1. A FUNCTIONAL CONTEXTUALIST THEORY OF BORDERLINE PERSONALITY DISORDER
Michel André Reyes Ortega PhD * ** ***
Angélica Nathalia Vargas Salinas MA * ** ***
Edgar Miranda Terres MA ** ***
Iván Arango de Montis MD **
* Association for Contextual Behavioral Science Mexico Chapter
** Instituto Nacional de Psiquiatría Juan Ramón de la Fuente Muñiz
*** Instituto de Ciencias Conductual Contextuales y Terapias Integrativas

2. PERSONALITY
STRUCTURALIST VIEW
FUNCTIONAL VIEW
Internal psychological organization which manifests in the public behaviors specified in diagnostic criterias.
(Sturmey, 2008)
Repertoire of behaviour imparted by an organized set of contingencies.
(Skinner, 1974)
Personality and hence personality disorder, is only a series of overt and covert behaviours.
(Swales & Heard, 2009)

3. BORDERLINE TOPOGRAPHY (adapted from Millon, 2004)
FUNCTIONAL VIEW
Related to context
REMEMBER
motivational operations
BORDERLINE TOPOGRAPHY (adapted from Millon, 2004)
STRUCTURALIST VIEW
Constitutional
PATHOLOGY
NORMALITY
Frantic efforts to avoid real or imagined abandonment.
Unstable relationships characterized by alternating extremes of idealization and devaluation of others.
Identity disturbance / Unstable and polarized self-image.
Impulsive and self-destructive behavior.
Affective instability – Suicidal and parasuicidal behavior.
Chronic emptyness related to difficulties to identify values and commit to them.
Transient paranoid ideation and dissociative symptoms.
Sensitive to rejection.
Complex relationships with realistic expectations.
Experimental identity, curiosity for alternative lifestyles.
Sensations seeking.
Emotionaly intense – Spontaneous and prone to exaggeration.
Concerned about social life, creativity and continuous searching for having and entertaining life.
No paranoid ideation or disociative symptoms.
Behavior under aversive control
Behavior under apetitive control
Age
Treatment
(Paris, 2008)

4. FROM THE ACT MATRIX MODEL (Matrix adapted from Polk, 2014)
Adapt ideographically
FIVE SENSES EXPERIENCE
Frantic efforts to avoid abandonement.
Unstable relationships.
Impulsivity.
Suicidal and parasuicidal behavior.
Difficulties to mantein commitments.
Dissociative symptoms.
Complex relationships.
Experimental identity.
Intense sensations seeking.
Exaggeration and spontaneity.
Continuous entertaining seeking.
PERSPECTIVE
CHOICE POINT
AVOIDANCE
ÁPROACHING
Fear of abandonement.
Idealization and devaluation.
Identity diffusion
Unstable Self-image.
Affective unstability.
Cronic emptyness feelings.
Paranoid ideation.
Realistic expectancies.
Curiosity for alternative lifestyles.
Emotionaly intense.
Iterest for social life and creativity.
MENTAL EXPERIENCE

5. DIVERSITY Sensitive to limitations of nomotetic approaches.
OUR CONTEXTUAL VIEW
Topographic variation related to context
STRUCTURALIST VIEW
Seeking for description and categorization
Sensitive to limitations of nomotetic approaches.
BPD diagnosed persons possess different temperamets, have unic learning histories, and show different problematic behaviors (self-mutilation, alcohol abuse, binge eating, etc.) (Morton & Shaw, 2012).
Millon (2004).

6. BPD ¿ETHIOLOGY? INSTABILITY
BIOLOGICAL FACTORS
(BIOLOGICAL TRAITS)
ENVIRONMENTAL FACTORS
(LEARNING HISTORY)
BPD
INSTABILITY
COGNITIVE, AFFECTIVE, INTERPERSONAL AND BEHAVIORAL
(Linehan, 1993)

7. BIOLOGICAL TRAITS AND LEARNING IMPLICATIONS
Great discounting.
Needs more rehearsal and examples to stablish self- regulation skills.
Perspective taking, emotion regulation, rule following.
Low threshold to aversive stimulus.
Prone to aversive conditioning.
COGNITIVE UNSTABILITY
IMPULSIVITY
EMOTIONAL UNSTABILITY
Genetic factors, hostile uterine environment, etc. (Gottman & Katz, 1990)
Paris (2008)

