Academic Journal
View in EDS

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

Bibliographic Details
Title: A prospective study of VR-assessed state paranoia and anxiety suggests threat-related developmental pathways in adolescence.
Authors: Inan C; Center for Clinical Psychiatry, Research Group Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium., Samaey C; Laboratory for Biological Psychology, Department of Brain and Cognition, KU Leuven, Leuven, Belgium., Vansteelandt K; Center for Clinical Psychiatry, Research Group Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium., Lecei A; Center for Clinical Psychiatry, Research Group Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium., Gayer-Anderson C; Department of Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.; ESRC Centre for Society and Mental Health, King's College London, London, UK., Valmaggia L; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.; Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK., van Winkel R; Center for Clinical Psychiatry, Research Group Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium. ruud.vanwinkel@kuleuven.be.
Source: Social psychiatry and psychiatric epidemiology [Soc Psychiatry Psychiatr Epidemiol] 2026 Aug; Vol. 61 (8), pp. 1617-1627. Date of Electronic Publication: 2026 Mar 13.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: Springer International Country of Publication: Germany NLM ID: 8804358 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1433-9285 (Electronic) Linking ISSN: 09337954 NLM ISO Abbreviation: Soc Psychiatry Psychiatr Epidemiol Subsets: MEDLINE
Imprint Name(s): Original Publication: [Berlin] : Springer International, [c1988-
MeSH Terms: Paranoid Disorders*/psychology , Paranoid Disorders*/diagnosis , Paranoid Disorders*/epidemiology , Anxiety*/psychology , Anxiety*/diagnosis , Anxiety*/epidemiology , Virtual Reality*, Humans ; Adolescent ; Male ; Female ; Prospective Studies ; Child ; Longitudinal Studies ; Surveys and Questionnaires ; Psychiatric Status Rating Scales
Abstract: Purpose: 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.
Methods: 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.
Results: 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).
Conclusion: 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.
(© 2026. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Competing Interests: Declarations. Competing interest: The authors declare no competing interests. Ethical considerations: The study received ethical approval from the Medical Ethics Committee of UZ/KU Leuven (S62124). Informed consent was obtained from all participants and their parents or guardians prior to participation.
References: Schizophr Res Cogn. 2020 Mar 29;21:100176. (PMID: 32547929)
Psychol Rep. 2001 Feb;88(1):227-35. (PMID: 11293033)
Cyberpsychol Behav Soc Netw. 2014 Mar;17(3):191-5. (PMID: 23992475)
Behav Cogn Psychother. 2019 Jan;47(1):52-66. (PMID: 29938626)
Psychol Med. 2008 Aug;38(8):1121-32. (PMID: 18533055)
Child Abuse Negl. 2023 Oct;144:106346. (PMID: 37473619)
Neurosci Biobehav Rev. 2004 May;28(3):333-42. (PMID: 15225975)
Schizophr Bull. 2016 Nov;42(6):1363-1371. (PMID: 27038469)
Eur Child Adolesc Psychiatry. 2021 Apr;30(4):591-605. (PMID: 32405792)
Soc Psychiatry Psychiatr Epidemiol. 2025 Feb;60(2):305-318. (PMID: 38942902)
BMC Med. 2024 Sep 11;22(1):382. (PMID: 39256825)
Schizophr Res. 2018 Jul;197:144-149. (PMID: 29398206)
Behav Res Ther. 2019 Jul;118:101-109. (PMID: 31030002)
J Youth Adolesc. 2024 Mar;53(3):701-717. (PMID: 38097883)
Eur Arch Psychiatry Clin Neurosci. 2000;250(6):274-85. (PMID: 11153962)
Aust N Z J Psychiatry. 2021 Dec;55(12):1166-1177. (PMID: 33423520)
Cyberpsychol Behav Soc Netw. 2019 Apr;22(4):288-292. (PMID: 30802148)
Schizophr Bull. 2010 Nov;36(6):1140-8. (PMID: 19429844)
Psychol Med. 2025 Feb 11;55:e37. (PMID: 39930797)
J Nerv Ment Dis. 2007 Sep;195(9):781-4. (PMID: 17984781)
Lancet Psychiatry. 2017 Feb;4(2):146-158. (PMID: 27856392)
Schizophr Bull. 2012 Mar;38(2):360-7. (PMID: 20709763)
Cogn Neuropsychiatry. 2003 Feb;8(1):19-41. (PMID: 16571548)
Lancet Psychiatry. 2018 Mar;5(3):217-226. (PMID: 29429948)
Schizophr Bull. 2012 Mar;38(2):247-57. (PMID: 22258882)
Schizophr Res. 2018 Feb;192:89-95. (PMID: 28454921)
Psychol Med. 2017 Oct;47(14):2393-2400. (PMID: 28325167)
Schizophr Res. 2008 Jul;102(1-3):254-60. (PMID: 18442898)
Epidemiol Psychiatr Sci. 2015 Feb;24(1):6-11. (PMID: 25693861)
Schizophr Res. 2018 Feb;192:96-101. (PMID: 28442248)
Br J Psychiatry. 2014 Sep;205(3):221-9. (PMID: 25012682)
J Behav Ther Exp Psychiatry. 2023 Dec;81:101885. (PMID: 37354896)
Acta Psychiatr Scand. 2013 Nov;128(5):327-46. (PMID: 23379898)
Br J Clin Psychol. 2002 Nov;41(Pt 4):331-47. (PMID: 12437789)
Schizophr Bull. 2013 Nov;39(6):1281-7. (PMID: 23223342)
Arch Gen Psychiatry. 2009 Jul;66(7):785-95. (PMID: 19581570)
Psychol Assess. 2012 Dec;24(4):833-45. (PMID: 22329531)
Sci Rep. 2021 Dec 14;11(1):23923. (PMID: 34907279)
Eur Child Adolesc Psychiatry. 2024 Jun;33(6):1945-1954. (PMID: 37725168)
Soc Psychiatry Psychiatr Epidemiol. 2012 Aug;47(8):1195-203. (PMID: 21928153)
Sci Rep. 2019 Oct 11;9(1):14723. (PMID: 31605005)
J Occup Health Psychol. 1996 Apr;1(2):170-86. (PMID: 9547044)
J Child Psychol Psychiatry. 2025 Jun;66(6):821-833. (PMID: 39670330)
Soc Psychiatry Psychiatr Epidemiol. 2016 Jul;51(7):921-36. (PMID: 27262562)
Contributed Indexing: Keywords: Adolescence; Anxiety; Childhood adversity; Longitudinal study; State paranoia; Virtual reality
Entry Date(s): Date Created: 20260313 Date Completed: 20260827 Latest Revision: 20261008
Update Code: 20261008
DOI: 10.1007/s00127-026-03061-z
PMID: 41824017
Database: MEDLINE
Description
ISSN:1433-9285
DOI:10.1007/s00127-026-03061-z