One side effect of having an ambiguous relationship with automobiles is that you spend more time getting around by other methods--including your feet. On a routine short walk to the local bookstore I saw evidence of the increasing car-centrism of our society.

As I walk past the Marriott hotel I see that the path from the street to the from door is immaculately cleared, as is the carpark in its entirety. The footpath along the road, however, is snow covered and has been for days. In fact it is easier to walk along the outside edge of the carpark then on the path (although if you do so while walking your dog, a security guard will evict you from the grounds).

As I cross the overpass I see that the roadway is in perfect condition. The pavement, however, is completely covered in slick ice. The Wildberry eatery has also not shoveled the public pavement directly outside their building, although the pathway from the carpark to their front door is carefully cleared.

I suppose the logic is that, on some basis, pedestrian traffic does not count. We are not numerous enough, rich enough, or afforded enough alternatives. We aren't customers worth considering or caring for. But pedestrian, especially pedestrains with long memories and cold feet can be very contrary. Marriot and Wildberry go on my list of places not to shop.

AUTHOR: Rajalin S & Summala H
JOURNAL: Accident Analysis and Prevention 1997; 29: 277-283.

ABSTRACT: "The effects of involvement in a fatal accident on surviving drivers' subsequent driving behavior were studied. The quantity (mileage) and quality of driving (offences in driver records) of 245 surviving drivers were compared in three-year periods before and after the accident. A random sample of 253 drivers from the driver register were additionally used as controls. The data showed that about half of the car drivers decreased their driving, with greater reductions being associated with more serious injuries. However, the total number of convictions did not reduce but even showed a tendency to increase in proportion to the amount of driving. The proportion of car drivers with post-crash offences was approximately constant (27-32%) independent of any change in mileage. The data suggest that professional heavy-vehicle drivers incurred fewer convictions during the post-crash period in comparison to car drivers. Thirty-seven surviving drivers were further interviewed on the duration and specificity of the effects. With the exception of three drivers, all said that the fatal accident had affected their driving behavior, but only for a relatively short time. Most commonly, the drivers reported that the effect was limited to those circumstances and situations which led to the accident and did not generalize to safer driving practices. This study suggests that car drivers, if not seriously injured, typically return to their 'normal' driving within a few months, while heavy-vehicle drivers show a tendency towards more cautious behavior after a fatal crash in terms of violations, presumably due to the continuous reinforcement which the latter receive in their work community." [abstract]

SUMMARY/TAKE HOME MESSAGE: About 20% of driving involved in an accident where there was a fatalities permanently reduce or cease their driving behavior. Drivers who believed their own error caused the accident were more severely affected.

The role of instigating events
Driving anxiety is common is more common than many people realise, including those suffering from the condition. It is distinguished mainly by the symptoms of fear or anxiety in relation to driving and avoidance of driving either in general or under certain circumstances (such as one freeways).

Motor vehicle accident
It may occur as a result of a motor vehicle accident (Mayou, 2002; Vingilis, 1996). After an accident about half of drivers reduce their driving behavior, but the effect is generally temporary (Rajalin & Summala, 1997).

No instigating event
There is a tendency to assume psychological disorders have an instigating event, or to assume an events immediately prior to the onset fo severe symptoms are causal. However many psychological conditions are known to occur without any obvious precipitating conflict, trauma or significant experience.

For example: 45% of hoarders do not report any stressful life event before the onset of their maladaptive behavior (Grisham et al, 2006)

Many people develop driving anxiety despite never experiencing a motor vehicle accident (Taylor et al, 2000; Taylor & Deane, 1999).

Measuring anxiety
Driving anxiety can be measured in a range of ways including verbal reports and physiological responses (heart rate, skin conductivity).

Treating driving anxiety
There are three general approaches to treatment: Pavlovian, psychoanalysis, and cognitive therapy.

Pavlovian approaches required controlled exposure to the stressful situation. As real driving situation can be uncontrolled and dangerous, virtual reality is being explored as an alternative (Wald & Turner, 2007; Mühlberger, 2007).

References
Grisham JR Frost RO Steketee G Kim HJ Hood S 2006 Age of onset of compulsive hoarding' Journal of Anxiety Disorders 20 675-686.

AUTHOR: Mayou RA
JOURNAL: Psychiatry in the Medically Ill 2002; 25: 27-41.

ABSTRACT: "Psychiatric complaints are frequent following motor vehicle accidents and may be major predictors of persistent pain and other complaints. Outcomes are not related closely to the nature or severity of any medical injury. Psychiatric problems often are unrecognized and untreated. There is a need for more behaviorally inferred routine care, early recognition of complications, and the use of psychological and pharmacological interventions."

SUMMARY/TAKE HOME MESSAGE: Motor vehicle accidents are relatively common and frequently have serious mental health consequences including driving-related phobia.

PEER-REVIEWED

AUTHORS: Mühlberger, A., Bülthoff, H.H., Wiedemann, G., Pauli, P.
JOURNAL: Psychological Assessment 2007; 19: 340-346.

ABSTRACT: "An overall assessment of phobic fear requires not only a verbal self-report of fear but also an assessment of behavioral and physiological responses. Virtual reality can be used to simulate realistic (phobic) situations and therefore should be useful for inducing emotions in a controlled, standardized way. Verbal and physiological fear reactions were examined in 15 highly tunnel-fearful and 15 matched control participants in 3 virtual driving scenarios: an open environment, a partially open tunnel (gallery), and a closed tunnel. Highly tunnel-fearful participants were characterized by elevated fear responses specifically during tunnel drives as reflected in verbal fear ratings, heart rate reactions, and startle responses. Heart rate and fear ratings differentiated highly tunnel-fearful from control participants with an accuracy of 88% and 93%, respectively. Results indicate that virtual environments are valuable tools for the assessment of fear reactions and should be used in future experimental research."

SUMMARY: Most treatments for phobia involve some kind of counter conditioning. That is being placed in the feared situation, usually starting with low intensity, and replacing feelings of fear with feelings of relaxation. As the authors note, placing driving in a feared situation such as driving in a tunnel, is neither easy nor particularly safe.

This study further developed a virtual reality system as a fully controlled and safe substitute for real driving. The study shows that those with a specific fear of driving in tunnels did become more fearful during periods of simulation of tunnel driving, but not during open driving (there was also a control group that did not become afraid at all). this suggests that virtual reality systems may, in the future, have a useful role in treating driving phobias.

Fearfulness was measured from self-report, but also heart rate, and skin conductivity. Self report was the most useful measure, followed by heart rate with which it was moderately correlated. Skin conductivity was, well a bit rubbish all round.

MY THOUGHTS: This is all very nice... but can we move along with using it for actual treatments?

Mühlberger, A., Bülthoff, H., Wiedemann, G., & Pauli, P. (2007). Virtual reality for the psychophysiological assessment of phobic fear: Responses during virtual tunnel driving. Psychological Assessment, 19 (3), 340-346 DOI: 10.1037/1040-3590.19.3.340

See also:
Efficacy of virtual reality exposure therapy to treat driving phobia: a case report