Literature Review: In Progress

Driving anxiety (also called driving phobia) is more common than many people realize, including those suffering from the condition.  People who suffer from driving anxiety often suffer in silence or experience considerable ridicule for what others see as an irrational fear.

Driving anxiety is a "situational phobia". That is symptoms of fear or anxiety occur only when the person is driving a vehicle.  It ay also occur only under specific driving situations such as being on unfamiliar roads or 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 and Summala, 1997). It may also occur as a result of an experience such as military deployment (Possis et al, 2014).

Impaired driving ability
Driving anxiety may occur, quite rationally, after the onset of any condition that reduces driving ability, such as traumatic brain injury (Ross et al, 2015).

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 of 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 and Deane, 1999).

At this time driving anxiety is still commonly assumed to be a learned fear but this assumption is being considerably undermined as more data is collected (see Poulton & Menzies, 2002). It is possible that diving phobia often has more of a evolutionary/biological basis, like the fear of spiders.

Predisposing Factors

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

Vestibular Function
It has been suggested that individuals with impaired vestibular (inner ear) function might be more likely to develop phobias such 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 reproduced 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 (habituation, desensitization, and counter-conditioning)
Pavlovian approaches required controlled exposure to the stressful situation. For safety reasons this is usually in a simulated environment. Those with acquired anxiety may write about the instigating even (Baker et al, 2015).

Several researchers are also exploring the possibilities of virtual reality  (Wald & Turner, 2007; Mühlberger, 2007), that is 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.
  • Baker, Aaron S., Scott D. Litwack, Joshua D. Clapp, J. Gayle Beck, and Denise M. Sloan. "The Driving Behavior Survey as a measure of behavioral stress responses to MVA-related PTSD." Behavior therapy 45, no. 3 (2014): 444-453.
  • 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.
  • 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.
    • 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.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.
  • 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.
  • 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.

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