Environmental Social Stress, Paranoia and Psychosis Liability: A Virtual Reality Study

Wim Veling*, Roos Pot-Kolder, Jacqueline Counotte, Jim van Os, Mark van der Gaag

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


The impact of social environments on mental states is difficult to assess, limiting the understanding of which aspects of the social environment contribute to the onset of psychotic symptoms and how individual characteristics moderate this outcome. This study aimed to test sensitivity to environmental social stress as a mechanism of psychosis using Virtual Reality (VR) experiments. Fifty-five patients with recent onset psychotic disorder, 20 patients at ultra high risk for psychosis, 42 siblings of patients with psychosis, and 53 controls walked 5 times in a virtual bar with different levels of environmental social stress. Virtual social stressors were population density, ethnic density and hostility. Paranoia about virtual humans and subjective distress in response to virtual social stress exposures were measured with State Social Paranoia Scale (SSPS) and self-rated momentary subjective distress (SUD), respectively. Pre-existing (subclinical) symptoms were assessed with the Community Assessment of Psychic Experiences (CAPE), Green Paranoid Thoughts Scale (GPTS) and the Social Interaction Anxiety Scale (SIAS). Paranoia and subjective distress increased with degree of social stress in the environment. Psychosis liability and pre-existing symptoms, in particular negative affect, positively impacted the level of paranoia and distress in response to social stress. These results provide experimental evidence that heightened sensitivity to environmental social stress may play an important role in the onset and course of psychosis.
Original languageEnglish
Pages (from-to)1363-1371
JournalSchizophrenia Bulletin
Issue number6
Publication statusPublished - Nov 2016


  • psychosis
  • ultra high risk
  • stress
  • sensitization
  • virtual reality

Cite this