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

Pauline Dibbets*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

14 Citations (Web of Science)
226 Downloads (Pure)


BACKGROUND AND OBJECTIVES: 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.

METHOD: 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.

RESULTS: 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.

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

CONCLUSION: 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.

Original languageEnglish
Article number101449
Number of pages8
JournalJournal of Behavior Therapy and Experimental Psychiatry
Early online date8 Jan 2019
Publication statusPublished - Jun 2020


  • Avoidance
  • Intrusions
  • PTSD
  • Risk factors
  • Stress-related disorders
  • Virtual reality

Cite this