1. A Virtual Arm to Stop Smoking A comparative study B. Girard 1, V. Turcotte 1 and S. Bouchard 2 1.GRAP, Occupational psychology clinic Saguenay (Québec) Canada 2. University Quebec Outaouais, (Québec) Canada Cybertherapy and behaviour conference San Diego, U.S.A., June 23-24th 2008

2. TO STOP SMOKING VIRTUAL ARM

3. PILOT STUDY 2007 OBSERVATIONS : 1.Usability of the method for smokers and clinicians. 2.Some clinical evidences of modifying craving and smoking behaviours. 3.An action-cue exposure (ACET) strategy could be considered in the treatment of substance addiction.

4. Hypothesis: in the treatment of tobacco addiction, crushing cigarettes with a virtual arm will have a higher efficiency than catching balls after four sessions of cybertherapy (1month) and at the end of psychosocial support (3 months). The difference will be calculated by the percentage of non smokers, the reduction of daily consumption and the intensity of the symptoms of dependence and withdrawal.

5. OBJECTIVES A comparative study on 91 smokers January – May 2008 PRESENTATION : Method Preliminary results

6. STUDY DESIGN Combined therapy : cybertherapy + psychosocial support (no medication) 91 subjects randomized Two conditions : active : crushing cigarettes control : catching balls No target quit date Study is submitted to the ethical board of UQO (University Quebec Outaouais)

8. STUDY POPULATION Recruitment : Through local media Preselecting : By phone Selection :Selection : In-clinic visit

9. PRESELECTING (by phone) Inclusion criteria : Age between 18 – 65 Daily smoking 10 cigarettes and more (last year) Fewer than 3 months abstinence (last year) Motivated to stop smoking Exclusion criteria : Any serious or unstable disease (6 months) Treatment for major mental illness (last year) Use of medication to stop smoking (6 months) Regular use of CNS medication Treatment with cybertherapy (last year) History of severe substance abuse (last year) Pregnancy

10. SELECTION (clinic visit) Physical data : vital signs body mass index Smoking history :age at beginning duration no attempts abstinence periods mean daily use Exhaled co test Questionnaires VR adaptation session (10 min.) and tests Consent’s document Randomization

11. INTERVENTION 1.0Psychosocial support Brief individual counselling (10-15 min) by a nurse : assist in problem solving, give information on withdrawal, analyse smoker’s journal. Smoking cessation selfhelp booklet : guide to becoming a non smoker Health Canada 2003. Exhaled co test, vital signs and body mass index. Questionnaires. Frequency of visits : - weekly for 1 to 4th week - biweekly for 6th to 12th week Medical counselling (if necessary)

12. INTERVENTION 2.0Cybertherapy Four weekly sessions : week 1 to 4th Time : 30 min. Scenario : catching balls or crushing cigarettes (max. 50 objects) Questionnaires Waiting time after exposition : 10-15 min.

13. Pentium IV with nVidia 7300GS video card capable of stereoscopy eMagin Z800 HMD Logitech wireless gamepad 3D work was integrated into a well-know game engine call Unreal 2 from the game Unreal Tournament 2004 XSI from Softimage was used for the virtual arm and environment’s creation EQUIPMENTS

14. Measures : (at each clinic visit) Smoking status : - Self report - Journal of 7 or 14 last days - Exhaled co test Motivation : - Richmond test (Richmond 1993) Dependence : - Fagerström test (Heatherton, 1991) - CDS-12 (Etter, 2002) - Horn test (Taytard, 1999) Withdrawal : - Tiffany test (Toll, 2006) - Minnesota test (Hugues, 1986) VR reaction : - State of presence - Cybersickness - Neuropsychological symptoms

15. PRELIMINARY RESULTS Participant disposition 215 respondents 110 screened 96 randomized 91 included 46 actives (cigarettes) 6 weeks - 35 12 weeks - 23 45 controls (balls) 6 weeks - 21 12 weeks - 13

16. PRELIMINARY RESULTS Drop out rate : ACTIVESCONTROLS 6 weeks11/46 - 23,9%24/45 - 53,3% 12 weeks23/46 - 50,0%32/45 - 71,1%

17. PRELIMINARY RESULTS Demographic characteristics ACTIVECONTROL AGE : 18 – 30 31 – 50 51 et + 76 2023 1916 SEXE : F M 2725 1920 OCCUPATION: Yes No 34 1211

18. PRELIMINARY RESULTS Smoking history ACTIVE CONTROL Daily consumption (No cig/day) : 10 - 203020 21 - 301217 31 et +48 No attempts : 0 – 32620 4 et +1722 Age at beginning (years): 18 et -4241 19 - 3034 31 et +10 Duration (no years) : 0 - 1055 11 - 301921 31 et +2219

19. Cybertherapy