Driving phobia, driving anxiety, vehophobia, amaxophobia or driving-related fear (DRF) is a pathological fear of driving. It is an intense, persistent fear of participating in car traffic (or in other vehicular transportation) that affects a person's

lifestyle Lifestyle is the interests, opinions, behaviours, and behavioural orientations of an individual, group, or culture. The term "style of life" () was introduced by Austrian psychologist Alfred Adler in his 1929 book, ''The Case of Miss R.'', w ...

, including aspects such as an inability to participate in certain jobs due to the pathological avoidance of driving. The fear of driving may be triggered by specific driving situations, such as expressway driving or dense traffic. Driving anxiety can range from a mild cautious concern to a

phobia A phobia is an anxiety disorder, defined by an irrational, unrealistic, persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected ...

Symptoms

The fear of driving is associated with various physical and subjective emotional symptoms that somewhat vary from individual to individual. For example, the physical symptoms might involve increased

perspiration Perspiration, also known as sweat, is the fluid secreted by sweat glands in the skin of mammals. Two types of sweat glands can be found in humans: eccrine glands and Apocrine sweat gland, apocrine glands. The eccrine sweat glands are distribu ...

tachycardia Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal ...

(pathologically accelerated heart rate), or

hyperventilation Hyperventilation is irregular breathing that occurs when the rate or tidal volume of breathing eliminates more carbon dioxide than the body can produce. This leads to hypocapnia, a reduced concentration of carbon dioxide dissolved in the blo ...

. On the cognitive level, the patient may experience a loss of sense of reality, or thoughts of losing control while driving, even in situations that are reasonably safe. On a behavioral level, the avoidance of driving tends to perpetuate the phobia. Patients who developed their amaxophobia after a serious

traffic collision A traffic collision, also known as a motor vehicle collision, or car crash, occurs when a vehicle collides with another vehicle, pedestrian, animal, road debris, or other moving or stationary obstruction, such as a tree, pole or building. Tr ...

frequently develop the

post-traumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental disorder that develops from experiencing a Psychological trauma, traumatic event, such as sexual assault, domestic violence, child abuse, warfare and its associated traumas, natural disaster ...

(PTSD) that may involve experiencing

intrusive thoughts An intrusive thought is an unwelcome, involuntary thought, image, or unpleasant idea that may become an obsession, is upsetting or distressing, and can feel difficult to manage or eliminate. When such thoughts are paired with obsessive–compulsi ...

or anxious dreams of the original collision and/or other typical PTSD symptoms. A noteworthy part of post-collision symptomatology is the phantom brake syndrome. It is the passenger's partly involuntary or unintended pressing the foot on the floor of the car in a reflexive attempt "to brake." This unintended behavior usually occurs in skilled drivers when they are seated as a passenger next to a less competent person who drives the vehicle as a reflexive response to potentially dangerous traffic situations. The phantom brake syndrome is particularly common in survivors of serious car collisions.

Associated conditions

Some patients who present with phobia of driving also describe features consistent with various other

anxiety disorders Anxiety disorders are a group of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause phys ...

, including

panic disorder Panic disorder is a mental disorder, specifically an anxiety disorder, characterized by reoccurring unexpected panic attacks. Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath ...

agoraphobia Agoraphobia is an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives their environment to be unsafe with no way to escape. These situations can include public transit, shopping centers, crowds and q ...

specific phobia Specific phobia is an anxiety disorder, characterized by an extreme, unreasonable, and irrational fear associated with a specific object, situation, or concept which poses little or no actual danger. Specific phobia can lead to avoidance of the o ...

, and

social phobia Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impairing ability to function in at least some as ...

. The majority of survivors of serious car collisions tend to experience only the phobia of driving, but they often report generalized anxiety as a part of their post-traumatic adjustment disorder. The amaxophobia tends to be perpetuated by persistent

pain Pain is a distressing feeling often caused by intense or damaging Stimulus (physiology), stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sense, sensory and emotional experience associated with, or res ...

caused by the car crash, and by pain related

insomnia Insomnia, also known as sleeplessness, is a sleep disorder where people have difficulty sleeping. They may have difficulty falling asleep, or staying asleep for as long as desired. Insomnia is typically followed by daytime sleepiness, low ene ...

