Category Archives: fear of driving

Treatment of fear of driving in a driving simulator

Driving phobia or excessive fear of driving refers to people who are so afraid to drive a car, that they avoid to drive a car. These people have obtained their drivers licence at some time. This may impact their lives severely and reduces their mobility. In the Netherlands between 800.000 and 1.000.000 people suffer from some form of fear of driving or driving phobia. Driving in a simulator can help to overcome fear of driving or driving phobia.

Methods and techniques based on Virtual Reality are applied to treat fear effectively, for example hosophobia, fear of spiders, etc., and they have proved to work. The advantage of simulators, and virtual reality in general, consists of the opportunities it provides to practice in a safe environment while the stimuli that evoke the fear response are presented in a controlled way. People are exposed to the fear-inducing stimuli, a technique also referred to as exposure therapy. This is probably the most effective technique from behavioural therapy to treat specific fears, such as driving phobia. Driving in a simulator will initially be frightening for people with fear of driving, but after some time of driving, fear will typically reduce.

The training has to have the following characteristics to be effective:

  • Driving in the simulator must be realistic.
  • The most frightening situations must be trained, for example driving on a highway with high traffic density.
  • People with driving experience and an age above 30 may be susceptible to simulator sickness. The simulations must be made such that the risk of simulator sickness is small.
  • The simulations must be long enough. If the session is too short and stops while fear has not been reduced, then the session may be counterproductive.


Clinical applications in a driving simulator

Car driving simulators are particularly known for their use in driver training, police training, and also for their application in DUI simulation and demonstrating the effects of driver distraction. However, a driving simulator can be also be succesfully applied in a number of clinical applications, especially fear of driving, evaluation of fitness to drive and rehabilitation in a clinic.

Treatment of fear of driving

For clinical psychologist who treat various anxieties and phobias and use exposure therapy to treat their clients, a simulator can be an instrument in the treatment of fear of driving or driving phobia. Exposure therapy involves the exposure of the patient to the feared object or context without any danger, in order to overcome their anxiety. Giving exposure therapy to people with fear of driving in a real car in traffic is difficult in practice: the real risk of accidents is high and always involves a licenced driver instructor as well as a therapist which makes the therapy sessions expensive and difficult to arrange. Also, the environment is in real car in the real word is impossible to control, which is definitely not what a therapist wants. Exposure therapy in a driving simulator to treat fear of driving gives the therapist a controlled virtual environment in which the client is exposed to the anxiety inducing situations without any danger. Virtual reality is used more often to treat phobias.

Evaluation of fitness to drive

Fitness to drive for older drivers and drivers with neurological disorders, after CVA or sleep disorders is typically done by general practitioners using paper and pencil tests, blood samples and eye measurements. However, a simulator can make the fitness to drive test more ecologically valid: it resembles the driving tasks and testing can be done in a structured environment with the same test for all clients. While a simulator may someties be less suitable for the assessment of driving behaviour in older people, because of the increased risk of simulator or cyber sickness in this population, the incidence of simulator sickness can be reduced substantially, when a number of precautions are being taken in the design of the tests. Simulator tests can be a valuable addition to the set of diagnostic instruments to evaluate fitness to drive.

A special branch of clinical applications is the use in a test battery of neuropsychological tests. In a research simulator setup, clinical tests can be developed, for example to evaluate if patients with sleeping disorders are at risk of falling asleep while driving.

Driver rehabilitation and occupational therapy

A driving simulator program can offer a number of practice to people in occupational therapy for the purpose of driver rehabilitation. Especially, turning at intersections, reacting to unexpected events and negotiating fourway intersections and roundabouts can be trained in this group. The goal of driver rehabilitation is to aid individuals with disabilities or age-related impairments maintain independent driving and transportation. This maybe done through the use of specialized mobility equipment and training.


Treatment of phobias with Virtual Reality techniques

A relatively new method to treat phobias is by means of virtual reality techniques. A number of research studies have demonstrated the positive effects of VR in the treatment of several types of phobia, such as fear of heights, fear of spiders, fear of flying and claustrophobia, as well as agoraphobia. New clinics have been established, specialized in virtual reality techniques to treat various phobias.

A car driving simulator is similar to a Virtual reality system, except for the helmet mounted displays (HMD’s). In both types of system, a computer generate world is presented to the client and the client can interact with this world. In the case of a driving simulator, you drive through the computer generated world as if you are seated in a real car and you interact with other traffic participants and the road infrastructure in a very realistic but also safe way.

For driving, the HMD as used in VR is not very well suited, because of the risk of cybersickness that comes with the use of HMD’s. This is aggravated because of two independent types of motions in driving a car:

  • the vehicle moves through the world, controlled by the steering wheel and pedals of the driver.
  • the client looks around in the environment by turning the head (head tracking)

These two types of motions in combination give a high risk of cybersickness in a VR system. The brain is not very well able to distinguish these movements. This is the most important reason that a driving simulator is a much better solution for the treatment of driving phobia or fear of driving: in a driving simulator the risk of ‘simulator sickness’ is a lot smaller, especially if the simulations are designed to keep lateral and longitudinal accelerations to a minimum.