Anxiety disorders are diagnosed when people become overreactive, disassociated, and feel emotionally unable to control feelings to the extent that their daily lifes are affected. Driving phobia is one of the widespread anxiety disorders in modern society, which cause problematic disruptions of a patient's daily activities. Exposure therapy is an approach gaining popularity for treating patients with stress disorders. Virtual reality (VR) technology allows people to interact with objects and stimuli in an immersive way. The VR for phobic therapy using indirect exposure, which can be safely discontinued or lowed in terms of intensity, is the area of research with literature published and patents granted. This research focuses on reviewing virtual reality exposure therapy (VRET) literature and patents. The chapter also presents the research and development of a novel driving phobia VRET system with the detailed experiments to demonstrate the design, development, implementation, enhancement, and verification of VRET.
Top1. Introduction
Patients suffering from anxiety disorders have high levels of anxiety and a variety of symptoms, such as inattention, irritability, fatigue, and insomnia. Common types of anxiety disorder include panic disorder (PD), phobia, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) (Gautam et al., 2017). Studies have pointed out that when PTSD is accompanied by other anxiety or comorbid depression, PTSD symptoms are more severe (Spinhoven et al., 2014; Momartin et al., 2004; Hruska et al., 2014). A National Comorbidity survey replication showed that patients with PTSD included about 44% of patients with three or more anxiety diagnoses other than PTSD (Elhai et al., 2008). PTSD also increases the risk of suicidality and functional impairment (Giaconia et al., 1995; Perkonigg et al., 2000).
Motor vehicle accidents (MVA) are the leading cause of medical treated trauma in the United States (US) (Blanchard & Hickling, 2004). In 2018, the number of MVA exceeded 6.7 million and about 2.7 million people were injured during the accidents in the US. Research from the National Institute of Mental Health (NIMH) has shown that 39% of the MVA survivors met DSM-III-R criteria for post-traumatic stress disorder (PTSD). Patients who had PTSD often develop disabling memories and anxiety related to the car accident event. These individuals were more likely to be subjectively distressed by environmental conditions with increased impairment in commuting to work or driving a car for pleasure (Blanchard & Hickling, 1995). The type of PTSD caused by MVAs referred to as driving phobia disorder. Driving phobia is a common disorder and the degree of fear differs significantly between patients. Some patients are only afraid of particular driving situations, while some may break out in a cold sweat when seated in the driver’s seat.
System desensitization (SD) refers to slowly exposing patients to the situation that causes neurotic anxiety and psychological relaxation to combat this anxiety to eliminate patients’ neurotic anxiety. SD is widely used in clinical psychology, including assisting patients to overcome particular phobias, and the efficacy of SD is recognized. VRET uses the concept of SD to immerse patients in a virtual environment, deepen the sense of presence through visual, sound, and tactile immersion, and create stimuli to make patients feel moderately fearful. Ougrin’s research (2011) demonstrated that VRET is as effective as traditional cognitive behavioral therapy (CBT). Some qualitative case studies have initially confirmed the effectiveness of VRET in the treatment of phobias (Beck et al., 2007; Zinzow et al., 2018; Kaussner et al., 2020), and other studies have shown that the efficacy of VRET is even better than that of traditional CBT (Scozzari & Gamberini, 2011).
This research will focus on constructing a new driving phobia VRET system as an example to verify the effectiveness of the treatment. The experiment will provide an immersive experience of driving for subjects, integrating subjects’ biodata collection via a control group-based experimental design. The VRET experiment combines comprehensive biodata analysis with the survey analysis between treatment and control group to measure the effectiveness of the system. The chapter is organized in the following sections. In Section 2, the literature of VRET and specific driving phobia treatments are reviewed. Self-measurement surveys related to driving behavior and patents related to VR driving applications are also reviewed. Section 3 describes the methodologies and approaches applied and integrated with this research, including experimental details, fear of driving questionnaire analysis, and real-time physiological data analysis. Section 4 interprets the implications of the experiment. Section 5 summarizes the essential findings and contributions of the research. The analytical results of VRET’s effectiveness for treating driving phobia and the future development required in the field are addressed in the final remarks.