Amy C. Traylor

Assessing reactivity to virtual reality alcohol based cues

The use of virtual reality (VR) programs in behavioral science research has been gaining prominence over the past several years. In the field of substance abuse, VR cue reactivity programs have been successfully tested for feasibility in nicotine and cocaine dependent samples. Seeking to expand VR applications in alcohol cue research, a novel VR alcohol cue reactivity assessment system incorporating visual, auditory, and olfactory stimuli was developed and tested. In a controlled trial, 40 non-treatment-seeking drinkers with alcohol use disorders were exposed to VR alcohol cue environments. Subjective craving, attention to alcohol cues, and level of presence (realism of experience) in VR were assessed across the environments. Overall, subjective craving for alcohol increased across the VR alcohol-related cue environments versus VR neutral cue environments. Participants reported high levels of presence in VR, indicating that the environments were perceived as realistic and compelling. These initial findings support the use of VR based cue reactivity environments for use in alcohol cue-based treatment and research.

Reactivity to cannabis cues in virtual reality environments.

Abstract Virtual reality (VR) cue environments have been developed and successfully tested in nicotine, cocaine, and alcohol abusers. Aims in the current article include the development and testing of a novel VR cannabis cue reactivity assessment system. It was hypothesized that subjective craving levels and attention to cannabis cues would be higher in VR environments with cannabis cues compared to VR neutral environments. Twenty nontreatment-seeking current cannabis smokers participated in the VR cue trial. During the VR cue trial, participants were exposed to four virtual environments that contained audio, visual, olfactory, and vibrotactile sensory stimuli. Two VR environments contained cannabis cues that consisted of a party room in which people were smoking cannabis and a room containing cannabis paraphernalia without people. Two VR neutral rooms without cannabis cues consisted of a digital art gallery with nature videos. Subjective craving and attention to cues were significantly higher in the VR cannabis environments compared to the VR neutral environments. These findings indicate that VR cannabis cue reactivity may offer a new technology-based method to advance addiction research and treatment.

What virtual reality research in addictions can tell us about the future of obesity assessment and treatment.

Virtual reality (VR), a system of human-computer interaction that allows researchers and clinicians to immerse people in virtual worlds, is gaining considerable traction as a research, education, and treatment tool. Virtual reality has been used successfully to treat anxiety disorders such as fear of flying and post-traumatic stress disorder, as an aid in stroke rehabilitation, and as a behavior modification aid in the treatment of attention deficit disorder. Virtual reality has also been employed in research on addictive disorders. Given the strong evidence that drug-dependent people are highly prone to use and relapse in the presence of environmental stimuli associated with drug use, VR is an ideal platform from which to study this relationship. Research using VR has shown that drug-dependent people react with strong craving to specific cues (e.g., cigarette packs, liquor bottles) as well as environments or settings (e.g., bar, party) associated with drug use. Virtual reality has also been used to enhance learning and generalization of relapse prevention skills in smokers by reinforcing these skills in lifelike environments. Obesity researchers and treatment professionals, building on the lessons learned from VR research in substance abuse, have the opportunity to adapt these methods for investigating their own research and treatment questions. Virtual reality is ideally suited to investigate the link between food cues and environmental settings with eating behaviors and self-report of hunger. In addition, VR can be used as a treatment tool for enhancing behavior modification goals to support healthy eating habits by reinforcing these goals in life-like situations.

Assessing Craving in Young Adult Smokers Using Virtual Reality

Cigarette smokers, when confronted with cues associated with smoking, evidence strong reactions, including increased craving. These reactions have not been extensively studied in young adult smokers, a group that research suggests may respond differently than adults or adolescent smokers. We used virtual reality, which presents a complex array of smoking cues that may be particularly salient to young adult smokers, and measured self-report of craving. Young adult smokers responded strongly to these cues and, unlike adults, did not return to a baseline of craving following cue exposure, suggesting young adult smokers differ from other smokers in terms of cue responses.

Cue Reactivity in Virtual Reality: The Role of Context

Cigarette smokers in laboratory experiments readily respond to smoking stimuli with increased craving. An alternative to traditional cue-reactivity methods (e.g., exposure to cigarette photos), virtual reality (VR) has been shown to be a viable cue presentation method to elicit and assess cigarette craving within complex virtual environments. However, it remains poorly understood whether contextual cues from the environment contribute to craving increases in addition to specific cues, like cigarettes. This study examined the role of contextual cues in a VR environment to evoke craving. Smokers were exposed to a virtual convenience store devoid of any specific cigarette cues followed by exposure to the same convenience store with specific cigarette cues added. Smokers reported increased craving following exposure to the virtual convenience store without specific cues, and significantly greater craving following the convenience store with cigarette cues added. However, increased craving recorded after the second convenience store may have been due to the pre-exposure to the first convenience store. This study offers evidence that an environmental context where cigarette cues are normally present (but are not), elicits significant craving in the absence of specific cigarette cues. This finding suggests that VR may have stronger ecological validity over traditional cue reactivity exposure methods by exposing smokers to the full range of cigarette-related environmental stimuli, in addition to specific cigarette cues, that smokers typically experience in their daily lives.