, and also by persistent post-conconcussion and whiplash symptoms caused by the crash. The PTSD symptoms, e.g., in the forms of flashbacks such as intrusive images of a bleeding person injured in the same car crash, may also contribute to amaxophobia. Correlations of PTSD scores to scores on measures of driving anxiety are significant and range from .31 to .79.

Causes

There are three major categories of driving phobia, distinguished by their onset. The most common cause of a fear of driving is traffic collisions. Thus, the amaxophobia often develops as a reaction to a particularly traumatic vehicular collision. Beck and Coffey reported that 25–33% of people involved in a car collision associated with injuries and related evaluation in a hospital experience subsequent fear of driving. Hickling and Blanchard and Kuch, Swinson, and Kirby found higher rates of driving phobia, ranging from 42% to 77%. The majority of experienced drivers with fear of driving in the aftermath of their serious collisions rate themselves as safer drivers than average, though they feel physically and emotionally too uncomfortable. For some patients, the fear escalates in very specific situations such as when near large vehicles (transport trucks, buses), but in others, the fear may be triggered already just by getting seated in the car or even just by thinking about having to again travel in a car in the near future. Several psychological questionnaires have been developed for clinicians to assess the situational intensity and facets of driving anxiety in novice drivers or also in experienced drivers traumatized by a recent car collision.Some novice drivers and passengers who were never involved in a serious car collision also report symptoms of amaxophobia. The driving fear may be, in some patients, an extension of agoraphobia. Additional factors contributing to driving phobia include a fear of losing control, anticipation of accidents, or previous exposure to unsafe driving conditions. In some cases, individuals may experience driving anxiety due to pre-existing conditions such as generalized anxiety disorder (GAD) or post-traumatic stress disorder (PTSD). Cognitive distortions, like overestimating the likelihood of danger, can further reinforce the fear.

Treatment

The most common treatment for both driving phobia and milder forms of driving anxiety is

behavior therapy Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or oth ...

in the form of

systematic desensitization Systematic desensitization, (relaxation training paired with graded exposure therapy), is a behavior therapy developed by the psychiatrist Joseph Wolpe. It is used when a phobia or anxiety disorder is maintained by classical conditioning. It shares ...

. An emerging treatment approach to treating amaxophobia is through the use of

virtual reality therapy Virtual reality therapy (VRT), also known as virtual reality immersion therapy (VRIT), simulation for therapy (SFT), virtual reality exposure therapy (VRET), and computerized CBT (CCBT), is the use of virtual reality technology for psychological o ...

. With repeated exposure such as via devices similar to video games, the subjective distress is gradually reduced: the patient may subsequently be more willing to proceed to engaging in driving in real life situations, as the next stage of

exposure therapy Exposure therapy is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the patient to the anxiety source or its context (without the intention to cause any danger). Doing so is thought to help them overc ...

Psychological assessment

A variety of

inventories Inventory (British English) or stock (American English) is a quantity of the goods and materials that a business holds for the ultimate goal of resale, production or utilisation. Inventory management is a discipline primarily about specifying ...

have been developed to assess driving anxiety. * The ''Driving Behavior Survey (DBS)'' consists of 20 items, each of which is rated on a 1–7 scale; for example, "I have trouble staying in the correct lane". * The ''Driving Cognition Questionnaire (DCQ)'' also consists of 20 items. These are rated on a 0–4 scale. Some items of this questionnaire assess related social anxieties and self-image issues, e.g., "People will think I am a bad driver". Such

self-image Self-image is the mental picture, generally of a kind that is quite resistant to change, that depicts not only details that are potentially available to an objective investigation by others (height, weight, hair color, etc.), but also items that ...

issues are relatively uncommon in patients with a post-crash amaxophobia some of whom drove without collisions and without emotional discomfort for decades. * The ''Driving and Riding Avoidance Scale (DRAS)'' also consists of 20 items. These are scored from 0 to 4. Its 20 items describe various situations in which driving is avoided. As discussed by Taylor and Sullman, the wording of DRAS items allows for responses that are not necessarily based on fear of driving, but could also involve economic or practical issues. For instance, the travel via subway trains or streetcars within the center of some major North American or European cities is far more rapid than in cars and/or it saves both gasoline and parking fees.

Epidemiology

Little is known about the prevalence of driving anxiety. One study found that 16% of New Zealand adults have "moderate to severe driving anxiety".

References

{{Reflist Driving Situational phobias