Abstract
BackgroundCraving is a clinically important phenotype for the development and maintenance of nicotine addiction. Virtual reality (VR) paradigms are successful in eliciting cue-induced subjective craving and may even elicit stronger craving than traditional picture-cue methods. However, few studies have leveraged the advances of this technology to improve the assessment of craving.ObjectiveThis report details the development of a novel, translatable VR paradigm designed to both elicit nicotine craving and assess multiple eye-related characteristics as potential objective correlates of craving.MethodsA VR paradigm was developed, which includes three Active scenes with nicotine and tobacco product (NTP) cues present, and three Neutral scenes devoid of NTP cues. A pilot sample (N=31) of NTP users underwent the paradigm and completed subjective measures of nicotine craving, sense of presence in the VR paradigm, and VR-related sickness. Eye-gaze fixation time (“attentional bias”) and pupil diameter toward Active versus Neutral cues, as well as spontaneous blink rate during the Active and Neutral scenes, were recorded.ResultsThe NTP Cue VR paradigm was found to elicit a moderate sense of presence (mean Igroup Presence Questionnaire score 60.05, SD 9.66) and low VR-related sickness (mean Virtual Reality Sickness Questionnaire score 16.25, SD 13.94). Scene-specific effects on attentional bias and pupil diameter were observed, with two of the three Active scenes eliciting greater NTP versus control cue attentional bias and pupil diameter (Cohen d=0.30-0.92). The spontaneous blink rate metrics did not differ across Active and Neutral scenes.ConclusionsThis report outlines the development of the NTP Cue VR paradigm. Our results support the potential of this paradigm as an effective laboratory-based cue-exposure task and provide early evidence of the utility of attentional bias and pupillometry, as measured during VR, as useful markers for nicotine addiction.
Highlights
Craving for substances is considered essential for understanding the pathogenesis and maintenance of addiction, as highlighted by the incentive salience model [1,2] and for the inclusion of craving as a criterion for substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5) [3] and the International Classification of Diseases (10th edition; ICD-10) [4]
The nicotine and tobacco product (NTP) Cue Virtual reality (VR) paradigm was found to elicit a moderate sense of presence and low VR-related sickness
This report outlines the development of the NTP Cue VR paradigm
Summary
Craving for substances is considered essential for understanding the pathogenesis and maintenance of addiction, as highlighted by the incentive salience model [1,2] and for the inclusion of craving as a criterion for substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5) [3] and the International Classification of Diseases (10th edition; ICD-10) [4]. Naturalistic cues can be very complex and involve a number of contextual factors that are difficult to replicate in laboratory-based cue-exposure paradigms [13], limiting their ability to invoke a true craving state [9,14]. New technologies such as virtual reality (VR) afford the opportunity to increase the ecological validity of cue-exposure paradigms through the implementation of interactive and immersive presentations of cues within the typical context of use (eg, the presence of others within a setting where the substance is commonly taken), greatly enhancing our ability to invoke craving in the laboratory [9]. Few studies have leveraged the advances of this technology to improve the assessment of craving
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