DRIVING ANXIETY

EXPERIMENTAL REPORT: Driving difficulties among military veterans: clinical needs and current intervention status

2016-07-15T19:45:00.000-07:00

CITATION: Possis, Elizabeth, Thao Bui, Margaret Gavian, Jennie Leskela, Effie Linardatos, Jennifer Loughlin, and Thad Strom. "Driving difficulties among military veterans: clinical needs and current intervention status." Military medicine 179, no. 6 (2014): 633-639.

ABSTRACT: Military personnel deployed to Iraq and Afghanistan often develop mental health difficulties, which may manifest as problematic driving behavior. Veterans may be more likely to engage in risky driving and to subsequently be involved in motor vehicle accidents and fatalities. This article reviews literature on driving difficulties among military veterans and evaluates available research on the potential pathways that underlie risky driving behavior. Current interventions for problematic driving behaviors are considered, and the necessity of modifying these interventions to address the unique difficulties encountered by military veterans is highlighted. The review concludes with a discussion of clinical implications of these findings and identification of possible avenues for future research and intervention.

MY TAKE ON IT: This review identifies fear- or anxiety-related behaviors as a cause of unsafe driving behaviors in military veterans. This anxiety can be expressed in risky responses like drunk-driving and road rage. It may also be expressed as classic phobic behavior like avoiding highways and other situations perceived as dangerous. The recommended treatment for driving phobia is cognitive-behavioral therapy and counter-conditioning, although the authors note that their effectiveness specifically with veterans is not well studied.

"Hands Free" phones just as distracting for drivers, reseach shows

2016-07-05T08:29:00.002-07:00

Dr Graham Hole, Senior Lecturer in Psychology at the University of Sussex conducted research that shows: “A popular misconception is that using a mobile phone while driving is safe as long as the driver uses a hands-free phone. Our research shows this is not the case. Hands-free can be equally distracting because conversations cause the driver to visually imagine what they’re talking about. This visual imagery competes for processing resources with what the driver sees in front of them on the road.

Animals as Vehicles

2016-03-21T07:29:00.001-07:00

Like many people who commute to work on foot, I understand the perils of being a pedestrian. It seems as if our transport infrastructure always caters to the needs of the automobile majority, even at the expense of other travelers just trying to get from A to B.

It is not that car-centric communities are necessarily dangerous to others. But they can be when paired with a sense of entitlements, one that says: "the road is for vehicles and anyone else on them is on the wrong place and deserves whatever they get".

That arrogance is why pedestrians get hit even when crossing roadways safely, even on a signaled crosswalk, because drivers just never even consider they might be there, let alone that they should always look for and give way to us. Automobiles give people power, but that is also meant to bring with it vigilance and a sense of responsibility, especially to those traversing the land in slower and more vulnerable ways.

And that does not just mean on foot, but by traditional animal-based forms of transport. Outside of marked highways, these are also permitted forms of travel not mere inconvenient obstacles in the road.

So that is why I despair when I read of a lawyer saying, of a defendant who by all accounts (other than his own) deliberately rammed a horse and rider: "We place more value on the lives of our animals than our humans."

It seems to me that what happens routinely on our roads is that we place more value on the lives of people encased in vehicles than anyone else with a legitimate reason for being on the roadway. Just as on the water, power gives way to sail, every driver should know and respect that rule that power gives way to foot or pedal, or hoof, or paw.

To not only fail to pass slow or wide enough, but circle around and ram a mounted rider (no matter what she may have said or done) is not about just where on the scale of moral merit you place a horse or a woman or a man. (After all, a mounted rider is equally human and animal, and only by circumstance was the animal killed and the rider injured but survived.) It is about whether you are a decent human being, or not.

EXPERIMENTAL REPORT On the road again after traumatic brain injury: driver safety and behaviour following on-road assessment and rehabilitation

2015-12-20T14:53:00.002-08:00

CITATION: Ross, Pamela, Jennie L. Ponsford, Marilyn Di Stefano, Judith Charlton, and Gershon Spitz. "On the road again after traumatic brain injury: driver safety and behaviour following on-road assessment and rehabilitation." Disability and rehabilitation (2015): 1-12.

ABSTRACT: Purpose: To examine pre- and post-injury self-reported driver behaviour and safety in individuals with traumatic brain injury (TBI) who returned to driving after occupational therapy driver assessment and on-road rehabilitation. Method: A self-report questionnaire, administered at an average of 4.5 years after completing an on-road driver assessment, documenting pre- and post-injury crash rates, near-crashes, frequency of driving, distances driven, driving conditions avoided and navigation skills, was completed by 106 participants, who had either passed the initial driver assessment (pass group n = 74), or required driver rehabilitation, prior to subsequent assessments (rehabilitation group n = 32). Results: No significant difference was found between pre- and post-injury crash rates. Compared to pre-injury, 36.8% of drivers reported limiting driving time, 40.6% drove more slowly, 41.5% reported greater difficulty with navigating and 20.0% reported more near-crashes. The rehabilitation group (with greater injury severity) was significantly more likely to drive less frequently, shorter distances, avoid: driving with passengers, busy traffic, night and freeway driving than the pass group. Conclusions: Many drivers with moderate/severe TBI who completed a driver assessment and rehabilitation program at least 3 months post-injury, reported modifying their driving behaviour, and did not report more crashes compared to pre-injury. On-road driver training and training in navigation may be important interventions in driver rehabilitation programs.

