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Why is the driver rarely motion sick? The role of

controllability in motion sickness
a b
ARNON ROLNICK & R. E. LUBOW
a
Motion Sickness and Human Performance Laboratory, Israeli Naval Hyperbaric Institute,
Haifa, Israel
b
Department of Psychology, Tel-Aviv University, Tel-Aviv, Israel
Published online: 30 May 2007.

To cite this article: ARNON ROLNICK & R. E. LUBOW (1991): Why is the driver rarely motion sick? The role of controllability in
motion sickness, Ergonomics, 34:7, 867-879

To link to this article: http://dx.doi.org/10.1080/00140139108964831

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 Why is the driver rarely motion sick? The role of controllabili@in
motion sickness

Motion Sickness and Human Performance Laboratory, Israeli Naval Hyperbaric Institute,
Haifa, Israel
and
R. E. L u ~ o w
Department of Psychology, Tel-Aviv University, Tel-Aviv, Israel

Keywordr: Motion sickness; Controllability; Stress (psychological),

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The central hypothesis of the work is that the dimension of control-no control
plays an important role in motion sickness. Although it is generally agreed that
having control over a moving vehicle greatly reduces the likelihood of motion
sickness, few studies have addressed this issue directly, and the theoretical
explanation for this phenomenon is not completely clear. In the study, we equated
groups differing in controllability for head movement, vision, activity, and
predictability, which have often been suggested in the literature as explanations
for the driver's immunity to motion sickness. Twenty-two pairs of yoked subjects
were exposed to nauseogenic rotation. One subject of each pair had control over
the rotation and head movements, while the other was exposed passively to the
same motion stimulus. Subjects who had control reported significantly fewer
motion sickness symptoms and less of a decrement in their well-being, as
compared to the yoked subject without control. The results are discussed in
relation to Reason's sensory rearrangement theory and the concept of feed-
forward mechanisms in motion perception.

1. Introduction
Motion sickness continues to be a major problem in modem navies (Rolnick 1984,
Rolnick and Gordon 1989, Petbybridge 1982), air forces (Hixon el a/.1975, Geeze
and Pierson 1986, Fox and Arnon 1988) and in civil transportation (Lawther and
Griffin 1986, 1988). While it is generally agreed that a functional vestibular system is
necessary for the production of motion sickness, and this has been the focus of many
studies in this area (De Wit 1953, Shupak et al. 1989, Attias et al. 1987), higher
mechanisms and processes may play a significant role in modulating motion sickness.
This paper examines controllability as a possible factor in motion sickness.
It,has often been noted that having control over a moving vehicle greatly reduces
the likelihood of motion sickness (Reason and Brand 1975). Howard and Templeton
(1966, p. 136) note that: 'The driver is rarely sick even though subjected to sickness
when he is a passenger.' A similar phenomenon has been reported in airplanes, where
it was found that pilots are less susceptible to motion sickness than other crew
members (Geeze and Pierson 1986). Although these observations are well known, we
are not aware of any formal experimental work that substantiates those reports. In
addition, the theoretical basis for this phenomenon is not completely clear. The only
laboratory study that addressed this issue (though not directly) was published by
Reason and Benson (1978). They compared the rate of perceptual adaptation to
cross-coupled stimulation under conditions of active and passive body tilt, using the
0014-0139/91 $ 3 4 0 8 1991 Taylor & Francis Ltd.
 /

A. ~ o l n i c kand R. E. Lubow

estimated magnitude of the oculogyral illusion as the main dependent variable. An

incidental finding was that active conditions produced less motion sickness than did
other conditions. However, the authors noted that since symptoms were relatively
mild (motion sickness was not the issue of this study), these data could only be taken
as suggestive rather than conclusive.
Nevertheless the Reason and Benson results are uniquely important because they
suggest that motion sickness can not be explained solely on the basis of sensory
information, but must take into account the role of intention, feed-forward
mechanism or efferent-afferent correlation. The purpose of the present work is to
validate empirically these observations, and to obtain information regarding possible
explanations for this phenomenon.
First, we shall briefly review a variety of factors that have been suggested to
explain the apparent immunity of the driver as compared to the passenger. These
factors relate to the following differences between driver and passenger: (1) head
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movements; (2) visual information; (3) perceived control; (4) predictability; (5)
activity.

