Treating Fear of Driving in Virtual Reality

C2Drive is an application dedicated to the treatment of amaxophobia or fear of driving. Its repercussion is important and tends to be generalized on the whole of the life of the people who are affected by it: loss of autonomy, isolation, solicitations to the entourage, restrictions of the geographical area during a job search, impossibilities to pass the driving licence…The list of disabilities caused by amaxophobia is long. Virtual reality appears as an efficient solution to treat this disorder.

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We use Artificial Intelligence both through a coach named Camille and through virtual characters within the scenes. Camille provides support and acts as a trusted companion to whom you can share your concerns without fear of judgment. On the other hand, the virtual characters faithfully replicate real-life social behaviors. You will be able to interact with them in various everyday contexts, such as a party, a date, a job interview, or a spontaneous conversation on the street. Learn more

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ARTICLE : WRITTEN BY JULIE FACINI

March 16, 2020

C2Drive is an application dedicated to the treatment of amaxophobia or fear of driving. Its repercussion is important and tends to be generalized on the whole of the life of the people who are affected by it: loss of autonomy, isolation, solicitations to the entourage, restrictions of the geographical area during a job search, impossibilities to pass the driving licence…The list of disabilities caused by amaxophobia is long. Virtual reality appears as an efficient solution to treat this disorder. Based on the principles of exposure of cognitive-behavioral therapies, the in virtuo treatment is based on the necessity to gradually confront the patient with the most dreaded and disabling driving situations.

In order to do so, it was necessary to have environments that could elicit the same activations as reality. C2Care has thus designed a software dedicated to the treatment of the fear of driving. Equipped with a steering wheel and a pedal board, therapists will be able to expose their patients to a variety of driving situations. Indeed, in order to achieve total immersion, it is important to place the patient in conditions similar to reality.
Therefore, the use of accessories such as a steering wheel and a pedalboard, activates the muscle recruitment inherent to driving, facilitating the dysfunctional emotional activation for the exposure work. Moreover, in the opposite direction, the enrichment of the simulation of driving a car by the accessories, allows to maximize the transfer of learning.
In other words, the more in virtuo learning is assimilated in a realistic context that creates a strong sense of presence, the more optimal the in vivo application of this new learning will be. This concern to perform a virtual reality as close as possible to the materiality, has been concretized in the C2Care environments dedicated to the management of amaxophobia and gathered in the C2Drive application. In this software, the main roads, sources of anxiety, have been conceptualized and embellished with high functionality in order to promote the problematic behaviors in their singularity. The idiosyncrasy of the disorder will be respected by the multitude of stimuli. Specifically, the therapist can expose the patient to the following road contexts :

The highway

A real virtual highway available for exhibitions. This highway is a real source of anxiety for amaxophobes. Perceived as an immense potential for danger and accidents, it results in a high rate of avoidance of the highway, a factor in the maintenance of the phobia. The therapist will be able to gradually expose the patient to situations related to the motorway theme in complete safety. Indeed, the considerable advantage of virtual reality is that it allows for effective therapeutic support without danger, either for the patient or for the therapist.
Moreover, the graduation of situations is made possible by the control over the environmental stimuli. The management of the motorway flow is placed under the therapist’s monitoring: fluid traffic, average or dense traffic and traffic jams. It is thus possible to expose the subject to the same context (the freeway) by progressively increasing the anxiogenic load with regard to the singularity of his disorder. Moreover, the quality of the stimuli is also placed under the therapist’s examination, he will be able, according to the anxiogenic elements related by the patient, to add trucks and motorcycles in the environment. Obstacles and unforeseen events can be placed on the route, such as an accident with sound and visual stimuli (ambulance, siren). These features allow the patient to be exposed to road hazards to which they do not have access because of the avoidance set up. It is clinically relevant not only to expose patients with driving phobia to anxiety-provoking realities but also to accustom them to the potential stimuli they will encounter on the road. In addition, the exposure progression can be done by not immediately placing the patient as a driver but in the passenger seat.

These driving options are accessible from the software controller : immersion with a perspective of the environment from the driver’s seat or from the passenger seat. Some people suffering from amaxophobia have generalized their disorder to the point of not being able to bear a car ride even as a passenger. For the latter, it is essential to expose them first to situations where they will not be responsible for driving. This solution is made possible by an automatic piloting system that does not require any additional equipment (steering wheel, pedals). In addition, among the many functions that allow the management to be adjusted to the patient’s clinical reality, it is also possible to choose the vehicle’s speed of movement.
These alternatives result in multiple exposures. For example, to extinguish an anxiety response elicited by highway driving, the therapist may place the patient in a fluid traffic situation with a vehicle traveling at 90 km/h, repeat the exposure until the anxiety is extinguished, and then progress to a more severe anxiety level by increasing the speed to 110 km/h and increasing the traffic. The weather is also under the control of the clinician. He will be able to propose an exhibition in good weather, with rain or even in foggy weather. 

