# aVeRsive tension: A new virtual reality paradigm to assess emotional arousal in adolescent and young adult patients with symptoms of borderline personality disorder

## TL;DR

A new virtual reality tool called aVeRsive tension was developed to measure emotional arousal in young people with borderline personality disorder symptoms, showing it can effectively detect differences compared to healthy controls.

## Contribution

The aVeRsive tension paradigm is a novel VR-based method for assessing emotional arousal in adolescents and young adults with BPD symptoms.

## Key findings

- Patients with BPD symptoms showed significantly higher emotional arousal levels than healthy controls across both VR conditions.
- The BPD group maintained elevated emotional arousal during the stress condition in the Cyberball task, unlike the HC group.
- Physiological data, such as heart rate, supported the subjective findings, particularly during the stress condition.

## Abstract

High emotional arousal (EA) is a core feature of borderline personality disorder (BPD). While virtual reality (VR) has shown promise in treating emotion-based disorders, research on VR applications for BPD remains limited, especially in adolescence. This study aimed to validate a novel VR-based aVeRsive tension paradigm for assessing EA in adolescents and young adults with BPD symptoms.

In a multimodal study, we investigated the validity of aVeRsive tension: We surveyed 62 patients with BPD symptoms and 62 healthy controls (HC) aged 13–25 years who completed two VR sessions (stress/control condition). Each session included an adapted Trier Social Stress Test (TSST) followed by a cyberball paradigm. Subjective EA ratings and physiological measurements were taken during the sessions.

The BPD group showed significantly higher EA levels compared to HC across both conditions. While both groups exhibited peak EA after TSST, HC demonstrated EA reduction during Cyberball in both conditions. The BPD group maintained elevated EA levels in the stress condition. Physiological data partially supported these findings, with the BPD group showing higher heart rates, particularly during Cyberball in the stress condition.

The aVeRsive tension paradigm successfully discriminated between BPD and HC groups, capturing both subjective and physiological responses. The sustained EA in the BPD group during stress conditions aligns with characteristic emotion dysregulation patterns. While task-specific effects were observed, with TSST eliciting stronger responses than Cyberball, the paradigm effectively simulated real-life stressors in a controlled VR environment.

This study validates the aVeRsive tension protocol as a promising tool for assessing EA in adolescents and young adults with BPD symptoms. The VR-based approach offers advantages in experimental control and ecological validity, showing potential for both diagnostic assessment and therapeutic intervention in clinical settings.