1.1. Diferent head movements

Fukuda (1976) compared the postural behaviour of the bus driver to the bus
passengers, and noted that, ' . . . the head and trunk of a bus driver incline toward the
right when he turns the wheel to the right in order to turn the bus to the right, while
the head and trunk of a passenger in the same bus incline toward the left. Thus the
postures of the two individuals incline in opposite directions. From the view-point of
centrifugal force, it is interesting to note that the driver leans across the midline,
against the centrifugal force, talung a centripetal stance. The passenger, however,
leans across the midline at an inclination counter to the turning of the bus and
displays a centrifugal posture' (p. 238).
Fukuda's conclusions were based primarily on his observations (partly from
watching the ancient and traditional stage comedy of Japan!).' His only experimental
evidence was based on a study in which he showed that different head positions
produced a different number of nystagmus beats. However, the correlation between
nystagmus and motion sickness is dubious (Lentz and Collins 1976).

1.2. Different visual information

Visual information has been well documented as a major factor in motion sickness
(Money 1970, Lackner and Graybiel1979). Manning and Stewart (1949) have shown
that subjects in closed swings exhibit almost twice the incidence of motion sickness
as that shown by subjects in open swings. In a recent experiment, we showed that
visual information from. the external world could reduce motion sickness and
performance deficits under conditions of tilt (Rolnick and Bles 1989). Indeed, it is
likely that passenger and driver receive different visual inputs. The driver has to look
at the outside world, monitor hislher direction etc., whereas the passenger may be
reading or looking elsewhere, and receiving visual information incongruent with the
motion stimuli.

1.3. Perceived control

In this paper, we distinguish between 'perceived control' or 'sense of control', which
refers to' the subjective cognitive appraisal of the situation, and the term
'controllability', which refers to the objective relationship between an action and its
 Motion sickness and controllability 869

consequences. The fact that perceived control can reduce the aversiveness of a
situation is well documented in the psychological literature (cf. Averill 1973,
Thompson 1981). Seligman, whose 'Learned helplessness' theory is probably the
most accepted explanation for the debilitating consequences of experience with
uncontrollable events, wrote: 'I tend to get motion sick in a small ocean-going boat,
but I found a technique that prevents illness: If I steer, turn the wheel and control the
boat as it breaks over the 4 foot swell, I don't become nauseated' (1 975, p. 126). Over
the past decade, research in the area of learned helplessness has proliferated. The
debilitating consequences of experience with uncontrollable events have been
observed in cats, fish, and rats, as well as other species. (See Maier and Seligman
(1976) for an extensive review of the'work on learned helplessness in animals.) In
particular, animals and humans show more stress when faced with noxious events
that they cannot control than with equivalent controllable ones. According to this
theory, then, the mere perception of control might be the reason for the driver's
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immunity.

1.4. Activity or attention diversion

Wendt (1 95 1) suggested that one of the reasons drivers are rarely troubled by motion
sickness is that they are mentally. engaged in controlling the vehicle. There are a
number of observations supporting the notion that engaging in a mental task or
performing a demanding activity can alleviate the symptoms. Hill (1 936) wrote that
sailors' seasickness 'was lost in an ecstasy of hymn singing'. In our work with the
Israeli Navy we often heard that sailors' nausea disappears in emergency situations.
However, few experiments have specifically examined these interesting observations.
As a by-product of a study designed for a different purpose, Guedry (1964) found
that solving a mechanical comprehension problem helped to keep subjects relatively
free of motion sickness symptoms. Although Rolnick et al. (1986) were unable to
replicate this finding, it is still possible that the advantage of controllability might be
explained (at least partly) in terms of attention diversion.

