Effects of childhood adversity on socially learned placebo analgesia in virtual reality: A cross-sectional study

Early life adversity (ELA), indexed through Adverse Childhood Experiences (ACEs), is associated with long-term alterations in emotion regulation, stress responsivity, and social learning--factors that may shape learned pain modulation. Social observation in immersive virtual environments offers a powerful way to investigate these mechanisms. To examine whether ELA influences social observation-induced placebo analgesia and empathy responses in immersive and non-immersive contexts. Adults with self-reported low versus high ACE exposure completed an observational learning task in immersive virtual reality (VR) or a non-immersive format. Participants observed Human or Avatar demonstrators experiencing pain relief and then underwent self-pain testing. Measures included socially induced placebo analgesia and affective and cognitive components of state empathy. Individuals with high ACE exposure showed stronger social observation-induced placebo analgesia, particularly within immersive VR. High ACE participants exhibited reduced affective state empathy, while cognitive empathy remained comparable to the low ACE group. Elevated ELA is unexpectedly associated with enhanced responsiveness to socially learned placebo analgesia, especially in immersive VR settings. These findings highlight how early adversity may shape sensitivity to socially transmitted treatment cues, with implications for the design of VR-based therapeutic interventions.