Connections between social stress, immune dysregulation and psychosis:a virtual reality study

Connections between social stress, immune dysregulation and psychosis.A virtual reality study.Childhood trauma, ethnic minority position or growing up in an urban environment increase the risk for psychosis. The social environment, combined with genetic susceptibility, is important in the development of psychosis. We examined if an altered reaction to social stress is involved. We used a virtual reality (VR) environment, a VR café. The VR café was quiet or crowded. Virtual humans had similar or different skin colour as participants and reacted in a friendly or hostile way. Participants felt more stressed and paranoid and their physiological stress levels increased in reaction to VR stressors. This reaction was similar for persons with and without a psychosis. However, as psychosis patients were more stressed to begin with, their stress levels ended up higher. In contrast, participants with a history of childhood trauma reacted stronger to social stress.We also examined a possible role for immune dysregulation. Previous studies found altered immune markers in psychosis patients and after childhood trauma. We did not find altered immune markers in our study. Immune dysregulation may occur mainly in combination with obesity. Obesity is more common in psychosis patients. However, the psychosis patients in our sample had an healthy weight on average. Our results highlight that childhood trauma and life style warrant attention in psychosis patients

Anxiety Partially Mediates Cybersickness Symptoms in Immersive Virtual Reality Environments

The use of virtual reality (VR) in psychological treatment is expected to increase. Cybersickness (CS) is a negative side effect of VR exposure and is associated with treatment dropout. This study aimed to investigate the following: (a) if gender differences in CS can be replicated, (b) if differences in anxiety and CS symptoms between patients and controls can be replicated, and (c) whether the relationship between exposure to VR and CS symptoms is mediated by anxiety. A sample (N = 170) of participants with different levels of psychosis liability was exposed to VR environments. CS and anxiety were assessed with self-report measures before and after the VR experiment. This study replicated gender differences in CS symptoms, most of which were present before exposure to VR. It also replicated findings that a significant correlation between anxiety and CS can be found in healthy individuals, but not in patients. In a VR environment, anxiety partially mediated CS symptoms, specifically nausea and disorientation. A partial explanation for the differences found between patients and controls may lie in a ceiling effect for the symptoms of CS. A second explanation may be the partial overlap between CS symptoms and physiological anxiety responses. CS symptoms reported at baseline cannot be explained by exposure to VR, but are related to anxiety. Caution is required when interpreting studies on both CS and anxiety, until the specificity in measurements has been improved. Since anxiety mediated the CS symptoms, CS is expected to decline during treatment together with the reduction of anxiety

Effect of virtual reality exposure therapy on social participation in people with a psychotic disorder (VRETp):study protocol for a randomized controlled trial

Background: Many patients with a psychotic disorder participate poorly in society. When psychotic disorders are in partial remission, feelings of paranoia, delusions of reference, social anxiety and self-stigmatization often remain at diminished severity and may lead to avoidance of places and people. Virtual reality exposure therapy (VRET) is an evidence-based treatment for several anxiety disorders. For patients with a psychotic disorder, the VRETp was developed to help them experience exposure to feared social situations. The present study aims to investigate the effects of VRETp on social participation in real life among patients with a psychotic disorder. Methods/design: The study is a single-blind randomized controlled trial with two conditions: the active condition, in which participants receive the virtual reality treatment together with treatment as usual (TAU), and the waiting list condition, in which participants receive TAU only. The two groups are compared at baseline, at 3 months posttreatment and at 6 months follow-up. All participants on the waiting list are also offered the virtual reality treatment after the follow-up measurements are completed. The primary outcome is social participation. Secondary outcomes are quality of life, interaction anxiety, depression and social functioning in general. Moderator and mediator analyses are conducted with stigma, cognitive schemata, cognitive biases, medication adherence, simulator sickness and presence in virtual reality. If effective, a cost-effectiveness analysis will be conducted. Discussion: Results from the posttreatment measurement can be considered strong empirical indicators of the effectiveness of VRETp. The 6-month follow-up data may provide reliable documentation of the long-term effects of the treatment on the outcome variables. Data from pre-treatment and mid-treatment can be used to reveal possible pathways of change

