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.

Proceedings of the Fourth Workshop on Computational Linguistics and Clinical Psychology –- From Linguistic Signal to Clinical Reality

“…Thus the interactivity in this example serves not so much to allow the patient to explore different outcomes, but to enable them to initiate outcomes as if they are causing them to occur. There is some evidence from virtual reality research that this sense of immersion and control may increase the intensity of exposures and therefore increase their efficacy (Price and Anderson, 2007;Walshe et al, 2003).…”

Android based Introduction of Dewata Nawa Sanga Virtual Reality Application

“…This driving simulation can reduce anxiety felt by patients while driving in virtual world. This study shows that VR is beneficial in treatment of patients with phobia after an accident, even in the most terrifying conditions, such as post-traumatic stress disorder and depression [12].…”

Using a Digital Game for Training Desirable Behavior in Cognitive–Behavioral Therapy of Burnout Syndrome: A Controlled Study

“…[61][62][63][64] Also, as mentioned earlier, many games and ''playful interventions'' have been developed for therapeutic purposes. [33][34][35][36][37][38][39][40][41][42][43][44][45] However, the use of games as a tool for cCBT is quite uncommon. In fact, only one study of a game fully integrated into a CBT surrounding was found.…”

“…Yet, support has been reported of beneficial effects in the treatment of a variety of complaints, including depression, divorce trauma, autism, and phobias. [33][34][35][36][37][38][39][40][41][42][43][44][45] This article reports a pilot study testing the incremental value in terms of user motivation and treatment effectiveness of ''gamifying'' an existing online CBT-based burnout module.…”