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Testing augmented reality for Eliciting cue-Provoked Urges to smoke: toward moving cue-exposure into the real world.

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 (i.e., 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 x 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 to 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.