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.
Showing posts with label 2000. Show all posts
Showing posts with label 2000. Show all posts
Thursday, July 17, 2008
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.
FREE FULL TEXT ONLINE
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.
FREE FULL TEXT ONLINE
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.
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.
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