Freeway Fright: Facing Fears Head-On

From the WebMD Archives

July 26, 2000 -- Spend much time in rush-hour traffic? Add a light rainfall, and it's a perfect formula for fear. Erratic drivers, sudden stops, and screeching breaks add up to an accident just waiting to happen. Are the thousands of drivers in your rearview mirror paying attention? A new study sheds light on our freeway fears -- and offers hope for getting over them.

It seems that all people who are so-called "driving fearfuls" have essentially the same anxieties -- whether they have actually had a fender bender -- or worse -- or not, according to the study's author, Frank P. Deane, PhD, a psychologist and researcher at the University of Wollongong in Australia. Their anxieties are very specific, often related to coping with bad-weather conditions and the classic, critical-mouthed "backseat driver."

By getting to the root of those anxieties -- through a bit of therapy -- people can get past some of their worst driving fears, Deane says. Defensive driving courses that boost skill levels also can increase confidence, he adds.

Most research has focused on fears that develop after driving accidents, which has often led to a diagnosis of post-traumatic stress disorder (PTSD) in those with more extreme reactions. But focusing on those people may have inadvertently led to a neglect of the larger population of people who fear driving, says Deane.

Through newspapers and radio stations, Deane found 190 people -- 175 women and 15 men -- who were fearful of driving. The people were asked about their driving records, including number of accidents and traffic offenses. They were also asked to describe situations that caused the most anxiety and to rate the severity of their fears on a scale. Finally, they rated their avoidance of those situations.

Seventy-three percent reported having two or fewer accidents. Among the people who had an accident history, 77% reported being nervous before trips, 71% tell the driver what to do, 63% get easily upset in the car, and 58% drive less than they used to.

The top two situations that produced high anxiety -- whether the person had had an accident or not -- were driving alone, especially in fog, and driving with a criticizing person. In fact, 50% of the surveyed drivers avoided the "backseat driver scenario" to some degree more than any other driving situation, researchers found. Nearly 20% reported that because of their fears, they avoided getting a driver's license. Nearly 60% said that their fears interfered with their daily lives to a great extent.

Interestingly, although most people believe that being involved in an accident worsens your fears of driving and driving scenarios, the researchers did not find much difference between levels of fear and the severity of it in people who'd had previous accidents and those who had not.

Driving-related phobias are "probably more common than we know," says Jonathan Abramowitz, PhD, clinic director of the Center for Treatment and Study of Anxiety at the University of Pennsylvania School of Medicine. "I think there are a bunch of people out there who don't seek treatment because they're embarrassed."

While it's sane to be somewhat fearful in traffic, "when fears are excessive and cause impairments in the person's functioning, it's a different story," he tells WebMD.

Getting past those fears isn't always easy, says Deane. Because loss of vehicle control -- or at least fearing that loss -- is a big issue, he recommends defensive driving classes. "Treatment might involve training in skid control procedures, driving in icy or wet conditions, or maximizing the use of visual cues for making judgments and improving reaction time."

Abramowitz says he has treated "a fair number of people" for true driving phobia. "They're afraid of the way they feel when they get anxious. They're driving over a bridge, for instance, and they feel a little anxious. Then it's the fight or flight response," he says. "They start to feel dizzy, tense, like they're having a little chest pain."

Some people misinterpret that bodily response, Abramowitz says. "They look for reasons why they should be anxious, and that makes them more uncomfortable. They think, 'I'm losing control of the car; I've gotta stop, gotta escape.' They might think, 'Something terrible is happening to me ... I'm having a heart attack.' It's kind of like a panic attack."

When it comes to that point, the true driving phobics will do everything in their power to try to escape the panicky feeling. "They stop the car to avoid going over that bridge," he says. "So they never learn that those anxiety sensations really are innocuous, that they will go away. They only learn to avoid those situations."

Deane and Abramowitz agree that the best type of treatment for any phobia is cognitive behavioral therapy, which involves teaching patients about phobias and about the way anxiety affects their bodies. Then they learn to challenge and restructure thoughts.

"Basically, it's learning to identify the automatic thoughts they have when they get anxious, the 'ohmygod thoughts'... 'ohmygod what if I drive off the road?' 'ohmygod what if I lost control of the car?'" Abramowitz says. "In cognitive therapy, you work on challenging their validity. If these thoughts are saying 'this is an unsafe road' you need to question, how often do people really drive off bridges? And the fact is, it's pretty rare. So the road really is safe; it must be something else. Or 'I'm going to faint behind the wheel.' How often have they had this anxiety attack? How often have they really fainted? It's probably very rare."

After that, he takes them on the road. "The most important piece of cognitive therapy," he adds, "is exposure ... in real life. We take the patient and practice this situation -- go on the road, and confront whatever they're afraid of. It's not just confronting it and leaving. You have to stay in the situation for a prolonged period of time until the anxiety goes away on its own. The person can learn that they can drive over this bridge or whatever and have the experience, and that their fears will naturally die down. ... That's the exposure principal."

As for handling the backseat driver, "As a therapist, I might sit in the backseat and start yelling things at the driver, so he can learn how to [cope]," Abramowitz tells WebMD. "You're helping the person to learn that they can still drive and they can tune them out, and that they're the one in control of the car ultimately, not the other person. That's what they need to keep in mind."