The Integrative Psychiatry Matrix
In my efforts to organize the Integrative Psychiatry approach, I have developed a four-quadrant matrix to help guide an integrative analysis and the construction of a plan of care.
This matrix will be discussed in considerable detail in my book, “A New Way Forward,” and specific treatment strategies for each quadrant are expanded upon at length in the Integrative Psychiatry Program. The components of the matrix can be divided into 5 B’s and include:
Brain (Top-Left): What does the individual experience? This quadrant helps to clarify the individual's phenotypic expression and underlying neural networking and biochemical abnormalities. Pharmaceuticals, nutraceuticals, and psychotherapeutic strategies are used in this area to target and modify or rewire brain networking.
Behaviors (Top-Right): What does the individual do in response to what the individual experiences (Top-Left)? This quadrant expands upon reactive behavioral responses as part of a three-form (or ABC) contingency. From here, you can complete the picture of the antecedent (preceding events), behavioral response, and consequences (short-term and long-term positive and negative outcomes).
Body (Bottom-Left): How is this experience reflected in the body? This quadrant aids in evaluating body systems that are dynamically related to the brain (Top-Left). It brings more objectivity and bodily-based considerations into psychiatric practice. The systems included can be captured by the acronym HPAGGTIE (Hypothalamic-Pituitary-Adrenal axis, hypothalamic-pituitary-Gonadal axis, Gut-brain axis, Thyroid axis, Immune-brain axis, and Epigenetics).
Balance (Bottom-Right): What lifestyle imbalances are present, and how do these relate to the other quadrants? This quadrant illuminates key areas of proactive lifestyle activities and the individual’s value system. This quadrant is expanded upon through the WeLLNESSs (Relationships [We], Leisure, Labor, Nutrition, Exercise, Sleep, Substance use, Spirituality) acronym. The first two domains (Relationships and Leisure) capture “Who” and “What,” respectively, are important to the individual. Often, what an individual experiences (Top-Left) and their reaction (Top-Right) impedes one’s value system and lifestyle. The balance (Bottom-Right) also has a bidirectional relationship with the body (Bottom-Left).
Big Picture (Center): What does all of this mean? In the center of the four quadrants, we consider the big picture, how all of these changes are narrativized, and how the individual’s meaning structure is applied to their experiences. This informs how personality is organized and the individual’s access to the “I” at the center of their experiences. This domain opens up considerations for depth work and psychospiritual practices to assist in rescripting the narrative and nurturing access to the Self. Movements across the center (i.e., Top-Left to Bottom-Right, Bottom-Left to Top-Right) more easily enter conscious awareness, whereas movements around the outside of the matrix may remain outside of conscious awareness.
The right two quadrants reflect the internal environment, and the left two reflect the external environment. The two are dynamically related and reflect each other. The external environmental interactions represent our defense structure, our means of engaging with the world. The top two quadrants (Brain and Behaviors) are more superficial, whereas the bottom two (Body and Balance) are more deep. Depth work guides us into the body and lifestyle (especially value structure).
For more information about the Integrative Psychiatry Matrix (IPM)…
In the next blog, we’ll take a look at the first quadrant “The Brain” in a little more detail.
