xml: <clinical_study>
    <!-- This xml conforms to an XML Schema at:
      https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
    <required_header>
      <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
      <link_text>Link to the current ClinicalTrials.gov record.</link_text>
      <url>https://clinicaltrials.gov/ct2/show/NCT05994105</url>
    </required_header>
    <id_info>
      <org_study_id>Bahria University</org_study_id>
      <nct_id>NCT05994105</nct_id>
    </id_info>
    <brief_title>Integration of Augmented Reality in Expressive Art Therapy for Borderline Personality Features</brief_title>
    <official_title>Integration of Augmented Reality in Expressive Art Therapy for Borderline Personality Features</official_title>
    <sponsors>
      <lead_sponsor>
        <agency>Bahria University</agency>
        <agency_class>Other</agency_class>
      </lead_sponsor>
    </sponsors>
    <source>Bahria University</source>
    <oversight_info>
      <has_dmc>Yes</has_dmc>
      <is_fda_regulated_drug>No</is_fda_regulated_drug>
      <is_fda_regulated_device>No</is_fda_regulated_device>
    </oversight_info>
    <brief_summary>
      <textblock>
        From the last decades, applied approach for the use of augmented reality on clinical and&#xD;
        health psychology has grown exponentially. Hence, the present study is aimed to examine the&#xD;
        effectiveness of augmented reality for the treatment of borderline personality features in&#xD;
        young adults. For the purpose, it is hypothesized that (i) borderline personality features of&#xD;
        experimental groups will be reduced in posttest followed by the integration of augmented&#xD;
        reality in expressive art therapy (ii) Borderline personality features of experimental group&#xD;
        will decrease significantly as compared to control group in the post test followed by the&#xD;
        integration of augmented reality in expressive art therapy (iii) Borderline personality&#xD;
        feature of self-destruction will be reduced in posttest followed by the integration of&#xD;
        augmented reality in expressive art therapy (iv) Borderline personality feature of affect&#xD;
        regulation will be reduced in posttest followed by the integration of augmented reality in&#xD;
        expressive art therapy and (v) Borderline personality feature of negative self-perception&#xD;
        will be reduced in posttest followed by the integration of augmented reality in expressive&#xD;
        art therapy. For the present purpose, a total of 20 subjects experiencing symptoms of&#xD;
        Borderline personality features will be screened and recruited from the Umeed e Nau clinics&#xD;
        of the Institute of Professional Psychology Bahria University Karachi Campus by initial&#xD;
        screening of the subjects. Participants will be monitored through pre and post-screening of&#xD;
        Borderline Symptoms Checklist assigned to an experimental (treatment group) and control&#xD;
        (waiting list) group using convenient sampling. The experimental group will receive the&#xD;
        Management plan; which will be comprised of total 14 sessions. The effectiveness of the&#xD;
        intervention plan will be measured via quantitative measure (the latest version of SPSS).&#xD;
      </textblock>
    </brief_summary>
    <detailed_description>
      <textblock>
        The final sample consisted of 20 participants (aged 18-36, males n=5, and females n=15). Half&#xD;
        of the sample was assigned to the intervention group, while the other half was assigned to&#xD;
        the control group as per convenient sampling method. The intervention group participants were&#xD;
        provided with a total of fourteen psychotherapy sessions at Umeed-e-Nau clinic at the&#xD;
        Institute of Professional Psychology.&#xD;
  &#xD;
        Assemblr Studio: Easy AR Maker (android version 4.1.7) Assemblr studio was used to make&#xD;
        augmented reality within the sessions. It is a free android application for turning 2-D and&#xD;
        3-D images into augmented reality. The application was designed by Assemblr (2018) and&#xD;
        consists of a marker less based type of augmentation. Rather it uses basic templates and&#xD;
        camera picture upload options, transforming a simple image into augmented reality format. It&#xD;
        also provides drag and drop options and does not require any coding.&#xD;
  &#xD;
        3-D Pen/ Doodling pen A digital 3-D pen was used to contrast art in the sessions. It was a&#xD;
        portable and handheld type of machine.&#xD;
  &#xD;
        Procedure Approval to conduct this research was taken from the board of the Institute of&#xD;
        Professional Psychology, Bahria University, Karachi Campus. The participants were then&#xD;
        approached via advertisement on social media platforms highlighting awareness regarding&#xD;
        borderline personality features and the objectives of the present research. The sample frame&#xD;
        consisted of 36 individuals which were then screened for the inclusion criteria using the&#xD;
        Borderline symptoms list. The final 20 participants were then randomly divided into two equal&#xD;
        groups, namely the treatment group and the control waiting-list group. The final 20&#xD;
        participants were all made privy to the details and purpose of the research and their consent&#xD;
        was taken. Confidentiality was maintained and the participants retained the right to withdraw&#xD;
        their participation at any point in the study, as well as remain able to decide not share&#xD;
