Virtual reality applied to amaxophobia

A review of the characteristics of amaxophobia and how it can be treated with virtual reality.

Amaxophobia or fear of driving is defined as a specific situational phobia that causes an irrational, intense and persistent fear of driving. irrational, intense and persistent fear of driving itself, but also of the thoughts of having to make a journey by car, and even of the many stimuli of driving. and even to the many stimuli that occur around driving: weather, lane changes, increase or decrease in speed, braking and, above all, car breakdowns, all of which can constitute a risk for the patient and for other people on the road at the same time.

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 co-driver) being one of the phobias for which more people ask for an appointment in our office.

Symptomatology of the amaxophobia

The amaxophobia is a phobia that causes clinically significant discomfort and interference in the patient's work and social life, The symptomatology is 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 together with tremors, precordial Pain or tightness, tachycardia, hyperventilation and tingling sensation in hands and feet.
• Behavioral: Sensation of blocking the ability to drive and, therefore, the patient always tries to be accompanied if he/she has to drive, avoiding driving whenever possible.

To the naked eye, nothing happens to the patient except that he/she as much as possible, he avoids the use of the car to make his usual journeys, using public transport.This ends up affecting the patient's own independence and can create real anxiety crises if he/she has no other option for getting around.

Causes

Among the main causes is having 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) which state that social factors, such as social pressure to drive and verbal aggression from other drivers, would also be causes of anxiety disorders..

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

Therapeutic objectives

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

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

• Modify the irrational thoughts and beliefs that the patient has about traffic.
• Modify the patient's own perception of his or her competence in driving.
• To 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 relaxation techniques and cognitive-behavioral strategies to control anticipatory activation and coping with the phobic situation. However, in this program ( Badós, 2015) the efficacy of cognitive-behavioral therapy together with exposure techniques is analyzed. And, here is where we differ.

Virtual reality for face-to-face treatment.

Unlike exposure techniques, virtual reality (VR) allows control over 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 (cell phone, passengers, loud music), car accident on the road and breakdown.
• City: traffic density, weather, time, number of passengers, speed, horn, braking, ambulance, traffic jam, less or more anxiogenic circuit.

If it is an amaxophobia without serious interference with work life, with an average of eight sessions could be sufficient, but this will depend very much on the patient.but this will depend a lot on the patient, how long he/she has had the phobia, the severity of the phobia, the associated symptomatology...

Virtual Reality for online treatment

As a result of the confinement and the doubts about how to continue treating our patients who were using to continue treating our patients who used Virtual RealityIn the last few years, a new tool has appeared that we continue to use in our office; it is called Psious at Home. This tool allows, through a cell phone or a Tablet and both Android and IOS systems, to perform both directed sessions and "send homework" to our patients who usually do online sessions due to geographical distance or health issues, at the present time.

The only existing difference is that in the face-to-face sessions VR is done through glasses that allow the experience to be in 3D, while in the online format the therapy is done in 2D and, therefore, the sense of presence decreases, although there are "tricks" such as being in a darkened room and with the light off, duplicating the image on the television by wireless connection (although it could worsen the image quality) or increasing the brightness of the mobile or tablet screen to increase the clarity of the image.

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, assessment 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. Retrieved from http://editora.unoesc.edu.br/index.php/ACBS/article/
• Sáiz Vicente, E., Bañuls Egeda, R. and Monteagudo Soto,M.J. (1997). Exploration of anxiety in novice and professional drivers. Anales de Psicología,13 (1), 65-75 [https://revistas.um.es/analesps/article/view/30721/29891].