Motor Vehicle Accidents

For those people who have ever been involved in a motor vehicle accident, you know what I mean when I say the sounds of twisting metal, shattering glass, and screeching tires and brakes are like no others. Together they form a perceptual conglomerate that can be firmly stamped into our memories and difficult to get out. They represent a soundtrack of trauma for those persons traumatized from being in an automobile accident, the way explosions, screams, and gunshots may represent the soundtrack for combat trauma. Even as I write this, I have images, though not intrusive, per se, of my own car accidents; shamefully, there have been a few too many. Posttraumatic Stress Disorder can develop in a certain percentage of car accident victims. Laurence Miller (1998) depicts the posttraumatic experience for car accident survivors quite well in the following description:

[A] survivor of a serious motor vehicle accident may be afraid to ride in cars or may be such a jittery passenger that she becomes a pest to drive around with. She may develop a paralyzing preoccupation with physical symptoms or injuries resulting from the accident. She may suffer headaches and other aches and pain, even when no physical injury has occurred. Anxieties, irritability, and depression are common. She may be unable to read or watch stories of traffic accidents, hear traffic reports on the radio, or even tolerate automobile commercials on TV. Phobias to particular models of cars involved in the accident may develop, even to colors that remind her of the vehicles. Some patients develop a curious perceptual distortion in which cars or street corners appear closer then they actually are. The usual posttraumatic stress reactions of intrusive recollection and emotional numbing are typically seen. (p. 122)

Miller (1998, p. 122) cites that some estimates are as high as one-third of car drivers who have been involved in an accident with a fatality suffer "persistent psychological aftereffects," including PTSD. One study showed that nearly 50 percent of car accident victims who sought medical treatment met criteria for PTSD (Blanchard et al., 1994). An important caveat to this is that these same individuals were found to have a history of prior trauma and a significant percentage of PTSD diagnoses from prior trauma. This group also had higher rates of prior depression. Blanchard et al. (1994) found that for some victims, avoidance and numbing symptoms fade after a 6-month period, but hyperarousal is more persistent.

Most, if not all, of us depend on cars and automobiles in one form or another to get to work, pick up our children, and go to the grocery store. Few of us rely on trains or other nonautomobile forms of transportation to the extent that we rely on cars, buses, and trucks. The fact is, the economy of the United States, and the world for that matter, depends heavily on automobiles. Being able to drive or ride in a car is a near absolute requirement for modern survival. If someone cannot, they cannot function. I don't believe that it is being dramatic to state that with so much riding (pardon the pun) on being able to travel in an automobile, treatment of motor vehicle accident-related PTSD (MVA-PTSD) is of vital importance.

Miller (1998) discusses various treatment approaches to MVA-PTSD. Therapy may vary in length from a few sessions to months. Miller cites the work of Best and Ribbe (1995), who recommend that treatment should begin with patient education, followed by a treatment phase that focuses on physical symptoms, then cognitive symptoms, then behavioral symptoms. Best and Ribbe make several general treatment recommendations for MVA-PTSD sufferers. During evaluation and assessment, it may be important to simply and in a straightforward manner ask the patient if they believed they might have died. They also suggest that in addition to structured and directive treatment, simply letting the patient tell his or her story has vital assessment and therapeutic value.

Miller (1998) outlines three areas for treatment: (1) reducing arousal, (2) cognitive-behavioral therapy, and (3) exposure therapy. Deep muscle relaxation, systematic desensitization, and cure-controlled breathing are common and useful techniques. Among the cognitive-behavioral modalities, Albert Ellis's rational-emotive therapy is considered specifically useful for accident survivors (Best & Ribbe, 1995) because of its focus on cognitions of fairness, causality, and control. Other more specific CBT techniques, including cognitive restructuring, thought stopping, and role playing, are also suggested. Finally, exposure therapy using in vivo exposure procedures have been found to be especially helpful for MVA-PTSD. If patients are particularly fixed on fears of injury, imaginal flooding may be used to augment in vivo procedures. Kuch (1989) suggests that when the victim is particularly avoidant of driving, exposure techniques as a passenger may have to be done first. Kuch also recommends beginning the exposure hierarchy with practicing in empty parking lots, on deserted or country roads, or even in an idling car and then moving on to more intense and involved driving experiences.

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