Virtual reality applied to amaxophobia

Amaxophobia or fear of driving is defined as a specific situational phobia that occurs with a Irrational, intense and persistent fear of driving but also of having to travel by car and even in the face of the many stimuli that occur around driving; weather, lane change, speed increase or decrease, braking and, above all, car breakdowns, all of which may constitute a risk to the patient himself and to other people who are, at the same time, in the highway.

Although different studies indicate that the prevalence of amaxophobia is around 4%, the truth is that the figures are around 22% of the population with some type of fear associated with driving (either as a driver or as a co-pilot) being one of the phobias for which more people ask for an appointment in our Cabinet.

• Related article: "Types of Phobias: Exploring Fear Disorders"

Symptomatology of amaxophobia

Amaxophobia is a phobia that causes clinically significant discomfort and interference in the work and social life of the patient, being the symptomatology of four types:

• Cognitive: negative automatic thoughts, fear of losing control of the car, fear of not knowing how to react on the road, fear of having an accident ...
• Emotional: anxiety, stress, restlessness before driving.
• Physiological: anxiety and restlessness before driving along with tremors, chest pain or tightness, tachycardia, hyperventilation, and tingling in the hands and feet.
• Behavioral: A feeling of blocking the ability to drive and, therefore, always try to be accompanied if you must drive, avoiding it whenever possible.

At first glance, nothing happens to the patient except that avoid, as much as possible, the use of the car to make your usual trips, using public transport; This ends up affecting the patient's own independence and can create real anxiety attacks, if he has no other option to move.

Causes

Among the main ones, it would be found to have suffered a traumatic accident on the road, although it does not seem to be the only one since there are studies (Barp and Mahl, 2013; Sáiz, Bañuls and Monteagudo, 1997) who would affirm that social factors such as social pressure to drive and verbal aggression from other drivers would also be causes.

Finally, in a study by Alonso et al (2008) it is stated that, among Spanish drivers, 21.9% suffer from depression and 11.2% some other type of anxiety disorder.

• You may be interested in: "Types of Anxiety Disorders and their characteristics"

Therapeutic goals

When any patient arrives at the Cabinet, we set with it the therapeutic objectives to be achieved, from which the entire treatment plan is developed. We work both with patients who, in their role as patient, suffer from amaxophobia and with those who feel the same fear but in their role as co-pilots.

In any case, the main therapeutic goals to be achieved They are:

• Modify the irrational thoughts and beliefs that the patient has about traffic.
• Modify the patient's own perception of his competence in driving.
• Stop conditioning driving to an anxiety response.
• Eliminate escape and avoidance responses to feared stimuli.
• Improve coping strategies.

All this is usually done within a cognitive-behavioral protocol and using the multicompetent program that includes techniques relaxation and cognitive-behavioral strategies to control anticipatory activation and coping with the situation phobic. However, in this program (Badós, 2015) the efficacy of cognitive-behavioral therapy is analyzed together with exposure techniques. And, here is where we differ.

Virtual Reality for face-to-face treatment

Unlike exposure techniques, virtual reality (VR) allows you to control the different parameters that act as variables. Thus, for each of the environments, the variables that we can control as therapists are:

• Road: time, weather, type of road, absence or presence of curves, speed, lane changes, distractors (mobile, passengers, loud music), car crashed on the road and breakdown
• City: traffic density, weather, time, number of passengers, speed, horn, braking, ambulance, traffic jam, less or more anxious circuit

If it is amaxophobia without serious interference in working life, an average of eight sessions could be enough, but this will depend a lot on the patient, since when did they have the phobia, its severity, the associated symptoms ...

Virtual reality for online treatment

As a result of the confinement and doubts about how continue treating our patients using Virtual Reality, a new tool has appeared that we continue to use in our Cabinet; It is called Psious at Home. This tool allows, by means of a mobile phone or a Tablet and both in Android and IOS systems, to carry out both directed sessions and "Send homework" to our patients who usually do online sessions due to geographical distance or health issues, at the moment current.

The only difference is that in face-to-face sessions, VR is performed using glasses that allow the experience to be in 3D, while in the format online therapy is done in 2D and, therefore, the sense of presence decreases, although there are “tricks” such as being in a dark room with the light off, duplicating the image on television via wireless connection (although the image quality may deteriorate) or increase the brightness of the mobile or tablet screen to increase the clarity of the picture.

Bibliographic references:

• Alonso, F., Sanmartín, J., Esteban, C., Calatayud, C., Alamar, B. and López-de-Cózar, E. (2008). Road health. Diagnosis of Spanish drivers. Valencia: Attitudes.
• Badós, A. (2015). Specific phobias: nature, evaluation and treatment. Downloaded from: http://hdl.handle.net/2445/65619
• Barp, M. and Mahl, AC (2013). Amaxophobia: a study on the causes of fear of driving. UNOESC and Science - ACBS, 4, 39-48. Recovered from http://editora.unoesc.edu.br/index.php/ACBS/article/
• Sáiz Vicente, E., Bañuls Egeda, R. and Monteagudo Soto, M.J. (1997). Exploring anxiety in novice and professional drivers. Annals of Psychology, 13 (1), 65-75 [ https://revistas.um.es/analesps/article/view/30721/29891]