All the features mentioned above, in this case a virtual highway environment with features designed for the exhibition exercise, also exists in a night version.

Tunnel

The tunnel is a context often cited by driving phobics among the situations generating a high anxiety rate. This environment has been recreated virtually. The user will experience the sensations inherent in going through a tunnel, the anxiety necessary to allow the counter-conditioning to act. In this application, the therapist will have the same possibility of control over the environment: adjustable vehicle speed, management of the traffic flow, addition of specific vehicles (motorcycles, trucks), perspectives from the car (passenger, driver), reversible weather (rain, fog, sun)…

The city

The fear of driving has a particularity that distinguishes it from many other phobias, namely that it can lead to dangerous situations (accident, loss of control of the vehicle). These deleterious potentials are very significant when driving in the city because of the number of stimuli present in the environment: signals, red lights, store windows, heavy traffic, pedestrians, proximity to other vehicles…). These facts make in vivo exposure particularly delicate and dangerous for the patient and the therapist in charge of the treatment. The virtual city makes it possible to overcome these difficulties and to immerse the patient in an interactive environment that is an ideal reflection of the urban road contexts frequently encountered. Thus, the patient will be able to experience the reality of driving in the city: red lights, sound stimuli, pedestrians, right-of-way crossings, etc… The exposures can be graduated according to the singularity of each patient’s phobia and repeated as many times as necessary to achieve therapeutic gains. Typical situations generating the activation of fear have been placed on the road course of this environment: bridge, narrow passages, road with non-secure borders…

Amaxophobia is, like other anxiety disorders, a pathology whose etiology and manifestation of symptoms remain specific to the patient. Its treatment requires a reassuring framework to undertake an exposure therapy. Virtual reality appears to be the most optimal solution. C2Drive conceptualizes a software offering access to a set of typical road environments related to the anxiety-provoking theme of driving phobia. Exposure therapies are currently the most effective treatments for amaxophobia. Virtual reality provides a framework for this methodology by its properties, which are perfectly in line with the active principles of behavioral therapies: safety, repetition, accessibility, graduation

C2Care virtual reality environments are also used for the management of patients with brain injuries. Medical teams in SSR uses it for the ecological evaluation of the ability to resume driving.