        details of specific traumatic or hurtful life events. Moreover, the researchers took all&#xD;
        necessary steps to ensure safety of the participants' wellbeing.&#xD;
  &#xD;
        The experimental group's treatment plan for augmented reality-based art therapy interventions&#xD;
        comprised of 14 weekly individual standard sessions. Each session was of approximately 90&#xD;
        minutes, duration of which was divided into 5 minutes initial check-in to reflect&#xD;
        participant's outer world, 30 minutes for making art, 30 minutes for discussing the art, 10&#xD;
        minutes to wrap up the session, and 5 minutes final check-out to reflect on the session's&#xD;
        interventions, explorations, and learning.&#xD;
  &#xD;
        The treatment plan was divided into three levels. Level one comprised of three primary&#xD;
        intervention-based sessions designed to help build rapport and have the participants get&#xD;
        familiar with intervention's concept. Level two, lasting from session four to session twelve,&#xD;
        dealt with gradually evolving the participants' perceptual continuum to a developmental&#xD;
        continuum where the individual would the be able to make desired changes and recreate their&#xD;
        thoughts, feelings, and behaviors. The third and final level included sessions thirteen,&#xD;
        fourteen, and the consequent follow-ups. Its purpose was to reflect upon the participants'&#xD;
        learning so far and to sum up the termination phase of therapy. The follow-up session took&#xD;
        place three weeks after the unilateral termination of the regular sessions. Here the&#xD;
        participants were required to complete the Borderline Symptoms List (Bohus et al., 2007), and&#xD;
        if it was assessed that a participant needed further therapeutic help, they were provided&#xD;
        with referrals to professionals. The control group participants were also assessed for&#xD;
        post-test borderline symptoms at this point of time.&#xD;
  &#xD;
        After the completion of the study, the results were coded and analyzed using SPSS version&#xD;
        22.0.&#xD;
  &#xD;
        Session Plan Session 01 - GROW (The Kitchen Table Classroom, 2019). The aim of this session&#xD;
        was to develop rapport with the participant through semi structured interview and goal&#xD;
        setting. The objective of the session was to explore the concept of personal change in&#xD;
        clients via art medium where they drew the word GROW and self-reflected from their onwards.&#xD;
  &#xD;
        Session 02 - Scribble zoom in and out (Khat &amp; Macklin, 2019). The aim of the session was to&#xD;
        facilitate the process of catharsis, and have the client engage in and explore their&#xD;
        impulsivity and curiosity. Moreover, childhood insecurities and traumas were explored in this&#xD;
        session as well and the artwork was used to discuss the participant's self-perception of&#xD;
        change.&#xD;
  &#xD;
        Session 03 - Blind Contour Drawing (Hu et al., 2021). The aim of the session was to&#xD;
        psychoeducate the participant with the primary goal of using blind contour drawing to draw&#xD;
        attention towards differences of perceptions and conceptualization of information. The&#xD;
        objective of this intervention was to help the participant become aware of their own&#xD;
        judgmental reactions in different life circumstances.&#xD;
  &#xD;
        Session 04 - Self-Awareness via Johari's window (Batool, 2018). The aim of the session was to&#xD;
        introduce the concept of thought modification via developing insight through blind spots, in&#xD;
        a nonjudgmental and nonthreatening manner. The objective of the session's activity was to&#xD;
        help the participant become self-aware and to bring positive change in self-development.&#xD;
  &#xD;
        Session 05 - My Life Outline (Batool, 2018). The aim of the session was to address&#xD;
        self-harming behavior in session by identifying distressing elements in the participant's&#xD;
        life, and to learn to better cope with these distressing elements in a nonjudgmental manner.&#xD;
        The objective was to have the participant become able to identify different distressing and&#xD;
        pleasant moments in their life, eventually leading to development of insight and stability in&#xD;
        mood regulation.&#xD;
  &#xD;
        Session 06 - Free Flow Writings without stimulus (Batool, 2018). The aim of the session was&#xD;
        to channel emotional distress, negative thoughts, and self-destructive behavior. It was based&#xD;
        upon the presumption that, while everybody has something to say and the ability to say it,&#xD;
        the mental wellspring may be blocked by apathy, self-criticism, resentment, anxiety about&#xD;
        deadlines, fear of failure or censure, or other forms of resistance. Objective was to explore&#xD;
        and discuss features of personality malfunctions.&#xD;
  &#xD;
        Session 07 - Draw what you hear (Chowdhury, 2019). The aim of the session was to provide the&#xD;
        participant with cathartic medium to anchor their self, with respect to emotional distress&#xD;
        and mood regulation. The objective was that via this integration of the self, the participant&#xD;
        would then be able to regulate their free affirmative emotions.&#xD;
  &#xD;
        Session 08 - Draw your breath (Batool, 2018). The aim of the session was to strengthen&#xD;
