Assessment and treatment of motor vehicle accident victims

Measuring Anxiety-Related Avoidance With the Driving and Riding Avoidance Scale (DRAS)

Abstract. Driving anxiety is a common experience that, for those with high levels of driving anxiety, can markedly interfere with functioning, particularly because of avoidance behavior. The Driving and Riding Avoidance Scale (DRAS; Stewart & St. Peter, 2004 ) is a promising measure of self-reported avoidance, but its psychometric properties have been questioned as the instructions do not specifically ask respondents to report avoidance that is due to driving anxiety. The present study investigated the psychometric properties of the DRAS using revised instructions in 437 participants from the general population of New Zealand. Internal consistency for the DRAS was 0.94 and ranged from 0.79 to 0.90 for the four subscales. A two-factor solution was supported, in line with previous research using the revised instructions, supporting the distinction between general and traffic avoidance compared with weather and riding avoidance. Further work on the psychometric properties of this measure with clinical samples is needed to clarify the subscale structure.

Scared behind the wheel: what impact does driving anxiety have on the health and well-being of young older adults?

BACKGROUND

Driving anxiety can range from driving reluctance to driving phobia, and 20% of young older adults experience mild driving anxiety, whereas 6% report moderate to severe driving anxiety. However, we do not know what impact driving anxiety has on health and well-being, especially among older drivers. This is problematic because there is a growing proportion of older adult drivers and a potential for driving anxiety to result in premature driving cessation that can impact on health and mortality. The purpose of the current study was to examine the impact of driving anxiety on young older adults' health and well-being.

METHOD

Data were taken from a longitudinal study of health and aging that included 2,473 young older adults aged 55-70 years. The outcome measures were mental and physical health (SF-12) and quality of life (WHOQOL-8).

RESULTS

Hierarchical multiple regression analyses demonstrated that driving anxiety was associated with poorer mental health, physical health, and quality of life, over and above the effect of socio-demographic variables. Sex moderated the effect of driving anxiety on mental health and quality of life in that, as driving anxiety increased, men and women were more likely to have lower mental health and quality of life, but women were more likely to have higher scores compared to men.

CONCLUSION

Further research is needed to investigate whether driving anxiety contributes to premature driving cessation. If so, self-regulation of driving and treating driving anxiety could be important in preventing or reducing the declines in health and quality of life associated with driving cessation for older adults affected by driving anxiety.

Demographics, clinical characteristics and quality of life of Brazilian women with driving phobia

Driving phobia is associated with serious consequences such as restriction of freedom, career impairments and social embarrassment. The main objective of this paper is to compare clinical characteristics and quality of life between women with driving phobia and women without this phobia. These factors were assessed using structured interviews, semi-structured questionnaires, scales and inventories. We accessed diagnoses, depressive symptoms, anxiety symptoms, anxiety traits, driving cognitions and quality of life. There was no difference between groups with regard to demographic data and driving history. Both groups were also equivalent in the number of traumatic events and accidents experienced while driving or riding. The fear of driving group showed higher state and trait anxiety scores. A high frequency of cognitive distortions can explain why people with driving phobia often engage in maladaptive safety behaviors in an attempt to protect themselves from unpredicted dangers when driving. Regarding quality of life, the control group had slightly higher scores on all subscales, but significant differences were observed for only three scales: "functional capacity", "social aspects", and "mental health". More studies with larger samples more instruments and other contexts are needed to further investigate the clinical characteristics and personality traits of people who have a fear of driving.

Properties of the Driving Behavior Survey among individuals with motor vehicle accident-related posttraumatic stress disorder

Data suggest anxious drivers may engage in problematic behaviors that place themselves and others at increased risk of negative traffic events. Three domains of problematic behavior--exaggerated safety/caution, performance deficits, and hostile/aggressive behaviors--previously were identified during development of the Driving Behavior Survey (DBS), a novel measure of anxiety-related behavior. Extending this research, the current study examined the psychometric properties of DBS scores among individuals with posttraumatic stress disorder (PTSD) subsequent to motor vehicle trauma (N=40). Internal consistencies and 12-week test-retest reliabilities for DBS scales ranged from good to excellent. Comparison of scores to normative student data indicated dose-response relationships for safety/caution and performance deficit subscales, with increased frequency of anxious behavior occurring within the PTSD sample. Associations with standard clinical measures provide additional evidence for anxiety-related driving behavior as a unique marker of functional impairment, distinct from both avoidance and disorder-specific symptoms.

