Physiological responses to the virtual reality-based Trier social stress test in patients with psychosis

Objectives: The Trier social stress test (TSST) is one of the most reliable and widely used laboratory tests for evaluating the physiological stress response. We developed a virtual reality-based TSST (VR-TSST) and investigated the physiological responses to this test in patients with psychosis and healthy controls (HCs). Methods: The participants comprised 60 patients with psychosis and 66 HCs. The VR-TSST consisted of three scenarios: a resting phase (baseline; 2 min), a job interview (5 min), and a mental arithmetic task (5 min). Blood cortisol levels were measured at baseline, during the test, and at 5–10 min and 30 min after the test. The skin conductance level, heart rate, and RR intervals were measured at baseline, during the job interview, and during the arithmetic task. Results: The VR-TSST produced no discernible cortisol response in patients with psychosis compared to the HCs. However, a higher skin conductance level and heart rate and shorter RR intervals were found in the patients than in the HCs at baseline, during the job interview, and during the arithmetic task. Conclusion: These findings suggest that the current version of the VR-TSST induces stronger autonomic and cardiovascular, but not endocrine, responses in patients with psychosis than in HCs. The VR-TSST could be a valuable tool to evaluate or train the stress response in patients with psychosis.