Testing Augmented Reality for Eliciting Cue-Provoked Urges to Smoke: Toward Moving Cue-Exposure Into the Real World

Abstract

Background Cue exposure for extinguishing conditioned urges to smoking cues has been promising in the laboratory, but difficult to implement in natural environments. The recent availability of augmented reality (AR) via smartphone provides an opportunity to overcome this limitation. Testing the ability of AR to elicit cue-provoked urges to smoke (ie, cue reactivity [CR]) is the first step to systemically testing the efficacy of AR for cue exposure therapy. Objectives To test CR to smoking-related AR cues compared to neutral AR cues, and compared to in vivo cues. Methods A 2 × 2 within-subject design comparing cue content (smoking vs. neutral) and presentation modality (AR vs. in vivo) on urge response. Seventeen smokers viewed six smoking-related and six neutral cues via AR smartphone app and also six smoking and six neutral in vivo cues. Participants rated their urge to smoke and reality/co-existence of the cue. Results Average urge to smoke was higher following smoking-related AR images (Median = 7.50) than neutral images (Median = 3.33) (Z = −3.44; p = .001; d = 1.37). Similarly, average urge ratings for in vivo smoking-related cues (Median = 8.12) were higher than for neutral cues (Median = 2.12) (Z = −3.44; p = .001; d = 1.64). Also, greater CR was observed for in vivo cues than for AR cues (Z = −2.67, p = .008; d = .36). AR cues were generally perceived as being realistic and well-integrated. Conclusions CR was demonstrated with very large effect sizes in response to AR smoking cues, although slightly smaller than with in vivo smoking cues. This satisfies the first criterion for the potential use of AR for exposure therapy. Implications This study introduces AR as a novel modality for presenting smoking-related stimuli to provoke cue reactivity, and ultimately to conduct extinction-based therapy. AR cues presented via a smartphone have the advantage over other modes of cue presentation (pictures, virtual reality, in vivo, etc.) of being easily transportable, affordable, and realistic, and they can be inserted in a smokers’ natural environment rather than being limited to laboratory and clinic settings. These AR features may overcome the generalizability barriers of other methods, thus increasing clinical utility for cue exposure therapies.

Augmented reality for extinction of cue-provoked urges to smoke: Proof of concept.

“…Moreover, we limited the AR extinction cues to proximal smoking-related stimuli rather than more complex or distal cues (e.g., human figures, affective cues, or other precursors of smoking, such as coffee or alcohol) because these proximal cues produce the most reliable urge responses (Conklin et al, 2008) and are more generalizable than other personalized conditioned stimuli. The experimental AR cues consisted of six AR smoking cues (i.e., smoking paraphernalia: cigarette, pack of cigarettes, pack and lighter, pack and ashtray, cigarette and lighter, and lit cigarette in an ashtray with smoke motion) and six AR neutral cues (i.e., pen, notebook, pencil and eraser, pencil with notepad, sticky notes and pen, and soda bottle with motion of effervescence and condensation, K. O. Brandon et al, 2021).…”

“…The experimental AR cues consisted of six AR smoking cues (i.e., smoking paraphernalia: cigarette, pack of cigarettes, pack and lighter, pack and ashtray, cigarette and lighter, and lit cigarette in an ashtray with smoke motion) and six AR neutral cues (i.e., pen, notebook, pencil and eraser, pencil with notepad, sticky notes and pen, and soda bottle with motion of effervescence and condensation, K. O. Brandon et al, 2021). Each cue was presented for 60 s. In both conditions, a pretest AR neutral cue (i.e., pencil) was presented in the first trial to establish a baseline urge, and then a pretest AR smoking cue (i.e., cigarette) was presented in the second trial to assess pretest CR.…”

“…We developed smoking-related proximal AR objects (i.e., smoking paraphernalia such as a cigarette and ashtray) and neutral AR objects (e.g., pen, notebook) to test the efficacy of AR cues for CET in a laboratory setting. Earlier studies demonstrated that AR smoking cues are perceived as integrated into the environment and elicit urge to smoke, with CR approximating that of in vivo cues (K. O. Brandon et al, 2021; Vinci, Brandon, Kleinjan, Hernandez, et al 2020).…”

“…Earlier studies demonstrated that AR smoking cues are perceived as integrated into the environment and elicit urge to smoke, with CR approximating that of in vivo cues (K. O. Brandon et al, 2021;Vinci, Brandon, Kleinjan, Hernandez, et al 2020). As a next step, the current proof of concept study for AR aimed to test the ability of AR cues to extinguish CR, as measured by self-reported urge in the laboratory.…”

Augmented reality as a novel approach for addiction treatment: development of a smoking cessation app

“…Our team developed a basic AR smartphone app for the delivery of CET as an adjuvant strategy for smoking cessation treatments, and we evaluated whether it met the two necessary conditions for CET: (1) that the smoking cues elicited cue-reactivity, particularly self-reported urge to smoke and (2) that repeated exposure to the cues produced evidence of extinction. Both of these conditions were met in a controlled laboratory-based setting among daily smokers [ 20–22 ]. Specifically, we developed 6 smoking paraphernalia AR objects (e.g.…”