Driving anxiety: causes, coping strategies and treatment options

Driving anxiety is not a separate formal diagnosis, but it describes a pattern that is very familiar to clinicians. At the mild end it is nervousness about particular roads or situations. At the severe end it is a phobia, which the NHS defines as an anxiety condition usually caused by a particular object or situation, where the fear is out of proportion to the danger and affects everyday life.

The AA, drawing on Anxiety UK, says there are varying degrees of driving phobia: some people cannot drive on motorways but cope on A and B roads, while others fear roundabouts, parallel parking, or being caught in traffic and not being able to escape. It is often the idea of facing an issue like this that fuels the anxiety. An anxious driver may be unwilling to drive alone, avoid unfamiliar routes or certain triggers, or only drive at certain times.

The physical symptoms are those of anxiety and panic in general. For phobias the NHS lists severe anxiety and worry, feeling dizzy and lightheaded, a more noticeable heartbeat, tightness in the chest, feeling or being sick, trembling or shaking, and a strong fear that you may faint, lose control or die. In panic disorder the NHS describes a racing heartbeat, sweating, shortness of breath, chest pain and a feeling of dread, and says most panic attacks last between 5 and 20 minutes, are frightening but are not dangerous.

Because those symptoms can also come from other conditions, it is important to see a GP if you have chest pain, palpitations or breathlessness that is new or unexplained, rather than assuming they are anxiety.

The AA lists accidents, near misses, embarrassing parking mishaps and being out of practice as common causes. The NHS says it is not always clear why a phobia starts, but many are linked to a frightening event or stressful situation, and that you may be more likely to have one if you had a frightening experience, family or friends with a phobia, others reacted negatively to your fear, or you have a family history of anxiety disorders.

If anxiety began after a collision or other frightening event, it is worth telling the GP or talking therapies service about it so the right type of support is offered.

The AA gives practical tips for nervous drivers, and the NHS general advice on phobias and panic adds relaxation and breathing techniques.

• Plan the route, save the address in your satnav, and avoid busy times such as rush hour.

• Choose routes that place fewer demands on you and take roads you are familiar with, and check the weather.

• Turn off your phone and put it out of reach when you first get in the car.

• Give yourself plenty of time and allow for breaks; if you feel anxious, find a safe place to pull over and take a breather.

• Afterwards, sit calmly for a few minutes and focus on your breathing.

• Keep driving regularly rather than stopping altogether.

• Try breathing exercises, talk to someone you trust and consider a self-help group, as the NHS suggests for phobias.

• Avoid caffeine after 3pm, as the NHS says it can affect sleep and make anxiety worse.

The NHS says treatments for phobias include talking therapies such as cognitive behavioural therapy (CBT), hypnotherapy, and medicines such as antidepressants, beta blockers and sedatives. You can refer yourself directly to an NHS talking therapies service without a GP referral. The NHS describes CBT as a talking therapy in which a therapist helps you change how you think and act, usually 5 to 15 sessions, and says it is available free on the NHS or privately through an accredited therapist on the UK CBT register.

In CBT, the NHS says you talk through situations you find difficult and how they make you think, feel and act, and work with the therapist on different ways of approaching them. A GP can help if panic attacks, low mood or other symptoms are involved, and may refer to a mental health specialist if symptoms do not improve.

The AA says that in the case of anxiety and depression the DVLA does not need to be told as long as your doctor can confirm there are no concentration problems, agitation, behavioural disturbance or suicidal thoughts. If your doctor thinks you could have severe driving anxiety, you must tell the DVLA. If you continue to drive against medical advice and do not report it, your doctor can do so without your permission. Anxiety is a condition that has to be reported on a form rather than online.

The AA also says it is your responsibility to tell your car insurer if you are advised to, and to answer questions honestly when buying or renewing a policy. It says insurers cannot charge a higher premium without evidence of increased risk and that there is no general policy to charge more for people with anxiety. Check the current DVLA guidance and your policy wording, as these rules can change.

The NHS says to see a GP if you think you have a phobia and the symptoms are affecting your life. If you are avoiding driving to the point that it limits work, family life or independence, or panic attacks are frequent, it is worth seeking help rather than waiting for it to improve.

If you are in a mental health crisis, the NHS has a page on where to get urgent help for mental health, and 999 is for emergencies.