The media coining of the phrase “road rage” has led to increased attention to the occurrence of aggressive driving in general, lending a sense of novelty to the phenomenon. In actuality, however, aggressive driving behaviors have been around for some time, probably since the advent of the automobile.

Although investigators have defined aggressive driving in a variety of ways, it is most commonly considered to be intentional acts of anger or aggression on the roadways, with its most extreme form involving confrontation and physical assault (Wells-Parker et al., 2002). Specific examples of aggressive driving range from moving violations such as speeding, unsafe passing or lane changes, running stop signs or stoplights, tailgating, failure to yield the right of way to hostile hand gestures, honking and verbal and/or physical confrontations. Despite the lack of consensus on the exact definition of aggressive driving, researchers agree that the intention to scare, endanger or harm others is a key element. This element distinguishes aggressive driving from similar driving behaviors that are caused by lapses in judgment or driver error (Galovski & Blanchard, 2002a; Deffenbacher, 1999).

The evidence to suggest that aggressive driving is reliably associated with an increased risk of motor vehicle accidents (MVAs) is more clearcut. In fact, this association has been duly noted across a number of studies (Hemenway & Solnick, 1993; Blanchard, Barton, & Malta, 2000; Chliaoutakis et al., 2002; Dula & Ballard, 2003; and Wells-Parker et al., 2002). In summary, it is safe to conclude that aggressive driving is fairly commonplace and can indeed result in significant societal, financial, and personal costs.

Finally, Galovski’s group developed a program of research with community participants. This program consisted of three main areas of interest; psychopathology and psychiatric distress in aggressive drivers, psychophysiological reactivity in aggressive drivers, and the development and subsequent testing of a psychological intervention specifically targeting aggressive driving behavior. This program included both participants mandated by the courts secondary to some aggressive driving incident, as well as community volunteers who either self-identified or who were identified by a significant other as an aggressive driver. The following provides a brief review of the results of studies 1 and 3. Study 2, the psychophysiology of aggressive drivers, is beyond the scope of this paper, but can be reviewed in full detail in Galovski, Blanchard, Malta, & Friedenberg (2003)

The goal of Study 1 (Galovski, Blanchard, & Veazey, 2002; Galovski & Blanchard, 2002a) was to begin to develop a psychiatric profile and to determine the psychological characteristics of those individuals who choose to drive aggressively. Towards this end, twenty court-referred aggressive drivers (CR group) and ten self-referred aggressive drivers (SR group) were compared to twenty non-aggressive driving controls. The results cannot be presented here in their entirety, but a brief review of the highlights follows. With respect to psychiatric diagnoses, 80% of the aggressive drivers met diagnostic criteria for some current or past Axis I disorder. Most notably, the aggressive drivers endorsed significantly more past alcohol or substance abuse and dependence, more current alcohol and drug abuse, and more current Intermittent Explosive Disorder than their non-aggressive driving counterparts. In fact one-third of the aggressive drivers met criteria for IED while no controls endorsed criteria consistent with this diagnosis. With respect to Axis II disorders, 40% of the aggressive drivers met criteria for one or more Axis II disorders; specifically, the aggressive drivers were significantly more likely to be diagnosed with Antisocial and Borderline Personality Disorder. Elevated rates of Narcissistic, Obsessive-Compulsive and Paranoid Personality Disorders also emerged in the aggressive driving group. In addition to the high prevalence rate of psychiatric conditions, the aggressive drivers also evidenced significantly elevated levels of psychological distress across a number of dimensions including anxiety, depression, and anger. Thus, in summary, this population seems to suffer from significant mental health issues which may be implicated, at least in part, in their roadway behaviors.

Given the level of observed distress and the severity of the driving behaviors that the Albany participants endorsed, it appeared that psychological intervention may be warranted. Thus, Study 3 tested the efficacy of a cognitive-behavioral intervention specifically targeting aggressive driving behaviors in this community sample. The treatment manual and copies of relevant forms and handouts are described in their entirety in Galovski, Malta, & Blanchard, 2005. Briefly, this four-session intervention is conducted in small group format, each session approximately 1.5-2 hours in length. Session 1 includes psychoeducation about aggressive driving and its societal ramifications as well as general discussion and education about anger and aggression. It is during this session that the therapist provides the rationale for treatment and strives to motivate the (often unwilling!) participant to both admit that he/she is, in fact, an aggressive driver and to embrace the need for change. This motivational process is often ongoing throughout the course of therapy and clinical hints towards this end are provided in the above-cited book. Next, in session 1, Larson’s (1996) five driver categories are incorporated into the discussion and Larson’s key cognitive restructuring strategies are introduced to begin to challenge these beliefs. Hierarchy lists of the participants’ most challenging or annoying driving situations on the roadways are developed and used as examples for the applications of the skills taught for the remainder of the therapy. Finally, the session ends with the introduction and practice of the 16 muscle group progressive relaxation technique. The participant is asked to practice the deep relaxation once a day as well as to practice the cognitive skills in the car in response to the least provoking driving situation on his/her hierarchy list.