        self-awareness, which eventually helped the participant to maintain mood, regulate&#xD;
        self-image, and possibly reduce self-harm. Objective was to help the participant feel relief&#xD;
        by the end of the session.&#xD;
  &#xD;
        Session 09 - Body Healing in Ink (Batool, 2018). The aim of the session was to reduce the&#xD;
        participant's aggressive and suicidal impulses, thus, helping them better cope with their&#xD;
        self-destructive behavior. In this manner, the objective of the session was to utilize and&#xD;
        project participant's aggression in making art in a nonjudgmental manner.&#xD;
  &#xD;
        Session 10 - Paint inside a Heart (Khat &amp; Macklin, 2019). The aim of the session was to&#xD;
        provide the participant with a nonthreatening and nonjudgmental medium through which they may&#xD;
        process the emotions being experienced in that moment. The objective of the session was to&#xD;
        bring into awareness the participant's own emotional burdens and help them create a positive&#xD;
        self-image.&#xD;
  &#xD;
        Session 11 - Sculpture of Anger (Godfrey, 2008). The aim of the session was to have the&#xD;
        participant become aware of their emotional distress and the ways in which they manage that&#xD;
        distress. To attain this goal, the participant was asked to create an art form sculpture that&#xD;
        most resembled their anger in real life. By the end of session, the participant was then able&#xD;
        to become self-aware of their aggression and frustration, which automatically led to a&#xD;
        reduction in tendency to self-harm and helped them better regulate their mood.&#xD;
  &#xD;
        Session 12 - Words of Mind Haiku (Stephenson &amp; Rosen, 2015). The aim of the session was to&#xD;
        provide the participant with a unique way to become mindful of their progress, enabling them&#xD;
        to manage their borderline personality features in healthy way. The objective of the session&#xD;
        was to have the participant self-reflect and then accept their self-image. By the end of the&#xD;
        session, the participant was able to write their creative thoughts in form of poems, helping&#xD;
        them to understand compassion and self-regulation.&#xD;
  &#xD;
        Session 13 - Recollection of Moments (Filmore, 2019). The aim of the session was to reflect&#xD;
        upon the growth and improvement observed by the participant as well as the therapist. In the&#xD;
        session, progress exhibited by the participant was discussed and goals of the therapy process&#xD;
        were reviewed. At last, one final objective was to ready the participant for termination of&#xD;
        therapy.&#xD;
  &#xD;
        Session 14 - What I Have. Aim of the session was to talk about the developmental continuum of&#xD;
        the participant, to explore their awareness and acceptance of recreational thoughts while&#xD;
        taking examples from their real-life scenarios. Therapy was terminated and closure was&#xD;
        provided.&#xD;
  &#xD;
        Follow-up session. It took place three weeks after the termination session. In the follow-up&#xD;
        session, the participants completed formal post-Intervention assessment of the Borderline&#xD;
        Symptoms List (Bohus et al, 2007). Moreover, if required, further referrals and psychiatric&#xD;
        consultations were made for the participant with their agreement.&#xD;
  &#xD;
        Statistical Analysis The pre- and post-intervention assessments of the treatment group and&#xD;
        the control group for the Borderline Symptoms List (Bohus et al., 2007) was scored. The&#xD;
        results were coded and exported to SPSS, version 22.0. The data was then analyzed with paired&#xD;
        sample analysis to explore the possible significant differences between scores of BSL of&#xD;
        treatment group as compared to control group.&#xD;
      </textblock>
    </detailed_description>
    <overall_status>Completed</overall_status>
    <start_date type="Actual">April 1, 2020</start_date>
    <completion_date type="Actual">November 12, 2022</completion_date>
    <primary_completion_date type="Actual">March 15, 2022</primary_completion_date>
    <phase>N/A</phase>
    <study_type>Interventional</study_type>
    <has_expanded_access>No</has_expanded_access>
    <study_design_info>
      <allocation>Non-Randomized</allocation>
      <intervention_model>Parallel Assignment</intervention_model>
      <primary_purpose>Treatment</primary_purpose>
      <masking>None (Open Label)</masking>
    </study_design_info>
    <primary_outcome>
      <measure>Borderline Symptoms Checklist</measure>
      <time_frame>four months</time_frame>
      <description>The Borderline Symptoms List (Bohus et al, 2007) was used as self-report measure to assess the participants' level of borderline personality features. It is comprised of 95 total items which are rated using a 5-point Likert scale where 0 = not at all and 4 = very strongly. The test is reported to have internal consistency Cronbach's α = 0.97. Moreover, BSL has seven subscales, namely, self-perception, affect regulation, dysphoria, loneliness, intrusions, hostility, and the self-destruction subscale which measures aspects of suicidal ideation, self-harm behavior, longing for death, and fascination with death using 12 items with a Cronbach's α = 0.94.</description>
    </primary_outcome>
    <number_of_arms>2</number_of_arms>
    <enrollment type="Actual">20</enrollment>
    <condition>Self Destructive Behavior</condition>
