開車恐懼症屬於一種創傷後壓力症候群(Post-traumatic stress disorder, PTSD)，它所代表的是指患者在經歷過嚴重的交通事故之後對開車行為所產生出的抗拒感與強烈的恐懼。患有開車恐懼症容易對患者的工作表現與日常生活造成影響，因此最近這幾十年來對於開車恐懼症治療的研究愈發廣泛。認知行為療法(Cognitive behavioral therapy, CBT)是治療開車恐懼症的傳統方式，隨著虛擬實境技術的成熟與普及，虛擬實境暴露療法(Virtual reality exposure therapy, VRET)成了治療開車恐懼症的新選擇，許多相關研究已經證實在開車恐懼症的治療上，採用VRET比採用CBT有著更加顯著的治療成效。本研究主要朝著VRET技術與應用中的三大方向進行。第一點，通過全面性的非專利文獻以及專利文獻的審查和分析進行VRET技術挖掘，以建立VRET知識本體與技術布局策略。第二點，設計出一套能夠整合虛擬實境技術、駕駛情境設計、蒐集受試者生理回饋訊號的感測器的VRET系統。第三點，本研究將會進行三項臨床實驗，第一項用於系統的預測試實驗，第二項用於系統改善實驗，第三項用於自適應系統應用實驗，藉此驗證VRET雛型系統對開車恐懼症的治療成效。研究的成果可被歸納為以下三項。第一項，根據專利技術布局分析，人們對於虛擬實境技術領域的研究逐漸增多，但只有為數不多的廠商在針對暴露療法與恐懼症治療的領域進行研究，這代表VRET應用領域在未來具有高度發展性。第二項，在系統的預測試實驗中介紹了VRET開車恐懼症的七階級的情境設計，並在後續的系統改善實驗中改良成VRET開車恐懼症的四階級的情境設計。第三項，三項臨床實驗的結果證明了VRET系統可以提供受試者高擬真度的駕駛模擬體驗，且在參與VRET實驗後可以減輕他們對於特定開車場景的焦慮感和恐懼感。

Driving phobia is a kind of post-traumatic stress disorder (PTSD) that refers to a persistent and intense fear of driving for people who suffered from traumatic vehicle accidents. Being diagnosed with a driving phobia interferes patient's working performance and quality of life. Researches about treating driving phobia have been widely studied during the past decades. Cognitive-behavioral therapy (CBT) is one of the traditional treatments for driving phobia, but with the maturity and popularization of virtual reality technology, virtual reality exposure therapy (VRET) has become another option for treating driving phobia. Several studies had proved that the latter is more effective in various kinds of phobia treatment. This thesis focuses on three main tasks in studying VRET technologies and applications. First, the VRET technology mining is conducted through comprehensive non-patent literature and patent review and analysis to build VRET knowledge ontology and its technology portfolio. Second, the VRET system, seamlessly incorporating VR techniques, driving scenario application, and the biosensors for subject data collection, is design and implemented. Third, three clinical experiment designs, one for system pre-testing, another for system refinement, and the other for self-adaptive design examination, are developed and conducted to test the effectiveness of the VRET prototype for driving phobia treatment. The research result can be summarized as follows. First, according to technology portfolio analysis, studies about VR technology show an increasing trend, but few assignees have focused on exposure therapy and phobia treatment, showing that the VRET application domain is developmental and has a prosperous future. Second, the seven-level scenario design is presented in the pre-test experiment, and another four-level scenario design is presented in subsequent refinements. Third, the result of three clinical experiments proves that the VRET system could provide an authentic experience to subjects, and their subjective distress and fear of driving in specific scenes were mitigated after participated in the VRET experiment.

Abstract I
摘要 III
Table of Contents IV
List of Figures VI
List of Tables VII
Chapter 1. Introduction 1
1.1 Research background 2
1.2 Research purposes 2
1.3 Research outline 2
Chapter 2. Technology mining - Non-Patent Literature Review 4
2.1 Non-patent literature about driving phobia treatment 4
2.1.1 Post-traumatic stress disorder 4
2.1.2 Cognitive behavior therapy 6
2.1.3 Virtual reality exposure therapy 7
2.1.4 Questionnaire design 9
2.1.5 Self-adaptive system 10
2.2 Knowledge map and review summary 11
Chapter 3. Technology mining - Patent review and case study 13
3.1. Patents review about VRET application 13
3.2. VRET patent research history 14
3.3. Case study 15
Chapter 4. VRET design and development 20
4.1 System development flow 20
4.2 Scenario design and immersive environment introduction 21
4.3 System architecture 24
4.3.1 Hardware 25
4.3.2 Software 26
4.3.3 Database 27
4.4 Self-adaptive VRET system design 27
4.4.1 Self-adaptive design flow 27
4.4.2 Self-adaptive design algorithm 29
Chapter 5. Clinical experiments and data analysis 32
5.1 First experiment result 32
5.1.1 Prior hypothesis definition 32
5.1.2 Participant's inclusion criteria 33
5.1.3 Experiment flow 33
5.1.4 Questionnaire design 34
5.1.5 Statistical analysis 36
5.2 Second experiment result 39
5.2.1 Prior hypothesis definition 39
5.2.2 Participant's inclusion criteria 39
5.2.3 Experiment flow 42
5.2.4 Questionnaire design 43
5.2.5 Statistical analysis 44
5.3 Result comparison between the first and the second experiment 50
5.4 Third experiment result 54
Chapter 6. Conclusion 57
References 59

Ali, M., Al Machot, F., Haj Mosa, A., Jdeed, M., Al Machot, E., & Kyamakya, K. (2018). A globally generalized emotion recognition system involving different physiological signals. Sensors, 18(6), 1905.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Bandura, A., & McClelland, D. C. (1977). Social learning theory (Vol. 1). Prentice Hall: Englewood cliffs.
