A prospective study of VR-assessed state paranoia and anxiety suggests threat-related developmental pathways in...

Adolescence is a sensitive period for the emergence of subclinical psychotic experiences, including paranoid ideation. Understanding their developmental course in relation to common mental health difficulties such as anxiety, is important for clarifying etiological processes and potential progression to clinical psychosis. This study longitudinally examined the possible bidirectional relationship between anxiety and paranoia assessed in a Virtual Reality setting in adolescents aged 12 to 18 and the role of childhood threat experiences, as part of the EMBRACE study.

Data were collected in two waves, 18 months apart at baseline. State paranoia was assessed using the State Social Paranoia Scale (SSPS) in two distinct Virtual Reality (VR) environments. Anxiety was measured with the Revised Children's Anxiety and Depression Scale (RCADS25), while childhood threat exposure was evaluated using the Juvenile Victimization Questionnaire (JVQ). Linear and multiple regression analyses were conducted to examine associations and moderation effects.

At baseline, 120 adolescents participated, of whom 97 completed both waves. State paranoia in a school canteen VR environment at baseline significantly predicted state paranoia in a VR bar environment 18 months later (β = 0.45, SE = 0.10, p < 0.001). Similarly, anxiety at baseline strongly predicted anxiety at follow-up (β = 0.46, SE = 0.10, p < 0.001), but no associations were found between state paranoia and anxiety over time in either direction. Childhood threat exposure moderated the relationship between baseline state paranoia and anxiety at follow-up (β = -0.17, SE = 0.06, p = 0.009), with adolescents experiencing higher state paranoia and threat exposure at baseline showing lower anxiety at follow-up. In contrast, the interaction between Wave 1 anxiety and Wave 1 childhood threat exposure in predicting follow-up state paranoia was non-significant (β = -0.17, SE = 0.11, p = .117).

VR can capture subtle paranoid ideation in ecologically valid, dynamic social interactions that are consistent over time and across different VR environments. The developmental trajectories of paranoia and anxiety may diverge depending on childhood threat exposure, highlighting the role of early adversity in shaping their interplay.