Development of a Virtual Reality Coping Skills Game to Prevent Post-Hospitalization Smoking Relapse in Tobacco Dependent Cancer Patients

Paul Krebs, Jack Burkhalter, Shireen Lewis, Tinesha Hendrickson, Ophelia Chiu, Paul Fearn, Wendy Perchick, Jamie Ostroff


Many smokers hospitalized for cancer-related surgery return to smoking after discharge even though continued smoking can compromise treatment effectiveness, reduce survival, increase risk of disease recurrence, and impair quality of life. After leaving the smoke-free hospital, patients encounter smoking cues at home, i.e., family members who smoke or emotional triggers such as stress that can elicit powerful urges to smoke and lead to smoking relapse. Enabling smokers to experience such urges in a controlled setting while providing the ability to practice coping skills can build quitting self-efficacy. We developed a virtual reality coping skills (VRCS) game to help hospitalized smokers practice coping strategies to manage these triggers in preparation for returning home after hospitalization. Our multidisciplinary team developed the prototype VRCS game using Second Life, a platform that allowed rapid development and functionality. The prototype uses virtual home spaces (e.g., living room, kitchen) populated with common triggers to smoke. The patient uses a “toolkit” with scripted actions that enable the avatar to test out coping strategies. Since eliciting urges to smoke is essential to the game’s efficacy, we are assessing whether the virtual smoking trigger scenarios elicit urges to smoke with 8 cancer patients with a history of smoking. We guided each patient through a VRCS scenario during which we asked the patient to evaluate urges and coping. Initial data indicate that patients report high urges to smoke (7-10 on a 10 point scale) when their patient avatar confronts virtual triggers such as drinking coffee. Patients rated virtual practice of coping strategies, such as drinking water or watching TV, as very helpful (7-10 on a 10 point scale) in reducing these urges. With further development, this VRCS game has potential to provide low-cost, effective behavioral rehearsal to prevent relapse to smoking in hospitalized cancer patients.


smoking cessation; health behavior; virtual reality

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