Smoking-related cue reactivity in a virtual reality setting: association between craving and EEG measures

Stefano Tamburin,Marco Turatti,Riccardo Saccà,Simone Campagnari,Denise Dal Lago,Cristiano Chiamulera,Federica Armani

doi:10.1007/s00213-020-05733-3

Abstract

BackgroundCue-reactivity is the array of responses that smokers exhibit when exposed to conditioned and contextual stimuli previously associated to substance use. The difficulty to experimentally recreate the complexity of smokers’ spatial experience and context requires more ecological models. Virtual reality (VR) creates a state of immersion close to reality allowing controlled assessments of behavioral responses. To date, no studies investigated brain activation associated to smoking cue-reactivity in VR using electroencephalography (EEG).AimsTo investigate whether a VR cue-reactivity paradigm (a) may increase smoking craving, (b) is feasible with EEG recording, and (c) induces craving levels associated to EEG desynchronization.MethodsSmokers (N = 20) and non-smokers (N = 20) were exposed to neutral and smoking-related VR scenarios, without and with smoking conditioned stimuli, respectively. EEG was recorded from occipital and parietal leads throughout the sessions to assess alpha band desynchronization. Smoking and food craving and presence visual analogue scales (VAS) were assessed during the session.ResultsTo be smoker, but not non-smoker, significantly influenced smoking craving VAS induced by smoking cue VR but not by neutral VR. No significant food craving changes was observed during the VR sessions. The new finding was that EEG alpha band power in posterior leads was significantly increased by the smoking context scenario only in smokers, and that the degree of smoking (i.e., heavy vs. light) was significantly associated to this neurophysiological measure.ConclusionsThis study demonstrated, for the first time, the feasibility of EEG recording in a VR setting, suggesting that EEG desynchronization may be a neurophysiological marker of smoking cue-reactivity.

Highlights

Cue-reactivity is the vast array of responses that addicted people exhibit when exposed to conditioned and contextual stimuli previously associated to substance use (Chiamulera et al 2017)
To be a smoker, but not a non-smoker, significantly influenced smoking craving induced by exposure to the smoking cue scenario (VAS4), but not by neutral and control scenarios
The absence of increasing smoking craving during the session when no smoking cues were presented excluded that higher craving scores at the end of the session was due to passage of time or to pre-session cigarette craving carry-over effect

Summary

Introduction

Cue-reactivity is the vast array of responses that addicted people exhibit when exposed to conditioned and contextual stimuli previously associated to substance use (Chiamulera et al 2017). Virtual reality (VR), which creates a state of immersion closer to reality, allowing the controlled measure of neuropsychological and behavioral responses (Pericot-Valverde et al 2015), may create an ecological and realistic experimental setting in human studies For this reason, VR has been extensively used in drug and tobacco addiction, e.g., to explore smoking withdrawal, craving and cue reactivity (Pericot-Valverde et al 2015). The present study was aimed to investigate (a) whether a cuereactivity paradigm may induce an increase in smoking craving in a controlled VR condition, (b) the feasibility of EEG recording in this experimental setting, and (c) if smoking craving level is associated to a specific pattern of EEG desynchronization To these aims, smokers and non-smokers were exposed to a control (i.e., no smoking-related cues) VR scenario and to smokingrelated VR scenarios, with and without smoking conditioned stimuli. Inclusion and exclusion criteria were verified during an interview led by one of the experimenters prior to the study

Study design

Results

Discussion

Compliance with ethical standards