Virtual Reality and Cognitive-Behavioral Therapy for Driving Anxiety and Aggression in Veterans: A Pilot Study

Within the U.S. military, motor vehicle accidents (MVAs) are the leading cause of preventable morbidity and mortality. Prior combat exposure and anxiety symptoms are associated with risky and aggressive driving, which is responsible for over half of MVA fatalities. Therefore, interventions are needed to reduce driving anxiety and aggression in veterans in order to mitigate the public health impact of MVAs. Virtual reality exposure therapy (VRET) offers safe, controlled exposure to distressing stimuli. The current study piloted a novel virtual reality and cognitive behavioral intervention (VRET + CBT) for veterans that integrated both anxiety and anger management components. Virtual reality driving scenarios were delivered in a driving simulator and tailored for the military population. Six previously deployed veterans completed eight intervention sessions, as well as pre/post, one month follow-up and six to nine month follow-up assessments. Repeated measures ANOVAs demonstrated significant decline and large effect sizes for PTSD symptoms, driving phobia, hyperarousal in driving situations, anxiety/anger-related thoughts and behaviors, and risky driving. Hyperarousal in driving situations declined by 69%, aggressive driving declined by 29%, and risky driving declined by 21%. Treatment gains were maintained at follow-up. Recruitment, retention, immersion, simulator sickness scores, and qualitative feedback demonstrated feasibility of the intervention. Implications for future research and adaptation are discussed.     

Distressed in the queue? Psychophysiological and behavioral evidence for two alternative car-following techniques

BackgroundNature offers numerous examples of animal species exhibiting harmonious collective movement. Unfortunately, the motorized Homo sapiens sapiens is not included and pays a price for it. Too often, drivers who simply follow other drivers are caught in the worst road threat after a crash: congestions. In the past, the solution to this problem has gone hand in hand with infrastructure investment. However, approaches such as the Nagoya Paradigm propose now to see congestion as the consequence of multiple interacting particles whose disturbances are transmitted in a waveform. This view clashes with a longlasting assumption ordering traffic flows, the rational driver postulate (i.e., drivers’ alleged propensity to maintain a safe distance). Rather than a mere coincidence, the worldwide adoption of the safety-distance tenet and the worldwide presence of congestion emerge now as cause and effect. Nevertheless, nothing in the drivers’ endowment impedes the adoption of other car-following (CF) strategies. The present study questions the a priori of safety-distance, comparing two elementary CF strategies, Driving to keep Distance (DD), that still prevails worldwide, and Driving to keep Inertia (DI), a complementary CF technique that offsets traffic waves disturbances, ensuring uninterrupted traffic flows. By asking drivers to drive DD and DI, we aim to characterize both CF strategies, comparing their effects on the individual driver (how he drives, how he feels, what he pays attention to) and also on the road space occupied by a platoon of DD robot-followers.MethodsThirty drivers (50% women) were invited to adopt DD/DI in a driving simulator following a swinging leader. The design was a repeated measures model controlling for order. The CF technique, DD or DI, was the within-subject factor. Order (DD-DI / DI-DD) was the between-subjects factor. There were four blocks of dependent measures: individual driving performance (accelerations, decelerations, crashes, distance to lead vehicle, speed and fuel consumption), emotional dimensions (measures of skin conductance and self-reports of affective states concerning valence, arousal, and dominance), and visual behavior (fixations count and average duration, dwell times, and revisits) concerning three regions of the driving scene (the Top Rear Car –TRC- or the Bottom Rear Car –BRC- of the leading vehicle and the surrounding White Space Area -WSA). The final block concerned the road space occupied by a platoon of 8 virtual DD followers.ResultsDrivers easily understood and applied DD/DI as required, switching back and forth between the two. Average speeds for DD/DI were similar, but DD drivers exhibited a greater number of accelerations, decelerations, speed variability, and crashes. Conversely, DI required greater CF distance, that was dynamically adjusted, and spent less fuel. Valence was similar, but DI drivers felt less aroused and more dominant. When driving DD visual scan was centered on the leader’s BRC, whereas DI elicited more attention to WSA (i.e., adopting wider vision angles). In spite of DI requiring more CF distance, the resulting road space occupied between the leader and the 8th DD robot was greater when driving DD.     

