“Help! I’m Afraid of Driving!” Review of Driving Fear and its Treatment

Driving anxiety and anxiolytics while driving: Their impacts on behaviour and cognition behind the wheel

Introduction

The interaction between road safety and drivers' mental health is an important issue to take into consideration on transportation and safety research. The present review deals specifically with the link between anxiety and driving activity from two complementary points of view.

Method

A systematic review into primary studies, following the PRISMA statement, was carried out in four databases: Scopus, Web of Science, Transport Research International Documentation and Pubmed. A total of 29 papers were retained. On the one hand, we present a systematic review of research articles exploring the cognitive and behavioural effects of driving anxiety, regardless its onset, when concerned people have to drive. The second goal of the review is to compile the available literature on the influence of legal drugs, which are used to fight against anxiety, on actual driving tasks.

Results

Eighteen papers have been retained for the first question, whose main findings show that exaggerated cautious driving, negative feelings and avoidance are associated with driving anxiety. Most of the conclusions were drawn from self-reported questionnaires and little is known about the effects in situ. Concerning the second question, benzodiazepines are the most studied legal drugs. They affect different attentional processes and could slow reaction times down depending on the population and treatment features.

Conclusions

The two standpoints included in the present work allow us to propose some possible lines of research to study certain aspects that have not been explored in depth about people who either feel apprehensive about driving or who drive under the effects of anxiolytics.

Practical applications

The study on driving anxiety may be crucial to estimate the consequences for traffic safety. Furthermore, it is relevant to design effective campaigns to raise awareness about the issues discussed. To propose standard evaluations of driving anxiety and exhaustive research works to find out the extent of anxiolytics use are also important to be considered for traffic policies.

Psychological therapy using virtual reality for treatment of driving phobia: a systematic review

PURPOSE

Driving phobia is prevalent in injured individuals following motor vehicle crashes (MVCs). The evidence for virtual reality (VR) based psychological treatments for driving phobia is unknown. This systematic review synthesized the available evidence on the effectiveness, feasibility, and user experience of psychological treatments for driving phobia using VR.

METHODS

Three databases (PsycINFO, SCOPUS, and PubMed) were searched. Eligibility criteria included adults with clinical or sub-clinical levels of driving phobia manifesting as part of an anxiety disorder or post-traumatic stress disorder (PTSD). Primary outcomes were driving-related anxiety/fear or avoidance, PTSD symptoms and driving frequency/intensity, as well as treatment feasibility including recruitment, treatment completion and retention rates, user experience and immersion/presence in the VR program. Secondary outcomes were other health outcomes (e.g., depression) and VR technological features.

RESULTS

The 14 included studies were of low methodological quality. Clinical and methodological heterogeneity prevented quantitative pooling of data. The evidence provided in this review is limited by trials with small sample sizes, and lack of diagnostic clarity, controlled designs, and long-term assessment. The evidence did suggest that VR-based psychological interventions could be feasible and acceptable in this population.

CONCLUSIONS

For VR-based psychological interventions to be recommended for driving phobia, more high-quality trials are needed. Implications for rehabilitationVirtual reality (VR) based psychological treatments may be feasible and acceptable to patients with driving phobia.There is potential to increase accessibility to psychological therapies in patients with driving phobia following motor vehicle crashes through the use of digital psychiatry such as VR.

How Does Driving Anxiety Relate to the Health and Quality of Life of Older Drivers?

OBJECTIVES

11% of drivers aged 65+ report moderate to extreme driving anxiety, with associated reduction in driving. Knowledge about the relationships of driving anxiety with health and quality of life for older people is minimal. The present study examined these relationships.

METHOD

1170 community dwelling drivers aged 65+ in New Zealand completed a population survey.

RESULTS

After adjusting for socio-demographic variables, higher driving anxiety was associated with lower quality of life and lower odds of 'very good' self-reported health, but no difference in odds of multi-comorbidity.

DISCUSSION

Further research is needed to examine the influence of driving anxiety on health and quality of life outcomes with a broader range of older people who experience more challenges to their health and wellbeing, especially to mental health.