8. LEARNING HISTORY -EMOTIONAL INSTABILITY-
DEVELOP ACCEPTANCE AND WILLIGNESS
ACT: EXPERIENTIAL EXERCISES AND METAPHORS TO DEVELOP DISCOMFORT ACCEPTANCE AND RELATE IT TO VALUES.
DBT: VALIDATION STRATEGIES.
FAP: IN VIVO REINFORCEMENT OF REGULATED EMOTION EXPRESSION.
DEPRIVATION / CONTINUOUS
ABUSE
(MULTIPLE EXEMPLARS)
RESPONDENT LEARNING
RESPONDENT GENERALIZATION
AVERSIVE FUNCTIONS DERIVATION
EXCESSIVE NEGATIVE EMOTIONS INTENSITY OR DEACTIVATION
EXPERIENTIAL AVOIDANCE
(PREVENTS COPING SKILLS LEARNING)
(PREVENTS STIMULUS HABITUATION AND RESPONDENT EXTINTION)
EMOTION DYSREGULATION AT RELEVANT SD

9. LEARNING HISTORY -COGNITIVE INSTABILITY-
INVALIDATION
TRIVIALIZATION OF INTERNAL EXPERIENCE
UNDERDEVELOPED
DEICTIC FRAMMING
ATTACHMENT TO A NEGATIVE SELF AS CONTENT
DIFFICULTIES FOR SHIFTING PERSPECTIVES
“I” TACTS UNDER PUBLIC CONTROL
UNSTABLE IDENTITY
EXPERIENTIAL AVOIDANCE
OF INVALIDATION
SELF AS CONTEXT DEVELOPMENT AND VALUES CLARIFICATION TO ACHIEVE PSYCHOLOGICAL FLEXIBILITY
ACT
AND INTEGRATE A SENSE OF IDENTITY
*USE EXERCISES AND METAPHORS.
(Kohlenberg, Tsai, Kanter & Parker, 2009)
FAP
DEFINE “I UNDER PUBLIC CONTROL” EXAMPLES AND DIFFICULTIES TO UNDERSTANDING OTHERS VIEW AS CRB1s.
IDENTIFICATION, ASSERTION OF NEEDS AND EMOTIONAL EXPRESSION AS CRB2s AND O2s.
*APPLY 5 RULES
LEARNING HISTORY -COGNITIVE INSTABILITY-
(Kohlenberg & Tsai, 1991)
(Morton & Shaw, 2012)

10. LEARNING HISTORY -BEHAVIORAL INSTABILITY-
TEACH COPING SKILLS AND FRAME THEM AS VALUED COMMITED ACTIONS
*DBT, MDT SKILLS WILL WORK.
*USE ACT METAPHORS AND EXPERIENTIAL EXCERCISES TO CLARIFY VALUES
SELF HARMING BEHAVIORS AS EXPERIENTIAL AVOIDANCE STRATEGY
SELF HARM MODELS
FEW ALTERNATIVE MODELS
EMOTIONAL VULNERABILITY
INVALIDATION –DIFFERENTIAL REINFORCEMENT OF EXTREME BEHAVIORS
*PREVENT THIS STRATEGIES TO FUNCTION AS EXPERIENTIAL AVOIDANCE.
*PREVENT COUNTERPLIANCE.
*BALANCE
ACCEPTANCE-CHANGE FOCUS

