Driving phobia

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Driving phobia
Specialty Psychology

Driving phobia, [1] driving anxiety, [1] [2] vehophobia, [3] amaxophobia or driving-related fear (DRF) [4] is a pathological fear of driving. It is an intense, persistent fear of participating in car traffic (or in other vehicular transportation) that affects a person's lifestyle, including aspects such as an inability to participate in certain jobs due to the pathological avoidance of driving. [5] [4] [6] The fear of driving may be triggered by specific driving situations, such as expressway driving or dense traffic. [7] Driving anxiety can range from a mild cautious concern to a phobia.

Contents

Symptoms

The fear of driving is associated with various physical and subjective emotional symptoms that somewhat vary from individual to individual. For example, the physical symptoms might involve increased perspiration or tachycardia (pathologically accelerated heart rate), or hyperventilation. On the cognitive level, the patient may experience a loss of sense of reality, or thoughts of losing control while driving, even in situations that are reasonably safe. [8] On a behavioral level, the avoidance of driving tends to perpetuate the phobia. Patients who developed their amaxophobia after a serious traffic collision frequently develop the post-traumatic stress disorder (PTSD) that may involve experiencing intrusive thoughts or anxious dreams of the original collision and/or other typical PTSD symptoms. [8] A noteworthy part of post-collision symptomatology is the phantom brake syndrome. It is the passenger's partly involuntary or unintended pressing the foot on the floor of the car in a reflexive attempt "to brake." This unintended behavior usually occurs in skilled drivers when they are seated as a passenger next to a less competent person who drives the vehicle as a reflexive response to potentially dangerous traffic situations. The phantom brake syndrome is particularly common in survivors of serious car collisions. [9]

Associated conditions

Some patients who present with phobia of driving also describe features consistent with various other anxiety disorders, including panic disorder, agoraphobia, specific phobia, and social phobia. [5] The majority of survivors of serious car collisions tend to experience only the phobia of driving, but they often report generalized anxiety as a part of their post-traumatic adjustment disorder. [10] [ unreliable source ] The amaxophobia tends to be perpetuated by persistent pain caused by the car crash, and by pain related insomnia, and also by persistent post-conconcussion and whiplash symptoms caused by the crash. The PTSD symptoms, e.g., in the forms of flashbacks such as intrusive images of a bleeding person injured in the same car crash, may also contribute to amaxophobia. Correlations of PTSD scores to scores on measures of driving anxiety are significant and range from .31 to .79. [11]

Causes

There are three major categories of driving phobia, distinguished by their onset. [12]

The most common cause of a fear of driving is traffic collisions. Thus, the amaxophobia often develops as a reaction to a particularly traumatic vehicular collision. Beck and Coffey reported that 25–33% of people involved in a car collision associated with injuries and related evaluation in a hospital experience subsequent fear of driving. [8] Hickling and Blanchard [13] and Kuch, Swinson, and Kirby [14] found higher rates of driving phobia, ranging from 42% to 77%. The majority of experienced drivers with fear of driving in the aftermath of their serious collisions rate themselves as safer drivers than average, though they feel physically and emotionally too uncomfortable. [5] For some patients, the fear escalates in very specific situations such as when near large vehicles (transport trucks, buses), but in others, the fear may be triggered already just by getting seated in the car or even just by thinking about having to again travel in a car in the near future. Several psychological questionnaires have been developed for clinicians to assess the situational intensity and facets of driving anxiety in novice drivers or also in experienced drivers traumatized by a recent car collision. [15] [ unreliable source ] Some novice drivers and passengers who were never involved in a serious car collision also report symptoms of amaxophobia. [5] The driving fear may be, in some patients, an extension of agoraphobia. [5]

Additional factors contributing to driving phobia include a fear of losing control, anticipation of accidents, or previous exposure to unsafe driving conditions. In some cases, individuals may experience driving anxiety due to pre-existing conditions such as generalized anxiety disorder (GAD) or post-traumatic stress disorder (PTSD). Cognitive distortions, like overestimating the likelihood of danger, can further reinforce the fear. [16]

Treatment

The most common treatment for both driving phobia and milder forms of driving anxiety is behavior therapy [17] in the form of systematic desensitization. [17] [18] [19] An emerging treatment approach to treating amaxophobia is through the use of virtual reality therapy. [20] With repeated exposure such as via devices similar to video games, the subjective distress is gradually reduced: the patient may subsequently be more willing to proceed to engaging in driving in real life situations, as the next stage of exposure therapy.[ citation needed ]

Psychological assessment

A variety of inventories have been developed to assess driving anxiety.

