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. 2023 Aug;53(11):5070-5080.
doi: 10.1017/S0033291722002070. Epub 2022 Aug 4.

Virtual reality cue exposure therapy for tobacco relapse prevention: a comparative study with standard intervention

Eric Malbos  1   2 , Baptiste Borwell  1 , Mélodie Einig-Iscain  1   2 , Théo Korchia  1 , Robin Cantalupi  3 , Laurent Boyer  4 , Christophe Lancon  1
Affiliations

Virtual reality cue exposure therapy for tobacco relapse prevention: a comparative study with standard intervention

Eric Malbos et al. Psychol Med. 2023 Aug.

Abstract

Background: Successful interventions have been developed for smoking cessation although the success of smoking relapse prevention protocols has been limited. Cognitive behavioural therapy (CBT) in particular has been hampered by a high relapse rate. Because relapse can be due to conditions associated with tobacco consumption (such as drinking in bars with friends), virtual reality cue exposure therapy (VRCE) can be a potential tool to generate 3D interactive environments that simulate risk situations for relapse prevention procedures.

Methods: To assess the effectiveness of VRCE with CBT, a comparative trial involving 100 smoking abstinent participants was designed with all required virtual environments (VE) created with an inexpensive graphic engine/game level editor.

Results: Outcome measures confirmed the immersive and craving eliciting effect of these VEs. Results demonstrated that more participants in the VRCE group did not experience smoking relapse and that VRCE is at least as efficacious as traditional CBT in terms of craving reduction and decrease in nicotine dependence. Dropout and relapse rate in the VRCE group was noticeably lower than the CBT group. Aside from mood scores, no significant differences were found regarding the other scales.

Conclusion: The present clinical trial provides evidence that VRCE was effective in preventing smoking relapse. Improvement in technology and methodology for future research and applications is delineated.

Keywords: Cue exposure therapy; game level editor; tobacco relapse prevention; virtual environments; virtual reality.

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Figures

Fig. 1.
Fig. 1.
Screenshots of four VEs constructed for the present study. Note the smoking-related cues (cigarettes and packets, ashtray, alcohol) and the avatars' smoking attitudes (beach bar, restaurant, bus stop and interior with balcony).
Fig. 2.
Fig. 2.
Flowchart of the different stages of inclusion and progression through the protocol.
Fig. 3.
Fig. 3.
Line representation of mean SSQ, mean and maximum craving, RMSSD and Pnn50 across all exposure sessions in the VRCE group (sessions 3–8). SSQ, Simulation Sickness Questionnaire; RMSSD, root mean square of successive differences (ms); pNN50, proportion of adjacent R waves more than 50 ms (%).
Fig. 4.
Fig. 4.
Line representation of mean PQ, HR and HRmax across all exposure sessions in the VRCE group (sessions 3–8). PQ, Presence Questionnaire; HR, mean heart rate per min; HRmax maximum heart rate per min.
Fig. 5.
Fig. 5.
Representation of mean and standard deviations of the dependent variables between pretest and post-test. VRCE, virtual reality cue exposure; CBT, cognitive behavioural therapy; CDS12, Cigarette Dependence Scale; FTCQ12: French tobacco Craving Questionnaire.
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