MY TAKE ON IT: Driving anxiety can result from an acquired impairment to driving ability such as traumatic brain injury.

EXPERIMENTAL REPORT: The Unifying Creative-Meditation Technique and Physiological Measurement of Anxiety in Romanian Amateur Drivers

2015-12-10T18:06:00.000-08:00

TITLE: "The Unifying Creative-Meditation Technique and Physiological Measurement of Anxiety in Romanian Amateur Drivers."
AUTHOR: Mitrofan, Laurentiu, Mihaela Chraif, Florinda Golu, and Emil-Razvan Gatej.
JOURNAL: Procedia-Social and Behavioral Sciences
ABSTRACT: Nowadays, road accidents are very frequent. Anxiety plays an important role in traffic safety. In this study, we tried to prove that the Unifying Creative-Meditation Technique has a beneficial effect on anxiety which was measured through physiological parameters. The participants were 30 drivers (for the experimental group) and 30 drivers (for the witness group) that have been selected from our Department's students. The subjects had been part of the experimental group were asked to have the driving license for minimum one year. (Full text here).

MY TAKE: This is a not especially impressive paper. It is full of typos and poorly structured so that it omits most of the information it should include and put the rest in the wrong order. This only thing that is really clear is the authors pro-"Creative-Meditation" bias. The tool used to choose the experiment group is a general anxiety scale rather than one relating specifically to driving anxiety. Even after combing through the whole thing twice I have no idea what it has to do with driving behavior at all. They seem to have left that part. Along with explaining what "Creative Meditation" actually is.

TL;DR -- Skip this one entirely

EXPERIMENTAL REPORT The Driving Behavior Survey as a Measure of Behavioral Stress Responses to MVA-rlated PTSD

2015-12-09T18:06:00.002-08:00

TITLE: The Driving Behavior Survey as a Measure of Behavioral Stress Responses to MVA-rlated PTSD
AUTHOR: Aaron S Baker, Scott D Litwack, Joshua D Clapp, J Gayle Beck, Denise M Soan
JOURNAL: Behavior Therapy
ABSTRACT: Numerous treatments are available that address the core symptoms of posttraumatic stress disorder (PTSD). However, there are a number of related behavioral stress responses that are not assessed with PTSD measures, yet these behavioral stress responses affect quality of life. The goal of the current study was to investigate whether a recently developed measure of behavioral stress response, the Driving Behavior Survey (DBS), was sensitive to change associated with treatment among a group of participants diagnosed with PTSD. The DBS indexes anxious driving behavior, which is frequently observed among individuals with motor vehicle accident-related PTSD. Participants (n = 40) were racially diverse adults (M age = 40.78, 63% women) who met diagnostic criteria for motor vehicle accident-related PTSD. Hierarchical linear modeling analyses indicated that participants who were assigned to a brief, exposure-based intervention displayed significant reductions on the DBS subscales relative to participants assigned to the wait-list control condition (r = .41–.43). Moreover, mediational analyses indicated that the observed reductions on the DBS subscales were not better accounted for by reductions in PTSD. Taken together, these findings suggest that the DBS subscales are sensitive to changes associated with PTSD treatment and can be used to augment outcome assessment in PTSD treatment trials.

MY TAKE: When driving anxiety was he result for PTSD caused by a motor vehicle accident, therapeutic writing exercises where they vividly described he accident led to reduced driving anxiety symptoms.

EXPERIMENTAL REPORT: 1 Effect of alprazolam (0.5 mg) on driving performance of anxiety patients and healthy controls Effect of alprazolam (0.5 mg) on driving performance of anxiety patients and healthy controls

2015-11-20T07:10:00.000-08:00

TITLE: Effect of alprazolam (0.5 mg) on driving performance of anxiety patients and healthy controls
AUTHOR: Katerina Touliou, Dr. Evangelos Bekiaris, Dr. Maria Panou
JOURNAL: International Conference on Alcohol, Drugs and Traffic Safety (T2013), 20th, 2013, Brisbane, Queensland, Australia.
ABSTRACT:In the present study the major objective was to investigate the effect of alprazolam in treated and untreated anxiety patients compared to a healthy control group after oral alprazolam administration (0.5 mg) (acute phase) in a simulated environment. Primary variables were the vehicle variables (driving performance measures). The secondary objective was to compare multiple cognitive and subjective measures collected for each participant in order to establish the whole range of driving impairment.(Full text here)

MY TAKE:This study demonstrates that a common medication used for anxiety reduces driving performance.

