Treating patients with driving phobia by virtual reality exposure therapy – a pilot study

English version

Autoři: Y. Kaussner ^aff001; A. M. Kuraszkiewicz ^aff002; S. Schoch ^aff001; Petra Markel ^aff002; S. Hoffmann ^aff003; R. Baur-Streubel ^aff002; R. Kenntner-Mabiala ^aff003; P. Pauli ^aff002
Působiště autorů: Department of General Practice, University of Würzburg, Würzburg, Germany ^aff001; Department of Psychology 1 (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany ^aff002; Würzburg Institute for Traffic Sciences (WIVW), Veitshöchheim, Germany ^aff003; Center of Mental Health, Medical Faculty, University of Würzburg, Würzburg, Germany ^aff004
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0226937

Souhrn

Objectives

Virtual reality exposure therapy (VRET) is a promising treatment for patients with fear of driving. The present pilot study is the first one focusing on behavioral effects of VRET on patients with fear of driving as measured by a post-treatment driving test in real traffic.

Methods

The therapy followed a standardized manual including psychotherapeutic and medical examination, two preparative psychotherapy sessions, five virtual reality exposure sessions, a final behavioral avoidance test (BAT) in real traffic, a closing session, and two follow-up phone assessments after six and twelve weeks. VRE was conducted in a driving simulator with a fully equipped mockup. The exposure scenarios were individually tailored to the patients’ anxiety hierarchy. A total of 14 patients were treated. Parameters on the verbal, behavioral and physiological level were assessed.

Results

The treatment was helpful to overcome driving fear and avoidance. In the final BAT, all patients mastered driving tasks they had avoided before, 71% showed an adequate driving behavior as assessed by the driving instructor, and 93% could maintain their treatment success until the second follow-up phone call. Further analyses suggest that treatment reduces avoidance behavior as well as symptoms of posttraumatic stress disorder as measured by standardized questionnaires (Avoidance and Fusion Questionnaire: p < .10, PTSD Symptom Scale–Self Report: p < .05).

Conclusions

VRET in driving simulation is very promising to treat driving fear. Further research with randomized controlled trials is needed to verify efficacy. Moreover, simulators with lower configuration stages should be tested for a broad availability in psychotherapy.

Klíčová slova:

Animal behavior – Fear – Psychometrics – Heart rate – Post-traumatic stress disorder – Mental health therapies – Pilot studies – Instructors

Zdroje

1. NHTSA (National Highway Traffic Safety Administration). Summary of Motor Vehicle Crashes (Final Edition). Traffic Safety Fact Sheet. dot: HS 812 376. 2017 [cited 2 January 2018]. Available from: https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812376.

2. Maercker A. Therapie der posttraumatischen Belastungsstörungen. Berlin, Heidelberg: Springer-Verlag; 2003.

3. Wiederhold BK, Wiederhold MD. Virtual Reality Treatment of Posttraumatic Stress Disorder Due to Motor Vehicle Accident. Cyberpsychology, Behavior and Social Networking. 2010;13(1):21–27. doi: 10.1089/cyber.2009.0394 20528289

4. Blanchard EB, Veazey CH. Mental disorders resulting from road traffic accidents. Current Opinion in Psychiatry. 2001;14(2):143–147.

5. APA (American Psychiatric Association). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.

6. Mayou R, Simkin S, Threlfall J. The effects of road traffic accidents on driving behaviour. Injury. 1991;22(5):365–368. doi: 10.1016/0020-1383(91)90095-v 1806495

7. Taylor S, Koch WJ. Anxiety disorders due to motor vehicle accidents: Nature and treatment. Clinical Psychology Review. 1995;15(8):721–738.

8. APA (American Psychiatric Association). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. Guideline Development Panel for the Treatment of PTSD in Adults. Adopted as APA Policy February 24, 2017 [cited 2 January 2018]. Available from: http://www.apa.org/ptsd-guideline/ptsd.pdf.

9. NICE (National Institut of Clinical Excellence). Post-traumatic Stress disorder–management. Clinical guideline. Guideline Number 26. 2005 [cited 2 January 2018]. Available from: http://www.nice.org.uk/guidance/cg26.

10. AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.). AWMF S3-Leitlinie. Behandlung von Angststörungen. AWMF-Leitlinien Register 051–028. 2014 [cited January 2018]. Available from: http://www.awmf.org/uploads/tx_szleitlinien/051-028l_S3_Angststörungen_2014-05_2.pdf.

11. Rothbaum BO, Meadows EA, Resick P, Foy DW. Cognitive-behavioral therapy. In Foa E. B., Keane T. M., Friedman M. J., editors. Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. New York, NY: Guilford Press; 2000. p. 320–325.

12. Foa EB, Meadows EA. Psychosocial treatments for posttraumatic stress disorder: A critical review. Annual Review of Psychology. 1997;48:449–480. doi: 10.1146/annurev.psych.48.1.449 9046566

13. Antony MM, Swinson RP. Phobic Disorders and Panic in Adults: A guide to Assessment and Treatment. Washington, DC: American Psychological Association; 2000.

14. Hood HK, Antony MM. Evidence-Based Assessment and Treatment of Specific Phobias in Adults. In: Davis III TE, Ollendick TH, Öst L-G, editors. Intensive One-Session Treatment of Specific Phobias. New York: Springer; 2012. p. 19–42.