    <condition>Mood Disturbance</condition>
    <condition>Self Esteem</condition>
    <arm_group>
      <arm_group_label>Control Group</arm_group_label>
      <arm_group_type>No Intervention</arm_group_type>
      <description>individuals who will not receive the management plan</description>
    </arm_group>
    <arm_group>
      <arm_group_label>Experimental Group</arm_group_label>
      <arm_group_type>Experimental</arm_group_type>
      <description>Individuals who will receive therapy</description>
    </arm_group>
    <intervention>
      <intervention_type>Behavioral</intervention_type>
      <intervention_name>Art based Augmented Reality</intervention_name>
      <description>The participants will be provided 14 sessions management plan</description>
      <arm_group_label>Experimental Group</arm_group_label>
      <other_name>Psychotherapy</other_name>
    </intervention>
    <eligibility>
      <criteria>
        <textblock>
          Inclusion Criteria&#xD;
  &#xD;
            -  Age comprises of young adults above 18 years (minimum) to 36 years (maximum) with at&#xD;
               least academic qualification of 12th grade.&#xD;
  &#xD;
            -  Individuals whose raw score on elation (50 or above) or percentile 50 or above on a&#xD;
               scale of Borderline Symptoms Checklist in pre assessment phase.&#xD;
  &#xD;
            -  Participants who subjectively rate on 50 or above on personal state of borderline&#xD;
               symptoms checklist.&#xD;
  &#xD;
            -  Participants who has no prior record of diagnosis of Borderline personality disorder.&#xD;
  &#xD;
            -  Participants who were not go into psychological consultations (past or present).&#xD;
  &#xD;
            -  Participants who were not go into psychiatric consultations (past or present).&#xD;
  &#xD;
            -  Individuals who were ready to volunteer, committed and motivated to undertake the&#xD;
               interventions.&#xD;
  &#xD;
            -  Individuals who thinks that face instant Interpersonal conflicts (Pseudo or Meta&#xD;
               conflict).&#xD;
  &#xD;
            -  Individuals who believe that their daily living is unable to bear for them (suicidal&#xD;
               ideation).&#xD;
  &#xD;
            -  Participants who has social support at present (both through informal networks (social&#xD;
               mediums and in person).&#xD;
  &#xD;
            -  Participants who understand the language instruction of i.e. Basic English and Urdu&#xD;
               language.&#xD;
  &#xD;
            -  Willing to agree for in-person therapy. Exclusion Criteria&#xD;
  &#xD;
            -  History of physical illness or organic brain damage; especially in the last few years.&#xD;
  &#xD;
            -  Any related medication taken or medication being taken now in this regard.&#xD;
  &#xD;
            -  Age of young adults below 18 years to and above 36 years.&#xD;
  &#xD;
            -  Individuals who raw score on low (49 or below) or percentile 49 or below on a scale of&#xD;
               Borderline Symptoms Checklist in pre assessment phase.&#xD;
  &#xD;
            -  Participants who subjectively rate on 49 or below on personal state of borderline&#xD;
               symptoms checklist.&#xD;
  &#xD;
            -  Participants who has a prior record of diagnosis of Borderline personality disorder.&#xD;
  &#xD;
            -  Active or recent physical addiction to alcohol or drugs.&#xD;
  &#xD;
            -  Individuals with already receiving psychological therapy or psychiatric consultations&#xD;
               for the same matter.&#xD;
  &#xD;
            -  Individuals who are involved in persistent suicide risk who require proper health&#xD;
               management.&#xD;
  &#xD;
            -  Participants who opt for online therapy.&#xD;
        </textblock>
      </criteria>
      <gender>All</gender>
      <minimum_age>19 Years</minimum_age>
      <maximum_age>36 Years</maximum_age>
      <healthy_volunteers>No</healthy_volunteers>
    </eligibility>
    <location>
      <facility>
        <name>Institute of Professional Psychology, Bahria University</name>
        <address>
          <city>Karachi</city>
          <state>Sindh</state>
          <country>Pakistan</country>
        </address>
      </facility>
    </location>
    <location_countries>
      <country>Pakistan</country>
    </location_countries>
    <verification_date>August 2023</verification_date>
    <study_first_submitted>November 18, 2022</study_first_submitted>
    <study_first_submitted_qc>August 8, 2023</study_first_submitted_qc>
    <study_first_posted type="Actual">August 16, 2023</study_first_posted>
    <last_update_submitted>August 8, 2023</last_update_submitted>
    <last_update_submitted_qc>August 8, 2023</last_update_submitted_qc>
    <last_update_posted type="Actual">August 16, 2023</last_update_posted>
    <responsible_party>
      <responsible_party_type>Principal Investigator</responsible_party_type>
      <investigator_affiliation>Bahria University</investigator_affiliation>
      <investigator_full_name>Zohra Batool</investigator_full_name>
      <investigator_title>PhD Scholar</investigator_title>
    </responsible_party>
    <condition_browse>
      <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
      <mesh_term>Borderline Personality Disorder</mesh_term>
      <mesh_term>Self-Injurious Behavior</mesh_term>
    </condition_browse>
    <patient_data>
      <sharing_ipd>No</sharing_ipd>
    </patient_data>
    <!-- Results have not yet been posted for this study                                          -->
  </clinical_study>
  
