Written by Julie Faccini

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.