Psychiatric consequences of motor vehicle accidents

AUTHOR: Mayou RA
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.

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

PEER-REVIEWED

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

New Url

Please update your bookmarks to http://www.drivinganxiety.info

I apologise for the downtime; it took a little while to get the domain, host and blog host to all play well together.

It will take just a little longer to settle fully into this new theme and get everything linked up and looking pretty....

But I hope that once that is done this site will be a lot more functional, and I have a lot more great information to add to it.

Discomfort, affects and coping strategies in driving activity

AUTHORS: Cahour, B
JOURNAL: Proceedings of the 15th European conference on Cognitive ergonomics: the ergonomics of cool interaction, 2008

ABSTRACT: "Psychological comfort/discomfort is a global feeling constructed from the affective states which are lived by the users during the activity. This empirical study is about discomfort and emotions lived during all sorts of driving situations, and it is based on "explicitation interviews" and questionnaires. The analysis allowed us to specify the categories of uncomfortable situations during driving and their level of discomfort, to develop the underlying cognitive and social sources of discomfort (need of multiple attention; impossible anticipation; loss of control and feeling of un-ability; social image and relation), and to look at how people cope with the disagreeable situations, specifying the different types of coping modes (internal coping, external coping, avoidance)." [Full text available here (pdf)]

SUMMARY: This study is based on hour long interviews with 18 participants from a range of age groups. It is a general examination of experiences that cause negative emotions during driving. It was found that the most commonly experienced emotions were "tension and fear", followed by anger and then all other feelings. The sources of these feelings seem to be the need to attend to multiple aspects of a situation, of failures to see or anticipate events, feelings of being out of control or unskilled and the interference and opinions of other people. Coping strategies fall into three main groups: trying to change ones own thoughts or behavior, trying to change the situation, and avoidance of situations such as driving in certain areas. "It seems that older people are more often avoiding uncomfortable situations of driving..."

MY THOUGHTS: While not specifically about driving anxiety this paper gives a good background to the causes and outcomes of negative feelings whilst driving.

Béatrice Cahour (2008). Discomfort, affects and coping strategies in driving activity ACM International Conference Proceeding Series, 369

Why am I so afraid of driving?

POPULAR PRESS
AUTHORS: Fox, S.
PUBLICATION: The Times (London), 1999.

SUMMARY: A journalist account of suffering from spontaneous driving anxiety and seeking help for it.

"...I was horrified at how out of proportion my fears had become."

"It was a relief to sit with Professor Ehlers who, without be judgmental, was able to explain what happened to me."

"Professor Ehler divides driving phobics into three categories. Post-traumic stress disorder follows an accident ... another group .. suffer from panic disorder ... someone with a driving phobia."

"Professor Ehlers ... "I would hope that your anxiety could be dealt with in 12 to 15 sessions...."
MY THOUGHTS: So this article neither explains what causes the anxiety, nor goes even as far as beginning to treat it.

TAKE HOME MESSAGE: Why call an article "why am I so scared of driving?" and then not provide any kind of answer? A phobia diagnosis describes that you are afraid--it does not explain why.

Psychosocial sequelae of motor vehicle collisions: a follow-up study

AUTHORS: Vingilis E, Larkin E, Stoduto G, Parkinson-Heyes A, McLellan B.
JOURNAL: Accident; Analysis and Prevention, 1996

ABSTRACT: One-hundred-and-forty-nine motor vehicle collision trauma victims were interviewed one year after discharge from a Regional Trauma Unit. Follow-up data indicated major post trauma problems such depression, anxiety, family stress, financial problems and driving fears. Almost 40% reported drinking driving after the crash with a greater proportion of alcohol (blood alcohol content) positive drivers engaging in drinking driving than blood alcohol content negative drivers. Notably, almost 16% of the blood alcohol content positive and 13% of the blood alcohol content negative reported involvement in another crash in the year since discharge.. [Abstract here; Keywords: Canada; Trauma; Motor vehicle injuries; Alcohol; Sequelae; Psychosocial ]

SUMMARY: A Canadian study of 149 people who suffered injuries (requiring hospital treatment) from a car crash found that 25-50% had post-traumatic problems as a result. One third experienced driving anxiety and 1/4 fear of cars. After one year 16% had not resumed driving. Driving who had no blood alcohol at the time of their crash were more likely to develop fear of driving and take longer to resume driving.

MY THOUGHTS: The consequences of traumatic crashes are often diverse and serious, often including severe driving anxiety.

TAKE HOME MESSAGE: It seems driving anxiety is a relatively common result of a driving accident resulting in trauma. Although it is not clear what proportion of people suffering from driving anxiety develop it as a result of a crash.