Cue reactivity in virtual reality: The role of context

Abstract

Cigarette smokers in laboratory experiments readily respond to smoking stimuli with increased craving. An alternative to traditional cue-reactivity methods (e.g., exposure to cigarette photos), virtual reality (VR) has been shown to be a viable cue presentation method to elicit and assess cigarette craving within complex virtual environments. However, it remains poorly understood whether contextual cues from the environment contribute to craving increases in addition to specific cues, like cigarettes. This study examined the role of contextual cues in a VR environment to evoke craving. Smokers were exposed to a virtual convenience store devoid of any specific cigarette cues followed by exposure to the same convenience store with specific cigarette cues added. Smokers reported increased craving following exposure to the virtual convenience store without specific cues, and significantly greater craving following the convenience store with cigarette cues added. However, increased craving recorded after the second convenience store may have been due to the pre-exposure to the first convenience store. This study offers evidence that an environmental context where cigarette cues are normally present (but are not), elicits significant craving in the absence of specific cigarette cues. This finding suggests that VR may have stronger ecological validity over traditional cue reactivity exposure methods by exposing smokers to the full range of cigarette-related environmental stimuli, in addition to specific cigarette cues, that smokers typically experience in their daily lives.

Withdrawal Symptoms and Nicotine Dependence Severity Predict Virtual Reality Craving in Cigarette-Deprived Smokers

“…These results are consistent with previous VR studies that evaluated craving in cigarette smokers. 12,13,17,20,34 In our study, the paraphernalia room increased craving to a lesser extent than the more detailed social setting that included avatar interaction in the party room. This finding supports existing literature showing that richer, more salient environments may have greater ecological validity and therefore elicit greater craving responses.…”

“…21 The majority of VR studies involving cigarette smokers have used non-deprived participants. 12,13,17,20,22,23 One exception was a study that demonstrated an effect of cue-induced VR craving in smokers who had not smoked for at least 12 hr, though this system did not use a head mounted device (HMD) to create a fully immersive environment. The only other exception was a functional magnetic resonance imaging (fMRI) study in deprived smokers that used magnetic resonance imagining compatible goggles to create a 3D environment.…”

“…This sense of presence in virtual environments has been evaluated using the Imagery and Realism Presence Questionnaire 15 in which participants have reported that they feel as if they are inside the VR environment. 16,17 VR environments have been shown to be more effective in increasing reactivity over traditional cue presentation methods in methamphetamine-, 18 alcohol-, 16 and cocaine-dependent populations, 19 as well as in nicotine-dependent individuals. 20 The evidence is compelling for VR eliciting greater craving versus that achieved with isolated cue presentations, and also when drug versus non-drug stimuli are shown.…”

Eliciting Nicotine Craving with Virtual Smoking Cues

“…11,12 There is an extensive literature on the efficacy of VR cues and contextual settings for the elicitation of craving. [13][14][15][16][17] Even with nonclinical samples, craving can be easily elicited with VR, allowing health promotion interventions in earlier stages of nicotine dependence. 18 Also, some studies have illustrated the advantage of eliciting craving through VR over traditional exposure techniques.…”

Comparison of Craving Between Smoked and Smokeless Tobacco Across a Variety of Cue Exposures

“…The virtual reality paradigm has been used extensively in craving research now (Carter, Bordnick, Traylor, Day, & Paris, 2008;Paris et al, 2011), but mainly focuses on the visual cues and context. Some studies have moved towards incorporating olfactory cues along with virtual reality, to dissociate impact of each modality on the craving experience (Traylor, Bordnick, & Carter, 2009).…”