Bandura, A. (2006). Guide for constructing self-efficacy scales. Self-efficacy beliefs of adolescents, 5(1), 307-337.
Beck, J. G., Palyo, S. A., Winer, E. H., Schwagler, B. E., & Ang, E. J. (2007). Virtual reality exposure therapy for PTSD symptoms after a road accident: An uncontrolled case series. Behavior therapy, 38(1), 39-48.
Blanchard, E. B., & Hickling, E. J. (2004). After the crash: Psychological assessment and treatment of survivors of motor vehicle accidents. American Psychological Association.
Bradley, M. M., & Lang, P. J. (1994). Measuring emotion: the self-assessment manikin and the semantic differential. Journal of behavior therapy and experimental psychiatry, 25(1), 49-59.
Centers for Disease Control and Prevention. (2020, July 1). Nonfatal Injury Data. https://www.cdc.gov/injury/wisqars/nonfatal.html
Clapp, J. D., Olsen, S. A., Beck, J. G., Palyo, S. A., Grant, D. M., Gudmundsdottir, B., & Marques, L. (2011). The driving behavior survey: Scale construction and validation. Journal of anxiety disorders, 25(1), 96-105.
Claudio, A. P., Carmo, M. B., Gomes, I. L., Esteves, F., & Gaspar, A. (2015, June). Sense of presence inside a feared (virtual) tunnel. In 2015 10th Iberian Conference on Information Systems and Technologies (CISTI) (pp. 1-7). IEEE.
Costa, R. T. D., Carvalho, M. R. D., & Nardi, A. E. (2010). Virtual reality exposure therapy in the treatment of driving phobia. Psicologia: Teoria e Pesquisa, 26(1), 131-137.
Courtois, C. A., Sonis, J., Brown, L. S., Cook, J., Fairbank, J. A., Friedman, M., & Schulz, P. (2017). Clinical practice guideline for the treatment of post-traumatic stress disorder (PTSD) in adults. American Psychological Association, 119.
Craske, M., Wittchen, U., Stein, M., Andrews, G., & Lebeu, R. (2013). Severity measure for specific phobia—adult. Lake St. Louis: American Psychiatric Association.
Deffenbacher, J. L., Filetti, L. B., Lynch, R. S., Dahlen, E. R., & Oetting, E. R. (2002). Cognitive-behavioral treatment of high anger drivers. Behaviour Research and Therapy, 40(8), 895-910.
Dörner, R., Kallmann, M., & Huang, Y. (2015). Content creation and authoring challenges for virtual environments: from user interfaces to autonomous virtual characters. In Virtual Realities (pp. 187-212). Springer, Cham.
Emory University. (1998, September). System for treating patients with anxiety disorders. US5807114A.
Friedman, M. J. (2007). PTSD history and overview. United States Department of Veterans Affairs.[Available online].
Fuzhou Zhongheng Shidai Information Tech Co Ltd. (2017, December). Height-fear training device has angular velocity acquisition device that is provided with virtual reality machine, and virtual reality computer that is connected with virtual reality helmet device to provide immersive experience for user. CN206711427U.
Gerardi, M., Cukor, J., Difede, J., Rizzo, A., & Rothbaum, B. O. (2010). Virtual reality exposure therapy for post-traumatic stress disorder and other anxiety disorders. Current psychiatry reports, 12(4), 298-305.
Gigante, M. A. (1993). Virtual reality: definitions, history and applications. In Virtual reality systems (pp. 3-14). Academic Press.
Heilig, M. L. (1962). US Patent No. 3,050,870. Washington, DC: U.S. Patent and Trademark Office.
HRL Laboratories LLC. (2020, August). Transcranial current stimulation system and virtual reality for treatment of PTSD or fears. US20180154148.
