Chapter 1 10 1. Introduction This dissertation is about something that applies to us all. At the same time, it is about a select subgroup of people with a select problem – and the development of an even more select innovative intervention. So, what is it about? At the broadest, this dissertation is about the awareness and recognition of one’s own emotions. Somewhat more specific, it is about what it implies when the ability to be aware of and recognise emotions is hampered - in the even more specific situation that you happen to be a patient in therapy struggling with borderline personality pathology (BPP). For patients with BPP, hampered emotional awareness can aggravate their problems, while it simultaneously poses an additional challenge in getting the most out of their treatment - as treatment generally requires a certain awareness of emotions to be effective. Luckily, this dissertation is also about the development a potentially potent, technology driven, new intervention that could be of benefit to them. The dissertation contains 7 chapters. This first chapter provides a general introduction to the topics covered in the rest of the thesis. Starting with the work on emotion by William James in section 1, the reader is then introduced in section 2 to emotion regulation as the subsequent focus for therapy and research and shows how progressive insight continued to redirect clinicians and emotion researchers ‘back’ to the basic prerequisite of emotion regulation, namely emotional awareness. Section 3 introduces borderline personality disorder as one of the mental disorders most in need of ameliorating emotion regulation – and thus emotional awareness. Section 4 then taps into the topic of alexithymia, a personality construct characterised by a notably low level of emotional awareness. Sections 5 and 6 discuss the role of psychophysiology of emotion and thus in a way return to James’ theory on the embodiment of emotion. Section 5 focuses on the matter of ‘response coherence’: the degree to which the physiological, behavioural and experiential elements of an emotional response do - or do not – cohere. Section 6 goes into the concept of interoceptive awareness as a ‘bonding agent’ between bodily sensations and felt emotion, and how it is generally found missing in persons with BPP and/or alexithymia. Section 7 discusses the potential of present-day mobile health and biosensing technology in delivering a new way to help patients improve on their emotional awareness. Section 8 discusses some of the gaps and risks bound to the use technology in mental health care. Section 9 presents the aims and outline of this dissertation.
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