Elsevier

Schizophrenia Research

Volume 192, February 2018, Pages 89-95
Schizophrenia Research

Interpersonal sensitivity in those at clinical high risk for psychosis mediates the association between childhood bullying victimisation and paranoid ideation: A virtual reality study

https://doi.org/10.1016/j.schres.2017.04.029Get rights and content

Abstract

Background

Experience of bullying victimisation in childhood and heightened interpersonal sensitivity have been independently linked to the clinical high risk for psychosis.

Aim

To examine the potential mediating effect of interpersonal sensitivity in explaining the link between childhood bullying victimisation and real-time paranoid ideation in adult participants at clinical high risk for psychosis.

Method

In a cross-sectional study data were collected for 64 individuals at clinical high risk for psychosis. Measures included history of bullying victimisation, interpersonal sensitivity and state paranoid ideation following exposure to a social virtual reality environment. The virtual reality scenario was a London Underground journey.

Results

Path analysis indicated that interpersonal sensitivity fully explained the significant association between severe bullying victimisation in childhood and paranoid ideation in the clinical-high risk group. Based on AIC criteria the best model selected was the full mediation model: severe bullying  interpersonal sensitivity  state paranoid ideation. The results suggest that severity of bullying is more important than frequency of bullying in explaining state paranoid ideation.

Conclusions

The significant role played by interpersonal sensitivity in the association between being bullied in childhood and paranoid ideation in the clinical high risk group suggests that this could become a target for intervention.

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 othersparticularly 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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