Augmented Reality for Extinction of Cue-Provoked Urges to Smoke: Proof of Concept

Objective: Cue-exposure therapy (CET) aims to extinguish conditioned cue reactivity (CR) to aid in smoking cessation. A key disadvantage of extant CET is its limited ability to generalize extinction to the real world. Our team developed a set of augmented reality smoking-related and neutral cues that can appear in real-time in smokers’ natural environments as viewed through a smartphone screen. Prior to deployment as a clinical tool, the present study tested the ability of AR smoking cues to extinguish CR in a controlled laboratory study with an AR smartphone application developed for this project. We hypothesized that daily smokers who completed a single session of cue exposure with AR smoking cues (extinction condition) would demonstrate lower cue-provoked urge to smoke at posttest compared to those who viewed AR neutral cues (control condition). Method: Daily smokers (N = 129, 46.5% female, M^age = 47.6, Mcigarettes/day = 19.1) in acute abstinence were randomized to either the extinction or control condition comprising 28 AR trials. Results: As hypothesized, we found a Time × Condition interaction indicating that posttest urge ratings were lower in the extinction condition than in the control condition (p =.034). A secondary hypothesis that participants in the extinction condition would show a longer latency to smoke when provided a cigarette was not supported. Conclusions: These laboratory findings provide evidence supporting the potential clinical efficacy of AR cues for cue-exposure trials, setting the stage for testing in smokers’ naturalistic environments.