Measuring Driving Fear

Abstract. Presently, there is no instrument to support the diagnosis of driving fear and its severity. To enable a reliable and valid diagnosis, the 5-item German-language Instrument for Fear of Driving (IFD) was developed. The items, by DSM-5 criteria for a specific phobia, measure the emotional, cognitive, and physiological components of driving fear as well as the degree of avoidance and impairment. The present paper comprises two studies that describe the development of the IFD and its psychometric properties. In Study 1, the IFD was administered to 810 non-clinical participants in an online survey and demonstrated good reliability and construct validity. In Study 2, fifty-four people with a clinical diagnosis, including clinically relevant driving fear, completed the IFD and a clinical interview. The IFD demonstrated good sensitivity and specificity, and a cut-off score resulted in 95% sensitivity and 97% specificity. While the findings are preliminary and further studies with larger samples are needed, the IFD is a promising screening instrument for driving fear and its severity.

Cognitive and body manifestations of driving anxiety according to different onsets

BACKGROUND

Driving anxiety can have deleterious effects not only on driving behavior, but also on life quality. The interaction between motor vehicle collision (MVC) experiences and driving anxiety has been studied from different standpoints. However, the comparison with other events triggering it has been scarcely considered. Objectives: To analyze the body manifestations and the driving cognitions related to the accident, social and panic concerns in people suffering from different levels of driving anxiety. Method: A total of 260 participants suffering from driving anxiety were included in a survey, including Driving Cognition Questionnaire and Body Sensation Questionnaire. Results: Panic attacks and criticisms are the most relevant onsets of driving anxiety, more than MVC. Only 11.4% of MVC victims considered it as the onset. People with MVC history showed lower scores in social concerns than people without MVC experience and neither the responsibility of the MVC nor the role (driver/passenger) seemed to have an impact on the anxiety level. Conclusions: Although the most relevant body sensations, heart palpitations and sweating, were the same in people with panic attack experiences and MVC victims, a discrimination of the emotions behind the concept of "driving anxiety" is desirable to clarify the psychological effects of different onsets.

Kognitive Verhaltenstherapie bei Autofahrangst

Die Exposition im Straßenverkehr bei der kognitiv-verhaltenstherapeutischen Behandlung der Autofahrangst ist oftmals mit Fragen der praktischen Umsetzung sowie mit Haftungsfragen verbunden. Die folgende Handlungsempfehlung gibt einen Überblick über die Diagnostik, Ätiologie und psychometrische Erfassung der Autofahrangst und stellt versicherungsrechtliche Aspekte, die bei der Exposition im Straßenverkehr zu beachten sind, dar. Es wird ein Therapiemodul zur Behandlung der Autofahrangst vorgestellt, das konkrete Hinweise zur praktischen Umsetzung der Behandlung von Autofahrangst gibt.

Exploring the Participant-Related Determinants of Simulator Sickness in a Physical Motion Car Rollover Simulation as Measured by the Simulator Sickness Questionnaire

Physical motion driving simulators serve as a valuable research and training tool. Since many simulator participants suffer from simulator sickness (SS), we aimed to gain a better understanding of participant-related variables that may influence its incidence and severity. The study involved a 2-min mobile-platform car rollover simulation conducted in a group of 100 healthy adult participants. SS was measured with the Simulator Sickness Questionnaire immediately before and after the simulation. We investigated how the symptomatology of SS varies with gender, as well as with participants’ previous experiences such as extra driving training or car accidents. Although many SS symptoms occurred already before the simulation, all the symptoms except burping had a significantly greater incidence and severity after the simulation. Before the simulation, men reported disorientation symptoms more often than women, while participants with prior experiences of extra driving training or car accidents scored significantly higher in three out of four Questionnaire components: nausea symptoms, oculomotor symptoms, and the total score. The study offers interesting insights into associations between SS and prior experiences observed by means of high-fidelity real-motion simulations. More research is needed to determine the nature of these associations and their potential usefulness, for example, in helping accident survivors to cope with the distressing or even potentially disabling psychological consequences of accidents.