Saturday, May 2, 2009

Psychiatric consequences of motor vehicle accidents

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.

Friday, May 1, 2009

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


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