Digital phenotyping and interventions for sleep & circadian rhythms in borderline personality disorder

Thesis

Borderline personality disorder (BPD) is a mental health condition associated with severe psychological distress, considerable reductions to life expectancy, and significant increases to treatment cost relative to other psychiatric disorders. A growing body of evidence suggests that sleep disturbance is characteristic of the disorder and may be driven by circadian rhythm dysfunction.

This thesis aimed to understand whether digital interventions may be appropriate for treating sleep and circadian rhythm disturbances in individuals with BPD. This was undertaken first by using observational methods to first consider personality as a predisposing factor for insomnia (Chapter 2), and then by phenotyping sleep, rest-activity patterns, and mood instability in a BPD cohort and control group (Chapter 3). These findings motivate the remainder of the thesis, which focuses on clinical applications of digital interventions. Chapter 4 assesses the feasibility and preliminary efficacy of bright light therapy (BLT) and the first known study of digital cognitive behavioural therapy for insomnia (dCBT-I) in BPD. Chapter 5 explores participant experiences with these interventions and considers factors contributing to treatment adherence. Chapter 6 increases the generalisability of this thesis by systematically reviewing digital interventions treating symptoms of BPD, presenting meta-analyses of treatment effect, and considering the impact of interface design and implementation on the efficacy of digital interventions.

Findings suggest that maladaptive personality may contribute to sleep problems which in turn exacerbate mood instability, one of the core symptoms of BPD. Preliminary research on dCBT-I and BLT in BPD suggested improvements to sleep and an anti- depressant effect, though results require replication. Participants reported that treatment was acceptable but highlighted difficulties with motivation and implementation that were reflected in adherence data; these concerns may be addressed by implementing participant feedback and employing interface features associated with treatment efficacy. This thesis motivates regular clinical assessment of sleep in BPD and suggests that digitally delivered sleep and chronotherapeutic interventions may be feasible in this group with appropriate modifications.

Authors: Lindsay, J

• DOI: 10.5287/ora-9ojgemz17
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: borderline personality; personality disoder; cognitive behavioural therapy; circadian rhythms; digital interventions; mood instability; BPD; sleep; bright light therapy
• Subjects: Psychology; Circadian rhythms; Digital Interventions; Sleep; Personality disorders; Psychiatry