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.
Showing posts with label full text available. Show all posts
Showing posts with label full text available. Show all posts
Friday, July 15, 2016
Friday, November 20, 2015
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
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.
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.
Friday, May 14, 2010
OBSERVATIONAL REPORT: A cerebellar-vestibular explanation for fears/phobias
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.
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.
Saturday, May 8, 2010
REVIEW ARTICLE: Virtual Reality in Anxiety Disorders by Gorini, A & Riva, G
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).
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).
Wednesday, December 31, 2008
Young drivers: the driving behaviour of men and women
AUTHORS: Gylfason HM, Porisdottir R & Peerson M
ABSTRACT: None. [Full text available here (pdf)]
SUMMARY: A survey of 1782 Icelandic students at the high school and undergraduate level. There was a broad focus but in relation to driving anxiety the findings were that females had a lower "willingness to drive" and scored higher of a driving anxiety scale with questions such as "I avoid driving routes with access lanes into streets with fast traffic". Women also scored lower on a joyriding scale. Despite these reported difference young men and women drive at similar speeds.
MY THOUGHTS: This really just confirms that driving anxiety is higher in women not only as a severe condition, but in milder forms.
TAKE HOME MESSAGE: None.
ABSTRACT: None. [Full text available here (pdf)]
SUMMARY: A survey of 1782 Icelandic students at the high school and undergraduate level. There was a broad focus but in relation to driving anxiety the findings were that females had a lower "willingness to drive" and scored higher of a driving anxiety scale with questions such as "I avoid driving routes with access lanes into streets with fast traffic". Women also scored lower on a joyriding scale. Despite these reported difference young men and women drive at similar speeds.
MY THOUGHTS: This really just confirms that driving anxiety is higher in women not only as a severe condition, but in milder forms.
TAKE HOME MESSAGE: None.
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
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