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.

The purpose of this study was to investigate the effects of signaled transitions from relatively rich to lean conditions of food reinforcement on drinking concurrently available water or sucrose-sweetened water in rats. Past research demonstrated that these negative incentive shifts produce behavioral disruption in the form of extended pausing on fixed-ratio schedules. Four male Long-Evans rats operated on a two-component multiple fixed-ratio fixed-ratio schedule. In one manipulation, the ratio was held constant and the components arranged either a large six-pellet reinforcer (rich) or small one-pellet reinforcer (lean). In a second manipulation, the components both produced a one-pellet reinforcer but differed in terms of the ratio requirement, with the rich and lean conditions corresponding to relatively small and large ratios. In both manipulations, components were pseudorandomly presented to arrange four transitions signaled by retractable levers: lean-to-lean, lean-to-rich, rich-to-rich, and rich-to-lean (the negative incentive shift). During experimental conditions, a bottle with lickometer was inserted in the chamber, providing concurrent access either to tap water or a 10% sucrose solution. The negative incentive shift produced considerably more drinking than the other transitions in all rats during both manipulations. The level of drinking was not polydipsic; rather, it appears that the negative incentive shift enhanced the value of concurrently available reinforcers relative to food reinforcement.

Background The recent widespread availability of augmented reality via smartphone offers an opportunity to translate cue exposure therapy for smoking cessation from the laboratory to the real world. Despite significant reductions in the smoking rates in the last decade, approximately 13.7% of the adults in the United States continue to smoke. Smoking-related cue exposure has demonstrated promise as an adjuvant therapy in the laboratory, but practical limitations have prevented its success in the real world. Augmented reality technology presents an innovative approach to overcome these limitations. Objective The aim of this study was to develop a smartphone app that presents smoking-related augmented reality images for cue exposure. Smokers provided feedback on the images and reported on the perceived urge to smoke, qualities of reality/coexistence, and general feedback about quality and functioning. The feedback was used to refine the augmented reality images within the app. Methods In collaboration with an augmented reality design company, we developed 6 smoking-related images (cigarette, lighter, ashtray, lit cigarette in ashtray, etc) and 6 neutral images similar in size or complexity for comparison (pen, eraser, notebook, soda bottle with droplets, etc). Ten smokers completed a survey of demographic characteristics, smoking history and behavior, dependence on nicotine, motivation to quit smoking, and familiarity with augmented reality technology. Then, participants viewed each augmented reality image and provided ratings on 10-point Likert scales for urge to smoke and reality/coexistence of the image into the scene. Participants were also queried with open-ended questions regarding the features of the images. Results Of the 10 participants, 5 (50%) had experienced augmented reality prior to the laboratory visit, but only 4 of those 5 participants used augmented reality at least weekly. Although the sample was small (N=10), smokers reported significantly higher urge to smoke after viewing the smoking-related augmented reality images (median 4.58, SD 3.49) versus the neutral images (median 1.42, SD 3.01) (Z=–2.14, P=.03; d=0.70). The average reality and coexistence ratings of the images did not differ between smoking-related and neutral images (all P>.29). Augmented reality images were found on average to be realistic (mean [SD] score 6.49 [3.11]) and have good environmental coexistence (mean [SD] score 6.93 [3.04]) and user coexistence (mean [SD] score 6.38 [3.27]) on the 10-point scale. Participant interviews revealed some areas of excellence (eg, details of the lit cigarette) and areas for improvement (eg, stability of images, lighting). Conclusions All images were generally perceived as being realistic and well-integrated into the environment. However, the smoking augmented reality images produced higher urge to smoke than the neutral augmented reality images. In total, our findings support the potential utility of augmented reality for cue exposure therapy. Future directions and next steps are discussed.

Frustration stress, typically operationalized as the unexpected loss of reinforcement, has been shown to engender substance use. Abrupt reductions in reinforcer magnitude likely also function as frustration stressors. These negative incentive shifts were previously shown to produce tap-and sweetened-water drinking in rats. The purpose of this study was to investigate whether these shifts in food reward would occasion oral ethanol self-administration. Nine male Long-Evans rats operated on a two-component multiple fixed-ratio schedule with signaled components producing either a large (4 pellets) or small (1pellet) reinforcer. Components were pseudorandomly arranged to present 4 transitions between past and upcoming reinforcer magnitudes: small-to-large, small-to-small, large-to-large, and large-to-small (negative incentive shift). Experiment 1 investigated the effects of negative incentive shifts on consumption of concurrent, freely available 10% sucrose, 10% sucrose plus 10% ethanol, and following sucrose fading, 10% ethanol. Experiment 2 entailed continuation of schedule contingencies with a dose manipulation of 4 ethanol concentrations (0, 5, 10, and 20%) to assess dose-dependent differences in transition-type control and consumption. A lever-press extinction condition was then conducted with 10% ethanol availability. In this novel model of frustration stress, negative incentive shifts prompted ethanol self-administration at each dose investigated, whereas the other transitions did not.

Objective: Cue-exposure therapy (CET) aims to extinguish conditioned cue reactivity (CR) to aid in smoking cessation. A key disadvantage of extant CET is its limited ability to generalize extinction to the real world. Our team developed a set of augmented reality smoking-related and neutral cues that can appear in real-time in smokers’ natural environments as viewed through a smartphone screen. Prior to deployment as a clinical tool, the present study tested the ability of AR smoking cues to extinguish CR in a controlled laboratory study with an AR smartphone application developed for this project. We hypothesized that daily smokers who completed a single session of cue exposure with AR smoking cues (extinction condition) would demonstrate lower cue-provoked urge to smoke at posttest compared to those who viewed AR neutral cues (control condition). Method: Daily smokers (N = 129, 46.5% female, Mage = 47.6, Mcigarettes/day = 19.1) in acute abstinence were randomized to either the extinction or control condition comprising 28 AR trials. Results: As hypothesized, we found a Time × Condition interaction indicating that posttest urge ratings were lower in the extinction condition than in the control condition (p = .034). A secondary hypothesis that participants in the extinction condition would show a longer latency to smoke when provided a cigarette was not supported. Conclusions: These laboratory findings provide evidence supporting the potential clinical efficacy of AR cues for cue-exposure trials, setting the stage for testing in smokers’ naturalistic environments.

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Despite extinction-based processes demonstrating efficacy in the animal extinction and human anxiety literatures, extinction for substance use disorders (SUD) has shown poor efficacy (i. e., cue exposure treatment [CET]). Reasons for this lack of success include common threats to extinction, such as renewal and reinstatement. In recent decades, research on mindfulness for SUD has flourished, and a key aspect of these mindfulness-based interventions includes teaching individuals to stay present with whatever experience they have, even if unpleasant, without trying to change/escape/avoid it. Similarly, CET teaches individuals to not escape/avoid conditioned responses (e.g., craving) by engaging in drug use behavior. This paper discusses how mindfulness-based research and practices could positively influence CET through future research (e.g., Could mindfulness practice attenuate renewal? Might mindfulness training + CET enhance the ability to extinguish the most salient or motivational cues?), with the long-term goal of improving SUD treatment.