Sunday, May 25, 2008

Comorbid generalized anxiety disorder; phobia and panic disorder

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.


Friday, May 23, 2008

Acquisition and severity of driving-related fears

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.

Sunday, May 18, 2008

Determining the Focus of Driving Fears

AUTHORS: J E Taylor, F P Deane & J V Podd
JOURNAL: Journal of Anxiety Disorders 2000, Volume 14, pages 453-470.

ABSTRACT: "Fear of driving has been recognized as a complex diagnostic entity. Studies on flying phobia have drawn similar conclusions, although increasing clarity has been gained through research that indicates that there may be subtypes of flying phobia based on the focus of fear. However, it is unclear if similar subtypes exist for fear of driving. The aim of the present study was to conduct a preliminary investigation of driving fear subtypes and to clarify further whether there were differences between driving-fearful respondents who had been in a motor vehicle accident (MVA) and those who had not. Eighty-five driving-fearful, media-recruited respondents completed a questionnaire that assessed anxiety, avoidance, and concerns related to their driving fears. The sample had high expectations of negative events while driving. There were no significant differences between those who had experienced an MVA and those who had not on various measures of fear severity. Cluster analysis revealed two main foci of fear, one characterized by danger expectancies and the other based on anxiety expectancies and unpleasant driving situations. This emphasizes the importance of assessing both internal and external foci of fear. Although this finding is consistent with the results obtained for flying phobia, more research is required to replicate and extend these results and to develop and evaluate differential treatment programs."

SUMMARY: The authors describe how flying anxiety has been found to include several distinct sub-types, and suggest that the same may be true for driving anxiety. They mention that it is already known that sufferers of driving anxiety differ in various ways, for example some have previously experienced a motor vehicle accident and others have not. This article is based on a written survey completed by 85 people who suffer from driving anxiety. In general the respondents had high expectations that bad things would happen when they drove. Those who had experienced an accident did not differ significantly in the severity and focus of their fears from those who have not. There were two clusters of different types of people in the study. One group was focused on dangers on the road such as accidents, injury, losing control of the vehicle, and dangerous road conditions. Another group was more focused on the unpleasant emotions they felt when driving, such as anxiety and fear. The authors suggest that different treatment approaches might be needed for these groups, rather than taking a 'one size fits all' approach.

MY THOUGHTS: I appreciate the attempt the authors make to look beyond a simple diagnosis and investigate how people suffering from driving anxiety may have developed it differently, experience it differently and need tailored treatment approaches. I particularly appreciate the acknowledgement that they see that people who have not experienced a motor vehicle accident "deserve as much research attention and assistance as their MVA counterparts..." This research sets the scene for developing an appreciation of driving anxiety sub-types and tailored treatment approaches, although no specific suggestions can be made based on this data.

TAKE HOME MESSAGE: Not all people who have driving anxiety experience it the same way.