Epidemiology

Little is known about the prevalence of driving anxiety. One study found that 16% of New Zealand adults have "moderate to severe driving anxiety". [26]

See also

Related Research Articles

<span class="mw-page-title-main">Phobia</span> Anxiety disorder classified by a persistent and excessive fear of an object or situation

A phobia is an anxiety disorder, defined by an irrational, unrealistic, persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avoid the situation or object, to a degree greater than the actual danger posed. If the object or situation cannot be avoided, they experience significant distress. Other symptoms can include fainting, which may occur in blood or injury phobia, and panic attacks, often found in agoraphobia and emetophobia. Around 75% of those with phobias have multiple phobias.

<span class="mw-page-title-main">Anxiety disorder</span> Cognitive disorder with an excessive, irrational dread of everyday situations

Anxiety disorders are a group of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatigue, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual.

<span class="mw-page-title-main">Agoraphobia</span> Anxiety disorder

Agoraphobia is a mental and behavioral disorder, specifically an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives their environment to be unsafe with no easy way to escape. These situations can include public transit, shopping centers, crowds and queues, or simply being outside their home on their own. Being in these situations may result in a panic attack. Those affected will go to great lengths to avoid these situations. In severe cases, people may become completely unable to leave their homes.

Specific phobia is an anxiety disorder, characterized by an extreme, unreasonable, and irrational fear associated with a specific object, situation, or concept which poses little or no actual danger. Specific phobia can lead to avoidance of the object or situation, persistence of the fear, and significant distress or problems functioning associated with the fear. A phobia can be the fear of anything.

<span class="mw-page-title-main">Claustrophobia</span> Fear of small spaces

Claustrophobia is a fear of confined spaces. It is triggered by many situations or stimuli, including elevators, especially when crowded to capacity, windowless rooms, and hotel rooms with closed doors and sealed windows. Even bedrooms with a lock on the outside, small cars, and tight-necked clothing can induce a response in those with claustrophobia. It is typically classified as an anxiety disorder, which often results in panic attacks. The onset of claustrophobia has been attributed to many factors, including a reduction in the size of the amygdala, classical conditioning, or a genetic predisposition to fear small spaces.

Systematic desensitization, or graduated exposure therapy, is a behavior therapy developed by the psychiatrist Joseph Wolpe. It is used when a phobia or anxiety disorder is maintained by classical conditioning. It shares the same elements of both cognitive-behavioral therapy and applied behavior analysis. When used in applied behavior analysis, it is based on radical behaviorism as it incorporates counterconditioning principles. These include meditation and breathing. From the cognitive psychology perspective, cognitions and feelings precede behavior, so it initially uses cognitive restructuring.

The Liebowitz Social Anxiety Scale (LSAS) is a short questionnaire developed in 1987 by Michael Liebowitz, a psychiatrist and researcher at Columbia University and the New York State Psychiatric Institute. Its purpose is to assess the range of social interaction and performance situations feared by a patient in order to assist in the diagnosis of social anxiety disorder. It is commonly used to study outcomes in clinical trials and, more recently, to evaluate the effectiveness of cognitive-behavioral treatments. The scale features 24 items, which are divided into two subscales. 13 questions relate to performance anxiety and 11 concern social situations. The LSAS was originally conceptualized as a clinician-administered rating scale, but has since been validated as a self-report scale.

Pseudodysphagia, in its severe form, is the irrational fear of swallowing or, in its minor form, of choking. The symptoms are psychosomatic, so while the sensation of difficult swallowing feels authentic to the individual, it is not based on a real physical symptom. It is important that dysphagia be ruled out before a diagnosis of pseudodysphagia is made.

