NAME OF RESEARCHER
Charlotte Gayer-Anderson
NAME OF SUPERVISOR
Lucia Valmaggia & Craig Morgan
PROJECT TITLE
Risk & Protective Factors for Unfounded Paranoid Ideation in Adolescents: A Virtual Reality Study
CLINICAL ACADEMIC GROUP
Health Services and Population Research Dept
START & FINISH DATES:
01/11/2017 - 31/10/2020
PROJECT DESCRIPTION:
Current studies show that paranoid thoughts are commonly reported among adolescents (30-45%). These unusual experiences have been associated with more suicidal ideation, unsatisfactory peer relationships, fewer job opportunities, and more contact with the police. It is a major public health priority to understand the precursors to these symptoms, and how they may be prevented and/or treated. The high rates of reports of paranoia in adolescents may, however, be a result of misclassification.
Virtual Reality (VR) is a technology that has been pioneered to assist with understanding the onset and maintenance of paranoia in adults. The proposed project will be the first study to thoroughly investigate risk and protective factors for unwarranted paranoid thoughts towards others within adolescents.
This project will be nested in a unique longitudinal study of secondary school students in south London (the REACH study). The study will allow me to address three main aims: i) to establish within an inner-city sample of adolescents how often they experience paranoid thoughts in social situations; ii) to clarify which individual risk factors are associated with the occurrence of paranoid thoughts; and iii) to explore whether coping methods, social support, and school climate promote resilience against experiencing low-level paranoia within adolescents who have been exposed to specific risk factors. In addition, this research will inform the eventual development of a VR-assisted therapy package to help young people with unfounded paranoia and/or markers of social anxiety.
PROGRESS IN PAST YEAR:
Data Collection: We successfully recruited and assessed, using the virtual reality (VR) paradigm (and associated measures) the total baseline sample of 481 adolescents. 176 of those have repeated the VR assessment 9-12 months later. Unfortunately, due to the Covid-19 pandemic and associated restrictions from March 2020, it was not possible to complete follow-up data collection (which would have required intensive data collection in schools) before the end of the Fellowship.
Research Findings: Analyses on the baseline sample (n 481) have shown that:
1) exposure to various types of bullying victimization is associated with increased levels of unfounded paranoid thoughts in the VR school canteen, independent of age, gender, ethnicity, child place of birth, and mental health problems in first degree relatives. These associations were particularly strong for cyber bullying, and when stratified by gender, the effects remain only in girls, but not in boys.
2) higher levels of paranoia were associated with lifetime exposure to events that involve an element of intrusiveness and interpersonal threat (e.g. being physically hit or hurt, victim of a mugging or robbery, being discriminated against), but not associated with other types of stressful events or difficulties (e.g. parental death or separation, victim of a serious accident, involved in a fire or natural disaster, etc.). Our findings replicate previous research of the specificity of events with an intention to harm, unwanted interference being associated with the development of psychotic experiences or disorder.
3) cumulative effects of bullying experiences, and other interpersonal intrusive events, were found, such that adolescents who experienced several forms of bullying, and/or several types of intrusive events exhibited far greater levels of paranoid ideation than those who experienced fewer of these types of events.
4) compared with white British adolescents, black African, black Caribbean, and Asian ethnic groups had lower paranoid thoughts about others in the VR environment. This emulates findings in adult populations of ethnic minority groups experiencing elevated rates of psychotic disorder and non-clinical psychotic-like experiences. This is an interesting finding which may be indicative of the ethnic minority status of white British adolescents in the schools that we are recruiting from in south London (~10-15% of the schools’ population are white British).
5) interpersonal sensitivity, a personality trait defined as “an undue and excessive awareness of, and sensitivity to, the behaviour and feelings of others” was a strong mediator in the association between exposure to bullying victimisation and paranoid thoughts in the VR environment
6) facial emotion recognition, does not modify / moderate the association between experiences of bullying or other intrusive events, and paranoid ideation in the VR environment.
Implications: To our knowledge, this is the first study to examine associations between different types of adversity and paranoid ideation in a sample of adolescents using an age-appropriate VR experimental paradigm. Our study suggests a robust association between bullying victimization, other interpersonal and intrusive events, and paranoid ideation, as measured by a novel Virtual Reality scenario, in a large sample of adolescents. These findings support prominent theories that an accumulation of early adverse experiences create an enduring cognitive vulnerability, characterised by negative schematic models of the self/others. Such beliefs of the self as vulnerable, and appraisals of others as dangerous or untrustworthy, may create a tendency to attribute experiences as externally caused, perceive their social worlds as hostile, and, in turn, facilitate the formation of paranoid ideation.
In relation to potential clinical implications, the findings from this piece of work may suggest that:
early school-based interventions designed to stop bullying and targeted interventions to promote coping strategies in students would be very valuable. Furthermore, prompt assessment of psychotic symptoms in children who have been bullied, or who have experienced intrusive interpersonal events with an intention to harm, would also be important in order to implement effective and timely interventions.
interpersonal sensitivity may be considered a potential valuable target for therapeutic intervention. In fact, addressing social anxiety and hypersensitivity in social relationships might ameliorate social functioning and prevent transition to frank paranoid ideation.
