Efficacy of virtual reality exposure therapy to treat driving phobia: a case report

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.

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.

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