phobia. After a one week baseline, the patient received three treatment sessions over a ten day period. Treatment included practice of four VR driving scenarios. Peak anxiety decreased within and across sessions. Ratings of anxiety and avoidance declined from pre-treatment and post-treatment, with gains maintained at seven month followup. Phobia-related interference in daily functioning similarly decreased. The results suggest that it would be useful to further evaluate the efficacy of VRET for driving phobia in controlled clinical trials.

SUMMARY: A case study in which one woman received a sum total of three (of a planned eight) sessions with a virtual reality driving simulator. After treatment the subject drove more often and experienced less anxiety while driving.

MY THOUGHTS: I am rather surprised that the authors squeezed nine pages out of a case study that was curtailed to less than half of its intended length--well, partly thought very repetitive introduction and discussion sections. The subject apparently had a significant and chronic problem, however in the absence of any control the conclusions that can be drawn here are very limited. The subject was also actively seeking (and found) employment that required driving, highly likely to exhibit placebo effects, and quite possibly self-selecting (the way the subject was identified and selected is not described).

TAKE HOME MESSAGE: If a subject's driving anxiety is a conditioned phobia, virtual reality technology might be part of an effective program of systematic desensitization. Generally treatment programs put someone right into the car, and the authors of this paper correctly outline how this can be stressful, embarrassing and even potentially dangerous with some people. However a single, heavily confounded, case study doesn't really raise the effectiveness of this technique above the level of anecdote.

Comorbid generalized anxiety disorder; phobia and panic disorder

2008-05-25T11:06:00.000-07:00

AUTHORS: Brannon N and Schuyler DS

JOURNAL: Prim Care Companion J Clin Psychiatry. 2000 August; 2(4): 141–142.

ABSTRACT: No abstract

SUMMARY: This is a case study of a women with anxiety related to several events relating to travelling and dealing with other people which may have contributed to the occurrence of a skin rash. A particular focus is a fear of driving downtown for fear "she would get lost, be in the wrong lane, or drive too slowly". She was treated under the diagnosis of generalized anxiety disorder, specific phobia, panic disorder and agoraphobia. A course of treatment is described over eleven days including diagnosis, general discussion of the approach, challenging dysfunctional beliefs, driving to the next session and discussing other places to drive, making specific plans to drive to new places and anticipating potential problems that might occur and discussing the experiences afterward. After this the participant had driving to new places and reported being much less anxious and feeling more independent.

MY THOUGHTS: Although many people will not have access to this level of one-on-one assistance seems to be beneficial. It would have been nice to have some empirical data but in the end benefit to the person and their lifestyle are more important, and there is no reason to doubt the patients report of significant improvement in mood and driving freedom.

TAKE HOME MESSAGE: Nice help if you can get it.

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Acquisition and severity of driving-related fears

2008-05-23T16:04:00.000-07:00

AUTHORS: JT Taylor, FP Deane
JOURNAL: Behaviour Research and Therapy 1999, Volume 37, pages 435-449.

ABSTRACT: "Rachman's theory of fear acquisition proposes that directly-conditioned fears will differ from indirectly-conditioned fears in magnitude and anxiety response patterns, however the theory has received inconsistent empirical support. The aim of the present study was to describe the fear acquisition pathways for a community sample who reported driving-related fears and to test Rachman's theory of fear acquisition. One hundred and ninety participants completed a questionnaire which assessed a variety of driving-related situations, reactions to motor vehicle accidents (MVAs) and anxiety response patterns. Professional psychological helpseeking and perceived need for treatment for driving-related fears were also assessed. Results failed to support Rachman's predictions. However, it was confirmed that respondents who had been involved in a MVA were more likely to ascribe their fears to a directly-conditioned pathway. The theoretical and methodological implications of the findings are discussed, along with suggestions for assessment of those with driving-related fears."

SUMMARY: Rachman's theory, as mentioned in the abstract, is basically that there are three kinds of fear: 1) Pavlovian conditioned, 2) learned from observation and 3) learn from sources of information. Further he suggested that Pavlovian conditioned fears will be stronger, and associated with more physiological stress and fewer cognitive symptoms. The study was based on the responses of 190 participants (92% female). No difference in fear severity were found between groups who attributed their fear (as measured by bodily reactions and negative thoughts) to an accident and those who did not. It found that only 27% had experienced a motor vehicle accident and not all of those attributed their fear to the accident. 25% said they had "always been this way". The authors explained that belief to conditioning that was gradual or not remembered, instead (just for example) of considering that they may in fact have always been that way.

MY THOUGHTS: As someone who is not terribly interested in Rachman's theory in the first place, I am not terribly fascinated to find it is apparently wrong.

TAKE HOME MESSAGE: Never mind what Rachman said about fear types, try listening to what the study participants have to say about them.