1.5. Predictability
A large body of literature shows that unpredictable events may have profound
emotional, somatic and cognitive effects on the organism. For example, animals and
humans prefer predictable to unpredictable aversive events (Miller 1980), and
unsignalled aversive events appear to be more stressful than signalled ones (Seligman
1968, Weiss 1970). It is worth noting that the driver is more able to predict events
than the passenger and that this fact may have some bearing on the occurrence of
motion sickness.
It is clear that controllability and predictability are closely inter-related in the real
world. Although predictable events are not necessarily controllable, controllable
events involve a certain amount of predictability. Yet one can keep them
methodologically distinct by providing the non-controlling individual with external
time cues which will signal amving events. Miller (1980) argues that such a
procedure (which she calls 'actual control equated for predictability') effectively
eliminates differences in predictability between control and non-control conditions.
There is no doubt that one or more of the above-cited explanations may account
for part of driver's relative immunity to motion sickness. Nevertheless, it is proposed
that the major source of the differences between driver and passenger is to be found
in the fact that the driver has control of the vehicle movements. It is assumed that
 870 A. Rolnick and R. E. Lubow

control reduces the probability of developing motion sickness by promoting a direct

relationship between hislher (motor) efference and (vestibular and visual) afference.
Thus when the driver is turning the wheel, accelerating, or braking, feed-forward
information is sent to the central nervous system enabling it to process the motion
stimuli more efficiently. This hypothesis is partly based on Reason's (1 977) 'sensory
rearrangement theory'.

1.6. Reason's model

Reason (1977) suggested a model of motion sickness that takes into account the
source of the motion stimulus. He distinguishes between self-produced motion and
passive motion: 'When the transaction with the atypical force environment is
through the agency of self produced movements. . . the sequence begins with the
efference ("Tilt the head 45 degrees to the left shoulder."). This is communicated
simultaneously to the effector organ and to the neural store. It is postulated that the
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first instruction given to the neural store is to select the reafferent trace combination
which has the strongest associative bond with the current efference . . . when the
subject is moved passively by some external agency.. . no efference signal is
generated and so the rapid accessing of the appropriate stimulus trace provided by
the efferent trace is unavailable. As a result, the process of selecting appropriate
stored traces for matching with the current afferent input is a very lengthy and
inefficient one.' Reason's motion sickness model takes into account the
activelpassive distinction, which is used to explain differences in the adaptation
process. However, it is concerned only with active and passive muscular movements
and not with the effects of controllability. 'To date we have only considered extreme
cases along the active-passive continuum. But what of intermediate situations where
the subject, like the vehicle operator, retains some degree of INDIRECT control over
his own movement? (Reason 1977, p. 2 19). Reason and Brand (1 975, p. 274),
summing up their book on motion sickness, state, 'Clearly the exact role of volition
in the production of symptoms is still uncertain, but it is evident. . . that a greater
understanding of this component is needed before we can have a more complete
grasp of the aetiologic picture.'
The experiment described below focuses on controllability and equates across
groups potentially confounding factors: vision, head movements, activity,
predictability, and sense of control. The hypothesis is that even after these factors
have been equated, there will still be a difference in motion sickness syrnptomatology
between the group that has controt over the motion stimulus and the one that does
not.

2. The experiment
To manipulate controllability while exposing subjects to a nauseogenic motion
stimulus, two methods for provoking motion sickness were combined: cross-coupled
angular acceleration and the sudden stop technique. Cross-coupled angular
acceleration has been used by Guedry and Ambler (1972) in the Brief Vestibular
Disorientation Test (BVDT). This method involves tilting the subject's head while
hislher whole body is rotated about the vertical axis. The movement of the head
about an axis (which by itself is being rotated) produces inertial torque, which
stimulates the semicircular canals as though the head were turning about a third axis.
As a result, the subject receives a discrepant sensory input signalling that the head is
doing something other than the expected movement; the information from the
 Motion sickness and controllability 87 1