Each subsequent session reviews the information covered in the previous session as well as a review of the practice assignments that participants should have engaged in over the course of the last week. ABC (antecedents, behaviors, and consequences) sheets are then introduced in an effort to begin to teach participants the relationship between thoughts and feelings. The goal is to identify cognitive distortions that are causing distress, to challenge those distortions and subsequently, to reduce the distress. Next, a number of behavioral alternative coping strategies to driving aggressively are introduced. Cognitive restructuring continues over the course of the session. The session ends with the introduction and practice of four-muscle group progressive relaxation training and relaxation by recall. The participant is asked to practice the relaxation exercises once a day as well as to continue to practice the cognitive and behavioral strategies with items on his/her hierarchy list.

Session 3 begins with a review of last week’s key strategies and practice assignment. The participants are then invited to identify and discuss reinforcers to aggressive driving. The validity of these reinforcers is then challenged in session by group members. Role plays can be used on items on each member’s hierarchy list to continue practice in cementing cognitive strategies. Relaxation by recall is reviewed and cue-controlled relaxation is introduced. The participants are asked to continue practicing relaxation skills as well as to implement cognitive and coping strategies discussed in sessions.

Session 4 begins with a review of previous taught material and practice assignments. This session contains much clinician latitude and time is typically spent in cementing skills and continuing with cognitive work. Aggressive driving situations described by participants are re-examined and participants are asked how they would behave now in the same situation. Post-assessment measures are administered and participants complete the program.

Throughout the course of the treatment study, participants were asked to monitor driving behaviors on a daily diary. A number of psychological and driving assessments were administered prior to treatment, two weeks after the last treatment session and at a two month follow-up point. Participants were randomized to either an immediate treatment condition or to a waitlist control. Upon conclusion of the waitlist control, participants were crossed over to the active treatment. Thus everyone eventually received the active treatment and the study was afforded a within-study replication of results. Results from the daily monitoring diaries indicated that the immediate treatment group decreased aggressive driving behaviors by approximately 50% which was significantly better than the waitlist control group’s 0% improvement. Once the control participants were treated, their scores were averaged with the immediate treatment group’s scores. An average 62% decrease in aggressive driving behaviors was seen for the entire treated sample. Finally, the entire treated group evidenced significant decreases in several elements of driving anger and driver stress, state anxiety, trait anger, angry temperament, anger reactivity, and anger directed outward. These improvements were all maintained at the two month follow-up point. A full description of this study and these results are described in Galovski & Blanchard (2002b).

In summary it appears that the aggressive driving population may suffer from some level of psychiatric and psychological distress. It also appears that this is a behavior is amendable to change. The treatment program developed by Galovski appears to enjoy success in targeting this serious behavioral problem that can result in significant loss. In developing such a program, it was particularly helpful to collaborate with the judicial system. Each state has its own unique system to navigate; however, the resultant relationship or collaboration can be a win-win venture. This type of program provides the courts with an option to specifically address and potentially remediate a serious problem. Mandatory participation in the program itself can serve as a deterrent for the average driver on the roadways to engage in aggressive behavior. Suggestions for fostering this relationship with the judicial system as well as the forms used to expedite the process in the Albany studies are included in Galovski, Malta, & Blanchard (2005). Recruitment strategies for self-referred participants is described as well. All told, this short-term, focused intervention was deemed empirically successful, yet its true success, in terms of increased safety on the roadways, cannot be known. However, as one participant shared upon conclusion of the program, “When I got sent to this program, I thought there had been a mistake. I did not consider myself an aggressive driver. I didn’t realize the extent of the anger inside of me. I think if I hadn’t taken this class, I would’ve eventually become so angry, I would have killed somebody.”

References

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Author note

Correspondence regarding this manuscript should be addressed to Tara E. Galovski, Center for Trauma Recovery and Department of Psychology, University of Missouri-St. Louis, Kathy J. Weinman Bldg, lower level, 8001 Natural Bridge Road, St. Louis, MO 63121; galovskit@msx.umsl.edu