Subjective craving and experiential responses to immersive virtual reality smoking cues: a pilot smoker-non-smoker comparison.

BACKGROUND: Immersive virtual reality (VR) can present smoking cues in realistic first-person and social contexts. This pilot study examined subjective craving and experiential responses to a fixed, graded 360° VR smoking-cue sequence in current smokers and a comparison group reporting no smoking for at least six months. METHODS: Thirty-one men (15 current smokers, 16 comparison participants) completed pre-exposure measures of nicotine dependence, desire to smoke, and trait anxiety. They then viewed four fixed VR stages: a neutral cafe baseline, smoking paraphernalia, other people smoking, and first-person self-smoking. After exposure, participants rated calmness/anxiety, sense of reality, general craving, and current cigarette craving, and provided open-ended responses. RESULTS: Current smokers reported higher baseline smoking desire, trait anxiety, post-VR general craving, and current cigarette craving than the comparison group. Baseline desire was already substantially higher, and did not significantly differ from post-VR current craving within smokers (Wilcoxon W = 24.5, p = .141); the pre- and post-VR items were related but not identical. Sense of reality did not differ significantly between groups. Several pooled correlations weakened after group adjustment or restriction to smokers, and no qualitative theme remained significant after false-discovery-rate correction. CONCLUSIONS: The sequence differentiated current smokers from the comparison group in subjective and experiential responses, but did not demonstrate a VR-induced increase in craving or validate the paradigm. Larger counterbalanced studies should include women, verified lifelong never-smokers and characterized former smokers, repeated identical craving measures, and validated presence and craving instruments.