  
text: download date: ClinicalTrials.gov processed this data on September 20, 2023
  link text: Link to the current ClinicalTrials.gov record.
  url: https://clinicaltrials.gov/ct2/show/NCT05994105
  org study id: Bahria University
  nct id: NCT05994105
  lead sponsor: 
  has dmc: Yes
  is fda regulated drug: No
  is fda regulated device: No
  From the last decades, applied approach for the use of augmented reality on clinical and
        health psychology has grown exponentially. Hence, the present study is aimed to examine the
        effectiveness of augmented reality for the treatment of borderline personality features in
        young adults. For the purpose, it is hypothesized that (i) borderline personality features of
        experimental groups will be reduced in posttest followed by the integration of augmented
        reality in expressive art therapy (ii) Borderline personality features of experimental group
        will decrease significantly as compared to control group in the post test followed by the
        integration of augmented reality in expressive art therapy (iii) Borderline personality
        feature of self-destruction will be reduced in posttest followed by the integration of
        augmented reality in expressive art therapy (iv) Borderline personality feature of affect
        regulation will be reduced in posttest followed by the integration of augmented reality in
        expressive art therapy and (v) Borderline personality feature of negative self-perception
        will be reduced in posttest followed by the integration of augmented reality in expressive
        art therapy. For the present purpose, a total of 20 subjects experiencing symptoms of
        Borderline personality features will be screened and recruited from the Umeed e Nau clinics
        of the Institute of Professional Psychology Bahria University Karachi Campus by initial
        screening of the subjects. Participants will be monitored through pre and post-screening of
        Borderline Symptoms Checklist assigned to an experimental (treatment group) and control
        (waiting list) group using convenient sampling. The experimental group will receive the
        Management plan; which will be comprised of total 14 sessions. The effectiveness of the
        intervention plan will be measured via quantitative measure (the latest version of SPSS).
  The final sample consisted of 20 participants (aged 18-36, males n=5, and females n=15). Half
        of the sample was assigned to the intervention group, while the other half was assigned to
        the control group as per convenient sampling method. The intervention group participants were
        provided with a total of fourteen psychotherapy sessions at Umeed-e-Nau clinic at the
        Institute of Professional Psychology.
  