<span class="mw-page-title-main">Cynophobia</span> Fear of dogs and canines

Cynophobia is the fear of dogs and canines in general. Cynophobia is classified as a specific phobia, under the subtype "animal phobias". According to Timothy O. Rentz of the Laboratory for the Study of Anxiety Disorders at the University of Texas, animal phobias are among the most common of the specific phobias and 36% of patients who seek treatment report being afraid of dogs or afraid of cats. Although ophidiophobia or arachnophobia are more common animal phobias, cynophobia is especially debilitating because of the high prevalence of dogs and the general ignorance of dog owners to the phobia. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) reports that only 12% to 30% of those with a specific phobia will seek treatment.

Desensitization is a psychology term related to the treatment or process that diminishes emotional responsiveness to a negative or aversive stimulus after repeated exposure. This process typically occurs when an emotional response (feeling) is repeatedly triggered, but the action tendency associated with the emotion proves irrelevant or unnecessary.

Exposure therapy is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the patient to the anxiety source or its context. Doing so is thought to help them overcome their anxiety or distress. Numerous studies have demonstrated its effectiveness in the treatment of disorders such as generalized anxiety disorder (GAD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and specific phobias.

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous. Additional procedures include processing of the trauma memory and breathing retraining.

Social anxiety is the anxiety and fear specifically linked to being in social settings. Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum disorders, eating disorders, and substance use disorders. Individuals with higher levels of social anxiety often avert their gazes, show fewer facial expressions, and show difficulty with initiating and maintaining a conversation. Social anxiety commonly manifests itself in the teenage years and can be persistent throughout life; however, people who experience problems in their daily functioning for an extended period of time can develop social anxiety disorder. Trait social anxiety, the stable tendency to experience this anxiety, can be distinguished from state anxiety, the momentary response to a particular social stimulus. Half of the individuals with any social fears meet the criteria for social anxiety disorder. Age, culture, and gender impact the severity of this disorder. The function of social anxiety is to increase arousal and attention to social interactions, inhibit unwanted social behavior, and motivate preparation for future social situations.

Interoceptive exposure is a cognitive behavioral therapy technique used in the treatment of panic disorder. It refers to carrying out exercises that bring about the physical sensations of a panic attack, such as hyperventilation and high muscle tension, and in the process removing the patient's conditioned response that the physical sensations will cause an attack to happen.

<span class="mw-page-title-main">Social anxiety disorder</span> Anxiety disorder associated with social situations

Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impairing ability to function in at least some aspects of daily life. These fears can be triggered by perceived or actual scrutiny from others. Individuals with social anxiety disorder fear negative evaluations from other people.

In psychology, avoidance coping is a coping mechanism and form of experiential avoidance. It is characterized by a person's efforts, conscious or unconscious, to avoid dealing with a stressor in order to protect oneself from the difficulties the stressor presents. Avoidance coping can lead to substance abuse, social withdrawal, and other forms of escapism. High levels of avoidance behaviors may lead to a diagnosis of avoidant personality disorder, though not everyone who displays such behaviors meets the definition of having this disorder. Avoidance coping is also a symptom of post-traumatic stress disorder and related to symptoms of depression and anxiety. Additionally, avoidance coping is part of the approach-avoidance conflict theory introduced by psychologist Kurt Lewin.

<span class="mw-page-title-main">Fear of flying</span> Fear of being in a flying vehicle whilst in flight

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Fear of negative evaluation (FNE), or fear of failure, also known as atychiphobia, is a psychological construct reflecting "apprehension about others' evaluations, distress over negative evaluations by others, and the expectation that others would evaluate one negatively". The construct and a psychological test to measure it were defined by David Watson and Ronald Friend in 1969. FNE is related to specific personality dimensions, such as anxiousness, submissiveness, and social avoidance. People who score high on the FNE scale are highly concerned with seeking social approval or avoiding disapproval by others and may tend to avoid situations where they have to undergo evaluations. High FNE subjects are also more responsive to situational factors. This has been associated with conformity, pro-social behavior, and social anxiety.

