Once in a professional lifetime.
It is usually the case that a person who has a driving phobia also has other phobias. The basic fear in an agoraphobia, which is the most common phobia and is the condition from which most of the others derive, is of having a panic attack in one of a number of particular settings, including a car. Any place from which a phobic person feels he/she cannot immediately leave is a candidate to become one of those places. They include circumstances where there exists either a physical constraint, such as an elevator, which can become stuck, or a social constraint, such as sitting together with others in a restaurant. Once that situation is avoided, and then avoided again and again, the person is said to be phobic for that situation. Phobias typically spread. The following are some of these common situations: being in, or on, a bridge, tunnel, elevator, airplane, shopping center, restaurant, theater, escalator—and also a car.
The defining character of a panic attack is the sense of an imminent loss of control. This shows up in a driving phobia in two ways. Half of those with a driving phobia are afraid especially of being a passenger in the car, because they have a sense of not being in control. They may avoid airplanes for the same reason. The other half are afraid especially of driving the car because they are afraid of losing control of the wheel and causing an accident.
The essential element of an exposure therapy is convincing patients that they will not lose control. I tell them that in over forty years of dealing with this problem, the Anxiety and Phobia Center has never seen a patient have an accident when in the midst of a panic attack. On the other hand, I remember a woman who was so relaxed after treatment that she fell asleep on the road and drove into a tree. But she was not panicky at the time, and did not experience a return of her driving phobia as the result of the accident. On another occasion, I was working with a patient when another car jumped the guard rail and struck us. This incident did not worsen her driving phobia since the important element in a driving phobia is the fear of loss of control and not the fear of something else happening.
But when I try to reassure patients in this way, they are not reassured. They discount what I say. Although they, themselves, have never been in an accident, they feel that they were on the verge of an accident many times. If they hadn’t pulled over to the side of the road just then, or if something hadn’t happened just then to distract them, they would surely have had an accident. They remember driving a car as a series of near misses.
Usually, the only way patients can be truly reassured is by their driving over and over again, further and further, even when they are panicky. They have to discover for themselves that they will not lose control of the car. Sometimes, this takes considerable time. A patient may have to start driving in a driveway before progressing to driving around the neighborhood, and then, finally, to driving on highways.
Sometimes, although rarely, a driving phobia can begin suddenly following an accident. If the phobia takes hold, it can last a very long time. But there was one occasion when I found that I was in the exactly right set of circumstances to prevent such a phobia from developing.
A patient who was phobic in a number of ways, but had not yet developed a driving phobia, came late to her appointment.
“I was just in an accident,” she told me, very agitated. “I’m never going to get in a car again.”
The accident, it turned out, was not her fault; but her car was totaled. I told her what everyone knows, that she had to start driving immediately, or she would have trouble ever driving again. She said she would be too likely to have a panic attack; and we proceeded to the usual argument about whether that would cause an accident.
I knew she was planning on visiting her mother across town. “Listen,” I said, “you’re going to be late to see your mother. I just got a new car, you can borrow it,” and I handed her the key to my new car.
She stared at the key, but then took it. She drove the car to her mother and back, without any misgivings. “I figure you really thought I was safe,” she said, “if you were going to let me drive your new car.” She never did develop a driving phobia.
Now, I know the reader’s reaction to this story is to think I was reckless. But imagine that I really did mean it when I felt sure she would not lose control of the car. I knew, of course, that anyone can have an accident for any sort of reason; but I felt as safe as if a neighbor had asked to borrow my car. Besides, her mother only lived about twenty-five minutes away. And there was a lot at stake.
I never had the occasion to make such an offer again. (c) Fredric Neuman 2012 Follow Dr. Neuman's blog at fredricneumanmd.com/blog