Improve Borderline Personality Disorder Therapy with Virtual Reality

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By John M. de Castro, Ph.D.


“Through virtual reality, the brain can succumb to compelling evidence that you are actually somewhere else. . . not only putting users in a relaxing location, but also completing the exercises, can shift your mood and teach you to live a more mindful life — overcoming the stresses encountered in everyday life.” – Naomi Cornman


Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. Needless to say, it is widespread and debilitating.


One of the few treatments that appears to be effective for Borderline Personality Disorder (BPD) is Dialectical Behavior Therapy (DBT). It is targeted at changing the problem behaviors characteristic of BPD including self-injury. Behavior change is accomplished through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DPT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness.


Technology is recently becoming applied to training in mindfulness. Indeed, mindfulness training carried out completely on-line has been shown to be effective for as number of conditions. But, now virtual reality (VR) devices are improving and becoming readily available. Previously it has been shown the virtual reality (VR) can be helpful in treating phobias. It is not known, however, if VR can be used in mindfulness training and in the treatment of Borderline Personality Disorder (BPD).


In today’s Research News article “The Use of Virtual Reality to Facilitate Mindfulness Skills Training in Dialectical Behavioral Therapy for Borderline Personality Disorder: A Case Study.” See:

or see summary below or view the full text of the study at:

Nararro-Haro and colleagues performed a single subject case study of the use of VR to potentiate the effects of the mindfulness training used in Borderline Personality Disorder (BPD). The participant was a 32-year old woman who was diagnosed with BPD. She was being treated with Dialectical Behavior Therapy (DBT) but was having difficulty with the mindfulness component of DBT. In addition to the standard DBT virtual reality (VR) of floating down a gentle river was used along with the DBT mindfulness audio tracks. The participant was measured during and after training for mindfulness, mood, urges and dysfunctional behaviors.


After treatment, the participant had marked reductions in urges to commit suicide, harm herself, quit therapy, and substance abuse. In addition, she had markedly reduced negative emotions. These results are encouraging but there was only a single subject, there was no control condition, and there was no follow-up. So, no firm conclusions about effectiveness can be reached. But the results demonstrate that virtual reality can be employed to help potentiate the effectiveness of therapy of Dialectical Behavior Therapy (DBT) for Borderline Personality Disorder (BPD).


So, improve borderline personality disorder therapy with virtual reality


“Traditional exposure therapy is easier to do when the phobia is of something common and easily accessible. A person afraid of dogs can visit a neighbor’s dog. An agoraphobic can slowly venture outside for short periods of time. But treating phobias like fear of flying or fear of sharks with traditional exposure therapy may be expensive or impractical in real life. That’s where VR has a major advantage. Treating PTSD with VR works similarly, exposing patients to a simulation of a feared situation (a battle in Iraq, for example), and appears to be just as effective.” –  Emily Matchar

CMCS – Center for Mindfulness and Contemplative Studies


This and other Contemplative Studies posts are also available on Google+


Study Summary

Nararro-Haro MV, Hoffman HG, Garcia-Palacios A, Sampaio M, Alhalabi W, Hall K and Linehan M (2016) The Use of Virtual Reality to Facilitate Mindfulness Skills Training in Dialectical Behavioral Therapy for Borderline Personality Disorder: A Case Study. Front. Psychol. 7:1573. doi: 10.3389/fpsyg.2016.01573


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.


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