Comparing the effectiveness of virtual reality vs 2D display-based cue reactivity paradigms to induce nicotine-craving: a behavioral and psychophysiological study

Craving is a key symptom of nicotine addiction, driving the urge to seek cigarettes. It is often strongly influenced by social and environmental cues associated with the typical use of the substance. In both clinical and laboratory setting, craving can be experimentally triggered using cue reactivity paradigms, where nicotine-related cues are presented to evoke, and then assess, the desire to smoke. In the last few years, virtual reality (VR) has begun to attract a lot of interest in recreating realistic simulations to investigate craving through cue-reactivity exposure. However, a direct comparison between VR and non-immersive devices (e.g. 2D images presented using monitor) regarding their effectiveness in triggering cravings is still missing. In this study, we investigated differences in craving responses by comparing immersive and non-immersive nicotine-related cue-reactivity paradigms. A group of smokers (N = 23, F = 15, M_age = 23.2y.o.) and non-smokers (N = 22, F = 13, M_age = 23.7y.o.) participated in two sessions of cue reactivity exposure, featuring neutral and smoking-related scenarios presented through VR (immersive) and 2D display images (non-immersive). Each session included recording of physiological activity (skin conductance level), self-reported cigarette craving, and an assessment of the overall quality of the experience. Results showed that smokers experienced increase in cigarette cravings after exposure to nicotine-related cues compared to neutral scenarios. Moreover, self-report craving was higher after the VR cue reactivity compared to the 2D modality. A positive relationship between scores in the nicotine dependence questionnaire and self-report craving during VR cue-reactivity session was found, but not for the non-immersive session. Regarding physiological responses, smokers exhibited significantly higher skin conductance levels compared to non-smokers during the VR cue reactivity session. In contrast, no significant differences between the two groups were observed during the 2D display exposures. Participants evaluated the VR paradigm as more realistic tool to recreate credible simulations of real-life situations, and a positive correlation between self-reported craving and vividness of experience was found in the smokers' cohort. The present study provides further elements supporting the use of VR in the cue-reactivity paradigm for craving assessment, compared to non-immersive devices. Future studies will aim to confirm the effectiveness of VR as a better tool in assessing craving during clinical treatment.