Manual Index Fear of driving
- Driving Phobia and Virtual Reality
- Psious-based Treatment Protocol
- Tips for immersion
- Recommended Bibliography
- Annexes
1. DRIVING PHOBIA AND VIRTUAL REALITY
Fear of Driving is defined in the current mental disorders classification system as a situational phobia within specific phobias. It is characterized by an intense and persistent fear that increases with the anticipation or exposure to the driving stimuli. Recent studies have shown that the prevalence of this phobia is of 4% of the population, although the percentage of people with some type of driving-related fear could raise up to 22%. The symptoms of this phobia can cause significant discomfort and serious interference with the daily lives of the patients.
Certain factors affect the intensity of the patient’s emotional reaction to driving. The typical and most important ones are: speed, weather, amount of traffic, distance to be covered, time of day, characteristics of the road, type of car, if they are driving alone or with company, where the patient is driving through, etc.
Virtual reality has been proved to be a good alternative to traditional exposure techniques in the treatment of driving phobia. This technology is especially useful in repeating the exposure as many times as necessary in order to recreate the unpredictable circumstances that occur in the real situation. Moreover, VR naturally eliminates the chances of suffering an accident and the therapist has total standardization and control over the exposure session parameters.
2. PSIOUS-BASED CLINICAL PROTOCOL
A proposal for a treatment protocol that includes the Psious tool is described below. It is recommended to combine virtual reality with traditional techniques, such as relaxation or cognitive restructuring.
Session description
SESSION 1: PSYCHOEDUCATION
- Information about driving phobia: origin and manifestations (cognitive, physiological, and behavioral).
- Treatment protocol explanation. The patient should understand the applicability of virtual reality and relaxation techniques.
SESSION 2 + 3: RELAXATION
- Training of two relaxation techniques: Deep breathing and Progressive Muscular Relaxation.
- Patient’s familiarization with VR: Use of neutral environments (e.g., environments for other phobias).
Homework:
Practice of the relaxation techniques. Relaxation diary (see annex 6.2)
SESSION 4: VIRTUAL EXPOSURE + RELAXATION
- Virtual exposure + Relaxation:
- 1- City without cars, during the day when it’s sunny. Track 1.
- 2- City with cars, during the day when it’s sunny. Combine track 1 and 2 with traffic jam, slowdown and horn situations.
- 3- City with cars, during a rainy day + interoceptive exposure (blurry vision)
Homework:
Practice relaxation and self exposure. Relaxation and driving phobia diary (see annex 6.2).
SESSION 5: VIRTUAL EXPOSURE + RELAXATION
- Virtual exposure + Relaxation:
- 1- City with cars during a rainy night. Combine track 1 and 2 with the above mentioned situations.
- 2- City with cars during a rainy night + interoceptive exposure (blurry vision → tunnel vision + hyperventilation)
- 3- Road without cars during the day. Low, mid and high speed.
Homework:
Practice relaxation and self-exposure. Relaxation register and driving phobia diary (see annex 6.2).
SESSION 6: VIRTUAL EXPOSURE + RELAXATION
- Virtual exposure + Relaxation:
- 1- Highway with cars during a sunny day. Mid speed combined with some type of distractor
- 2- Highway with cars during a rainy day. Sections of tunnels and bridges. Highway with cars during a rainy day.
- 3- Sections with tunnels and bridges. Add curves and combine with accidented car. High speed.
Homework:
Practice relaxation and self-exposure. Self Recording of relaxation and driving phobia diary (see annex 6.2).
SESSION 7: VIRTUAL EXPOSURE + RELAXATION
- Virtual exposure + relaxation
- 1- Road with cars during a rainy day. Tunnels and bridges. High speed. Combine last session settings and the use of some type of distractor
- 2- Road with cars during a rainy night. Combine the different elements and add interoception effects.
Homework:
Practicing relaxation and self-exposure. Self Recording of relaxation and driving phobia diary (see annex 6.2).
SESSION 8: CONCLUSIONS AND RELAPSE PREVENTION
- Evaluation of the treatment.
- Future self-exposure planning.
- Tools for future relapse prevention.
3. TIPS FOR IMMERSION
It is important to accompany the exposure with comments, questions or indications. This is beneficial to the treatment because it helps the patient to become more involved in the situation and the exposure.
Some options for driving phobia:
- You are driving along a highway and there is still an hour left of driving
- It will take two more hours to get to our destination and it’s 8 in the evening. It’s getting dark…
- Now the highway has curves and slopes. Are you scared? Of what?
- You are about to get into the car to go to work and the day is very rainy.
- Today we will drive around the town. You know that in towns there are many / a lot of cars. In addition, today we have to go by in rush hour. And by the way, your cellphone battery is dead, so you can’t call anyone to calm you down neither before nor during the trip.
- Imagine you are alone in the car. Today we will travel for 4 minutes/10 minutes/30 minutes…
- Picture yourself driving and that someone is recording you in case you need to get points taken off.
- We are driving down a road packed with trucks. Yes, and you know that trucks sometimes overtake each other.
- In this section, you must go 62m/h because if you go over this speed, you will obstruct traffic.
- Now we are going to enter a tunnel. How long do you think the tunnel is? What do you feel when you see that the tunnel is longer than you expected?
- If the car in front of you were to derail, do you think you would have time to react?
4. RECOMMENDED BIBLIOGRAPHY
Da Costa, R.T., de Carvalho, M.R. & Nardi, A.E. (2010). Virtual reality exposure therapy in the treatment of driving phobia. Psicologia: Teoria e Pesquisa, 26(1), 131-137.
Kraft, T. & Kraft, D. (2004).Creating a virtual reality in hypnosis: A case of driving phobia. Contemporary Hypnosis, 21(2), 79-85.
Wald, J. & Taylor, S. (2000). Efficacy of virtual reality exposure therapy to treat driving phobia: A case study. Journal of Behavior Therapy and Experimental Psychiatry, 31(3-4), 249-257.
Wald, J. & Taylor, S. (2003). Preliminary research on the efficacy of virtual reality exposure therapy to treat driving phobia. CyberPsychology & Behavior, 6(5), 459-465.
Wald, J. (2004). Efficacy of virtual reality exposure therapy for driving phobia: A multiple baseline across-subjects design. Behavior Therapy, 35(3), 621-635.
Walshe, D.G., Lewis, E.J., Kim, S.I., O’Sullivan, K. & Wiederhold, B.K. (2003). Exploring the use of computer games and virtual reality in exposure therapy for fear of driving following a motor vehicle accident. CyberPsychology & Behavior, 6(3), 329-334.
4. ANNEXES
4.1 Fear of driving diary
AVOID DRIVING:
To what degree would you avoid driving today according to the scale indicated below?
| 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
| I wouldn’t avoid it | I would avoid it a bit | I would avoid it quite a bit. | I would avoid it a lot | I would completely avoid it | ||||
STATE OF DRIVING PHOBIA SYMPTOMS:
How do you assess your driving phobia symptoms today?
| 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
| No PHOBIA | A bit disturbing | Quite a bit disturbing | Very disturbing | Completely disturbing | ||||