Abstract
BackgroundAutomatic processes to approach smoking-related cues have been repeatedly linked to smoking status, intensity of smoking, and cigarette craving. Moreover, recent findings suggest that targeting those tendencies directly by means of approach bias modification (ABM) has merit in changing maladaptive approach tendencies for drug cues and reducing drug consumption. However, training effects tend to be small. Embedding the training into virtual reality (VR) technology could be a promising way to improve training efficacy. The present protocol describes a randomized controlled trial that aims to assess the efficacy of a newly developed VR-ABM as a means of reducing smoking-related approach biases or nicotine consumption in smokers seeking abstinence.MethodsOne hundred daily smokers who are motivated to quit smoking will be recruited into the randomized controlled trial. All participants will attend a brief smoking cessation intervention (TAU) and will be randomly assigned either to the experimental (VR-avoidance training) or the placebo-control group (VR-placebo training). During the VR-avoidance training, participants are implicitly instructed to make an avoidance movement in response to smoking-related objects (e.g., cigarettes) and an approach movement in response to alternative objects (e.g., healthy food). During the VR-placebo training, no such contingency between arm movement and item content exists. Trainings are administered in six sessions within two weeks. Training effects on automatic approach tendencies and smoking behavior are measured immediately after training and at a 7-week follow-up.DiscussionEmbedding the training into virtual reality (VR) technology could be a promising new way to improve ecological validity, realism, and immersion and thereby increase ABM training effects. The results of this study can inform future research in the optimization and advancement of treatment for addiction.Trial registrationRegistered with Current Controlled Trials: study ID ISRCTN16006023. Registered on 28 March 2019.
Highlights
Automatic processes to approach smoking-related cues have been repeatedly linked to smoking status, intensity of smoking, and cigarette craving
Our objective is to investigate whether the newly developed virtual reality (VR)-Avoidance Task (AAT) is capable of modifying existing approach biases for smoking cues and/or changing smoking behavior by promoting abstinence or reduction of nicotine consumption
The aim of the present study is to explore whether a newly developed VR-training is capable of modifying cognitive biases and/or reducing smoking in terms of nicotine consumption or withdrawal over and above a sham-training control condition
Summary
Automatic processes to approach smoking-related cues have been repeatedly linked to smoking status, intensity of smoking, and cigarette craving. One potential reason for these discouraging outcomes might be that addictive behavior is driven by explicit, rational, or reflective processes that are usually targeted, by traditional treatments and by implicit, hard to control, automatic processes [4, 5]. In line with this notion, dual process models of addiction [6, 7] propose that both limited reflective processes and strengthened impulsive processes are the key determinants of addiction development, maintenance, and treatment. The approach bias for smoking can be defined as the automatic tendency to approach smoking-related cues and is of special interest because of its strong connection with cigarette craving and actual smoking behavior [8, 9]
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