The Driving Anger Expression Inventory: A Validity Study with Community College Student Drivers

This study explored the relationship of driving anger expression to driving anger, trait anger, general anger expression, and aggressive and risky behavior while driving. Verbal, physical, and vehicular forms of expressing anger while driving correlated positively with each other, driving and trait anger, anger-in, and anger-out and negatively with adaptive/constructive driving anger expression and general anger-control. Adaptive/constructive expression formed small negative correlations with these measures, except for a positive correlation with anger-control. Regression models controlling for demographic variables and driving anger, trait anger, or general anger expression demonstrated forms of driving anger expression added variance to predicting aggressive and risky behavior. Forms of driving anger expression partially mediated the effects for driving anger, trait anger, and general anger expression on aggressive and risky behavior. No moderation effects were found for age, gender, or miles driven. Findings provided evidence for convergent and incremental validity for the Driving Anger Expression Inventory.     

Fear and avoidance of driving among drivers involved in a road traffic crash. The role of traumatic fear and driving cognitions

Fear and avoidance of driving are possible consequences of involvement in road traffic crashes (RTCs). Few studies have assessed the factors associated with fear and avoidance of driving after an RTC. The aim of this present study is to investigate the relations among trauma appraisals of fear, negative driving cognitions, fear and avoidance of driving in a sample of people who experienced vehicle crashes. Further, the mediating role of negative driving cognitions in the relation between trauma appraisals, fear of driving and avoidance of driving was assessed. The sample was comprised of 116 drivers who had been involved in an RTC in the past two years. Negative driving cognitions positively predicted fear of driving and avoidance of driving. Moreover, negative driving cognitions mediated the relation among trauma appraisals of fear with fear of driving and avoidance of driving. The theoretical and practical implications of these results are discussed.     

Effects of driving anger on driver behavior – Results from naturalistic driving data

There is a positive relationship between driving anger and near-crash or crash risk. However, it remains unclear if anger in fact contributes to traffic accidents and whether this happens due to cognitive overload or aggressive driving behaviors. This study investigated how anger affects driving behavior based on naturalistic driving data from the second Strategic Highway Research Program (SHRP 2). Ten-minute trip segments were analyzed in which drivers exhibited anger with regard to driving errors, violations, and aggressive expressions. This data was compared to a matched baseline consisting of the same drivers not exhibiting anger. Results showed that anger resulted in more frequent aggressive driving behaviors but did not increase driving error frequency. Anger consequently creates danger due to deliberate behaviors rather than because of cognitive overload. In congruence with this finding, only anger triggered by threats, provocations, and frustrations increased the frequency of deliberate infringements. In contrast, anger due to having conflicts with someone on the phone or with a passenger was not linked to any type of aberrant driving behavior. Finally, severe displays of anger were accompanied by more violations as compared to slight or marked anger.     

The different effects of personality on prosocial and aggressive driving behaviour in a Chinese sample

Dangerous driving behaviours, as a direct cause of accidents and death, are the focus of considerable research attention. However, unlike unsafe driving behaviours, few studies have explored safe driving behaviours and their effects on road traffic. This study aims to verify the Chinese version of the Prosocial and Aggressive Driving Inventory (PADI) and then investigate the relationship between personality and aggressive/prosocial driving behaviours. A total of 303 licensed drivers were recruited, and they voluntarily and anonymously completed the PADI, the Driving Behaviours Questionnaire (DBQ), and personality scales (anger, sensation-seeking and altruism). The results of this research confirmed the reliability and validity of the Chinese PADI. Most importantly, it was found that different relationships between different personalities and aggressive/prosocial driving behaviours. Specifically, individuals with high altruism exhibited more prosocial driving behaviours, while individuals with high sensation seeking presented more aggressive driving behaviours. The importance of these findings lies in two main potential implications: developing an effective measurement of prosocial driving behaviours in China and providing favourable evidence to guide drivers toward more prosocial driving behaviours.     

Examining U.S. drivers’ characteristics in relation to how frequently they engage in speeding on freeways