        Assemblr Studio: Easy AR Maker (android version 4.1.7) Assemblr studio was used to make
        augmented reality within the sessions. It is a free android application for turning 2-D and
        3-D images into augmented reality. The application was designed by Assemblr (2018) and
        consists of a marker less based type of augmentation. Rather it uses basic templates and
        camera picture upload options, transforming a simple image into augmented reality format. It
        also provides drag and drop options and does not require any coding.
  
        3-D Pen/ Doodling pen A digital 3-D pen was used to contrast art in the sessions. It was a
        portable and handheld type of machine.
  
        Procedure Approval to conduct this research was taken from the board of the Institute of
        Professional Psychology, Bahria University, Karachi Campus. The participants were then
        approached via advertisement on social media platforms highlighting awareness regarding
        borderline personality features and the objectives of the present research. The sample frame
        consisted of 36 individuals which were then screened for the inclusion criteria using the
        Borderline symptoms list. The final 20 participants were then randomly divided into two equal
        groups, namely the treatment group and the control waiting-list group. The final 20
        participants were all made privy to the details and purpose of the research and their consent
        was taken. Confidentiality was maintained and the participants retained the right to withdraw
        their participation at any point in the study, as well as remain able to decide not share
        details of specific traumatic or hurtful life events. Moreover, the researchers took all
        necessary steps to ensure safety of the participants' wellbeing.
  