The Driving Behavior Survey: scale construction and validation

Although long recognized in the clinical literature, problematic behavior characteristic of anxious drivers has received little empirical attention. The current research details development of a measure of anxious driving behavior conducted across three studies. Factor analytic techniques identified three dimensions of maladaptive behaviors across three college samples: anxiety-based performance deficits, exaggerated safety/caution behavior, and anxiety-related hostile/aggressive behavior. Performance deficits evidenced convergent associations with perceived driving skill and were broadly related to driving fear. Safety/caution behaviors demonstrated convergence with overt travel avoidance, although this relationship was inconsistent across studies. Safety/caution scores were associated specifically with accident- and social-related driving fears. Hostile/aggressive behaviors evidenced convergent relationships with driving anger and were associated specifically with accident-related fear. Internal consistencies were adequate, although some test-retest reliabilities were marginal in the unselected college sample. These data provide preliminary evidence for utility of the measure for both research and clinical practice.

Virtual reality exposure therapy in the treatment of driving phobia

A growing number of researches has appeared on virtual reality exposure therapy (VRET) to treat anxiety disorders. The purpose of this article was to review some evidences that support the VRET efficacy to treat driving phobia. The studies were identified through computerized search (PubMed/Medline, Web of Science, and Scielo databases) from 1984 to 2007. Some findings are promising. Anxiety/avoidance ratings declined from pre to post-treatment. VRET may be used as a first step in the treatment of driving phobia, as long as it may facilitate the in vivo exposure, thus reducing risks and high costs of such exposure. Notwithstanding, more randomized/controlled clinical trials are required to prove its efficacy.

What does the Driving and Riding Avoidance Scale (DRAS) measure?

Driving anxiety can have a significant impact on everyday functioning and usually results in some kind of avoidance behaviour. The Driving and Riding Avoidance Scale (DRAS; Stewart, A. E., & St. Peter, C. C. (2004). Driving and riding avoidance following motor vehicle crashes in a non-clinical sample: psychometric properties of a new measure. Behaviour Research and Therapy, 42, 859-879) shows promise in the self-report assessment of the degree of such avoidance. The present study investigated the psychometric properties of the DRAS in a sample of 301 university students. Internal consistency for the DRAS was 0.89 and temporal stability over two months was 0.71. The factor structure of the DRAS supported the use of the general and traffic avoidance subscales but not the weather and riding avoidance subscales in the present non-clinical sample. However, a significant limitation of the DRAS is that it does not assess the reasons for driving avoidance, and is therefore not a measure of avoidance that is due to driving anxiety. Some items may be rated highly for practical reasons, such as avoidance because of increasing fuel and other costs associated with driving. Modified instructions for the DRAS should ensure that it measures anxiety-related avoidance behaviour.

Driving fear and driving skills: Comparison between fearful and control samples using standardised on-road assessment

The present study explores driving skills in a group of 50 media-recruited driving-fearful and 50 control drivers, all of whom were women. Participants completed an on-road practical driving assessment with a professional driving instructor. Diagnostic as well as pre-post self-report and instructor driving assessments were conducted. Fearful drivers made more errors on the driving assessment than controls. However, the pattern of errors was identical for both groups, indicating that fear and anxiety may be associated with the number rather than the type of driving errors made. These differences remained when factors such as driving history, current driving frequency, and diagnosis were controlled using case selection. More research is needed to replicate the findings in more diverse samples. Additional work should also aim to clarify the specific role of driving skills in driving fear, which will facilitate treatment planning for exposure-based treatments and help identify cases where driving skills assessment may be appropriate.

Group cognitive behavioral treatment for PTSD: Treatment of motor vehicle accident survivors

Individual cognitive behavioral therapies (CBT) are now considered the first-line treatment for posttraumatic stress disorder (PTSD; Foa, Keane, & Friedman, 2000). As mental health reimbursement becomes more restricted, it is imperative that we adapt individual-format therapies for use in a small group format. Group therapies have a number of advantages, including provision of a natural support group, the ability to reach more patients, and greater cost efficiency. In this article, we describe the development of a group CBT for PTSD in the aftermath of a serious motor vehicle accident (MVA). Issues unique to the group treatment format are discussed, along with special considerations such as strategies to reduce the potential for triggering reexperiencing symptoms during group sessions. A case example is presented, along with discussion of group process issues. Although still in the early stages, this group CBT may offer promise as an effective treatment of MVA-related PTSD.