Psychosis liability, paranoia and distress in experimental virtual reality social environments

Background: Psychotic syndromes can be understood as disorders of adaptation to social context. It is not clear, however, how symptoms of psychosis develop in the daily social environment, in interaction with individual liability. Virtual Reality (VR) technology may help to investigate relationships between environment and psychosis, as it allows controlled exposure to various social risk environments. Methods: Four groups (total N=54) with different liability to psychosis (patients with first episode psychosis (FEP), siblings, ultra high risk individuals (UHR) and healthy controls) were exposed to virtual social environments. Psychological and physiological responses were measured repeatedly. The virtual environment was varied with regard to social stressors (population density, ethnic density and hostility of avatars). Results: Paranoid thoughts and social anxiety in real life correlated significantly with paranoid thoughts about avatars and subjective distress in virtual social stress environments (Spearman's correlation coefficients 0.4 0.5,

Self-reported Cognitive Biases Moderate the Associations Between Social Stress and Paranoid Ideation in a Virtual Reality Experimental Study

Introduction: Cognitive biases are associated with psychosis liability and paranoid ideation. This study investigated the moderating relationship between pre-existing self-reported cognitive biases and the occurrence of paranoid ideation in response to different levels of social stress in a virtual reality environment. Methods: This study included 170 participants with different levels of psychosis liability (55 recent onset psychosis, 20 ultrahigh risk for psychosis, 42 siblings of psychotic patients, and 53 controls). All participants were exposed to virtual environments with different levels of social stress. The level of experienced paranoia in the virtual environments was measured with the State Social Paranoia Scale. Cognitive biases were assessed with a self-report continuous measure. Also, cumulative number of cognitive biases was calculated using dichotomous measures of the separate biases, based on general population norm scores. Results: Higher belief inflexibility bias (Z = 2.83, P < .001), attention to threat bias (Z = 3.40, P < .001), external attribution bias (Z = 2.60, P < .001), and data-gathering bias (Z = 2.07, P < .05) were all positively associated with reported paranoid ideation in the social virtual environments. Level of paranoid response increased with number of cognitive biases present (B = 1.73, P < .001). The effect of environmental stressors on paranoid ideation was moderated by attention to threat bias (Z = 2.78, P < .01) and external attribution bias (Z = 2.75, P < .01), whereas data-gathering bias and belief inflexibility did not moderate the relationship. Conclusion: There is an additive effect of separate cognitive biases on paranoid response to social stress. The effect of social environmental stressors on paranoid ideation is further enhanced by attention to threat bias and external attribution bias

Self-esteem moderates affective and psychotic responses to social stress in psychosis:A virtual reality study

Background: Higher liability to psychosis is associated with low self-esteem and increased sensitivity to social stress. Recently, we reported a positive relation between liability to psychosis and affective and psychotic responses to social stress. This study investigated how self-esteem moderates paranoia, peak subjective distress and stress reactivity of people with different psychosis liability in response to social stressors in virtual reality. Methods: Ninety-four individuals with lower (41 siblings and 53 controls) and 75 persons with higher psychosis liability (55 with recent onset psychotic disorder and 20 at ultra-high risk for psychosis) explored five times a virtual cafe with various social stressors (crowdedness, ethnic minority status, and hostility). They rated momentary paranoia (State Social Paranoia Scale) after each experiment and subjective distress on a visual analogue scale before and after the experiments. Positive and negative self-esteem were assessed with the Self-Esteem Rating Scale. Results: Momentary paranoia, peak subjective distress, and reactivity to social stressors were associated with negative self-esteem, but not positive self-esteem. Effects of both positive and negative self-esteem on psychotic and affective stress responses, but not stress reactivity, became significantly stronger when individuals were exposed to more stressful environments. Effects of self-esteem on momentary paranoia and peak subjective distress did not differ between the high liability and low liability group. Persons with lower psychosis liability had a stronger effect of negative self-esteem on stress reactivity than persons with higher liability. Conclusions: Positive and negative self-esteem may play an important role in affective and psychotic responses to social stress. (C) 2018 Elsevier B.V. All rights reserved