        The experimental group's treatment plan for augmented reality-based art therapy interventions
        comprised of 14 weekly individual standard sessions. Each session was of approximately 90
        minutes, duration of which was divided into 5 minutes initial check-in to reflect
        participant's outer world, 30 minutes for making art, 30 minutes for discussing the art, 10
        minutes to wrap up the session, and 5 minutes final check-out to reflect on the session's
        interventions, explorations, and learning.
  
        The treatment plan was divided into three levels. Level one comprised of three primary
        intervention-based sessions designed to help build rapport and have the participants get
        familiar with intervention's concept. Level two, lasting from session four to session twelve,
        dealt with gradually evolving the participants' perceptual continuum to a developmental
        continuum where the individual would the be able to make desired changes and recreate their
        thoughts, feelings, and behaviors. The third and final level included sessions thirteen,
        fourteen, and the consequent follow-ups. Its purpose was to reflect upon the participants'
        learning so far and to sum up the termination phase of therapy. The follow-up session took
        place three weeks after the unilateral termination of the regular sessions. Here the
        participants were required to complete the Borderline Symptoms List (Bohus et al., 2007), and
        if it was assessed that a participant needed further therapeutic help, they were provided
        with referrals to professionals. The control group participants were also assessed for
        post-test borderline symptoms at this point of time.
  
        After the completion of the study, the results were coded and analyzed using SPSS version
        22.0.
  
        Session Plan Session 01 - GROW (The Kitchen Table Classroom, 2019). The aim of this session
        was to develop rapport with the participant through semi structured interview and goal
        setting. The objective of the session was to explore the concept of personal change in
        clients via art medium where they drew the word GROW and self-reflected from their onwards.
  
        Session 02 - Scribble zoom in and out (Khat & Macklin, 2019). The aim of the session was to
        facilitate the process of catharsis, and have the client engage in and explore their
        impulsivity and curiosity. Moreover, childhood insecurities and traumas were explored in this
        session as well and the artwork was used to discuss the participant's self-perception of
        change.
  
        Session 03 - Blind Contour Drawing (Hu et al., 2021). The aim of the session was to
        psychoeducate the participant with the primary goal of using blind contour drawing to draw
        attention towards differences of perceptions and conceptualization of information. The
        objective of this intervention was to help the participant become aware of their own
        judgmental reactions in different life circumstances.
  
        Session 04 - Self-Awareness via Johari's window (Batool, 2018). The aim of the session was to
        introduce the concept of thought modification via developing insight through blind spots, in
        a nonjudgmental and nonthreatening manner. The objective of the session's activity was to
        help the participant become self-aware and to bring positive change in self-development.
  
        Session 05 - My Life Outline (Batool, 2018). The aim of the session was to address
        self-harming behavior in session by identifying distressing elements in the participant's
        life, and to learn to better cope with these distressing elements in a nonjudgmental manner.
        The objective was to have the participant become able to identify different distressing and
        pleasant moments in their life, eventually leading to development of insight and stability in
        mood regulation.
  
        Session 06 - Free Flow Writings without stimulus (Batool, 2018). The aim of the session was
        to channel emotional distress, negative thoughts, and self-destructive behavior. It was based
        upon the presumption that, while everybody has something to say and the ability to say it,
        the mental wellspring may be blocked by apathy, self-criticism, resentment, anxiety about
        deadlines, fear of failure or censure, or other forms of resistance. Objective was to explore
        and discuss features of personality malfunctions.
  
        Session 07 - Draw what you hear (Chowdhury, 2019). The aim of the session was to provide the
        participant with cathartic medium to anchor their self, with respect to emotional distress
        and mood regulation. The objective was that via this integration of the self, the participant
        would then be able to regulate their free affirmative emotions.
  
        Session 08 - Draw your breath (Batool, 2018). The aim of the session was to strengthen
        self-awareness, which eventually helped the participant to maintain mood, regulate
        self-image, and possibly reduce self-harm. Objective was to help the participant feel relief
        by the end of the session.
  
        Session 09 - Body Healing in Ink (Batool, 2018). The aim of the session was to reduce the
        participant's aggressive and suicidal impulses, thus, helping them better cope with their
        self-destructive behavior. In this manner, the objective of the session was to utilize and
        project participant's aggression in making art in a nonjudgmental manner.
  
