A novel virtual reality paradigm: Predictors for stress-related intrusions and avoidance behavior

Most people are exposed to a violent or life-threatening situation during their lives, but only a minority develops a stress-related disorder. To examine risk factors for the development of stress-related symptoms, such as intrusions and avoidance, analogue trauma studies are necessary. The often-used trauma film paradigm has proven to be valuable to examine intrusions, but inherently to its technique is less suitable for assessing behavioral avoidance, a core symptom of stress-related disorders. The aim of the present study was twofold, first to further develop an analogue that explicitly addresses behavioral avoidance and second, to link previously-established risk factors for the development of stress-related symptoms.

Eighty-two healthy participants were subjected to a trauma induction using virtual reality (VR). At follow-up, participants were placed in a similar VR environment and could approach or avoid the trauma-scene, a trauma-related scene or a neutral, unrelated scene. Several pre- and peri-trauma risk factors were measured.

The VR paradigm increased negative mood and heart rate, decreased positive mood and heart rate variability, and resulted in stress-related symptoms as trauma-related thoughts and beliefs, intrusions and avoidance behavior. The most prominent risk factors that contributed to the stress-related symptoms were negative emotions during the trauma induction, trait anxiety, and avoidant coping strategies.

The stress-related symptoms were mild, resulting in a vast amount of participants without intrusions and limited avoidance behavior.

The current VR paradigm can elicit stress-related symptoms, including avoidance; risk factors contributing to these symptoms were similar to those observed in clinical research, indicating the potential of the general set up.