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FAQ

Virtual reality (VR) is an innovative technology that enables patients to be exposed to immersive and controlled environments, facilitating the management of numerous psychological and psychiatric disorders. Its use in mental health offers several advantages:
  • Gradual and Controlled Exposure: VR allows patients to confront anxiety-inducing situations in a secure environment, gradually adjusting the intensity of stimuli to promote habituation and emotional regulation.
  • Realistic and Reproducible Environments: Unlike traditional techniques, VR provides immersive scenarios that can be consistently reproduced, ensuring a coherent and effective approach.
  • Increased Patient Engagement: The interactive and immersive nature of VR enhances treatment adherence and motivates patients to continue their therapy.
  • Personalized Treatment: Virtual environments can be adapted to meet the specific needs of each patient.
  • Versatile Applications: VR is used to treat anxiety disorders (phobias, post-traumatic stress disorder, obsessive-compulsive disorders), addictions, mood disorders, and even cognitive remediation.
The use of virtual reality in healthcare is not new! It has been studied and utilized for over 30 years in the medical and psychological fields. As early as the 1990s, researchers began exploring its potential for treating anxiety disorders, particularly phobias and post-traumatic stress disorder. Since then, numerous scientific studies have confirmed its effectiveness in addressing various psychiatric, neurological, and cognitive disorders.
Today, VR is widely integrated into therapeutic and medical practices, with clinically validated protocols. It is used in hospitals, clinics, and psychologists' offices worldwide to provide patients with innovative, effective, and safe treatments.
To use virtual reality, one must immerse themselves in a virtual environment. There are several ways to achieve this.
In the past, the CAVE system (Cave Automatic Virtual Environment), a 3D setup consisting of multiple screen walls, was the primary method used. This system allowed users to be fully immersed in the virtual world, with their movements detected in real-time. However, this technology was expensive and not widely accessible.
Since around 2016, with the introduction of virtual reality headsets like the Oculus Rift and HTC Vive, VR has become much more accessible. These headsets immerse users in virtual reality through an enclosed screen that projects digital images. The user's head movements are tracked, enabling them to look around and interact with the environment as they would in the real world.
Today, VR headsets are wireless and standalone, providing maximum comfort and ease of use without requiring external sensors or cables.
A virtual environment is an immersive digital simulation created through virtual reality. It allows users to navigate in a 3D space that accurately replicates everyday situations or specific contexts.
In mental health, these environments are designed to help individuals gradually face certain situations, manage their emotions, or enhance cognitive skills. By interacting with these virtual spaces, patients can engage in meaningful experiences tailored to their needs.
You need to equip yourself with a virtual reality headset. Our software is compatible with Meta Quest 2, 3, and 3S. 
You will then only need an internet connection. 
Numerous studies confirm that virtual reality is safe to use. However, some restrictions are in place to protect users from potential adverse effects.
For instance, individuals with epilepsy and pregnant women should avoid this type of therapy.
As with any immersive technology, prolonged use may cause visual fatigue or mild discomfort, particularly for those sensitive to motion sickness. Therefore, it is recommended to take regular breaks and adjust session durations according to individual needs.
Virtual environments are designed to be gradual and controlled, minimizing the risk of excessive anxiety. Most users quickly adapt to immersion and experience the benefits of this innovative approach from the first sessions.
Anxiety disorders and phobias can be effectively treated using virtual reality. Patients are gradually and progressively exposed to anxiety-inducing situations in various environments while remaining in a safe space. This process helps develop a sense of habituation, ultimately reducing or even eliminating anxiety over time.
Behavioral and substance addictions can also be addressed through virtual reality. By incorporating synthetic stimuli into the environments that trigger craving responses, patients struggling with addiction can work on their cravings to diminish the urge to consume.
Additionally, multiple environments—such as bars, casinos, and social settings—enable cognitive work on dysfunctional beliefs associated with specific temptation scenarios.
Regarding eating disorders, virtual reality software helps target key etiological factors, such as body dysmorphia, allocentric lock (a tendency to focus on others rather than oneself), and food cravings.
Currently, our TERV (Virtual Reality Exposure Therapy) solutions include multiple software programs designed to address critical psychiatric, psychological, and neuropsychological determinants such as relaxation, cognitive stimulation, behavioral activation, and social skills training.
Reminiscence therapy is also a major therapeutic tool in treating depression. By allowing patients to relive sensations linked to past pleasurable activities (such as sports, driving, or traveling), virtual reality stimulates hypoactive brain areas, enhancing therapeutic success. VR serves as an excellent mediator for reigniting engagement in enjoyable activities.
Moreover, cognitive stimulation for elderly individuals is another area where virtual reality proves beneficial. By leveraging technology to make stimulation activities more engaging and accessible, patients and nursing home residents can improve executive functions and memory through specially designed applications.
Today, virtual reality in mental health care is advancing rapidly. Researchers, clinicians, and developers continue to explore new therapeutic targets to offer innovative and effective treatment solutions in the near future.
VR can be used by all healthcare professionals assisting patients with anxiety, phobias, post-traumatic stress disorders, addictions, or other psychological challenges.
It is particularly beneficial for psychologists, psychiatrists, neuropsychologists, specialized nurses, as well as psychomotor therapists, physiotherapists, dietitians, sophrologists, and hypnotherapists. With a wide range of immersive environments, VR enhances therapeutic approaches and provides innovative tools to improve patient care.
Healthcare providers incorporating virtual reality exposure therapy (VRET) expand their range of treatment options. VRET is a well-established therapeutic technique with scientific validation from cognitive-behavioral therapy research.
  • Professional Differentiation: Integrating VR into practice allows therapists to stand out from traditional treatment options.
  • Scientific Validation: VRET is backed by extensive research, reinforcing its credibility as an effective treatment method.
  • Improved Patient Engagement: The interactive nature of VR fosters greater patient involvement in therapy.
  • Time-Saving: VR provides direct access to various exposure environments without needing external logistics.

One of the considerable advantages of virtual reality is that it is effective on a wide spectrum of populations. Existing data from the literature on the subject shows us that it is entirely possible to expose a wide age group to virtual reality, with real therapeutic benefits.

The studies attest, in fact, to excellent feasibility and significant results; particularly in adults, in the treatment of anxiety disorders (including school phobia), autism, addictions, eating disorders, neuropsychological disorders, psychotic disorders and mood disorders.

The results are identical for adolescents with a significant added value concerning therapeutic engagement where virtual reality promotes adolescents' interest in their therapy.

Among elderly subjects, study results encourage the use of virtual reality with the aim of working on cognitive stimulation, on behavioral disorders but also on anxiety.

One of the major advantages of virtual reality is its effectiveness across a broad spectrum of the population. Existing literature on the subject shows that virtual reality can be used with individuals of various age groups, providing significant therapeutic benefits.
Studies confirm excellent feasibility and significant results, particularly among adults in the treatment of anxiety disorders (including school phobia), autism, addictions, eating disorders, neuropsychological disorders, psychotic disorders, and mood disorders.
The results are equally promising for adolescents, with a notable advantage in terms of therapeutic engagement, as virtual reality enhances their interest and participation in treatment.
For older adults, research supports the use of virtual reality to improve cognitive stimulation, behavioral disorders, and anxiety management.
However, people with epilepsy and pregnant individuals are not advised to undergo this type of therapy.
Yes, all our environments are grouped within a single application.
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