Identifying Specific Cues and Contexts Related to Smoking Craving for the Development of Effective Virtual Environments

Abstract

Craving is considered the main variable associated with relapse after smoking cessation. Cue Exposure Therapy (CET) consists of controlled and repeated exposure to drug-related cues with the aim of extinguishing craving responses. Some virtual reality (VR) environments, such as virtual bars or parties, have previously shown their efficacy as tools for eliciting smoking craving. However, in order to adapt this technology to smoking cessation interventions, there is a need for more diverse environments that enhance the probability of generalization of extinction in real life. The main objective of this study was to identify frequent situations that produce smoking craving, as well as detecting specific craving cues in those contexts. Participants were 154 smokers who responded to an ad hoc self-administered inventory for assessing craving level in 12 different situations. Results showed that having a drink in a bar/pub at night, after having lunch/dinner in a restaurant and having a coffee in a cafe or after lunch/dinner at home were reported as the most craving-inducing scenarios. Some differences were found with regard to participants' gender, age, and number of cigarettes smoked per day. Females, younger people, and heavier smokers reported higher levels of craving in most situations. In general, the most widely cited specific cues across the contexts were people smoking, having a coffee, being with friends, and having finished eating. These results are discussed with a view to their consideration in the design of valid and reliable VR environments that could be used in the treatment of nicotine addicts who wish to give up smoking.

Individual variables related to craving reduction in cue exposure treatment

“…Previous studies have demonstrated that heavy smokers experience greater craving for cigarettes than light smokers (García-Rodríguez et al, 2011;Kober et al, 2010). As a consequence, the reduction in craving produced by the treatment may be more noticeable.…”

“…Previous research has also found that females show higher sensitivity than males to negative emotional cues (Carpenter et al, 2014;Colamussi, Bovbjerg, & Erblich, 2007;Saladin et al, 2012;Wray et al, 2015). There are other factors that have been related to greater craving for cigarettes, including younger age, higher nicotine dependence and symptoms of anxiety (García-Rodríguez et al, 2011;Sayette, Martin, Wertz, Shiffman, & Perrott, 2001;ThompsonLake et al, 2014;Watson et al, 2012).…”

“…In addition, greater reductions among young smokers could be attributed to their baseline craving levels. Some studies have found that younger smokers show greater cue-induced cigarette craving in specific situations, such as having a drink in a bar, when compared to older smokers, because they are situations more relevant to the young smokers' own experience(García-Rodríguez et al, 2011). It is possible that the virtual environments used (e.g., a pub) may represent everyday situations for younger people.…”

Interrelations Between Virtual-World and Real-World Activities: Comparison of Genders, Age Groups, and Pathological and Nonpathological Internet Users

“…As a result, virtual world (VW) has penetrated into the real world (RW), and the clear boundary between RW and VW has begun to fade. This might result in transfer of behaviors gained in RW to VW 1,2 or vice versa. 3 In other words, the behaviors in RW and VW might be the parts of a continuum.…”

Predictors of Smoking Craving During Virtual Reality Exposure

“…The VR environments were developed on the basis of a previous study (García-Rodríguez et al, 2011) aimed at identifying frequent situations that produce smoking craving, as well as detecting specific craving cues in those contexts. In the environment breakfast at home, participants woke up and took a shower.…”