Borderline personality disorder (BPD) is a severe mental disorder characterized by a dysfunctional pattern of affective instability, impulsivity, and disturbed interpersonal relationships. Dialectical Behavior Therapy (DBT®) is the most effective treatment for Borderline Personality Disorder, but demand for DBT® far exceeds existing clinical resources. Most patients with BPD never receive DBT®. Incorporating computer technology into the DBT® could help increase dissemination. Immersive Virtual Reality technology (VR) is becoming widely available to mainstream consumers. This case study explored the feasibility/clinical potential of using immersive virtual reality technology to enhance DBT® mindfulness skills training of a 32 year old female diagnosed with BPD. Prior to using VR, the patient experienced difficulty practicing DBT® mindfulness due to her emotional reactivity, and difficulty concentrating. To help the patient focus her attention, and to facilitate DBT® mindfulness skills learning, the patient looked into virtual reality goggles, and had the illusion of slowly “floating down” a 3D computer-generated river while listening to DBT® mindfulness training audios. Urges to commit suicide, urges to self harm, urges to quit therapy, urges to use substances, and negative emotions were all reduced after each VR mindfulness session and VR mindfulness was well accepted/liked by the patient. Although case studies are scientifically inconclusive by nature, results from this feasibility study were encouraging. Future controlled studies are needed to quantify whether VR-enhanced mindfulness training has long term benefits e.g., increasing patient acceptance and/or improving therapeutic outcome. Computerizing some of the DBT® skills treatment modules would reduce cost and increase dissemination.

At the core of an overcontrolled personality and coping style is a tendency to have too much self-control, exhibiting as behavioral and cognitive inflexibility, high inhibition of emotion, high detail-focused processing and perfectionism, and a lack of social connectedness. Overcontrol underlies a wide variety of psychiatric illnesses and as such, an innovative transdiagnostic therapy called Radically Open Dialectical Behavior Therapy (RO DBT) has been developed to treat disorders characterized by overcontrol. RO DBT targets maladaptive social signaling in order to help individuals "rejoin the tribe," hypothesizing that increasing social connectedness by means of targeting social signaling is the central mechanism of change in treatment. Because RO DBT is used for individuals with an overcontrolled personality style, rather than individual disordered symptoms, it can be used transdiagnostically across a range of comorbid disorders, including treatment-resistant depression and anxiety, anorexia nervosa, and personality disorders such as obsessivecompulsive personality disorder. The current article introduces this novel treatment approach and discusses its emphasis on social signaling and its transdiagnostic nature. We then provide the first review of existing literature testing the efficacy of RO DBT across clinical populations, discuss issues related to assessment of overcontrol, and speculate on future directions for this novel therapy.

BackgroundEmotional sensitivity is a construct found in major developmental models of borderline personality disorder. However, the construct remains nebulous. The patient perspective is crucially important in helping to define and conceptualize any psychological construct – especially one that plays such a large role in the developmental theories of a given disorder. The aim of the current study was to explore the meaning of emotional sensitivity from the perspective of those who identify as being emotionally sensitive.MethodsParticipants were from a community sample of adults (Mage = 32.05, range: 21–59) who responded to an advertisement for a study of emotional sensitivity. Participants completed surveys related to personality pathology and a semi-structured interview about emotional sensitivity. Emotional sensitivity interviews were independently coded by two research assistants trained in qualitative analyses for content and process. Coders were blind to the personality pathology status of participants.ResultsRegardless of level of personality pathology, qualitative results of the emotional sensitivity interview largely suggest that emotional sensitivity is a heightened emotional reactivity to stimuli, including the emotions of other individuals, or a tendency to have emotional reactions to even low impact stimuli. However, emotional sensitivity was regarded predominantly as a negative trait (i.e. burden) only by those who have high levels of borderline personality pathology.ConclusionsThe implications of these results for the conceptualization and utility of emotional sensitivity in borderline personality disorder are discussed.

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