Psious Professionals

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.

• Ehlers A, Taylor JE, Ehring T, Hofmann SG, Deane FP, Roth WT, et al., (2007): The driving cognitions questionnaire: development and preliminary psychometric properties. J Anxiety Disord.;21:493-509.

• Sánchez, S., & Sánchez, J. (2009). Amaxofobia. Cómo enseñar a vencer el miedo a conducir. Barcelona: Gráficas Ochoa. 

• 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.

Intervention proposal

“All the information contained in this section is for guidance only. Psious environments are therapy supporting tools that must be used by the healthcare professional within an evaluation and intervention process designed according to the characteristics and needs of the user.

Also remember that you have the General Clinical Guide in which you have more information on how to adapt psychological intervention techniques (exposure, systematic desensitization, cognitive restructuring, chip economy…) to Psious environments.”

Example of intervention Fear of driving

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. It is recommended that each healthcare professional adapts the virtual exposure within the treatment protocol that he or she uses regularly. 

Description of treatment sessions

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 jams, 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. 

Evaluation

“All the information contained in this section is for guidance only. Psious environments are therapy supporting tools  that must be used by the healthcare professional within an evaluation and intervention process designed according to the characteristics and needs of the user. 

Also remember that you have the General Clinical Guide in which you have more information on how to adapt psychological intervention techniques (exposure, systematic desensitization, cognitive restructuring, chip economy…) to Psious environments.”

Fear of Driving

Evaluation Objectives

• Evaluate the presence and comorbidity of other emotional disorders, in particular specific phobias, other anxiety and mood disorders.

• Evaluate anxiety associated with components: intensity, frequency, characteristics…

• Set the feared stimulative settings for the patient and define to what extent. Exposure hierarchy development. 

• Measure the presence of distorted thoughts.

Some useful instruments for fear of driving

Taking the evaluation objectives into account let’s proceed onto listing some tools and devices that can be useful in gathering relevant information on the user characteristics. Always remember good goal setting, patient characterization and intervention planning are important in effective and efficient therapies, as that of your patients’ satisfaction. The following are the articles you will find in the bibliography where you can refer to the proposed tool characterization:

• Open or semi-structured interview

• Structured interview: ADIS-IV

• Behavioral approach test/behavior avoidance (in vivo or with virtual reality)

SELF-REPORTING

• Cuestionario para la evaluación del Miedo a Conducir (CEMIC, Sánchez y Sánchez, 2017)

• Driving Cognitions Questionnaire (DCQ, Ehlers A et al., 2007 )

• Psious Self-Reports for the elaboration of the hierarchy

Exposure Hierarchy development with Psious environments

Once we have received the evaluation information we can then proceed to develop the hierarchy exposure. To do this, in addition to using the data obtained during the initial evaluation, we can carry out a series of questions, (For example, what level of discomfort, on a scale of 0 to 100, does driving have to generate? What level of discomfort, on a scale of 0 to 100, would lead you to take a long car trip? Is there something that makes you feel even more uncomfortable?) all geared at the planning of the intervention via the virtual reality.

Fear of driving
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 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 healthcare professional has total standardization and control over the exposure session parameters.