I found the study on Virtual Reality Exposure Therapy (VRET) for Fear of Driving (FoD) to be a promising step towards treating this common phobia. The study found that VRET was well-tolerated by all participants, and they completed all eight intervention sessions. However, it is essential to consider the city context and settings in which the participants live and will have to overcome when driving in real-life situations.
Rio de Janeiro is a large city with heavy traffic and highly stressed drivers, especially during rush hour. The city's topography features many hills and tunnels, and the vast majority of cars have manual transmission (“stick shift”). Five out of eight participants had experienced a Motor Vehicle Accident (MVA), although none were driving when the incident occurred. This finding may indicate the influence of classic or Pavlovian conditioning as well as operant conditioning of avoidance behavior.
While there was no significant reduction in BDI and HAM-A scores, it is important to note that the participants already had low scores at baseline. However, there was a significant reduction in state anxiety scores, which can be defined as fear, nervousness, discomfort, and arousal of the autonomic nervous system induced temporarily by situations perceived as dangerous. In turn, trait anxiety can be defined as a relatively enduring disposition to feel stress, worry, and discomfort. Thus, it is understandable that there would be a change in state anxiety, but not trait anxiety, scores after VRET.
The study observed an increase in almost all of the SF-36 subscale crude scores, although there were statistically significant differences for only two subscales (vitality and mental health). Another article that investigated QoL after VRET showed improvement in three subscales – physical functioning, social functioning, and mental health. However, we cannot state that a direct correlation exists between improvement in FoD and better QoL; further research is needed.
Heart rate can be used as an objective measure for monitoring participant reactions during VRET, and it may be useful for assessing the emotional state of participants. There was a high correlation between SUDS scale scores and heart rate in the present studies. Both of these findings, as well as their correlation, are important to show that subjective and objective measures can be combined to increase study reliability. Taken together with the IPQ scores, the SUDS scores and heart rate variation measured provide evidence that participants experienced a sense of presence during the exposures; in other words, participants felt immersed in the virtual environment.
The VRET protocol was designed with progressive difficulties of generic driving situations rather than with the driving stimuli specifically feared by each subject in mind. This makes it impossible to speculate as to the specificity of desensitization to the phobic stimulus. However, the reduction in state anxiety may depend on a generic habituation effect. The study intended to establish a standard protocol with increasing degrees of difficulty in each challenge and allowed the participants to drive freely in the virtual environment.
The study found a gradual decrease in discomfort scores and heart rate during the subsequent exposures. Notably, we can link the observed reduction in perceived discomfort from one session to the next with the decrease in sense of presence, which might suggest that enriching the virtual environment and the apparatus may be necessary to enhance perceived immersion in the virtual environment.
While the study has several limitations, such as the small sample size, use of nonparametric statistical methods, and not recording other physiological parameters of interest, such as respiratory rate and electroencephalography, it is a promising first step towards investigating VRET for FoD in Brazil. Further research can assess whether the use of cognitive restructuring methods during the virtual exposure sessions could enhance the reduction of anxiety levels in participants.