A prospective study implicates distinct and potentially opposing threat-related developmental pathways of VR-assessed state paranoia and anxiety in adolescence

Abstract Purpose This study longitudinally examined the possible bidirectional relationship between anxiety and paranoia in adolescents aged 12 to 18 and the role of childhood threat experiences. Methods Data were collected in two waves, 18 months apart, involving 120 adolescents at baseline. State paranoia was assessed using the State Social Paranoia Scale (SSPS) in two distinct Virtual Reality (VR) environments. Anxiety was measured with the Revised Children’s Anxiety and Depression Scale (RCADS25), while childhood threat exposure was evaluated using the Juvenile Victimization Questionnaire (JVQ). Multilevel linear and multiple regression analyses were conducted to examine associations and moderation effects. Results State paranoia in a school canteen VR environment at baseline significantly predicted state paranoia in a VR bar environment 18 months later (b = 0.45, SE = 0.10, p < 0.001). Similarly, anxiety at baseline strongly predicted anxiety at follow-up (b = 0.46, SE = 0.10, p < 0.001), but no associations were found between state paranoia and anxiety over time in either direction. Childhood threat exposure moderated the relationship between baseline state paranoia and anxiety at follow-up (b = -0.17, SE = 0.06, p = 0.009), with adolescents experiencing higher state paranoia and threat exposure at baseline showing lower anxiety at follow-up. Conclusion VR can capture subtle paranoid ideation in ecologically valid, dynamic social interactions that are consistent over time and across different VR environments. The evolution of these paranoid ideations may be independent of, or even opposed to, that of general anxiety, suggesting distinct developmental pathways in anxiety and paranoia.