Safety behaviors are coping behaviors used to reduce anxiety and fear when the user feels threatened. An example of a safety behavior in social anxiety is to think of excuses to escape a potentially uncomfortable situation. These safety behaviors, although useful for reducing anxiety in the short term, might become maladaptive over the long term by prolonging anxiety and fear of nonthreatening situations. This problem is commonly experienced in anxiety disorders. Treatments such as exposure and response prevention focus on eliminating safety behaviors due to the detrimental role safety behaviors have in mental disorders. There is a disputed claim that safety behaviors can be beneficial to use during the early stages of treatment.

References

  1. 1 2 Zinzow, Heidi M.; Jeffirs, Stephanie M. (January 2018). "Driving Aggression and Anxiety: Intersections, Assessment, and Interventions". Journal of Clinical Psychology. 74 (1): 43–82. doi:10.1002/jclp.22494. ISSN   1097-4679. PMID   28636768.
  2. ↑ "r/drivinganxiety". Reddit . Retrieved January 7, 2022.
  3. ↑ "Aahhh! Study Reveals Tri-State's Most-Searched Phobias". WNBC. October 9, 2018. Retrieved February 4, 2022.
  4. 1 2 Taylor, Joanne; Deane, Frank; Podd, John (June 2002). "Driving-related Fear: A Review". Clinical Psychology Review . 22 (5): 631–645. doi:10.1016/s0272-7358(01)00114-3. PMID   12113199.
  5. 1 2 3 4 5 Taylor, Joanne E.; Deane, Frank P.; Podd, John V. (September–October 2000). "Determining the focus of driving fears". Journal of Anxiety Disorders . 14 (5): 453–470. doi:10.1016/s0887-6185(00)00033-5. PMID   11095540.
  6. ↑ Taylor, Joanne E. (2002). Understanding Driving-Related Fear (PhD thesis). Massey University.
  7. ↑ Mathew, R. J.; Weinman, M. L.; Semchuk, K. M.; Levin, B. L. (August 1982). "Driving phobia in the city of Houston: a pilot study". American Journal of Psychiatry . 139 (8): 1049–1051. doi:10.1176/ajp.139.8.1049. PMID   7091430.
  8. 1 2 3 Beck, J. Gayle; Coffey, Scott F. (December 2007). "Assessment and treatment of PTSD after a motor vehicle collision: Empirical findings and clinical observations". Professional Psychology: Research and Practice . 38 (6): 629–639. doi:10.1037/0735-7028.38.6.629. PMC   2396820 . PMID   18509507.
  9. ↑ Cernovsky, Zack Z.; Fattahi, Milad (2021-06-15). "Phantom Brake Phenomenon in Survivors of Car Accidents". European Journal of Clinical Medicine. 2 (3): 9–13. doi: 10.24018/clinicmed.2021.2.3.68 . ISSN   2736-5476. S2CID   237395446.
  10. 1 2 Gutierrez, Jaime; Nosonova, Vitalina; Cernovsky, Zack; Fattahi, Milad; Tenenbaum, Silvia (2019). "Gutierrez Questionnaire for Assessments of Patients after Car Accidents" (PDF). Archives of Psychiatry and Behavioral Sciences. 2 (2): 10–21. doi:10.22259/2638-5201.0202003. ISSN   2638-5201. Archived (PDF) from the original on June 19, 2020.
  11. ↑ Cernovsky, Zack Z.; Fattahi, Milad; Litman, Larry C.; Diamond, David M. (2021-04-19). "Validation of the PTSD Checklist for DSM-5 (PCL-5) on Patients Injured in Car Accidents". European Journal of Medical and Health Sciences. 3 (2): 154–159. doi: 10.24018/ejmed.2021.3.2.790 . ISSN   2593-8339. S2CID   236610072.
  12. ↑ Advice, Health Daily (2023-09-22). "Common Causes of Amaxophobia". Health Daily Advice. Retrieved 2023-09-30.
