1. A Virtual Arm to Stop Smoking A pilot perceptual learning experiment Benoît Girard and Vincent Turcotte GRAP, Occupational psychology clinic Saguenay (Québec) Canada Cybertherapy and behaviour conference Washington D.C., June 12th 2007

2. TO STOP SMOKING VIRTUAL ARM

3. INTRODUCTION SMOKING - 25 cig/day - Hand-mouth movement: 90,000 / year - Crushing cigarettes: 9,000 / year CONDITIONED REFLEX - Each smoker develops his own complex of stimuli (objects, emotions, social conditions…) which provokes the urge to smoke.

4. INTRODUCTION RESPONDANT CONDITIONING (Pavlov) CET = CUE-Reactivity + Desensitization VR APPROACH OPERANT CONDITIONING (Skinner) Action-Exposure = Modifying or blocking outcome of the addiction

5. INTRODUCTION Is a VR action-exposure (AE-VR) strategy capable of modifying craving and smoking behaviours? Could any clinical evidence be derived from this procedure? QUESTIONS OBJECTIVES Observation study of heavy smokers to evaluate the usability of this method Exploration of different variables for futures studies

6. PARTICIPANTS Age Nb. Cig./day Fagerström Motivation Nb. Attempts Female (8) 43.6 ± 3.8 20.6 ± 5.6 6.7 ± 2.6 8.4 ± 0.5 4.4 ± 3.3 Male (8) 49.7 ± 5.4 25.0 ± 8.0 8.3 ± 1.4 8.3 ± 1.3 6.5 ± 4.6 TOTAL (mean) 46.6 22.8 7.5 8.3 5.5

7. 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

8. PROCEDURES VR sessions : 4 sessions in 2 weeks Explanation of procedure and practice VR session (25 cigarettes to crush with no time limit) 10 to 15 minutes recovery time Data compilation : Profile of the subject Immersion propensity questionnaire Cybersickness and State of Presence Questionnaire Question regarding if any change occurred since last session Status of smokers Phone contact if participants abandoned before completion of 4 sessions.

10. RESULTS A fun user-friendly video game Average time: 20-40 minutes Running commentaries + Sense of enjoyment, waging war - Regret to doing it, confusion, scepticism High level of awareness and attraction All objects in the VR environment were seen as smoking symbols DURING SESSION

11. RESULTS Flashbacks (virtual arm, sounds, objects) Revisiting the virtual environment Reliving the session in their sleep Needs to crush cigarettes Crushing cigarettes instead of tapping it in the ashtray Recurrent images These reactions can be spontaneous or provocated by an urge to smoke AFTER SESSION

12. RESULTS 10/16 subjects completed 4 sessions Drop out rate 34.8% 8/10 quitted smoking (5 ♀, 3 ♂) 1/8 relapsed after 1 month Less urges to smoke Quantity:before:22.8 cig./day after:12.8 cig./day(p<0.01) OUTCOMES

13. DISCUSSION 1)IMPRINTING: An integrated sensorimotor system of conditioned stimuli in VR environment created a new cognitive map. 2)BLOCKING: Modifying craving or smoking behaviours. 3)DISRUPTING: In subjects not ready to quit. OBSERVATIONS

14. CONCLUSION 1)Usability of the method for smokers and clinicians 2)Some clinical evidences of modifying craving and smoking behaviours 3)A VR action-exposure (AE-VR) strategy could be considered in the treatment of substance addiction

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