The 4 quadrant 8 zones approach for comprehensive evaluation of patients
The 4 quadrants and 8 zones are basically perspectives through which any situation or life event can be looked at ,We are constantly interacting with these 4 quadrants and 8 zones in our normal day to day life but we aren’t consciously aware of it most of the time
Let’s try to understand the 4 quadrants and 8 zones in some detail
The 4 quadrants
The “I” quadrant ( individual interior ) - The I quadrant is the interior environment of an individual , so it basically means the internal thoughts , feelings , sensations ,emotions and perceptions of an individual.
Now each quadrant can be looked at from the interior and exterior .
Zone 1 ( interior ) - The individuals subjective experience of his thoughts, emotions and feelings . In psychiatry we call this descriptive phenomenology which means individuals subjective experience of pathological states eg feeling sad , fearful, angry .
Zone 2 ( exterior ) - This zone looks at the subjective realm from an objective stance which is called structuralism/ interpretive phenomenology , so when we take a structured interview or do a mental status examination we are interpreting an individuals subjective world in an objective way
The " IT" Quadrant ( individual exterior ) - The “IT” quadrant is the individuals exterior which includes an individual’s anatomy, physiology, biochemistry , his behaviour and actions in the physical world which can be studied and measured through scientific and empirical methods
Zone 3 ( interior ) - This is the realm of biological phenomenology and cognitive science where we look at the interior processes resulting in external behaviour eg cognitive distortions , defense mechanism which the patient is not aware of and can be measured or interpreted only objectively
Zone 4 ( exterior ) - In this zone we measure the observable neurophysiological and neuroanatomical correlates resulting from internal states or experiences of an individual eg brain wave patterns , MRI scans , genetics , imbalances in neurotransmitters , dysfunction in neural synapses
3 The " We" quadrant ( Collective interior ) - The We quadrant is the interior environment of a group eg a family , a group of friends , a tribe , a nation . It refers to the shared values , meanings , language , interests , mutual understanding of a particular group.
Zone 5 (. Interior ) Hermeneutics is the study of the interior environment of a group of people , so in history taking when we evaluate the interior environment of a person’s family we are focussing on this zone , it includes things like family members views about mental illness , causes of mental illness and expressed emotions .
Zone 6 ( exterior ) When we objectively observe the behaviour of a group of people we are focusing on this zone eg How the family members are interacting with the patient , what is their body language, how are they behaving with the patient.
- The ITs Quadrant ( Collective exterior ) This quadrant refers to the physical world of objects and the various systems of which an individual is a part of eg the political system, the economic system, the education system ,the social system, the ecosystem.
So this quadrant is all about how an individual perceives the external world and the various external systems of which he is a part of
Zone 7 ( interior ) - Individuals subjective experience of the external world and the various systems for eg a patient having Schizophrenia with delusion of reference and persecution will perceive the external world as threatening which in turn will affect his functioning in various areas of his life
Zone 8 ( exterior ) When we objectively observe and evaluate how the patients symptoms are affecting his relationship with the external environment we are focusing on this quadrant eg marital conflicts , unemployment , poor performance in academics .
Now just to give an example
Suppose a patient is suffering from Schizophrenia and how we can evaluate the patient in 8 zones .
- Zone 1( individual subjective experience ) - fear that people want to harm me
- Zone 2( objective interpretation of subjective experience ) - Delusion of persecution
3 .Zone 3 ( internal cognitive process)- Defense mechanism of projection , denial
4 . Zone 4 ( objective neurophysiological correlate)- increased dopamine in the mesolimbic pathway
5 Zone 5 ( subjective experience of family members)- expressed emotions of family members
6 .Zone 6( objective evaluation of family) - Family members reactions to patients delusional beliefs
7 Zone 7 ( subjective experience of externall world )- loss of reality contact
- Zone 8 ( objective interpretation of subjective experience )- disruptions of social systems , unemployment
Treatment modalities according to zones
- Zone 1 - meditation , mindfulness , introspection , contemplation
2 Zone 2 - Humanistic therapies , client centered psychotherapy , existential therapies
- Zone 3 - Cognitive behavioural therapy , dialectical behavioural therapy
- Zone 4 - Psychotropic medications , ECT, Rtms ,Tdcs
- Zone 5 and Zone 6 - Interpersonal therapy , Couples therapy , family therapy , psychoeducation of family members.
- Zone 7 and Zone 8 - Social skills training , occupational therapy