Speeding and speed-related crashes have consistently represented over 25% of all traffic fatalities over the past two decades. The severity of these speed-related incidents not only impact the drivers but all road users. Thus, characterizing drivers who speed, understanding their motivations, and identifying the types of risky driving behaviors associated with speeding play a critical role in developing, implementing, and sustaining effective countermeasures. Using a survey administered to a U.S. nationally representative sample (N = 2,930 licensed drivers aged 16 or older), this study develops a partial proportional odds model to examine differences in characteristics between types of speeders – frequent, occasional, and non-speeders – and explores characteristics and risk driving behaviors that are most associated with speeding behavior. Additionally, motivations for speeding are examined for drivers who frequently speed compared with those who occasionally speed. Results show speeders tended to engage in other unsafe driving behaviors, such as distracted, aggressive, unbelted, and alcohol-impaired driving. Among demographic and socio-economic variables examined in this study, drivers’ age was the greatest associated determinant. The association with engagement in red-light running, however, outweighed that with drivers’ age. Interestingly, the interaction between educational attainment and engagement in aggressive driving was also predictive of speeding behavior. For motivations for speeding, frequent speeders were more likely to report enjoying driving fast and disagreeing with speed limits compared with occasional speeders. The findings of this study are useful towards identifying the various characteristics and behaviors of drivers who engage in speeding, which can provide future insights into where effective countermeasures and prevention efforts should be focused.     

Personality and demographic differences in the perceived risks of potentially timid driving behaviours

Timid driving behaviours can be described as overly cautious and hesitant driving behaviours. Little research has examined behaviours that potentially resemble timid driving and how these behaviours are perceived by other drivers. This is despite the potential for these behaviours to be perceived in a way that leads to angry and aggressive retaliatory behaviours in some drivers (e.g., in anger-prone drivers). We conducted an online survey examining the perceived road safety risks of several behaviours that could potentially result from timid driving and their relationships with driver personality (trait anxiety, trait driving anger), behaviour (anxious driving, angry driving), and demographic (age, gender, annual mileage) background. Drivers (N = 439, M_age = 49.41 ± 5.59 years, aged 18–89) perceived excessively cautious and unpredictable braking behaviours as posing moderate levels of risk. Multiple linear regression analyses also indicated higher perceived risks of slow and excessively cautious behaviours in older, male, and anger prone drivers. No meaningful associations were found between driver characteristics and the risks of unpredictable braking behaviours. These results suggest that safety campaigns to reduce aggressive behaviour may benefit from targeting the perceptions of other drivers’ behaviours.     

Investigation of drivers’ thresholds of a subjectively accepted driving performance with a focus on automated driving

Lately, the development and implementation of automated driving moved to the center of interest in the automotive industry. In this context, one of the central issues – the configuration of adequate trajectories – is mainly tackled using a technical approach. However, it appears that a technically ideal driving performance does not necessarily coincide with the drivers’ subjective preferences. This study strives to determine thresholds of a subjectively accepted driving performance regarding lateral vehicle control. A second objective is to analyze the influence of selected personal and situational factors on these thresholds. An empirical online survey with 161 participants rating video sequences of driving performances was conducted. The video sequences differed not only with regard to the lateral offset of the ego-vehicle but also concerning the weather (sun/rain) and traffic conditions (existence/driving behavior of oncoming traffic). Additionally, the participants’ driving experience and sensation seeking were considered in the data evaluation. To analyze the data, binary logistic regression analyses were calculated. They revealed that the subjective evaluation of driving performances varies primarily depending on the lateral offset of both the ego-vehicle and the oncoming traffic. The results indicate that regarding the lateral offset certain thresholds of subjectively accepted driving performances do exist. Regarding the development of automated driving systems, two issues need to be considered in order to ultimately guarantee user acceptance. First, the subjective thresholds need to be integrated into the systems’ trajectory planning. Second, the oncoming traffic’s driving behavior has to be considered.     

Anger,aggression, risky behavior,and crash-related outcomes in three groups of drivers

High anger drivers who acknowledged problems with driving anger and were interested in treatment were compared to high and low anger drivers who did not acknowledge problems with driving anger or want treatment. Although high anger drivers who acknowledged problems reported greater anger on two measures than high anger drivers who did not acknowledge problems, both high anger groups tended not to differ from one another and were more frequently and intensely angered when driving, reported more aggressive and less adaptive/constructive forms of expressing anger while driving, engaged in more aggressive and risky behavior on the road, and experienced more of some accident-related outcomes than low anger drivers. High anger groups did not differ from each other, but reported more trait anxiety and anger and more outward negative and less controlled general anger expression than the low anger group. The two groups of high anger drivers, however, require different types of interventions given their state of readiness for driving anger reduction. Results were also interpreted as supportive of the state-trait model of anger and construct validity of the Driving Anger Scale.     

