Childhood trauma and social stress reactivity in psychosis: A virtual reality study

Introduction: Childhood trauma may be related to risk for psychosis by the mechanism of sensitization to social stress. Virtual Reality (VR) provides the opportunity to test this mechanism by controlled experimental exposure to different social environments. Methods: Fifty-five patients with recent onset psychotic disorder (FEP), 20 patients at ultra-high risk for psychosis (UHR), 42 siblings of patients with psychosis and 53 controls walked five times in a virtual bar with different levels of environmental social stress. Virtual social stressors were population density, ethnic density and hostility. Social stress sensitivity was measured with paranoia and subjective distress in response to virtual social stress exposures, childhood trauma and self-esteem were assessed at baseline. Multilevel random intercept regression analyses were used to test childhood trauma as predictor and moderator of paranoia and subjective distress in VR. Social stress sensitivity was tested as mediator between childhood trauma and symptoms of psychosis. Results: Childhood trauma was significantly associated with higher paranoia and subjective distress in the virtual social stress experiments. There was a positive and linear interaction between childhood trauma and degree of environmental social stress on paranoia and subjective distress. Social stress sensitivity measures mediated associations between childhood trauma, (minor) psychotic and affective symptoms, and psychosis liability. Conclusions: Childhood trauma is associated with heightened social stress sensitivity and contributes to psychotic and affective dysregulation later in life by sensitized paranoid and stress response to social stressors