title: Environmental Social Stress, Paranoia and Psychosis Liability: A Virtual Reality Study.
abstract: The impact of social environments on mental states is difficult to assess, limiting the understanding of which aspects of the social environment contribute to the onset of psychotic symptoms and how individual characteristics moderate this outcome. This study aimed to test sensitivity to environmental social stress as a mechanism of psychosis using Virtual Reality (VR) experiments. Fifty-five patients with recent onset psychotic disorder, 20 patients at ultra high risk for psychosis, 42 siblings of patients with psychosis, and 53 controls walked 5 times in a virtual bar with different levels of environmental social stress. Virtual social stressors were population density, ethnic density and hostility. Paranoia about virtual humans and subjective distress in response to virtual social stress exposures were measured with State Social Paranoia Scale (SSPS) and self-rated momentary subjective distress (SUD), respectively. Pre-existing (subclinical) symptoms were assessed with the Community Assessment of Psychic Experiences (CAPE), Green Paranoid Thoughts Scale (GPTS) and the Social Interaction Anxiety Scale (SIAS). Paranoia and subjective distress increased with degree of social stress in the environment. Psychosis liability and pre-existing symptoms, in particular negative affect, positively impacted the level of paranoia and distress in response to social stress. These results provide experimental evidence that heightened sensitivity to environmental social stress may play an important role in the onset and course of psychosis.
authors.forename: Wim
authors.initials: W
authors.lastname: Veling
authors.affiliation: Research Department, Parnassia Psychiatric Institute, The Hague, the Netherlands.|Department of Clinical Psychology, VU University, Amsterdam, the Netherlands.
authors.forename: Roos
authors.initials: R
authors.lastname: Pot-Kolder
authors.affiliation: Research Department, Parnassia Psychiatric Institute, The Hague, the Netherlands.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Counotte
authors.affiliation: Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands.|King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK.
authors.forename: Jim
authors.initials: J
authors.lastname: van Os
authors.affiliation: Research Department, Parnassia Psychiatric Institute, The Hague, the Netherlands.|Department of Clinical Psychology, VU University, Amsterdam, the Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: van der Gaag
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D010259:Paranoid Disorders / Q000209:etiology / Q000503:physiopathology*; D011618:Psychotic Disorders / Q000209:etiology / Q000503:physiopathology*; D012306:Risk; D035781:Siblings; D012931:Social Environment; D013315:Stress, Psychological / Q000150:complications / Q000503:physiopathology*; D014584:User-Computer Interface; D055815:Young Adult
keywords: psychosis; sensitization; stress; ultra high risk; virtual reality