Driving-related fear: a review

This article reviews the research on driving-related fear (DRF). Until recently, research has concentrated almost exclusively on the effect of motor vehicle accidents (MVAs) on subsequent levels of DRF. However, recent findings have suggested that MVAs are not solely responsible for this fear reaction, and that non-MVA driving fear can be just as strong. Studies of the broader driving-fearful population have encountered difficulty with diagnostic conceptualisation of DRF, although some have investigated a possible typology of DRF. Driving skill has been a neglected issue in the DRF research, and may prove to be a useful part of assessment and remediation of this potentially debilitating problem. Issues of definitional inconsistency are highlighted, and suggestions are made for several directions that future research might profitably take.

Post-traumatic stress in children following motor vehicle accidents

BACKGROUND

This study examined children's experiences following a motor vehicle accident (MVA).

METHODS

Approximately 9 months following the accident, children (n=50) and their parents (n=50) participated in extensive interviews about the accident and in comprehensive, structured diagnostic interviews concerning overall psychological functioning. Additional assessments included post-traumatic stress questionnaires, archival police report records, and emergency treatment medical records.

RESULTS

Of the 50 children, 7 children (14%) met criteria for PTSD diagnosis, and an additional 5 children met criteria for specific phobia (10%) related to the automobile accident on the structured diagnostic interview (DICA-R-C; total of 24%). Degree of physical injury predicted more PTSD symptoms, and previous accident experiences predicted fewer symptoms, before and after controlling for other variables. Holding degree of physical injury and age constant revealed that social support predicted fewer PTSD symptoms.

CONCLUSIONS

Findings suggest the possible inoculating role of previous accidents and the importance of social support following MVA injury.

Posttraumatic stress disorder and traumatic brain injury: can they co-exist?

The possibility that posttraumatic stress disorder (PTSD) can develop following traumatic brain injury (TBI) has been the subject of considerable debate. The traditional view has held that impaired consciousness that occurs with TBI precludes encoding of the traumatic experience, and this prevents subsequent reexperiencing symptoms. This paper critically reviews available, empirical studies on PTSD in TBI populations and suggests that these two conditions can co-exist. The various mechanisms that may mediate PTSD following TBI are discussed, and special attention is given to issues that recognize the distinctive features of PTSD following TBI. These processes include implicit processing, biologically mediated fear conditioning, and reconstruction of trauma memories. Finally implications for assessment, treatment, and forensic investigation of PTSD in TBI populations are, addressed. This review concludes that TBI populations provide a useful means by which the role of traumatic memories (and impaired memories) in posttraumatic adjustment can be studied.

Comparison and characteristics of motor vehicle accident (MVA) and non-MVA driving fears

Prior research has revealed the diagnostic complexity among people who report driving fears. However, the focus on survivors of motor vehicle accidents (MVAs) and diagnostic samples may have inadvertently led to a relative neglect of the broader driving-fearful population. No studies could be located that compared MVA survivors with those who had not experienced an MVA. The aim of the present study was to address these deficits by comparing the characteristics of MVA and non-MVA driving-fearfuls and also exploring a range of characteristics associated with driving fears. One hundred and ninety media-recruited driving-fearfuls completed a questionnaire that assessed severity of anxiety and avoidance associated with a variety of driving situations. It was found that fear levels were similar to samples of driving phobics and MVA victims. There were no significant differences between MVA and non-MVA respondents on various measures of fear severity. In addition, the sample rated a high level of anxiety when driving with someone who criticizes their driving. Implications of the findings are discussed, along with suggestions for assessment and treatment of those with driving-related fears.

Acquisition and severity of driving-related fears

Rachman's theory of fear acquisition proposes that directly-conditioned fears will differ from indirectly-conditioned fears in magnitude and anxiety response patterns, however the theory has received inconsistent empirical support. The aim of the present study was to describe the fear acquisition pathways for a community sample who reported driving-related fears, and to test Rachman's theory of fear acquisition. One hundred and ninety participants completed a questionnaire which assessed a variety of driving-related situations, reactions to motor vehicle accidents (MVAs), and anxiety response patterns. Professional psychological helpseeking and perceived need for treatment for driving-related fears were also assessed. Results failed to support Rachman's predictions. However, it was confirmed that respondents who had been involved in an MVA were more likely to ascribe their fears to a directly-conditioned pathway. The theoretical and methodological implications of the findings are discussed, along with suggestions for assessment of those with driving-related fears.