Better Safe Than Sorry? Exploratory Associations Between Fear-Learning Processes and Later Paranoia in Threat-Exposed Adolescents in Standardized Virtual Reality Environments.

BACKGROUND: Childhood threat exposure (CTE) has been linked to altered fear-learning, yet its prospective role in adolescent paranoia remains unclear. This study examined whether threat-safety discrimination (TSD) and fear generalization (FG) predict virtual reality (VR)-assessed state paranoia 18 months later, and whether CTE and gender moderate these associations.

METHODS: A total of 120 adolescents (aged 12-16) participated at wave 1, completing a classical conditioning and FG task and reporting CTE. At wave 2, 97 participants completed a VR social environment assessing state paranoia. Linear regression models tested TSD and FG main effects, followed by moderation by CTE, and the FG × CTE × gender interactions.

RESULTS: Neither TSD (β = 0.14, P = .198) nor FG (β = -0.07, P = .530) predicted wave 2 paranoia at group level. However, CTE significantly moderated the association between TSD and later paranoia (β = 0.21, P = .035), whereby adolescents with higher CTE and better discrimination showed higher paranoia. A significant FG × CTE × gender interaction (β = 0.53, P = .044) revealed divergent pathways: in boys, higher FG predicted lower paranoia (F(1, 84) = 7.34, P = .008), particularly with higher CTE, which was absent in girls.

CONCLUSION: Exploratory interactions, partly opposite to our hypotheses, suggested that better TSD and reduced FG were associated with higher paranoia in threat-exposed youth, particularly boys. This pattern may reflect a "better safe than sorry" strategy involving fine-grained appraisal of threat and safety cues, potentially adaptive in unpredictable and threatening environments but at the cost of greater distrust.