15. Mühlberger A, Herrmann MJ, Wiedemann G, Ellgring H, Pauli P. Repeated exposure of flight phobics to flights in virtual reality. Behaviour Research and Therapy. 2001;39:1033–1050. doi: 10.1016/s0005-7967(00)00076-0 11520010

16. Rothbaum BO. Using virtual reality to help our patients in the real world. Depression and Anxiety. 2009;26(3):209–211. doi: 10.1002/da.20556 19253416

17. Gonçalves R, Pedrozo AL, Coutinho ESF, Figueira I, Ventura P. Efficacy of Virtual Reality Exposure Therapy in the Treatment of PTSD: A Systematic Review. PLOS ONE. 2012;7(12),e48469:1–7.

18. Mühlberger A, Pauli P. Virtuelle Realität in der Psychotherapie. PiD—Psychotherapie im Dialog. 2011;2:143–147.

19. Beck JG, Palyo SA, Winer EH, Schwagler BE, Ang EJ. Virtual reality exposure therapy for PTSD symptoms after a road accident: An uncontrolled case series. Behavior Therapy. 2007;38,39–48. doi: 10.1016/j.beth.2006.04.001 17292693

20. da Costa RT, de Carvalho MR, Nardi AE. Virtual Reality Exposure Therapy in the Treatment of Driving Phobia. Psicologia: Teoria e Pesquisa. 2010;26(1):131–137.

21. Garcia-Palacios A, Botella C, Hoffman H, Fabregat S. Comparing Acceptance and Refusal Rates of Virtual Reality Exposure vs. In Vivo Exposure by Patients with Specific Phobias. Cyberpsychology and Behavior. 2007;10(5):722–724. doi: 10.1089/cpb.2007.9962 17927544

22. Garcia-Palacios A, Hoffman H, Carlin A, Furness TA III, Botella C. Virtual reality in the treatment of spider phobia: A controlled study. Behaviour Research and Therapy. 2002;40:983–993. doi: 10.1016/s0005-7967(01)00068-7 12296495

23. Emmelkamp PMG, Bruynzeel M, Drost L, van der Mast CAPG. Virtual reality treatment in acrophobia: a comparison with exposure in vivo. Cyberpsychology and Behavior. 2001;4(3):335–339. doi: 10.1089/109493101300210222 11710257

24. Meyerbröker K, Emmelkamp PMG. Virtual reality exposure therapy in anxiety disorders: A systematic review of process-and-outcome-studies. Depression and Anxiety. 2010;27:933–944. doi: 10.1002/da.20734 20734361

25. Wald J. Efficacy of virtual reality exposure therapy for driving phobia: A multiple baseline across-subjects design. Behavior Therapy. 2004;35:621–635.

26. Wald J, Taylor S. Efficacy of virtual reality exposure therapy to treat driving phobia: A case report. Journal of Behavior Therapy and Experimental Psychiatry. 2000;31:249–257. doi: 10.1016/s0005-7916(01)00009-x 11494960

27. Walshe DG, Lewis EJ, Kim SI, O’Sullivan K, Wiederhold BK. Exploring the Use of Computer Games and Virtual Reality in Exposure Therapy for Fear of Driving Following a Motor Vehicle Accident, Cyberpsychology & Behavior. 2003;6(3):329–334.

28. Kennedy RS, Lane NE, Berbaum KS, Lilienthal MG. Simulator sickness questionnaire: An enhanced method for quantifying simulator sickness. The International Journal of Aviation Psychology. 1993;3:203–220.

29. Brenner-Hartmann J. Durchführung standardisierter Fahrverhaltensbeobachtungen im Rahmen der medizinisch-psychologischen Untersuchung (MPU). Vortrag beim 38. BDP-Kongress für Verkehrspsychologie; Regensburg, Germany; 2002.

30. Kuch K, Cox BJ, Direnfeld DM. A brief self-rating scale for PTSD after road vehicle accident. Journal of Anxiety Disorders. 1995;9:503–514.

31. Foa EB, Riggs DS, Dancu CV, Rothbaum, BO. Reliability and validity of a brief instrument for assessing posttraumatic stress disorder. Journal of Traumatic Stress. 1993;6:459–473.

32. Beck AT, Steer RA, Brown GK. Beck-Depressions-Inventar (BDI–II, dt. Version: M. Hautzinger, F. Keller & C. Kühner, 2. Aufl.). Frankfurt: Pearson Assessment; 2009.

33. Beck AT, Stern RA. Beck-Angst-Inventar, Manual (BAI, dt. Version: J. Margraf & A. Ehlers). Frankfurt: Pearson Assessment; 2007.

34. Nübling J, Schulz H. FPTM. Fragebogen zur Psychotherapiemotivation. In: Brähler E, Schumacher J, Strauß B, editors. Diagnostische Verfahren in der Psychotherapie. Göttingen: Hogrefe; 2002. p. 141–145.

35. Hoffmann S, Buld S. Darstellung und Evaluation eines Trainings zum Fahren in der Fahrsimulation. In VDI-Gesellschaft Fahrzeug- und Verkehrstechnik, editor. Integrierte Sicherheit und Fahrerassistenzsysteme (VDI-Berichte, Nr. 1960). Düsseldorf: VDI-Verlag; 2006. p. 113–132.