Using augmented reality to deliver cue exposure treatment for smoking cessation: App usability findings and protocol for a randomized controlled trial

Abstract

Background

Augmented Reality (AR) is a rapidly developing technology with potential utility for treating addictive behaviors, including tobacco smoking. AR inserts digital images into a natural real-time scene as viewed on a smartphone or other video devices. With respect to smoking cessation, AR can place virtual smoking cues (i.e., smoking “triggers”) within an individual's natural smoking environment. Repeated exposure to these cues could enhance smoking cessation through Pavlovian extinction processes.

Method

In a usability study (N = 10), we evaluated the acceptability of a smoking cessation AR app to inform modifications to the app prior to an upcoming randomized controlled trial (RCT). For the subsequent RCT, individuals who enroll in a state tobacco quitline will be referred to the study and, if eligible and consented, randomized to use the app with AR features or without AR features (control) for 5 weeks. The efficacy of the AR features to enhance smoking cessation in the context of concurrent quitline treatment will be evaluated with the primary outcome of self-reported 7-day point-prevalence cigarette abstinence at 6 months post-enrollment. Implementation will be evaluated via incremental cost-effectiveness analyses and interviews with participants, quitline staff, and app coaches.

Conclusions

Interventions utilizing emerging mobile technologies such as AR have the potential, compared to traditional therapies, to improve both reach and efficacy by administering therapeutic elements in users' natural environments. Our AR app will target tobacco smoking, but the approach could be used to deliver exposure therapies for other addictive behaviors, as well as anxiety disorders.

Clinical Trial Registration: NCT06088498