title: Exploring the use of computer games and virtual reality in exposure therapy for fear of driving following a motor vehicle accident.
abstract: Specific phobia, situational type-driving, induced by accident (accident phobia) occurs in 18-38% of those involved in a vehicular accident of sufficient severity to warrant referral to the emergency departments of a general hospital. The objective is to investigate, in an open study, the effectiveness of the combined use of computer generated environments involving driving games (game reality [GR]) and a virtual reality (VR) driving environment in exposure therapy for the treatment of driving phobia following a motor vehicle accident (MVA) program. Fourteen subjects who met DSM-IV criteria for Simple Phobia/Accident Phobia and were referred from the emergency department of a general hospital were exposed to a Virtual Driving Environment (Hanyang University Driving Phobia Environment) and computer driving games (London Racer/Midtown Madness/Rally Championship). Patients who experienced "immersion" (i.e., a sense of presence with heightened anxiety) in one of the driving simulations (defined as an increase in SUD ratings of 3 and/or an increase of heart rate > 15 BPM in a 1-h trial session of computer simulation driving) were exposed to a cognitive behavioral program of up to 12 1-h sessions involving graded driving simulation tasks with self-monitoring, physiological feedback, diaphragmatic breathing and cognitive reappraisal. Subjects were assessed at the beginning and end of therapy with measurements of: physiological responsivity (heart rate), subjective ratings of distress (SUD), rating scales for severity of fear of driving (FDI), Posttraumatic Stress Disorder (CAPS) and depression (HAM-D) and achievement of target behaviors. Of all patients 7/14 (50%) became immersed in the driving environments. This immersed group (n = 7) completed the exposure program. Pre- and post-treatment comparisons showed significant post treatment reductions on all measures SUDS (p = 0.008), FDI (p = 0.008), CAPS (p = 0.008), HR (p = 0.008), CAPS (p = 0.008), HAM-D (p = 0.031). Further analysis of the FDI showed significant reductions in all three subscales: travel distress (p = 0.008), travel avoidance (p = 0.008), and maladaptive driving strategies (p = 0.016). The findings of this study suggest that VR and GR may have a useful role in the treatment of driving phobia post-accident even when co-morbid conditions such as post-traumatic stress disorder and depression are present.
authors.affiliation: Department of Psychiatry, University College Cork, St. Stephens Hospital, Cork, Ireland.
authors.forename: David G
authors.initials: DG
authors.lastname: Walshe
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Lewis
authors.forename: Sun I
authors.initials: SI
authors.lastname: Kim
authors.forename: Kathleen
authors.initials: K
authors.lastname: O'Sullivan
authors.forename: Brenda K
authors.initials: BK
authors.lastname: Wiederhold
mesh_terms: D000063:Accidents, Traffic / Q000523:psychology*; D001334:Automobile Driving / Q000523:psychology*; D003196:Computer Graphics; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005239:Fear; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D010698:Phobic Disorders / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D010775:Photic Stimulation; D013813:Therapy, Computer-Assisted / Q000295:instrumentation*; D013997:Time Factors; D014584:User-Computer Interface; D018910:Video Games