The impact of self-control and texting-related accidents on the relationship between mindfulness and mobile texting while driving behavior

Distracted driving behavior often occurs when drivers mindlessly send or receive text messages with their mobile devices. It is imperative to understand the relationship between mindfulness and texting while driving behavior because distracted driving behavior has led to a reported increase in texting related accidents and mortalities. Based on this report, the purpose of this study is to examine the relationships between mindfulness, self-control, frequency of texting-related accidents, near-miss accidents, and texting while driving behavior. Using a total of 609 adults with an average age of 34.11 (SD = 12.21), results showed that observe, aware, and describe were related to texting while driving. Additionally, we found evidence that self-control partially mediated the relationship between mindfulness and texting while driving. Results also showed that near-miss texting while driving accidents moderated the relationship between mindfulness and texting behavior while driving. The observed inverse relationship between mindfulness and texting while driving can increase researchers’ understanding of self-control’s role in vehicular accidents triggered by texting. Implications and limitations are offered, along with suggestions for future research.     

Safe driving communication: A regulatory focus perspective

This research article examines the effects of self‐regulation on adolescents' aggressive driving tendencies and their attitudes toward safe driving communication. Two experimental studies demonstrate that an individual's regulatory orientation is a good predictor of aggressive driving tendencies and that self‐regulation plays a moderating role on the effects of safe driving messages on recipients' attitudes. Specifically, the findings reveal that promotion‐oriented (vs. prevention‐oriented) individuals are more likely to demonstrate aggressive driving tendencies. In addition, promotion‐oriented individuals show more favorable attitudes toward gain‐framed safe driving messages than loss‐framed messages. Prevention‐oriented individuals show the opposite pattern. Implications for theory and practice are discussed.     

A Go/No-go approach to uncovering implicit attitudes towards safe and risky driving

Self-report measures of driving-related attitudes and beliefs miss potentially important precursors of driving behaviour, namely, automatic and implicit thought processes. The present study used an adapted Go/No-go Association Task to measure implicit thought without relying on the participants’ self-reports. Implicit attitudes towards safe and risky driving were measured in 53 Danish drivers (31 female, 22 male). Further, we explored the relationship between implicit attitudes towards risky and safe driving, and self-reported driving behaviour and skills. The results suggest that implicit attitudes towards driving behaviour can be measured reliably with the Go/No-go Association Task. Also, the results suggest that implicit attitudes towards safe driving and risky driving, respectively, may be separable constructs, and might thus stem from different cognitive processes. Finally, implicit attitudes were significantly related to self-reported driving behaviour and skills for male (but not female) drivers. Pending future research with larger sample sizes, the difference between implicit attitudes towards safe versus risky driving that we observed may contribute to a greater theoretical understanding of the causes of safe and risky driving.     

Car following with an inertia-oriented driving technique: A driving simulator experiment

BackgroundFor many decades, car-following (CF) and congestion models have assumed a basic invariance: drivers’ default driving strategy is to keep the safety distance. The present study questions that Driving to keep Distance (DD) is a traffic invariance and, therefore, that the difference between the time required to accelerate versus decelerate must necessarily determine the observed patterns of traffic oscillations. Previous studies have shown that drivers can adopt alternative CF strategies like Driving to keep Inertia (DI) by following basic instructions. The present work aims to test the effectiveness of a DI course that integrates 4 tutorials and 4 practice sessions in a standard PC computer designed to learn more adaptive driving behaviors in dense traffic. Methods. Sixty-eight drivers were invited to follow a leading car that varied its speed on a driving simulator, then they took a DI course on a PC computer, and finally they followed a fluctuating leader again on the driving simulator. The study adopted a pretest-intervention-posttest design with a control group. The experimental group took the full DI course (tutorials and then simulator practice). The control group had access to the DI simulator but not to the tutorials. Results. All participating drivers adopted DD as the default CF mode on the pre-test, yielding very similar results. But after taking the full DI course, the experimental group showed significantly less accelerations, decelerations, and speed variability than the control group, and required greater CF distance, that was dynamically adjusted, spending less fuel in the post-test. A group of 8 virtual cars adopting DD required less space on the road to follow the drivers that took the DI course.     

The influence of public self-consciousness and anger on aggressive driving

This study examined how anger interacted with public self-consciousness to influence aggressive driving. It was hypothesized that when people were angry, more aggressive driving behavior would occur when public self-consciousness was low than when public self-consciousness was high. To test this hypothesis the participants were required to complete measures of driving anger and public self-consciousness. Then participants gave a retrospective self-report of aggressive driving behavior. Further, participants were required to keep a log in which they recorded aggressive driving behavior. The results supported the prediction. Public self-consciousness interacted with anger to influence aggression while driving.     