semicircular canals does not correspond to the movement of the visual field or the
information from the otolith organs. This discrepancy causes motion sickness to
develop quite rapidly.
Graybiel and Lackner (1980) have described another procedure, involving
rotation and sudden stops, that produces motion sickness in a laboratory device. The
sudden stops produce .motion after-effects which are caused by the mechanical
properties of the copula. 'when motion is halted, the semicircular canals signal
rotation in the opposite direction from that v.;hich immediately preceded the
cessation of motion, while the other receptors signal the brain that the body is
stationary. This sensory conflict, which produces motion sickness symptoms, is even
more severe when the test is performed with eyes open.
The BVDT method for producing motion sickness symptoms has the
disadvantage of requiring a voluntary act on the part of the subject (tilting the head).
This is a limiting factor for research on controllability, because it precludes a
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completely uncontrolled condition. Lackner's procedure, on the other hand, does not
require any activity on the part of the subject. The subjects merely sit still and allow
themselves to be exposed to a series of rotations and stops. However, this technique,
usually of 20 min duration, requires very strong accelerations and decelerations, with
extremely rapid rotation to produce substantial symptoms. The procedure used in
the present study combines the powerful motion sickness induction stimulus (the
BVDT) with the ability to manipulate controllability (the sudden stop method).
A major requirement of the present study is to be able to expose the passive
subject to exactly the same stimulus presented to the controlling subject. To
accomplish this, paired active and passive male subjects were placed in a two-seat
rotating device. The active subject had a joystick in front of him with which he could
control rotation. The passive subject was exposed to the same rotation without
control. Since the nauseogenic stimulus also included the execution of head tilts
while rotating, heads of the two subjects were yoked by a rod attached to each of the
two helmets worn by the subjects. A head movement by one subject produced a
comparable movement in the other subject. This head movement yoking device also
provided a means to enhance the amount of control which was being manipulated.
Subjects were instructed that only the controlling subject was to initiate head
movements. The passive subject was asked simply to go along with these movements.

3. Method

3.1 . Subjects
The subjects were 44 males. Their ages ranged from 19 to 25 years. All had sailing
experience and agreed to participate in the experiment. They were randomly
assigned to two experimental groups. Before the experiment each subject rated his
motion sickness susceptibility using a 5-point scale (1: not susceptible,. . . , 5: very
susceptible). There was no significant difference between the groups regarding
previous motion sickness susceptibility (mean of controllability group= 2-8, mean of
noncontrollability 2.72).

3.1. Apparatus
The basic apparatus consisted of a rotatable platform with an earth-vertical axis of
rotation. Two chairs were mounted on the device in such a way that the centre of
each chair was situated 50 cm off the axis of rotation. The angle formed by the radius
 872 A. Rolnick and R. E. Lubow

and the line passing the saggital plane of the chair was 45" (see figure 1). The bearing
and drive system included a DC motor and a gear speed reducer. The chair and
platfonn.were surrounded by a plastic enclosure.
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Figure 1 . The head-yoking and the two-seat rotating device (A-Centre of rotation).

The head-yoking device, designed to ensure that both subjects performed the
same head movement, consisted of two commercial helmets of the type worn by
construction workers, connected from top centre to top centre by a 71 cm metal rod.
This metal rod connected the helmets in such a way that a head tilt by one subject
produced a comparable tilt in the other (see figure 1).

3.3. Procedure
Before the experiment, subjects were given a short description of the test. They were
asked to sit on the stationary chair and to practice execution of head movements
initiated by the controlling subject. Immediately after this instructional phase the
experiment began.
 Motion sickness and controllability
,
Subjects were rotated in pairs. The subject in the left seat was the controlling
subject. He had use of the joystick, which controlled the direction of rotation, its
velocity, and the rate of deceleration for stops. Movement of the joystick to the right
produced clockwise rotation, while movement to the left caused counter-clockwise
rotation. The velocity of rotation, a maximum of 11 revolutions/min, could be
controlled by moving the joystick at a wider angle to the sides. The subject could stop
the rotation by bringing the joystick to the centre.
The second subject was exposed to the same stimulus, but was not able to control
rotation or head movements. Both subjects were instructed to keep their eyes open.
Subjects were rotated for 6 min, during which time they were asked to perform head
movements every 15 s, according to verbal instructions from the experimenter. The
motion profile included four periods of rotation followed by four stops each of 15 s
duration. Each period of rotation consisted of 1.5 min of 1 1 revolutions/min rotation
clockwise or counter-clockwise. After the stops, rotation began in the other direction.
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A detailed description of the motion profile is provided in table 1.

Table 1. The motion profile.

Time (s) Direction of rotation Head position
clockwise centre
clockwise left
clockwise centre
clockwise right
clockwise centre
stop centre
counter-clockwise centre
counter-clockwise left
counter-clockwise centre
counter-clockwise right
counter-clockwise centre
stop centre
clockwise centre

... ...
counter-clockwise right
counter-clockwise centre
stop centre
end of experiment

Standardized instructions, informing both subjects of the next motion profile,

were delivered over an intercom. Thus, for both subjects the movements were
predicted, but only the left subject had control over them. In order to equate the
amount of activity in both conditions, a joystick similar to that of the controlling
subject was installed in front of the non-controlling subject. The latter was instructed
to move the joystick in the direction of rotation.

