title: Withdrawal Symptoms and Nicotine Dependence Severity Predict Virtual Reality Craving in Cigarette-Deprived Smokers.
abstract: BACKGROUND
  Virtual reality (VR) has been shown to be effective in eliciting responses to nicotine cues in cigarette smokers. The primary aim of this study was to investigate whether cigarette-deprived smokers would exhibit increased craving and changes in heart rate when viewing cigarette related cues as compared to non-smoking cues in a VR environment, and the secondary aim was to assess the extent to which self-assessed measures of withdrawal and dependence correlated with VR craving.
  
  
  METHODS
  Nicotine-dependent cigarette smokers were recruited for a 2 day study. On Day 1, participants smoked as usual and on Day 2 were deprived from smoking overnight. On both days, participants completed self-assessment questionnaires on withdrawal, craving, and nicotine-dependence. Participants completed a VR session during the cigarette deprivation condition only (Day 2). During this session, they were exposed to active smoking and placebo (non-smoking) cues.
  
  
  RESULTS
  The data show that self-reported levels of "craving" (p < .01) and "thinking about cigarettes" (p < .0001) were significantly greater after exposure to the active cues versus non-smoking cues. Significant increases in heart rate were found for 3 of 4 active cues when compared to non-smoking cues (p < .05). Finally, significant positive correlations were found between self-reported craving prior to the VR session and craving induced by active VR cues (p < .01).
  
  
  CONCLUSIONS
  In this report, active VR cues elicited craving during cigarette deprivation. This is the first study to demonstrate that self-reported craving, withdrawal symptoms, and nicotine dependence severity predict cue-induced craving in the VR setting.
authors.affiliation: Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX; daisythompsonlake@gmail.com.
authors.forename: Daisy G Y
authors.initials: DG
authors.lastname: Thompson-Lake
authors.affiliation: Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX;
authors.forename: Kim N
authors.initials: KN
authors.lastname: Cooper
authors.affiliation: Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX;
authors.forename: James J
authors.initials: JJ
authors.lastname: Mahoney
authors.affiliation: Graduate College of Social Work, University of Houston, Houston, TX;
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Bordnick
authors.affiliation: Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX;
authors.forename: Ramiro
authors.initials: R
authors.lastname: Salas
authors.affiliation: Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX;
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Kosten
authors.affiliation: Department of Neuroscience, University of Pennsylvania, Philadelphia, PA.
authors.forename: John A
authors.initials: JA
authors.lastname: Dani
authors.affiliation: Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX;
authors.forename: Richard
authors.initials: R
authors.lastname: De La Garza
mesh_terms: D000328:Adult; D066249:Craving; D003463:Cues; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010775:Photic Stimulation / Q000379:methods; D011237:Predictive Value of Tests; D012647:Self-Assessment; D012720:Severity of Illness Index; D012907:Smoking / Q000523:psychology* / Q000628:therapy; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D063367:Virtual Reality Exposure Therapy / Q000379:methods*