1. TESTING THE MATRIX AS AN ENHANCEMENT OF ACT FOR PEOPLE DIAGNOSED WITH BPD
Michel André Reyes Ortega PsyD 1,2,3,4
Angélica Nathalia Vargas Salinas PsyD 1,2,3,4
Benjamin Schoendorff, MPs, MCs5
Edgar Miranda Terrés, MPs 1,3,4
1Association for Contextual Behavioral Science Mexico Chapter
2Instituto Nacional de Psiquiatría Juan Ramón de la Fuente
3Instituto de Ciencia Conductual Contextual y Terapias Integrativas
4Contextual Psychology Institute

2. CONTEXT -INPRF BPD CLINIC-
MEXICO’S NATIONAL INSTITUTE OF PSYCHIATRY (INPRF)
INPRF BPD CLINIC
(ONLY EXISTING PUBLIC SECTOR CLINIC)
Decentralized public organization with its own budget and administration. Part of the system of National Institutes of Health in Mexico.
It’s functions are to:
Conduct scientific research.
Provide research and clinical training
Psychiatric patients treatment
Give advice other official and private institutions.
Contribute to the development of health policies at the national level in the areas of mental health and substance use.
Clinical team:
Only one hired clinical psychologist.
Rest of Therapists are non payed volunteers (help from 3-6 months only).
1 or 2 Clinical Psychology master degree students (Clinical Behavior Analysis Oriented).
2 Professors of the same program serve as clinic advisors and students supervisors.
Clients characteristics:
Clients treated per year = 100 (waitlist 100).
Clients with possible lethal behavior not admitted (yet symptoms pervasive enough to impair quality of life and treatment engagement).
So, first I’m going to tell you about our context…
Greatest authority in psychiatric research, teaching and consultation in Mexico. But with limited resourses… Example: BPD clinic, which is

3. CONTEXT -INPRF BPD CLINIC (3 YEARS AGO)-
TREATMENT OPTIONS
DBT, NOT POSSIBLE 
Transference focused psychotherapy
Clinic psychiatrists (2) trained in that model.
TAU back then (wasn’t working).
Dialectical Behavior Therapy?
Desirable for clients with severe behavioral dyscontrol (Stage 1) and/or severe trauma related symptoms (Stage 2).
Expensive and unrealistic.
Lenght of treatment.
Number of therapists needed (and clients).
Amount of training needed.
We tried ACT (Current TAU).
Good outcomes in: Reductions on self- harm behavior, emotion dysregulation, experiential avoidance, BPD symptoms severity, anxiety and depression (Gratz & Gunderson, 2006; Morton, Snowdon, Gopold & Guymer, 2012).
Students receiving training in ACT.
Now, our clinic is only 3 years old, my team was invited to colaborate from 2 years.

4. CONTEXT -WHY TRYING THE MATRIX-
The next problems where observed applying ACT treatment:
Understanding treatment strategies (metaphors of experiential exercises).
Relate treatment strategies with each other.
Coordinate in session experience with daily life experience.
Daily life behavioral changes observed between 6th and 8th session.
Related to neuropsychological problems identified in BPD (difficulties in attentional control, verbal fluency and memory fixation, consolidation and recovery processes).
Related to DRR fluency problems?
Could the Matrix, as a visual cue for DRR, improve ACT performance?
Stage 1 Behavioral Dyscontrol
Stage 2 Traumatizing Emotional Experience

5. DESIGN
Based on that reasoning we did a pylot study on Fap as an enhancement for our TAU.

6. HYPOTHESIS
ACT Matrix enhanced will outperform ACT in all the assessed variables.
Psychological Flexibility will significantly mediate BPD severity in both groups.

7. VARIABLES AND MEASURES
Experiential Avoidance – Acceptance and Action Questionnaire-II (Ciarrochi & Bilich, 2006; Patrón 2010).
α = .89
BPD symptoms severity – Borderline Evaluation of Severity Over Time Scale (Pfohl et. al. 2009; Reyes & García, 2014).
α =.88; r=0.62; p<.001
Emotion Dysregulation – Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004; Marín Tejeda et al. 2012).
α=.93 (.85 to .68); r=.76; p<.05
Experience of Self – Experience of Self Scale (Kanter, Parker, & Kohlenberg, 2001; Valero-Aguayo, Ferro-García, López-Bermúdez & Selva-López de Huralde, 2014).
α = .941 (.59 to .95)
Anxiety and Depression also assessed. Not described in this presentation.
α = Internal consistency; R=Test Retest; P= Concurent validity

8. ACT-TAU CHARACTERISTICS
1st 3 sessions

9. THE USUAL GROUP SESSION STRUCTURE
Feedback: What did you noticed? Was your reaction in this experience similar or different to the way you reacted to your pain this last week? Whay was useful about this experience?
Behavioral rehearsal: How could you practice noticing this next week?

10. THE USUAL INDIVIDUAL SESSION STRUCTURE

11. ACT-MATRIX CHARACTERISTICS

12. THE SMALL BIG CHANGE GROUP SESSIONS

13. THE SMALL BIG CHANGE INDIVIDUAL SESSIONS

14. PARTICIPANTS THERAPISTS
ACT
ACT-MATRIX
Group leader:
MPs, 15 years of clinical experience (male, 42 years old).
Co-therapists:
MPs, 6 years of clinical experience (male, 43 years old).
Monitor
MPs, 2 years of clinical experience (female, 28 years).
Group leader:
PhD, 10 years of clinical experience (male, 33 years old).
Co-therapists.
PhD 2nd year student, 6 years of clinical experience (female, 30 years old).
Monitor
MPs, 2 years of clinical experience (male, 33 years old).
All therapist have the same training, ACT-MATRIX therapist received aditional 20 hours training in Act Matrix.

15. RESULTS PRE – POST -DIFFERENCES INSIDE GROUPS-
Both groups showed statistical changes and big size effects

16. RESULTS PRE – FOLLOW UP -DIFFERENCES INSIDE GROUPS-
Same in follow up

17. RESULTS -DIFFERENCES BETWEEN GROUPS-
Matrix better than ACT

18. RESULTS -DIFFERENCES BETWEEN GROUPS-
Attrition less in 2 groups…

19. RESULTS -MEDIATION POST-TREATMENT-
Hierarchical linear regression (Matrix)
Hierarchical linear regression (ACT)
Psychological Flexibility %
BPD Symptoms Severity 34.5%
Emotion Regulation 1.8%
Psychological Flexibility %
BPD Symptoms Severity %
Emotion Regulation 30.8% R2
Durbin-Watson F
Sig. t
FIV
.345
1.630
4.994
.018
.716
.483
1.183 R2
Durbin-Watson F
Sig. t
FIV
.373
1.689
9.229
.001
3.906
.000
1.246

20. MAIN CONCLUSSIONS
ACT Matrix enhanced will outperform ACT in all the assessed variables.
ACT Matrix significantly enhanced classic ACT impact.
Possibly because its simplicity, repetitive and graphic nature makes its more adequate to clients with the neuropsychological characteristics associated with BPD (difficulties in attentional control, verbal fluency and memory fixation, consolidation and recovery processes).
Future studies could asses this characteristics impact as mediator of change.
Psychological Flexibility will significantly mediate BPD severity in both groups.
Preliminary evidence of ACT Matrix clinical value as a visual cue for DRR that improves psychological flexibility.
Future studies could asses Matrix impact in DRR (IRAP?).
Analysing single cases and finding moderators in Anxiety and Depression