Using virtual reality to assess young adult smokers' attention to cues.

Cigarette smokers, when confronted with cues associated with smoking, evidence strong reactions, including increased attentional bias toward those smoking-related cues. These reactions have not been extensively studied in young adult smokers, a group that research suggests may respond differently than adults or adolescent smokers. Furthermore, the impact of olfactory cues, such as cigarette smoke, on attentional bias has not been explored in young adult smokers. In this pilot study, 20 nicotine-dependent young adult smokers were randomized to receive scent cues or no scent cues and were exposed to four virtual reality (VR) rooms containing sensory and social content, including smoking or neutral cues. Participants entered a neutral VR room, followed by two different smoking VR rooms, and closed with the same neutral room. Subjective attention to smoking cues and thoughts about smoking responses were recorded upon exiting each room. Significant increases in attention to cues and thoughts about smoking were found when young adult smokers were exposed to VR smoking environments, but the inclusion of olfactory cues did not result in significantly higher attention to cues or thoughts about smoking. Results suggest that while further research is necessary to understand the impact of olfactory cues, VR appears to be an effective methodology for cue exposure studies exploring attentional bias in young adult smokers.

Using virtual reality to investigate complex and contextual cue reactivity in nicotine dependent problem drinkers

Alcohol and cigarette smoking frequently co-occur among adults in the U.S., resulting in a myriad of deleterious health outcomes. Cue reactivity has been posited as one factor that precludes individuals from overcoming alcohol and nicotine dependency. While cue reactivity studies have focused on the impact of proximal cues on cue reactivity, much less is known about the unique impact of complex and contextual cues. This pilot study compares nicotine and alcohol cue reactivity among a sample of nicotine dependent, daily drinkers (N=21) across neutral, party, and office courtyard virtual reality (VR) contexts embedded with proximal smoking cues to: 1) explore and compare the effects of complex nicotine cues on alcohol cross-cue reactivity between nicotine/alcohol dependent drinkers and nicotine dependent/non-alcohol dependent daily drinkers, and 2) assess the effectiveness of VR for eliciting cue-induced nicotine craving responses using complex nicotine cues. Nicotine dependent/non-alcohol dependent drinkers had significantly lower craving for alcohol in the non-alcohol congruent office courtyard VR scene and there was no difference in the alcohol-congruent party scene when compared to the alcohol dependent group, suggesting that the non-alcohol dependent daily drinking group was more likely to react to contextual cues. Consistent with prior cue reactivity studies, dependent smokers experienced significantly higher craving for nicotine in the VR smoking congruent contexts compared to the neutral contexts; however, nicotine/alcohol dependent participants did not return to baseline craving after exposure to smoking cues. These results suggest substantive differences in the ways that nicotine-dependent, daily alcohol drinkers and nicotine/alcohol dependent drinkers experience craving, whether cross-cue or traditional.

A Feasibility Study of Virtual Reality-Based Coping Skills Training for Nicotine Dependence

Objective: Virtual reality (VR)-based cue reactivity has been successfully used for the assessment of drug craving. Going beyond assessment of cue reactivity, a novel VR-based treatment approach for smoking cessation was developed and tested for feasibility. Method: In a randomized experiment, 10-week treatment feasibility trial, 46 nicotine-dependent adults, completed the10-week program. Virtual reality skills training (VRST) combined with nicotine replacement therapy (NRT) was compared to NRT alone. Participants were assessed for smoking behavior and coping skills during, at end of treatment, and at posttreatment follow-up. Results: Smoking rates and craving for nicotine were significantly lower for the VRST group compared to NRT-only group at the end of treatment. Self-confidence and coping skills were also significantly higher for the VRST group, and number of cigarettes smoked was significantly lower, compared to the control group at follow-up. Conclusions: Feasibility of VRST was supported in the current study.

Real-time craving differences between black and white smokers

Black and White smokers may experience aspects of nicotine dependence, including craving, differently. This study used a naturalistic technique, ecological momentary assessment (EMA), to explore differences in craving, mood, expectancy, and smoking enjoyment between Black and White smokers. Participants carried personal digital assistants (PDAs) programmed to obtain multiple daily assessments. Black smokers reported higher craving after smoking and at random assessment times and higher cigarette enjoyment. No differences were found in mood or expectancy. Racial differences in psychological factors related to smoking are explored in the contexts of genetic, sociological, and psychophysiological distinctions. Implications for practice and research are discussed. (Am J Addict 2010;00:1-5).

Comparative View of Prenatal Care between the United States and Cuba: Lessons for the United States?

Infant mortality is an indication of a country’s health. The United States has struggled to lower its infant mortality rates. Cuba, a small island with notably fewer resources, has been successful in maintaining a lower infant mortality rate than the United States. The two neighboring countries vary greatly in political systems, economies, and available resources. How can the difference in mortality rate be explained? What can the United States learn from Cuba? This article explores these differences and provides suggestions for change within the United States’ system of health care.