Background: Survivors of high impact car accidents, when traveling in cars as passengers, may exhibit the phantom brake reaction. The reaction consists of involuntarily pressing the foot on the floor of the car in a reflexive attempt "to brake", even though there is no brake pedal in front of the passenger seat. This study examines the incidence and correlates of this special phenomenon.
Method: De-identified data of 114 survivors (37 men, 77 women; mean age 38.6, SD=12.4) of high impact motor vehicle accidents (MVAs) were available, with their responses to the Brief Pain Inventory, Insomnia Severity Index, Rivermead Post-Concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), PTSD Checklist for DSM-5 (PCL-5), ratings of depression and of generalized anxiety, and 3 questionnaire measures of driving anxiety, i.e., Whetstone’s, Steiner’s, and the Driving Anxiety Questionnaire (DAQ). One item of the DAQ assesses the phantom brake phenomenon on a 4-point scale (0=No, 1=Mild, 2=Moderate, 3=Severe): this is the key variable in the present study.
Results: Mild to severe forms of the phantom brake reaction were reported by 92.1% of the post-MVA patients. Significant correlations (p<0.05, 2-tailed) were found of the intensity of phantom brake reaction to the intensity of post-MVA pain (rs from 0.20 to 0.33), insomnia (r=0.40), the Rivermead post-concussion scale (r=.29), other post-concussive and whiplash symptoms as measured by the SNPSS (r=0.19), depression (r=0.30), generalized anxiety (r=0.32), and to DAQ (r=0.47) and Whetstone’s (r=0.50) measures of driving anxiety. No significant relationships were found of the phantom brake reaction to age and gender.
Discussion and Conclusion: The phantom brake reaction was reported by almost all post-MVA patients and can be considered as a part of their post-MVA polytraumatic symptom pattern.
Gutierrez J, Nosonova V, Cernovsky Z, Fattahi M, & Tenenbaum S. Gutierrez Questionnaire for Assessments of Patients after Car Accidents. Archives of Psychiatry and Behavioral Sciences. 2019; 2(2): 10-21. http://www.sryahwapublications.com/archives-of-psychiatry-and-behavioral-sciences/pdf/v2-i2/3.pdf.
King NS, Crawford S, Wenden FJ, Moss NEG, Wade DT. The Rivermead Post Concussion Symptoms Questionnaire: a measure of symptoms commonly experienced after head injury and its reliability. Journal of Neurology. 1995; 242: 587-592.
Cernovsky ZZ, Mann SC, Velamoor V, Oyewumi LK, Diamond DM, and Litman LC. Validation of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) on Patients Injured in High Impact Car Accidents. Archives of Psychiatry and Behavioral Sciences. 2021; 4(1): 14-22. doi.org/10.22259/2638-5201.0401003.
Cernovsky ZZ, Litman LC, Mann SC, Oyewumi LK, Bureau Y, Mendonça JD, Diamond DM, Raheb H. Validation of the Subjective Neuropsychological Symptoms Scale (SNPSS) in Injured Motorists. Archives of Psychiatry and Behavioral Sciences. 2021; 4(1): 6-13.
Cernovsky ZZ, Mann SC, Velamoor VR, and Oyewumi LK. The Need for Three Separate Parallel WAD Ratings of Whiplash Injuries to Cervical, Lumbosacral, and Thoracic Spine in Clinical Assessments of Injured Motorists. European Journal of Medical and Health Sciences. 2021; 3(1): 1-6. doi: 10.24018/ejmed.2021.3.1.699.
Cleeland CS. The Brief Pain Inventory - User Guide. Houston, TX: The University of Texas – M. D. Anderson Cancer Center, 2009.
Morin CM, Belleville G, Bélanger L, Ivers H. The insomnia severity index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011; 34: 601-608.
Pinfold M, Niere KR, O'Leary EF, Hoving JL, Green S, Buchbinder R. Validity and internal consistency of a Whiplash-Specific disability measure. Spine. 2004; 29(3): 263-268.
Whetstone JP, Cernovsky Z, Tenenbaum S, Poggi G, Sidhu A, Istasy M, Dreer M. Validation of James Whetstone’s Measure of Amaxophobia. Archives of Psychiatry and Behavioral Sciences. 2020; 3(1): 23-33. http://www.sryahwapublications.com/archives-of-psychiatry-and-behavioral-sciences/pdf/v3-i1/3.pdf.
Cernovsky ZZ, Fattahi M, Litman LC, Tenenbaum S, Leung B, Nosonova V, Zhao C, and Dreer M. Validity of Steiner’s Automobile Anxiety Inventory. European Journal of Medical and Health Sciences. 2021; 3(1): 56-61 doi: 10.24018/ejmed.2021.3.1.661.
Weathers FW, Litz BT, Keane TM, Palmieri PA, Marx BP, & Schnurr PP. The PTSD Checklist for DSM-5 (PCL-5). The National Center for PTSD, US Department of Veterans Affairs, Washington, DC, 2013. www.ptsd.va.gov.
Wortman CB, Loftus EF, Weaver C, Atkinson ML. Psychology. (Alternate Edition for Canada). Toronto, ON, New York, NY, London, UK: McGraw-Hill, 2000.