Regarding its application to treatment of mental health difficulties, VR has proved to be very promising for treatment mental health problems in adults, including paranoia and psychosis. Further studies are necessary to explore potential applications of VR to treatment of mental health problems in adolescents.
PUBLICATIONS:
The first publication from this work is currently under review in Psychological Medicine.
Gayer-Anderson C, Knowles G, Beards S, Turner A, Stanyon D, Davis S, Blakey R, Lowis K, Dorn L, Orori A, Rus-Calafell M, Morgan C, Valmaggia L. Immersive virtual reality as a novel approach to investigate the association between adverse events and adolescent paranoid ideation.
Two other publications are in the final stages of preparation, to be submitted in the next month.
Lecce F, Knowles G, Beards S, Stanyon D, Turner A, Davis S, Blakey R, Dorn L, Rus-Calafell M, Morgan C, Valmaggia L, Gayer-Anderson C. The relationship between bullying victimization, interpersonal sensitivity and paranoid ideation in adolescence: a virtual reality study
Lecei A, Vansteelandt K, van Winkel R, Knowles G, Beards S, Stanyon D, Turner A, Davis S, Blakey R, Dorn L, Rus-Calafell M, Morgan C, Valmaggia L, Gayer-Anderson C. Facial emotion recognition is not associated with levels of state paranoid ideation in adolescents with experiences of childhood adversity: a large Virtual Reality population-based study
CONFERENCES ATTENDED:
I have presented the findings from this study at several national and international conferences and meetings, including:
The Digital Child Heath Conference (London, May 2018)
A meeting organised exclusively for European researchers and industrial partners who develop and use VR for the assessment and treatment of mental health conditions (Groningen, June 2018)
The International Federation of Psychiatric Epidemiology (IFPE, Melbourne, Oct 2018)
The IEPA Early Intervention in Mental Health conference (Boston, Oct 2018).
The Virtual Social Interaction Workshop (London, December 2018)
Unfortunately, due to Covid-19, two conferences at which I was due to present the findings of this research, were cancelled in 2020. These included:
Symposium presentation at The European Psychiatric Association (EPA) 2020 conference in Spain (March 2020)
Invited presentation at the Royal Society of Medicine on the uses of VR for mental health (November 2020).
I also demonstrated the VR canteen application to academic audiences as part of the NIHR Maudsley Biomedical Research Centre Away Day (Jan 2018) and the SLaM International Clinical Trials Day (May 2018). Finally, since 2018, I have been working with a research team who has translated the VR canteen application that we created to be used for a school based adolescent mental health study in Belgium.
WIDENING PARTICIPATION AND PUBLIC ENGAGEMENT:
This work has been the basis for several engagement and impact activities. For example, over the three years, I have led several practical sessions (more recently online, given the Covid-19 pandemic) on the use of VR in mental health research. This has reached an audience of around 150 to 200 secondary school students from schools in the local area which are participating in the REACH study. The aim of these sessions was to provide opportunities for young people from disadvantaged backgrounds to learn about research and to learn about, experience, and access university, as well as to stimulate interest in STEM subjects.
I have demonstrated the VR canteen at two prominent and highly regarded science festivals centered on raising awareness of mental health and scientific research in the general public:
London Science Museum Lates (London, July 2018). The event was attended by around 5,000 visitors in one evening.
New Scientist Live event, attended by over 30,000 visitors across 4 days (London, September 2018)
Two additional events in 2020 that I was invited to showcase the VR application at were cancelled because of Covid-19 (British Academy Summer Showcase, and the IoPPN Psychology and Systems Sciences Divisional School Participation Event).
MEDIA ATTENTION:
The work has also attracted some attention from national and international media outlets in the last 3 years, for example:
China Global Television Network (produced by Associated Press, broadcast November 2017) - two-minute coverage on the use of VR to assess paranoia in adolescents
BBC News TV Channel (‘BBC Click’ – broadcast June 2018) - four-minute coverage on the use of VR to assess paranoia in adolescents
BBC Tech programme (BBC World Service) to report on the use of virtual reality in mental health research and treatment (broadcast May 2019). This has a 75 million global reach.
Interviewed for Times Educational Supplement on uses for VR for mental health in schools (publication was deferred because of Covid-19).
POLICY AND INDUSTRY STAKEHOLDERS:
Invited to provide a demonstration of the VR school canteen at an exclusive soiree at the House of Commons (organised by MQ) which was attended by a number (~100) of politicians and celebrities (February 2018).
Presented results from, and demonstrated, the VR canteen to a delegation from the Korean government, Digital Contents Division, Software Policy, Bureau Ministry of Science and ICT (December 2018)
VR Canteen application was selected as a finalist for a ‘VR healthcare application of the year’ for the European VR Awards 2019.