Background
Methods/design
Study site and population
Study design and procedure
T0 (Baseline) | T1 (2 months after T0) | T2 (3 months after T1) | T3 (6 months after T1) | T4 (12 months after T1) | |
---|---|---|---|---|---|
Mattis1
| X | ||||
MINI2
| X | ||||
DSM-V nicotine dependence3
| X | X | X | X | X |
CDS-124
| X | X | X | X | X |
FTCQ-125
| X | X | X | X | X |
STAI-A6
| X | X | X | X | X |
BDI7
| X | X | X | X | X |
SF-128
| X | X | X | X | X |
EES-109
| X | X | X | X | X |
Co10
| X | X | X | X | X |
Treatment groups
Apparatus
Software and virtual environments
Evaluation outcome
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Tobacco abstinence is assessed using the carbon monoxide levels expired at T0, at the end of the therapy (2 months, T1) and at 3 (T2), 6 (T3) and 12 months (T4) after the end of therapy T2, T3 and T4.
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Tobacco dependence is assessed at T0, T1, T2, T3 and T4 with the DSM-V criteria and the Cigarette Dependence Scale (CDS-12) [39], a 12-item self-report instrument with scores ranging from 12 (no dependence) to 60 (high dependency). This scale has high test-retest reliability (≥0.83) and high internal consistency (Cronbach's alpha ≥0.84).
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Craving is assessed using two different measures. Smoking craving is evaluated at T0, T1, T2, T3 and T4 with the French Tobacco Craving Questionnaire (FTCQ-12) [40], a 12-item self-report instrument with scores ranging from 12 (no craving) to 84 (high craving). The internal consistency alpha coefficients were 0.83, 0.79, 0.69 and 0.66 for the different factors (emotionality, expectancy, compulsivity and purposefulness). Craving is also evaluated using an analogical craving scale, ranging from 0 (lack of desire) to 10 (extreme desire) [41] before, during and after each session.
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Anxiety is assessed at T0, T1, T2, T3 and T4 with the State-Trait Anxiety Inventory (STAI) [42] Y-A (state). The STAI is a 20-item self-report instrument with scores ranging from 20 (absence of anxiety) to 80 (high anxiety). The STAI is among the most widely researched and widely used measurements of general anxiety, with satisfactory internal consistency alpha coefficients (≥0.7).
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Depression is assessed at T0, T1, T2, T3 and T4 with the Beck Depression Inventory (BDI). The BDI is a 13-item self-report instrument. A total score between 4 and 7 shows a mild state of depression, between 8 and 15 an average to moderate state of depression, and 16 or higher a severe state of depression [43, 44]. This scale has satisfactory psychometric properties. A meta-analysis of the BDI's internal consistency estimates yielded a mean alpha coefficient of 0.81. The concurrent validity of the BDI with respect to clinical ratings and the Hamilton Psychiatric Rating Scale for Depression were also high. The BDI also distinguishes subtypes of depression and differentiates depression from anxiety [45].
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Quality of life is assessed at T0, T1, T2, T3 and T4 with the SF-12 [46], assessing physical function, physical pain, general health, vitality (energy and tiredness), social functioning and well-being, as well as limitations due to physical and mental health. Two composite scores are obtained with this self-report instrument: a Physical Component Score (PCS) and a Mental Component Score (MCS). A high score indicates a high level quality of life. Several studies have reported that the SF-12 is able to produce the two summary scales originally developed from the SF-36, one of the most widely used quality of life instruments, with considerable accuracy and yet with far less of a respondent burden [46, 47].
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Self-esteem is assessed at T0, T1, T2, T3 and T4 with the Rosenberg questionnaire [48]. This self-report questionnaire consists of 10 items and produces a total score of 10 to 40; a high score indicates high self-esteem. This questionnaire is a reliable and valid measurement of global self-worth [49].
Cravings at the beginning of the session | Cravings during the session | Cravings at the end of the session | HR1
| HRV2
| PQ3
| SSQ4
| |
---|---|---|---|---|---|---|---|
CBT | X | X | |||||
CBT coupled with VRET | X | X | X | X | X | X | X |
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Perception of presence is assessed by the Presence Questionnaire (PQ), version 3.0 [50]. The PQ consists of 32 items rated on a 7-point scale, and factor analyses found 6 factors: involvement, interface quality, adaptation and immersion, consistency with expectation, visual fidelity and auditory fidelity [51]. The PQ is a self-report instrument that has been validated in many empirical studies [50‐53] and has also demonstrated a relationship between presence and anxiety [52]. A high score indicates a satisfactory perception of presence.
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Symptoms reported to be associated with simulator sickness are assessed with the Simulation Sickness Questionnaire (SSQ) [53]. The SSQ is a 16-item self-report instrument with scores ranging from 16 (absence of cybersickness) to 48 (high cybersickness). Factor analyses found three main factors: oculomotor (for example, blurred vision), disorientation (for example, dizziness) and nausea (for example, vomiting).
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Heart rate (HR) and heart rate variability (HRV) are evaluated with a heart rate monitor (apparatus for technical description) for the duration of each therapeutic session. The HR reflects the average heart rate recorded during the therapeutic session. The HRV indicates the fluctuations in heart rate around an average heart rate [30]. HR and HRV reflect the autonomic responses involved in emotional arousal, most notably during anxiety, during which the HR is expected to increase and the HRV to decrease [54]. There is evidence that heart rate changes are correlated with presence [55]. Furthermore, HR is one of the main correlates of craving [8]. HR and HRV represent alternative objective measurements of anxiety response, presence and craving.