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A randomized clinical trial of cue exposure treatment through virtual reality for smoking cessation

Abstract:

Introduction: Cue-induced craving is a major motivator of smoking behavior, and, more importantly, a pbkp_redictor of relapse. Previous studies demonstrated that cue exposure treatment (CET) reduces both cue-induced craving and daily nicotine intake in smokers. However, the efficacy of CET for smoking cessation has rarely been tested in controlled trials. This two-site randomized clinical trial explored the effectiveness of a CET procedure in combination with a Cognitive-Behavioral Treatment (CBT) for smoking cessation among treatment-seeking patients from the general population. Methods: One hundred and two smokers were randomly assigned to one of two treatment conditions: CBT (n = 52) or CBT + CET (n = 50). The CBT intervention involved group-based sessions over the course of 6 weeks. In addition to CBT, participants in the CBT + CET condition received 5 individual sessions of CET through virtual reality. Results: The CBT + CET group showed a significant reduction in cue-induced craving. However, there were no significant differences in either retention nor abstinence rates between CBT and CBT + CET in any assessment period (end-of-treatment, 1-, 6-, and 12-month follow-up). Moreover, a higher rate of relapse over a 12-month follow-up period was found in the CBT + CET group compared to the CBT group (Wald χ2 = 4.796, p =.029). Conclusions: Findings support and expand previous evidence by showing that a CET protocol does not increase the effectiveness of a CBT intervention for smoking cessation among treatment-seeking smokers. Moreover, this study also reveals that CET may increase risk of relapse among nicotine-dependent individuals who successfully achieve abstinence. Until the mechanisms underlying the effect of CET are identified, researchers and clinicians should be cautious when utilizing this protocol.