        Session 10 - Paint inside a Heart (Khat & Macklin, 2019). The aim of the session was to
        provide the participant with a nonthreatening and nonjudgmental medium through which they may
        process the emotions being experienced in that moment. The objective of the session was to
        bring into awareness the participant's own emotional burdens and help them create a positive
        self-image.
  
        Session 11 - Sculpture of Anger (Godfrey, 2008). The aim of the session was to have the
        participant become aware of their emotional distress and the ways in which they manage that
        distress. To attain this goal, the participant was asked to create an art form sculpture that
        most resembled their anger in real life. By the end of session, the participant was then able
        to become self-aware of their aggression and frustration, which automatically led to a
        reduction in tendency to self-harm and helped them better regulate their mood.
  
        Session 12 - Words of Mind Haiku (Stephenson & Rosen, 2015). The aim of the session was to
        provide the participant with a unique way to become mindful of their progress, enabling them
        to manage their borderline personality features in healthy way. The objective of the session
        was to have the participant self-reflect and then accept their self-image. By the end of the
        session, the participant was able to write their creative thoughts in form of poems, helping
        them to understand compassion and self-regulation.
  
        Session 13 - Recollection of Moments (Filmore, 2019). The aim of the session was to reflect
        upon the growth and improvement observed by the participant as well as the therapist. In the
        session, progress exhibited by the participant was discussed and goals of the therapy process
        were reviewed. At last, one final objective was to ready the participant for termination of
        therapy.
  
        Session 14 - What I Have. Aim of the session was to talk about the developmental continuum of
        the participant, to explore their awareness and acceptance of recreational thoughts while
        taking examples from their real-life scenarios. Therapy was terminated and closure was
        provided.
  
        Follow-up session. It took place three weeks after the termination session. In the follow-up
        session, the participants completed formal post-Intervention assessment of the Borderline
        Symptoms List (Bohus et al, 2007). Moreover, if required, further referrals and psychiatric
        consultations were made for the participant with their agreement.
  
        Statistical Analysis The pre- and post-intervention assessments of the treatment group and
        the control group for the Borderline Symptoms List (Bohus et al., 2007) was scored. The
        results were coded and exported to SPSS, version 22.0. The data was then analyzed with paired
        sample analysis to explore the possible significant differences between scores of BSL of
        treatment group as compared to control group.
  allocation: Non-Randomized
  intervention model: Parallel Assignment
  primary purpose: Treatment
  masking: None (Open Label)
  measure: Borderline Symptoms Checklist
  time frame: four months
  description: The Borderline Symptoms List (Bohus et al, 2007) was used as self-report measure to assess the participants' level of borderline personality features. It is comprised of 95 total items which are rated using a 5-point Likert scale where 0 = not at all and 4 = very strongly. The test is reported to have internal consistency Cronbach's α = 0.97. Moreover, BSL has seven subscales, namely, self-perception, affect regulation, dysphoria, loneliness, intrusions, hostility, and the self-destruction subscale which measures aspects of suicidal ideation, self-harm behavior, longing for death, and fascination with death using 12 items with a Cronbach's α = 0.94.
  arm group label: Control Group
  arm group type: No Intervention
  description: individuals who will not receive the management plan
  arm group label: Experimental Group
  arm group type: Experimental
  description: Individuals who will receive therapy
  intervention type: Behavioral
  intervention name: Art based Augmented Reality
  description: The participants will be provided 14 sessions management plan
  arm group label: Experimental Group
  other name: Psychotherapy
  criteria: 
  gender: All
  minimum age: 19 Years
  maximum age: 36 Years
  healthy volunteers: No
  facility: 
  country: Pakistan
  responsible party type: Principal Investigator
  investigator affiliation: Bahria University
  investigator full name: Zohra Batool
  investigator title: PhD Scholar
  mesh term: Borderline Personality Disorder
  mesh term: Self-Injurious Behavior
  sharing ipd: No