Walshe David, Lewis Elizabeth, O'Sullivan Kathleen, Kim Sun I
Department of Psychiatry, University College Cork, St. Stephen's Hospital, Cork, Ireland.
Cyberpsychol Behav. 2005 Dec;8(6):532-7. doi: 10.1089/cpb.2005.8.532.
There is a small but growing body of research supporting the effectiveness of computer-generated environments in exposure therapy for driving phobia. However, research also suggests that difficulties can readily arise whereby patients do not immerse in simulated driving scenes. The simulated driving environments are not "real enough" to undertake exposure therapy. This sets a limitation to the use of virtual reality (VR) exposure therapy as a treatment modality for driving phobia. The aim of this study was to investigate if a clinically acceptable immersion/presence rate of >80% could be achieved for driving phobia subjects in computer generated environments by modifying external factors in the driving environment. Eleven patients referred from the Accident and Emergency Department of a general hospital or from their General Practitioner following a motor vehicle accident, who met DSM-IV criteria for Specific Phobia-driving were exposed to a computer-generated driving environment using computer driving games (London Racer/Midtown Madness). In an attempt to make the driving environments "real enough," external factors were modified by (a) projection of images onto a large screen, (b) viewing the scene through a windscreen, (c) using car seats for both driver and passenger, and (d) increasing vibration sense through use of more powerful subwoofers. Patients undertook a trial session involving driving through computer environments with graded risk of an accident. "Immersion/presence" was operationally defined as a subjective rating by the subject that the environment "feels real," together with an increase in subjective units of distress (SUD) ratings of >3 and/or an increase of heart rate of >15 beats per minute (BPM). Ten of 11 (91%) of the driving phobic subjects met the criteria for immersion/presence in the driving environment enabling progression to VR exposure therapy. These provisional findings suggest that the paradigm adopted in this study might be an effective and relatively inexpensive means of developing driving environments "real enough," to make VR exposure therapy a viable treatment modality for driving phobia following a motor vehicle accident (MVA).
有一小部分但数量在不断增加的研究支持计算机生成环境在驾驶恐惧症暴露疗法中的有效性。然而，研究也表明，很容易出现患者无法沉浸于模拟驾驶场景的问题。模拟驾驶环境不够“真实”，无法进行暴露疗法。这限制了虚拟现实（VR）暴露疗法作为驾驶恐惧症治疗方式的应用。本研究的目的是调查通过改变驾驶环境中的外部因素，对于驾驶恐惧症患者在计算机生成环境中是否能够实现>80%的临床可接受的沉浸/临场率。11名因机动车事故从综合医院急诊科或其全科医生处转诊而来、符合DSM-IV特定恐惧症-驾驶标准的患者，使用计算机驾驶游戏（《伦敦赛车手》/《疯狂都市》）接触计算机生成的驾驶环境。为使驾驶环境足够“真实”，通过以下方式改变外部因素：（a）将图像投射到大屏幕上；（b）通过挡风玻璃观看场景；（c）为驾驶员和乘客使用汽车座椅；（d）使用功率更大的低音炮增强震动感。患者进行了一次试验性疗程，包括在具有不同事故风险等级的计算机环境中驾驶。“沉浸/临场”在操作上定义为受试者主观评定环境“感觉真实”，同时主观痛苦单位（SUD）评分增加>3和/或心率增加>每分钟15次心跳（BPM）。11名驾驶恐惧症受试者中有10名（91%）符合驾驶环境中的沉浸/临场标准，从而能够进入VR暴露疗法阶段。这些初步研究结果表明，本研究采用的模式可能是一种有效且相对廉价的方式，能够开发出足够“真实”的驾驶环境，使VR暴露疗法成为机动车事故（MVA）后驾驶恐惧症的可行治疗方式。