IMEDICOM Co., Ltd. (2013, July). Virtual reality device for treating phantom pain and a method for treating phantom pain using the same capable of implementing realistic sensation. KR1284012B1.
Jianqun, G., & Qi, C. (2020, November). An Anti-anxiety Virtual Reality Room for the Treatment of Anxiety Disorders. U2020102622A4.
Jones, G., & Swain, A. (1992). Intensity and direction as dimensions of competitive state anxiety and relationships with competitiveness. Perceptual and motor skills, 74(2), 467-472.
Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in clinical neuroscience, 17(3), 337.
Kaussner, Y., Kuraszkiewicz, A. M., Schoch, S., Markel, P., Hoffmann, S., Baur-Streubel, R., ... & Pauli, P. (2020). Treating patients with driving phobia by virtual reality exposure therapy–a pilot study. PloS one, 15(1), e0226937.
Kim, S.I., Lee, J.H., & Kang, D.O. (2002, September). System and method of correlating virtual reality with biofeedback for enhancing attention. US20020128540A1.
Korea University Research and Business Foundation. (2020, April). Method and apparatus for virtual reality exposure therapy for post-traumatic stress disorder. KR2020043031A.
Lahiri, U., Warren, Z., & Sarkar, N. (2011). Design of a gaze-sensitive virtual social interactive system for children with autism. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 19(4), 443-452.
Ma, M., McNeill, M., Charles, D., McDonough, S., Crosbie, J., Oliver, L., & McGoldrick, C. (2007, July). Adaptive virtual reality games for rehabilitation of motor disorders. In international conference on universal access in human-computer interaction (pp. 681-690). Springer, Berlin, Heidelberg.
Mira Therapeutics Inc. (2020, July). Methods and Systems for Diagnosing and Treating Disorders. US20200234827A1.
North, M. M., North, S. M., & Coble, J. R. (1997). Virtual reality therapy: An effective treatment for psychological. Virtual reality in neuro-psycho-physiology: Cognitive, clinical and methodological issues in assessment and rehabilitation, 44, 59.
Qingdao CyberCare Information Technology Co Ltd. (2013, November). Virtual reality therapy system for driving post-traumatic stress disorder. CN103405239A.
Qingdao CyberCare Information Technology Co Ltd. (2014, March). Social phobia virtual reality treating system. CN203480511U.
Rizzo, A. S., & Kim, G. J. (2005). A SWOT analysis of the field of virtual reality rehabilitation and therapy. Presence: Teleoperators & Virtual Environments, 14(2), 119-146.
Saveetha Dental College and Hospitals. (2019, November). Dental virtual reality video for use as adjunctive tool to treat dental anxiety and phobia, comprises multiple videos on simple dental treatments, where virtual reality videos of scaling, lanthanum injection and restorations are provided. IN201741041842A.
Shaffer, F., & Ginsberg, J. P. (2017). An overview of heart rate variability metrics and norms. Frontiers in public health, 5, 258.
Soleymani, M., Lichtenauer, J., Pun, T., & Pantic, M. (2011). A multimodal database for affect recognition and implicit tagging. IEEE transactions on affective computing, 3(1), 42-55.
Stewart, A. E., & Peter, C. C. S. (2004). Driving and riding avoidance following motor vehicle crashes in a non-clinical sample: Psychometric properties of a new measure. Behaviour Research and Therapy, 42(8), 859-879.
Stevens, J. A., & Kincaid, J. P. (2015). The relationship between presence and performance in virtual simulation training. Open Journal of Modelling and Simulation, 3(02), 41.
Sutherland, I. E. (1968, December). A head-mounted three dimensional display. In Proceedings of the December 9-11, 1968, fall joint computer conference, part I (pp. 757-764).
The Lawson Research Institute. (2005, January). System for image-guided pulsed magnetic field diagnosis and treatment. WO2005000401A1.
Vaughan, N., Gabrys, B., & Dubey, V. N. (2016). An overview of self-adaptive technologies within virtual reality training. Computer Science Review, 22, 65-87.
Wald, J., & Taylor, S. (2003). Preliminary research on the efficacy of virtual reality exposure therapy to treat driving phobia. CyberPsychology & Behavior, 6(5), 459-465.
Westbrook, D., Kennerley, H., & Kirk, J. (2011). An introduction to cognitive behaviour therapy: Skills and applications. Sage.
Zinzow, H. M., Brooks, J. O., Rosopa, P. J., Jeffirs, S., Jenkins, C., Seeanner, J., McKeeman, A., & Hodges, L. F. (2018). Virtual reality and cognitive-behavioral therapy for driving anxiety and aggression in veterans: a pilot study. Cognitive and behavioral practice, 25(2), 296-309.