Stress Autism Mate (SAM) App for Stress Management in Adults With Borderline Personality Disorder Traits

The Effects of a Stress Management App on Enhancing Insight and Coping With Daily Stress in Adults With Borderline Personality Disorder Traits

The goal of this intervention study is to learn whether a stress management app (Stress Autism Mate, SAM) can help reduce stress and support coping in adults with borderline personality disorder traits receiving outpatient mental health care. The SAM app is a self-monitoring app designed in co-creation with and for individuals with autism, that supports users in recognizing, understanding, and managing daily stress. The app measures stress levels multiple times per day by asking what you were doing, how you were feeling and your stress signals. It offers real-time feedback and a visual overview of stress levels at both the daily and weekly level, and connecting to your activities. This allows users to recognize their own stress triggers and patterns. In addition, the app provides practical stress-reducing tips. The study focuses on changes in daily stress levels and self-reported perceived stress, coping self-efficacy, and resilience during and after use of the app.

The main questions this study aims to answer are:

1. Does using the SAM app change daily stress levels measured within the app during four weeks of use?
2. Does app use reduce perceived stress and improve coping self-efficacy and resilience after the intervention?

Participants will:

• Use the SAM app on their smartphone for four weeks
• Complete short in-app stress questionnaires multiple times per day
• Complete online questionnaires about stress, coping, and resilience at several time points
• Continue their regular outpatient treatment during the study

Study Overview

• Status: Completed
• Conditions: Borderline Personality Disorder; Stress (Psychology); Perceived Stress
• Intervention / Treatment: Behavioral: Mobile Application for Stress Monitoring and Coping

• Study Type: Interventional
• Enrollment (Actual): 16
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Netherlands
  • Amersfoort, Netherlands, 3811MG
    • GGZ Centraal

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Presence of at least one borderline personality disorder (BPD) trait, as assessed according to DSM-5 criteria and the diagnostic guidelines of the Dutch Association of Psychiatry (NVVP)
• Age 18 years or older

Exclusion Criteria:

• inability to understand Dutch
• inability to use a smartphone

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Stress Autism Mate App Intervention; Participants in this single study arm use the Stress Autism Mate mobile application during a four-week intervention period. The app prompts participants to complete brief stress questionnaires multiple times per day and provides visual feedback on stress patterns and personalized coping suggestions. The intervention is used alongside treatment as usual in outpatient mental health care. Participants serve as their own control through within-subject comparisons over time.

Behavioral: Mobile Application for Stress Monitoring and Coping; This intervention consists of a smartphone-based stress monitoring and coping application designed to support daily self-management of stress. The application uses ecological momentary assessment to prompt users multiple times per day to report stress-related experiences in their own environment. Based on these inputs, the app provides visual feedback on individual stress patterns over time and offers personalized coping suggestions. The intervention is low risk and self-guided.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline in Daily Stress Scores as Measured by In-App Assessments During the Intervention Period	Daily stress was assessed using brief self-report stress questions embedded in the mobile application. Participants were prompted multiple times per day to rate their current level of stress. Stress scores reflect momentary perceived stress experiences and were aggregated over time for each participant. Change in daily stress was evaluated by comparing stress scores during the intervention period to the baseline phase.	From baseline (day 1-7) to the end of the intervention period (day 8-30).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline in Perceived Stress as Measured by the Perceived Stress Scale (PSS)	Perceived stress was assessed using the 10-item Perceived Stress Scale (PSS), a self-report questionnaire measuring the extent to which situations in life are experienced as stressful. Change in perceived stress was evaluated by comparing scores at post-intervention and follow-up to baseline.	From baseline to pre-intervention (week 4), to post-intervention (week 8) and 4-week follow-up (week 12).
Change From Baseline in Coping Self-Efficacy as Measured by the Coping Self-Efficacy Scale (CSES)	Coping self-efficacy was assessed using the Coping Self-Efficacy Scale (CSES), which measures confidence in the ability to cope with stressful situations. Changes were evaluated by comparing post-intervention and follow-up scores to baseline.	From baseline to pre-intervention (week 4), to post-intervention (week 8) and 4-week follow-up (week 12).
Change From Baseline in Resilience as Measured by the Resilience Scale (RS-NL)	Resilience was assessed using the Dutch version of the Resilience Scale (RS-NL), which measures personal competence and acceptance of self and life. Change in resilience was evaluated by comparing post-intervention and follow-up scores to baseline.	From baseline to pre-intervention (week 4), to post-intervention (week 8) and 4-week follow-up (week 12).

Collaborators and Investigators

• Sponsor: GGZ Centraal
• Investigators: Study Director: Yvette Roke, MD, PhD, GGZ Centraal

Study record dates

Study Major Dates

• Study Start (Actual): April 16, 2024
• Primary Completion (Actual): October 15, 2024
• Study Completion (Actual): November 12, 2024

Study Registration Dates

• First Submitted: March 6, 2026
• First Submitted That Met QC Criteria: March 6, 2026
• First Posted (Actual): March 11, 2026

Study Record Updates

• Last Update Posted (Actual): March 11, 2026
• Last Update Submitted That Met QC Criteria: March 6, 2026
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Borderline Personality Disorder; Resilience; Smartphone application; Ecological momentary assessment; Single-case experimental design; Psychological Stress; Stress management; Mobile health intervention; Stress monitoring; Coping self-efficacy; Outpatient mental health care
• Additional Relevant MeSH Terms: Mental Disorders; Behavioral Symptoms; Personality Disorders; Behavior; Stress, Psychological; Borderline Personality Disorder; Behavior Therapy; Psychotherapy; Behavioral Disciplines and Activities; Coping Skills
• Other Study ID Numbers: SAM_BPD_240102

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: At this time, no public individual participant data sharing is planned, but data may be made available upon reasonable request from the corresponding author, in accordance with institutional and ethical guidelines.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No