Drivers’ performances and their subjective feelings about their driving during a 40-min test on a circuit versus a dynamic simulator

Car manufacturers expect driving simulators to be reliable research and development tools. Questions arise, however, as to whether drivers’ behavior on simulators exactly matches that observed when they are driving real cars. Drivers’ performances and their subjective feelings about their driving were compared between two groups during a 40-min driving test on the same circuit in a real car (n = 20) and a high-fidelity dynamic simulator (n = 27). Their speed and its variability, the braking force and the engine revolutions per minute (rpm) were recorded five times on a straight line and three times on a curve. The differences observed in these measurements between circuit driving (CD) and simulator driving (SD) from the 6th to 40th minute showed no significant changes during the drive. The drivers also completed the NASA Raw Task Load Index (NASA RTLX) questionnaire and the Simulator Sickness Questionnaire (SSQ) and estimated the ease and standard of their own driving performances. These subjective feelings differed significantly between the two groups throughout the experiment. The SD group’s scores on the NASA RTLX and SSQ questionnaires increased with time and the CD group’s perceived driving quality and ease increased with time, reaching non-significantly different levels from their usual car driving standards by the end of the drive. These findings show the existence of a fairly good match between real-life and simulated driving, which stabilized six minutes after the start of the test, regardless of whether the road was straight or curved. These objective findings and subjective assessments suggest possible ways of improving the match between drivers’ performances on simulators and their real-life driving behavior.     

The Effect of Reminders of Death on Reckless Driving: A TerrorManagement Perspective

Why do young people, especially young men, engage in reckless driving despite the fact that this behavior contradicts the basic biological imperative of self-preservation? Answering this interesting and crucial question may lead to effective interventions. A series of studies, based on terror management theory, examined the effects of reminders of death on risk taking while driving. The dependent measures were either self-reported behavioral intentions of risky driving or driving speed in a car simulator. Findings showed that mortality-salience inductions led to more risky driving than the control condition only among individuals who perceived driving as relevant to their self-esteem. The introduction of positive feedback about driving eliminated this effect. The complex role of self-esteem in the process of risk taking is discussed.     

Frequency and impact of hands-free telephoning while driving – Results from naturalistic driving data

The frequency and impact of hands-free telephoning while driving was analyzed based on naturalistic driving data from 106 drivers. The results from naturalistic driving data were compared with the results from experimental approaches. The implication of the overall results and the differences across drivers are discussed. Continuous information on the usage of the hands-free phone equipment was available which made it possible to include the entire database (∼1 000 000 km) in a completely automatized analysis. Results show that drivers talked on a hands-free phone about 11% of driving time. There were large differences across drivers in the frequency and usage of a hands-free phone. While telephoning, an adaptation of driving behavior could be found. Drivers slowed down and increased their distance to the lead vehicle. Furthermore, during telephoning, an overall reduction of potentially critical driving situations was found. Overall, the results indicate that compensation for telephoning was carried out with a long-term change of driving behavior, rather than with a short term adaption to the situation.     

A qualitative exploration of apprehended women’s experience of drink driving events

BackgroundIn Australia, drink driving remains a serious road safety issue. The few studies that have addressed drink driving behaviour amongst women often focus on aggregated statistical comparisons to men or view the concept of drink driving as part of broader criminological behaviour. In contrast, scant research has directly focused on convicted female drink drivers. The aim of this study was to explore the factors that contribute to drink driving in a cohort of women convicted for drink driving and examine why these women were unsuccessful in mitigating the risk of engaging in drink driving behaviour.MethodThe study thematically analysed the narratives of 14 women who had been apprehended and subsequently convicted of a drink driving offence in the state of Queensland (Australia). All participants were recruited by way of their attendance at a drink driving education program.ResultsOverall examination of participants’ narratives revealed drink driving behaviour derived from a complex set of processes including taking a risk, using alcohol to self-medicate and alleviate psychological distress, basing the decision to drive on subjective assessment, and past engagement in drink driving behaviour and punishment avoidance. Underpinning these themes was the participants lack of awareness about the increasing risks associated with their alcohol consumption levels, with cognisance only being achieved after apprehension.ConclusionThese findings add to the limited research addressing drink driving behaviour among women and highlight important factors to explain why women are increasingly engaging in this risky behaviour.