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Schizophr Bull. 2016 Nov;42(6):1363-1371. doi: 10.1093/schbul/sbw031. Epub 2016 Apr 2.

Environmental Social Stress, Paranoia and Psychosis Liability: A Virtual Reality Study.

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Research Department, Parnassia Psychiatric Institute, The Hague, the Netherlands.
Department of Clinical Psychology, VU University, Amsterdam, the Netherlands.
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.


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.


psychosis; sensitization; stress; ultra high risk; virtual reality

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