JMIR Publications

ABSTRACT

Background:

A core feature of borderline personality disorder (BPD) is impaired emotion regulation, which is associated with heightened stress reactivity. Self-management tools providing in-the-moment support may benefit this population. Mobile health apps could offer such support, but few address stress management in BPD. The Stress Autism Mate (SAM) app, developed for adults with autism, supports stress management through daily stress monitoring, pattern recognition and personalized feedback.

Objective:

This study evaluated the SAM app in adults with BPD traits, examining changes in daily stress as measured within the app and changes in perceived stress, coping self-efficacy, and resilience.

Methods:

A single-case A-B design was used to examine daily stress trajectories over 30 days in 16 adults with BPD traits, of whom 12 met the compliance threshold for single-case analyses. Non-overlap of All Pairs and Tau-U were calculated to quantify individual-level change. Standardized questionnaires assessed perceived stress, coping self-efficacy, and resilience at baseline, after four weeks of treatment as usual, post-intervention, and at 4-week follow-up. Changes were analyzed using linear mixed-effects models.

Results:

Daily stress trajectories varied across participants; three showed trends toward decreased stress, four toward increased stress, and five remained stable. Two participants showed statistically significant changes (Tau-U = −0.35, P < .001; Tau-U = 0.49, P = .039). Linear mixed-effects models showed that perceived stress decreased significantly at post-intervention (b = −0.36, 95% CI −0.71 to −0.02; P = .04) and follow-up (b = −0.53, 95% CI −0.93 to −0.14; P = .009), compared to baseline. Coping self-efficacy did not change immediately post-intervention but improved significantly at follow-up (b = 0.94, 95% CI 0.22 to 1.66; P = .01). Total resilience scores showed no significant change post-intervention but improved at follow-up (b = 0.22, 95% CI 0.04 to 0.40; P = .02). The resilience subscale acceptance of self and life improved both post-intervention (b = 0.24, 95% CI 0.04 to 0.44; P = .02) and at follow-up (b = 0.37, 95% CI 0.14 to 0.60; P = .002), compared to baseline.

Conclusions:

This study provides preliminary evidence that the SAM app may be feasible and benefit adults with BPD traits by reducing perceived stress and improving coping self-efficacy and resilience. Individual responses varied, highlighting the need for personalized approaches. Larger controlled trials and qualitative studies are needed to evaluate effectiveness and explore user experiences.