  13. ↑ Hickling, Edward J.; Blanchard, Edward B. (July–September 1992). "Post-traumatic stress disorder and motor vehicle accidents". Journal of Anxiety Disorders . 6 (3): 285–291. doi:10.1016/0887-6185(92)90040-E.
  14. ↑ Kuch, Klaus; Swinson, Richard P.; Kirby, Marlene (October 1985). "Post-traumatic Stress Disorder After Car Accidents". The Canadian Journal of Psychiatry . 30 (6): 426–427. doi:10.1177/070674378503000610. PMID   4063939. S2CID   6092875.
  15. 1 2 3 Whetstone, James Paul; et al. (2020). "Validation of James Whetstone's Measure of Amaxophobia" (PDF). Archives of Psychiatry and Behavioral Sciences. 3 (1): 23–33. doi:10.22259/2638-5201.0301003. ISSN   2638-5201. Archived (PDF) from the original on June 19, 2020.
  16. ↑ "Understanding and Managing Driving Anxiety: A Comprehensive Guide". Anxiety Checklist. 2 January 2025.
  17. 1 2 3 Wolpe, Joseph (1968). "Psychotherapy by Reciprocal Inhibition" . Conditional Reflex. 3 (4). Stanford University Press: 234–40. doi:10.1007/BF03000093. ISBN   978-0804705097. LCCN   58006709. PMID   5712667. S2CID   46015274.
  18. ↑ Rachman, S. (1967). "Systematic desensitization". Psychological Bulletin . 67 (2): 93–103. doi:10.1037/h0024212. PMID   6045340.
  19. ↑ Lauer, G. (1992). "The Treatment of Driving Phobia". International Journal of Psychology . 27 (3–4): 469. doi: 10.1080/00207599208246897 .
  20. ↑ Walshe, David G.; Lewis, Elizabeth J.; Kim, Sun I.; O'Sullivan, Kathleen; Wiederhold, Brenda K. (June 2003). "Exploring the Use of Computer Games and Virtual Reality in Exposure Therapy for Fear of Driving Following a Motor Vehicle Accident" (PDF). CyberPsychology & Behavior. 6 (3): 329–234. doi:10.1089/109493103322011641. PMID   12855091. Archived (PDF) from the original on June 19, 2020.
  21. ↑ Clapp, Joshua D.; et al. (January 2011). "The Driving Behavior Survey: Scale construction and validation". Journal of Anxiety Disorders . 25 (1): 96–105. doi:10.1016/j.janxdis.2010.08.008. PMC   3006470 . PMID   20832988.
  22. ↑ Ehlers, Anke; et al. (2007). "The Driving Cognitions Questionnaire: Development and preliminary psychometric properties". Journal of Anxiety Disorders . 21 (4): 493–509. doi:10.1016/j.janxdis.2006.08.002. PMID   16982173. S2CID   7839401.
  23. ↑ Stewart, Alan E.; St. Peter, Claire C. (August 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 (8): 859–879. doi:10.1016/S0005-7967(03)00203-1. PMID   15178463.
  24. ↑ Taylor, Joanne E.; Sullman, Mark J. M. (May 2009). "What does the Driving and Riding Avoidance Scale (DRAS) measure?". Journal of Anxiety Disorders . 23 (3): 504–510. doi:10.1016/j.janxdis.2008.10.006. PMID   19062251.
  25. 1 2 Steiner, Leon; Cernovsky, Zack (2020). "Convergent Validity of Leon Steiner's Measure of Driving Phobia" (PDF). Archives of Psychiatry and Behavioral Sciences. 3 (1): 45–50. doi:10.22259/2638-5201.0301005. ISSN   2638-5201. Archived (PDF) from the original on June 19, 2020.
  26. ↑ Taylor, Joanne E. (2018-10-01). "The extent and characteristics of driving anxiety". Transportation Research Part F: Traffic Psychology and Behaviour. 58: 70–79. Bibcode:2018TRPF...58...70T. doi:10.1016/j.trf.2018.05.031. ISSN   1369-8478. S2CID   149785869.
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