Fear of Driving

Overview
Fear of driving (Vehophobia), like fear of flying, is classified in the DSM 5 as a situational specific phobia. As in FOF, fear of driving is a complex phenomenon that spans multiple diagnostic categories from true driving phobia (where the focus is vulnerability accident and skill) to panic disorder. Complicating the picture is the occurrence of motor vehicle accidents (MVAs) resulting in post-traumatic stress disorder (PTSD)- related fear and avoidance.
This page will briefly cover the two subtypes of driving phobia: 1) fear of crash/distrust of skill and 2) fear of panic when driving.
Firstly, in the partial review of the research on fear of driving I did for this page, it became apparent that, although prevalence and severity rates for this phobia hover around 17-20 % for mild and 4-6% for severe, the literature on this phobia seems sparse and and mostly from New Zealand. As is the case with other anxiety disorders, studies of fear of driving indicate that more women than men experience this phobia. Age of onset can be early in one’s driving career, or later in life. It is difficult to determine the distribution of subtypes, as many studies have focused on MVAs or attempts to determine the prevalence in the general population. Nonetheless, it would appear that fear of accident/skill distrust is more common that panic amongst those who fear driving. In both subtypes, highways are avoided far more than are secondary roads.
Treatment
Fear of Accidents
In my practice it is actually rare for me to see a client with this driving phobia subtype, even though they probably represent a significant percentage of driving phobics. Unfortunately, with certain exceptions, I have had little success treating this group. Unlike fear of flying, where the person is a passenger, not piloting the aircraft, in fear of driving, one has to drive. Hence, not desensitizing is far more daunting than in Panic-driven HW agoraphobia. Moreover, there is more concern about safety in fear of driving given as anxiety affects skill and performance.  The few clients I have seen with fear of accidents and driving have have been able to drive on side streets in small and medium size towns, but not on highways or in cities. I have observed that the fear of vehicles has been very challenging for these clients. As result there has been a low ceiling of distress tolerance. My sense is that a specialized hybrid of driving instructors and therapists forming a team together with virtual reality training could result in more treatment success.
I have observed certain qualities and characteristics in the very few clients who have been successful: 1) high level of motivation, 2) high level of motivation, 3) did I mention motivation?, 4) less front-end fear, 5) some (limited) HW driving 6) age-appropriate mastery of driving skills that predates onset of of the phobia 7) no significant co-occurring psychiatric conditions 8) no history of MVAs and 9) supportive family and/or friends.
Treatment Summary Points
Progressive desensitization-type exposures carefully chosen and specific graded tasks Identification and dropping of safety behaviors
Mastering calming strategies
Frequent practice and repetition between sessions alone and with supportive friend/family who serve as a coach
More practice and repetition between sessions alone and with supportive friend/family who serve as a coach
Monitoring of anxiety reactions during exposures
More practice and repetition between sessions alone and with supportive friend/family who serve as a coach
Constant debriefing of exposures with particular attention to negative interpretations of slow treatment progress
Progressive steps to independence
Fear of Panic
Treatment of driving phobia related to panic disorder, follows standard panic control therapy with methods similar to those used in the treatment panic-related fear of flying. Clients with this subtype of driving phobia experience panic elsewhere and driving is often one of many agoraphobic triggers. Strategies need to be adapted to the context of driving, however, as full-blown or even partial panic can affect one’s ability to drive safely. Consequently, the hierarchy of exposures most be carefully chosen. Nonetheless, because in HW Panic, there is no fear related to the mechanics of driving, the rate of success for clients seeking treatment is quite high. Almost all clients I have treated, with this subtype, who have followed through with treatment achieve HW mastery and complete symptom remission.