3.4. Measurements
The magnitude of the motion sickness produced in the test was evaluated with 5-
point rating scales, which included the following symptoms: nausea, need to vomit,
 874 A. Rolnick and R. E. Lubow

cold sweat, dizziness, disorientation, headache and fatigue. Each item was rated from
1 (absence) to 5 (very strong).
Following Reason and Graybiel (1970), the subjects' well-being was also
measured. Well-being ratings were made on the basis of an 1 I -point category scale.
The extreme positions were defined as follows: 0: 'I feel fine', . .., 10: 'I feel awful,
just like I am about to vomit'. Ratings 1-9 represented intermediate positions along
this continuum. The instructions to the subjects stressed that the ratings were to
reflect their overall state of well-being rather than the severity of any particular
symptom. Subjects were asked three times to verbally report the number reflecting
their well-being, just before the experiment, and after 3 and 6 min into the rotation
procedure.
In addition to these measures, the subjects' motivations were assessed. For this
purpose, subjects were encouraged to express their desire to stop the experiment.
Such requests were tallied. In addition, after the experiment, subjects were asked
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(using an open-ended item) how much longer they believed they could have
continued rotating, and if they would agree to participate in another experiment that
involved the same conditions.

4. Results
Seven subjects asked to terminate the experiment before its completion. They all
indicated that they could not continue due to severe malaise. They were allowed to
leave the device with their yoked partners and they were both asked to fill out the
questionnaires. Five such requests were from subjects in the no-controllability group,
while only two were from the other group.

' 4.1. Motion sickness symptoms as a function of control

The motion sickness score for each subject was computed as the mean of his score on
the symptoms listed above. Mean score for the no-controllability group was 2.3 and
for the controllability group was 1.7. A t-test (one tail) revealed a significant
difference between the two groups (t=2.05, df=42, ~ € 0 . 0 5 ) .

4.2. Well-beingrating
Figure 2 presents the mean webbeing rating for each group as measured just before,
in the middle (after 3 minutes), and toward the end of the rotation procedure (6
minutes). As can be seen, well-being decreased with time of rotation, with the no-
controllability group showing an increased rate of decline in well-being as compared
to the controllability group. These conclusions are supported by an analysis of
variance (2x 3 ANOVA with the second as a repeated measures factor) which
revealed main effects for groups (F(1, 423-24.01 ~ € 0 - 0 0 1 )and for time (F(2,
84)=564-29 p<0.001), as well as a significant interaction between time and group
(F(2, 84)=22-2 pt0-001).

4.3. Estimation of ability to continue

No significant difference was found regarding how much time subjects estimated
they could have continued with the experiment, although the mean was in the
expected direction (control- 32.1 min, no control = 12.6 min, df=42, t = 1.7,
p=0-13). Nine subjects from the controllability group mentioned that they could
have continued for more than an hour, while only four no-controllability subjects
gave such an answer.
 Motion sickness and controllability 875

4.4. Agreement to participate in future experiments

Table 2 presents data regarding agreement to participate in future experiments. The
controllability group subjects were more willing to participate in future experiments
than the nocontrollability group subjects k2= 7-76, df= 1, p<0.006).

Table 2. Number of subjects agfeeing to participate in future experiments.

Agree Disagree

Control 13 9
No-control 4 18

. 5. Discussion
The conclusions of the study are quite clear. Subjects.who have control of the
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motion-producing conditions are afforded some degree of immunity from motion-

sickness symptoms as compared to subjects who receive the same pattern of
stimulation, but without the element of control. Thus, subjects in the controllability
group were less likely to terminate rotation before the completion of its course,
showed reduced symptoms of motion sickness, and less decrement in their well-being
as compared to the no-controllability group. In addition, the former group, as
compared to the latter, exhibited higher motivation to continue in similar types of
experiments. These results are in general agreement with the frequently reported
observations regarding the differences in motion-sickness susceptibility between
drivers and passengers.
Unlike the observational studies, the present experiment, using a yoking
procedure, was able to equate the many factors that usually co-vary with
controllabiljty, and therefore provide alternative explanations of motion sickness in
controllability and non-controllability groups. These factors and the way they were
equated across groups are presented in table 3.

