Interpersonal sensitivity in those at clinical high risk for psychosis mediates the association between childhood bullying victimisation and paranoid ideation: A virtual reality study
Introduction
Borne of research suggesting that there may be a specificity in the relationship between early adverse events and later development of psychotic symptoms (Bentall et al., 2012, Campbell and Morrison, 2007, Lopes, 2013), interest in a specific link between bullying victimisation and paranoid ideation has emerged (Valmaggia et al., 2015). Bullying victimisation has been linked with increased risk of psychotic experiences in clinical and non-clinical populations (van Dam et al., 2012) and high rates of bullying victimisation have been reported in people at Clinical High Risk (CHR) for psychosis (Addington et al., 2013, Stowkowy et al., 2016, Valmaggia et al., 2015) and in people with established psychosis (Trotta et al., 2013). The negative effects of bullying victimisation on mental health have been reported to exist independent of the occurrence of other adverse experiences in childhood such as sexual, physical and emotional abuse (Fisher et al., 2012, Lereya et al., 2015, Sansen et al., 2014). Childhood bullying victimisation has been linked to lower self-esteem and heightened interpersonal sensitivity in adult life (Butler et al., 2007). Interpersonal sensitivity describes a personality trait characterised by “an undue and excessive awareness of, and sensitivity to, the behaviour and feelings of others… particularly to perceived or actual situations of criticism or rejection…” (p. 342 (Boyce and Parker, 1989). Interpersonal sensitivity has been implicated in the formation of paranoid ideation (Bell and Freeman, 2014, Freeman et al., 2005); and it was found to be heightened in those at CHR for psychosis (Masillo et al., 2012, Masillo et al., 2016). The core characteristics of paranoid ideation are its interpersonal nature and unfoundedness (Freeman and Garety, 2004). Adequate measurement should thus ensure that paranoid ideation is not an appropriate response to a genuinely hostile environment, or absent of an interpersonal context. This has been termed the ‘paranoia problem’ (Freeman, 2008) and cannot always be circumvented by traditional testing paradigms or by measuring trait or baseline paranoia. In recent years, a number of studies have emerged implementing Virtual Reality (VR) technology which allows for the study of paranoid ideation, elicited in laboratory settings, in real-time, using computer programmed characters (avatars) and life like social environments (Valmaggia et al., 2016). The aim of the current study was to explore the potential mediating role played by interpersonal sensitivity in the association between self-reported experiences of childhood bullying victimisation and the occurrence of state paranoid ideation in a VR social environment.
Section snippets
Design
This study employed a cross-sectional design.
Sample
Participants (N = 65) were recruited the Outreach and Support in South London service (OASIS) which offers assessment and treatment to people at CHR for developing psychosis (Fusar-Poli et al., 2013). CHR individuals meet at least one of three criteria; (i) psychotic experiences of sub-threshold severity, (ii) psychotic experiences of psychotic intensity and frequency, which last less than one week and resolve without treatment or (iii) Functional
Socio-demographic variables
Age, gender, ethnicity, years in education, employment, and migrant status are reported in Table 1.
Bullying victimisation, interpersonal sensitivity and paranoid ideation
Levels of interpersonal sensitivity including the score for each subscale are reported in Table 2.
Bullying victimisation in this analysis was classified as frequent, moderate to severe bullying of either verbal, physical or relational types (see Table 2).
Table 2 also reports the results regarding paranoid ideation experienced in the VR environment.
Primary school bullying victimisation
Table 3 reports AIC model selection analyses
Discussion
To our knowledge this is the first study in a CHR group to examine the association between childhood bullying victimisation and state paranoid ideation with regards to the construct of interpersonal sensitivity, and its possible mediating effect. Further, it is one of the first studies to treat bullying victimisation according to its separate dimensions (frequency and severity) and to implement data modelling techniques to investigate the relationships within this particular variable set.
As
Conflict of interest
None.
Ethical approval
Research ethics approval was obtained from the National Research Ethics Service (Ethics REC number 08/H0722/45).
Funding
Brain and Behaviour Research Foundation (NARSAD Young Investigator Award) and Psychiatry Research Trust (Peggy Pollack Research Fellowship) awarded to Dr. Valmaggia.
Contributors
Author LRV designed the study and wrote the protocol and secured funding for the study. Authors LRV, JMcD, DS, and FD, managed the literature searches and statistical analysis. LRV & FD collected the data for the study. All authors contributed to writing the manuscript and have approved the final manuscript.
Acknowledgements
We would like to thank the participants and OASIS. We also acknowledge Prof Paul Chadwick for his advice regarding this study, Dr. Angus Antley, Prof Daniel Freeman and Prof Mel Slater for their guidance and recommendations regarding the VR Lab.
Dr. Valmaggia was supported by the Brain and Behaviour Research Foundation (NARSAD Young Investigator Award) and the Psychiatry Research Trust (Peggy Pollack Research Fellowship).
We also would like to express our gratitude to the National Institute for
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