Immersive virtual reality as a novel approach to investigate the association between adverse events and adolescent paranoid ideation

Paranoid ideation is common among adolescents, yet little is known about the precursors. Using a novel immersive virtual reality (VR) paradigm, we tested whether experiences of bullying, and other interpersonal/threatening events, are associated with paranoid ideation to a greater degree than other types of (i) non-interpersonal events or (ii) adverse childhood experiences.

Self-reported exposure to adverse life events and bullying was collected on 481 adolescents, aged 11–15. We used mixed effects (multilevel) linear regression to estimate the magnitude of associations between risk factors and paranoid ideation, assessed by means of adolescents’ reactions to ambiguously behaving avatars in a VR school canteen, adjusting for putative confounders (gender, year group, ethnicity, free school meal status, place of birth, family mental health problems).

Lifetime exposure to interpersonal/threatening events, but not non-interpersonal events or adverse circumstances, was associated with higher levels of state paranoid ideation, with further evidence that the effect was cumulative (1 type: ϐ_adj 0.07, 95% CI -0.01-0.14; 2 types: ϐ_adj 0.14, 95% CI 0.05–0.24; 3 + types: ϐ_adj 0.24, 95% CI 0.12–0.36). More tentatively, for girls, but not boys, recent bullying was associated with heightened paranoid ideation with effect estimates ranging from ϐ_adj 0.06 (95% CI -0.02-0.15) for physical bullying to ϐ_adj 0.21 (95% CI 0.10–0.32) for cyber bullying.

Our data suggest a degree of specificity for adversities involving interpersonal threat or hostility, i.e. those that involve unwanted interference and/or attempted control of an individual’s personal boundaries being associated with heightened levels of state paranoid ideation among adolescents.