The Use of Virtual Reality to Facilitate Mindfulness Skills Training in Dialectical Behavioral Therapy for Borderline Personality Disorder: A Case Study

Abstract

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.

The Use of Virtual Reality Facilitates Dialectical Behavior Therapy® “Observing Sounds and Visuals” Mindfulness Skills Training Exercises for a Latino Patient with Severe Burns: A Case Study

“…Patients can become discouraged by their difficulty concentrating, and decrease practice, stunting how much they benefit from mindfulness. Although, starting with basic mindfulness exercises and working toward more challenging exercises over time (i.e., scaffolding mastery) can address part of this problem, other facilitators of patient engagement and mastery with mindfulness exercises, such as increasing attentional focus using immersive virtual reality, might provide significant benefits (Navarro-Haro et al, 2016 ).…”

“…“Being there” in this rich, novel VR environment engages a significant portion of the participant's attentional resources, such that other competing stimuli are rendered comparably less potent. Immersive VR blocks patients' view of the real world (Hoffman et al, 2000 ; Hoffman, 2004 ), and may help patients focus their attention on the mindfulness skills exercise in VR (Navarro-Haro et al, 2016 ). Virtual Reality DBT® mindfulness skills learning is a simple new psychological technique that combines mindfulness with immersive virtual reality.…”

Virtual reality as a non-pharmacologic analgesic for fasciotomy wound infections in acute compartment syndrome: a case report

“…It has been shown in patients with burns that VR analgesics based on focus-shifting mechanisms are more effective at alleviating pain than that of mere passive distraction [23]. Skill-building aims to foster a patient's capacity to achieve a certain mental state, such as mindfulness mediation, in order to control their mental and physical responses to painful conditions [24,25]. As skillbuilding would require more active engagement than simple passive distraction [12], this might prove difficult for some patients in ICU.…”

Regulação emocional personalizada para sistemas tutoresinteligentes por meio de traços de personalidade

“…Quando errou, o agente pedagógico apoiou o estudante a reavaliar sua emoção no momento, por meio de mensagens motivacionais. Na realidade virtual, a estratégia de reavaliação cognitiva aconteceu por meio da técnica de mindfulness, em que foi mostrado imagens com paisagens conduzindo o estudante para um estado de atenção plena (BOSSE et al, 2012;NARARRO-HARO et al, 2016).…”

“…Quando houvesse uma falha, o agente pedagógico apoiava o estudante a reavaliar a sua emoção atual usando mensagens motivacionais. Na interação por realidade virtual, o estudo de Nararro-Haro et al (2016) consistiu em usar a estratégia de reavaliação cognitiva por meio da técnica de mindfulness mostrando imagens com paisagens, na qual levava o estudante a um estado de relaxamento. A realidade virtual também foi utilizada para o enfrentamento de situações de estresse, com a teoria proposta por Lazarus (1993).…”