11. LEARNING HISTORY -INTERPERSONAL INSTABILITY-
FAP
MADE IDEOGRAPHIC CONCEPTUALIZATIONS OF IDEALIZATION, DEPENDENT, AMBIBALENCE, HOSTILITY, ETC. AND DEFFINE THEM AS CRB1.
DEFFINE INTIMACY REPERTOIRE AS CRB2 AND O2.
*APPLY 5 RULES
INVALIDATION, MISTREATMENT, CONDITIONAL ACCEPTANCE
(MULTIPLE EXAMPLES)
MILD AFFECT (SCR+) AND UNATENTION (SCEXT), AND HIGH RATES OF PUBISHMENT (SCC+) OF ATTACHMENT BEHAVIOR
FEARFUL AND DISORGANIZED ATTACHMENT STYLE
(Mansfield & Cordova, 2007)
EXPERIENTIAL AVOIDANCE
(FEAR-ANGER-YEARN) TOWARDS AFFECT NEEDS
AMBIVALENCE
OSCILATION BETWEEN IDEALIZATION, AVOIDANCE AND AGRESSION

12. (MO) MOTIVATING OPERATIONS
DISTAL ANTECEDENTS
Traumatic experiences →
Invalidation →
Differential reinforcement →
Emotional dysregulation
Self-referent behavior under public control
Defficient perspective taking
Self-harm as Self-regulation strategie
Fearful-disorganized attachment behaviors
CONSIDER SKILLS TRAINING TO REDUCE EMOTIONAL VULNERABILITY.
DBT
*FRAME THEM AS VALUED ACTIONS.
BEHAVIORAL MODEL OF BORDERLINE PERSONALITY DISORDER SYNDROME (Reyes, Vargas & Tena, 2014)
(MO) MOTIVATING OPERATIONS
Biological needs deprivation →
Rejection ↔ Atention-affect deprivation →
Frustration / Repetitive stress →
Cognitive Fussion
Experiential Avoidance
Identity unstability ∙
(A) ANTECEDENT
(B) BEHAVIOR
(C) CONSECUENCE
SE → Postraumatic
and/or
dissociative
symptoms
SD = Invalidation
SR+ = Attention / Care
SR- = Calm
________________________________________________
Values incongruence
Emptiness feelings
Depression
PROBLEMATIC EMOTIONAL AND INTERPERSONAL REGULATION BEHAVIORS
PASSIVE AVOIDANCE
Reinforcing
Aversive

13. OUR TREATMENT PROPOSAL
Self-validation
(acceptance)
(G+I / 1-8)
Mindfulness
Relate discomfort to values
Radical acceptance
Validation
In vivo resolution of interpersonal problems
(I / 9-18)
FAP 5 rules
Bridging questions
Evocative excercises
Deffine ineffective attachment behaviors and “I” under public control as CRB1s
Skills training
(G+I / S:1-8)
Emotion regulation skills training.
Interpersonal effectiveness skills training.
Values clarification strategies.
Weekly valued based behavioral activation.
COMMON ELEMENTS ON EBT
(Paris, 2008)

14. EVIDENCED BASED TREATMENTS FOR BPD
Mentalization Based Treatment (Bateman & Fonagy, 1999, 2001)(P).
Transference Focus Psychotherapy (Clarkin et al., 2001) (P).
Schema Therapy (Geisen-Bloo et al., 2006) (P).
Dialectical Behavior Therapy (Scheel, 2000; Verheul et al. 2003) (P-B).
Evidence shows their effectiveness is based on their common elements,
validation, self-discrimination development and application of in vivo corrective interventions,
(Paris, 2008).
Data shows moderated impacts and is still limited
(Bailey, Mooney-Reh, Parker & Temelhovski, 2009;
Navarro-Leis & Hernández-Arrieta, 2013).

15. CHALLENGES FOR DOING CONTEXTUAL BEHAVIORAL THERAPY FOR BPD IN MEXICO
Solutions
Current dominance of mentalistic and structuralist models on clinical psychology training programs and personality theories.
Ignorance about advances and advantages of clinical behavior analysis (CBA).
Skepticism and ignorance of functional contextualism on academic behavioral circles.
Ignorance of learning theory (behaviorism) on psychiatric residential programs.
Insufficient data on contextual behavioral therapies for personality disorders.
Few training oportunities and few trained clinicians in BPD treatment and contextual psychotherapy.
Forming ACBS Mexico Chapter.
Introducing functional contextualism and CBA in clinical psychology and medical trainings.
Introducing functional contextualism and CBA to non professionals.
Starting research lines about contextual behavioral interventions.
Seeking training oportunities and establishing colaborations with rest of the world colaborators.