1 General Introduction 23 Chapter 4 describes an exploratory study in which the popular presumption of alexithymia being a transmission mechanism between BPP and several forms of emotional dysregulation is examined. To date, many of the studies on alexithymia, BPP and related clinical variables are still centred around examining bivariate associations. Although some studies contain analyses on moderation effects, there seems to be no published work on the possibility of alexithymia being a mediator in the interplay between BPP and other clinical variables. In this chapter, I describe a study in which a combined group of adult psychiatric in- and outpatients completed questionnaires on BPP, alexithymia, depression severity, dissociative experiences and direct and indirect SIB, and a clinical interview on alexithymia. The study addresses two important shortcomings present in the majority of studies on this topic: it not solely relies on the use of a (criticized) self-report questionnaire for alexithymia but employs a multi-method approach by also gathering data via a (psychometrically valid) structured clinical interview. Second, most studies still include a categorical approach for determining presence of borderline personality pathology in participants. In this study, BPP is measured via a dimensional approach, which is generally regarded as a more valid take on personality disorders. With its focus on alexithymia as a transmission mechanism, outcomes of this study add to the understanding of the role of alexithymia in BPP on a ‘deeper level’. Part III: development of a biosensor-informed wearable smartwatch/smartphone application to advance treatment of alexithymia and low emotional awareness Part III handles the second aim of this thesis. Here, the basic research paradigm is that of design science, rather than that of natural (psychological) science as it was in part I and II. Within design science the use of User Centered Design (UCD) - or its evolution, User Experience Design (UXD) - in mental health related apps has become a hot topic. Scientifically designing and developing a new type of therapeutic intervention requires three processes to be completed: first, the process of creating a conceptual framework by which to structure and formally guide subsequent development. Second, the process of identifying the main requirements for the intended intervention. Third, the process of actual practical realization of the intervention, in this case a software application, requiring use of academically valid tools and (evaluation) methods. However, many studies miss out on one or more of these three steps. For example, design frameworks provided in UCD studies often do not adhere to academically sound procedures and methods. Most publications fail to provide the reader with clear guidelines on how to actually go about in such usecase scenarios. Also, in many studies patients are not involved in the process of creating the app or intervention.
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