Parents Need to Talk to Their Children about School Bus Safety at the Start of the School Year

2015-08-04T07:08:00.002-07:00

According to the National Highway Traffic and Safety Administration, from 2004 through 2013, 1,344 people died in school transportation-related crashes—an average of 134 fatalities per year.

“As families begin to prepare for children returning to school, it's important for parents and children to go over school bus safety tips together," says Dawne Gardner, injury prevention coordinator, Comprehensive Children’s Injury Center, Cincinnati Children’s Hospital Medical Center. "This will help ensure a safe, enjoyable start to the school year for everyone.”

According to Gardner, many injuries happen when children are boarding or exiting the bus. “A blind spot extends about ten feet in front of the bus, obstructing the driver’s view,” she says. “Often times, children are not aware of this blind spot and might mistakenly believe that if they can see the bus, the bus driver can see them,” she explains.

Gardner offers the following suggestions to parents on how they can ensure their child is safe before, during and after their school bus ride.

While Waiting for the Bus
• Children should arrive at the bus stop at least five minutes before the bus is expected to arrive. Early arrival helps children avoid running across the street to catch the bus or running after the school bus if it has already left the bus stop.
• Parents should encourage their child to avoid horseplay while waiting for the bus to keep children and/or their belongings out of the road and away from traffic.
• Teach kids to stand at least three giant steps back from the curb as the bus approaches and to never move towards the bus until it has stopped and the driver opens the door.
• Children should avoid the school bus “danger zone” by staying 10 feet away from the front or back end of the bus so that the driver can see them.

During the Bus Ride
• If a child drops something, they should tell the bus driver and make sure the bus driver is able to see them before they pick it up.
• Children should always use the hand rail when entering the bus.
• Check that drawstrings, backpack straps, scarves and loose clothing cannot get caught on the bus handrail, door or the seats.
• Parents should teach children to never push or shove other students.
• All children can help prevent falls on the bus by keeping the aisles clear of backpacks or books that can trip someone or block the way to the emergency exit.
• Children should remain seated, facing forward at all times during the bus ride.
• Shouting should be avoided to avoid unnecessarily distracting the bus driver.
• Parents should discuss the importance of never throwing any objects into, out of, or inside the bus.

After the Bus Ride
• Children should never leave their seat until the bus makes a complete stop.
• Remind kids to use handrails when exiting the bus.
• If your child needs to cross the street after exiting the bus, he or she should take five giant steps in front of the bus, make eye contact with the bus driver and cross when the driver indicates it’s safe.
• The child should not talk to strangers when walking to and from bus stop.
• Teach kids to look left, right and left again before crossing the street.

About Cincinnati Children’s
Cincinnati Children’s Hospital Medical Center ranks third in the nation among all Honor Roll hospitals in U.S. News and World Report’s 2015 Best Children’s Hospitals. It is also ranked in the top 10 for all 10 pediatric specialties, including a #1 ranking in pulmonology and #2 in cancer and in nephrology. Cincinnati Children’s, a non-profit organization, is one of the top three recipients of pediatric research grants from the National Institutes of Health, and a research and teaching affiliate of the University of Cincinnati’s College of Medicine. The medical center is internationally recognized for improving child health and transforming delivery of care through fully integrated, globally recognized research, education and innovation. Additional information can be found at www.cincinnatichildrens.org. Connect on the Cincinnati Children’s blog, via Facebook and on Twitter.

In the news

2014-04-17T09:18:00.001-07:00

Jogger Finds Apology Note After Being Cut Off by Driver "Wracked With Guilt"
"Colwell said that as soon as she saw the note, she knew it was intended for her."

Texting Driver Who Slammed Cyclist: I, Like, 'Just Don't Care'
"I just don’t care because I’ve already been through a lot of bullshit and my car is, like, pretty expensive and now I have to fix it"

Driving Ambivalence

2014-03-01T17:31:00.005-08:00

A new phrase that is going around is "driving ambivalence"--that is, younger people either not getting a driving license or not owning a car.

Living without a car in Chicago

2014-02-19T09:56:00.001-08:00

Chicago News and Weather | FOX 32 News

Driving Anxiety in the News

2013-09-06T17:41:00.002-07:00

Chesapeake Bay Bridge: Saving drivers too scared to cross: "For those in the state of Maryland, that journey may involve driving across the long and notoriously nerve-racking Chesapeake Bay Bridge, ranked as one of the scariest in the world to cross. The trip is too much for some motorists, who pay someone else to drive them and their cars across the water."

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.

Wish I Could Be There: Notes from a Phobic Life

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.

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