Table 3. The way the yoked design equates the various factors.

The way factors are equated between .

Type of explanation control and no-control subjects

Head movements Subjects' heads are yoked. Thus they

produce similar head movements.
Visual information Both subjects are instructed to keep
their eyes open and to face the
front.
Perceived control Subjects in both groups are
informed that they can terminate
the experiment whenever they wish.
Both subjects are asked to comply
with the experimenter's instructions.
Activity Both subjects had a joystick task
to perform.
Predictability Both subjects received advance
. . information about the approaching
stimuli.
 876 A. Rolnick and R. E. Lubow

The yoking procedure equated the type and magnitude of motion stimulus for
subjects in the two groups. The basic components of the nauseogenic stimulus
(rotation direction and speed, head movements, vision) were equated, thereby
eliminating these factors as possible explanations of the differences in motion
sickness. Similarly, activity and predictability were equated. With regard to
predictability, all subjects heard the instructions over the intercom, so that they knew
in advance what was to be the next stimulus. Likewise, with regard to the perception
of control, subjects knew that the motion was dictated by the experimenter, and they
were assured that they could terminate the experiment whenever they wished. Thus,
on the face of it, all subjects had similar perceived control. The difference which
remains between the two groups is that of controllability per se; for the controlling
subject there was a correlation between motor output and sensory input.
The results of this experiment provide a serious challenge for several theories of
motion sickness. The over-stimulation theory of motion sickness claims that motion
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sickness is caused by excessive stimulation of the vestibular organ (De Wit 1953).
The theory states that the movement of the vehicle causes an unnaturally large influx
of neural messages from the otolith organ to the brain, some of which may spill over
to those areas of the brain responsible for eliciting characteristic motion sickness
symptoms. Although, over the years, this theory has become less popular, it is still
widely accepted (though sometimes not explicitly) by otolaryngologists who test
motion sickness susceptibility solely by measuring vestibular apparatus functioning.
However, in this experiment, members of each pair of subjects received 'equal
overstimulation', and so the theory does not explain why the controlling subject
experienced weaker motion sickness symptoms than the non-controlling subject.

bad
8

E /

8
M
6- //
/

no control +----+
control - - --.-
Time (min)
Figure 2. Mean well-being score as a function of group and time.

The same difficulty faces the sensory conflict theory (Reason and Brand 1975).
According to this theory, the sickness produced in this study should result from the
 Motion sickness a n d controllability 877

mismatch between the information from the various spatial senses. But, once more,
there is no reason to assume that this conflict was absent-or reduced in subjects who
had control, as compared to the no-control subjects. Since the heads of the subjects
were yoked, and subjects were rotated together, both groups were exposed to exactly
the same cross-coupled angular acceleration, and received the same conflicting
information. It seems, therefore, that some modification of the sensory conflict
theory is required for it to encompass the findings of this study. As was explained in
the introduction, Reason's version of this theory does take into account the
active-passive distinction, but it is limited to the adaptation process and to active
muscular movement.
The present data are in accord with classical findings in the field of perception.
Helmholtz (1925), Sperry (l950), Von Holst and Mittelstaedt (1950) and Held (1 961)
all note that voluntary production of sensory input initiates a different perceptual
process from that caused by passive reception of similar sensory input. They have
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demonstrated that, when a movement is generated by the subject, some type of

comparison of the original motor signal with the reafferent signal takes place. The
contention of the present writers is that it is this comparison process, initiated by the
active control of the motion-producing stimulus, that prevents or reduces motion
sickness.
It is interesting to note that, although low in magnitude, some symptoms of
motion sickness were also observed in the controllability group. A simple and more
natural motion stimulus might be more useful in demonstrating the complete
abolition of motion sickness under conditions of controllability. Indeed, with one
such procedure, using only rotations and stops, it was shown that control can almost
prevent the somatogyral illusion and nausea induced by the Purkinje effect (Rolnick
1986).
Irrespective of the relative complexity of the motion sickness inducing
conditions, the data from the present experiment leave no doubt that controllability
.. plays an important role in reducing the severity of motion-sickness symptoms and
related behaviours.

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Manuscript received September 1989.
Revised manuscript received September 1990.
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