Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.
Department of Psychology, University of South Florida, Tampa, FL.
Nicotine Tob Res. 2021 May 4;23(5):861-865. doi: 10.1093/ntr/ntaa259.
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.
To test CR to smoking-related AR cues compared to neutral AR cues, and compared to in vivo cues.
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.
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.
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.
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.
在实验室中，用线索暴露来消除对吸烟线索的条件性渴望已经很有前景，但在自然环境中很难实施。最近通过智能手机提供了增强现实（AR）的机会，这为克服这一限制提供了机会。测试 AR 引发吸烟相关线索（即线索反应[CR]）的能力是系统测试 AR 用于线索暴露疗法的疗效的第一步。
与中性 AR 线索相比，与体内线索相比，测试与吸烟相关的 AR 线索的 CR。
采用 2×2 被试内设计，比较线索内容（吸烟与中性）和呈现方式（AR 与体内）对冲动反应的影响。17 名吸烟者通过智能手机应用程序查看了六个与吸烟相关的和六个中性的 AR 线索，还查看了六个吸烟和六个中性的体内线索。参与者评估他们吸烟的冲动和线索的现实/共存。
与中性 AR 图像（中位数=3.33）相比，与吸烟相关的 AR 图像（中位数=7.50）引发的吸烟冲动更高（Z=-3.44；p=.001；d=1.37）。同样，体内与吸烟相关的线索（中位数=8.12）的平均冲动评分也高于中性线索（中位数=2.12）（Z=-3.44；p=.001；d=1.64）。此外，体内线索的 CR 明显高于 AR 线索（Z=-2.67，p=.008；d=0.36）。AR 线索通常被认为是真实的和良好整合的。
在对 AR 吸烟线索的反应中，CR 得到了证明，并且具有非常大的效应量，尽管略小于体内吸烟线索。这满足了使用 AR 进行暴露治疗的第一个标准。
本研究介绍了 AR 作为一种新的呈现吸烟相关刺激的模式，以引发线索反应，并最终进行基于消退的治疗。通过智能手机呈现的 AR 线索与其他呈现模式（图片、虚拟现实、体内等）相比具有易于携带、经济实惠和现实的优势，并且可以插入吸烟者的自然环境中，而不仅仅局限于实验室和临床环境。这些 AR 功能可能克服其他方法的普遍性障碍，从而提高线索暴露疗法的临床实用性。
