This article considers the pros and cons of using Method of Levels (MOL), a therapy based on Perc... more This article considers the pros and cons of using Method of Levels (MOL), a therapy based on Perceptual Control Theory (PCT). Five concerns about PCT are that it is an early theory, is not well known, originates from outside psychology, implies that established theories are inaccurate and has a mechanistic approach. Five positive features are that it explains how ‘control’ works, takes a phenomenological perspective, is grounded in biology, integrates many disciplines and has an evidence base. Five features of MOL can raise caution: it is not well known, emphasizes intrinsic change, requires the therapist to let go of control, concentrate intensively and use alternative evaluations of outcome. There are major advantages: it is a simple process to learn; theory-practice links are clear, it is ‘ultra cognitive therapy’ – focused on the present moment, client-centred and enables shifting in perspective, promotes service empowerment, and has an evidence base. This article will help therapists make an informed choice about using MOL.
The Covid-19 crisis has clarified the demand for an ultra-brief single-session, online, theory-le... more The Covid-19 crisis has clarified the demand for an ultra-brief single-session, online, theory-led, empirically supported, psychological intervention for managing stress and improving well-being, especially for people within organizational settings. We designed and delivered “4Ds for Dealing with Distress” during the crisis to address this need. 4Ds unifies a spectrum of familiar emotion regulation strategies, resilience exercises, and problem-solving approaches using perceptual control theory and distils them into a simple four-component rubric (Distract–Dilute–Develop–Discover). In essence, the aim is to reduce distress and restore wellbeing, both in the present moment through current actions (distract or dilute), and through expressing longer-term goal conflicts (e.g., through talking, writing, and drawing) to discover new perspectives that arise spontaneously after sufficient time and consideration. The intervention is user-led in that it draws on users’ own idiosyncratic and pr...
Different meta-emotion strategies are often categorised as either adaptive (e.g. compassionate ca... more Different meta-emotion strategies are often categorised as either adaptive (e.g. compassionate care) or maladaptive (e.g. suppression). Yet some evidence indicates that the same strategy can be adaptive in one culture and maladaptive in another. We aimed to test whether meta-emotion strategies and their effects can in fact vary across different social contexts within the same individuals. A total of 140 students completed measures of meta-emotion strategies, satisfaction with life scale, and anxiety. Each scale was adapted for both the family home and the university home context. On average, the students had a lower level of interest in their emotions and adopted a tough control to a lesser extent when in the family home, compared to the university home context. At the individual level, some students used suppression more in the family home than the university home, whereas for others the effect was reversed. A series of multiple regressions showed the context specificity of meta-em...
Intrusive thoughts, flashbacks, panic attacks and sudden physiological arousal are each experienc... more Intrusive thoughts, flashbacks, panic attacks and sudden physiological arousal are each experienced as involuntary, are difficult to control, and lead to considerable distress. Such observations have led to the suggestion that anxiety disorders are associated with the operation of automatic information-processing biases. Clinical and experimental evidence for this proposal is reviewed and three different classes of routes to the development and modification of these automatic processes are described: an innate route, repetition/habituation, and conscious appraisal. The review focuses in particular on the third route, proposing that automatic processing biases can be altered by accessing and modifying conscious appraisals of internal and external events. Indirect evidence is provided by selective attention paradigms in anxiety, treatment studies and clinical observations, although further research will be necessary for a direct test of the pathway. The implications for the theory and...
Aim This review considers the theoretical literature concerning communication between a person wi... more Aim This review considers the theoretical literature concerning communication between a person with dementia and a person without dementia. Methods Theoretical accounts of communication between a person with dementia and a person without dementia were identified through database searches, hand searching of reference lists and contacting experts in the topic area. Results Twenty-one articles were included in the final review, yielding 18 different theoretical accounts of communication in the context of dementia. Thematic synthesis showed that four categories could account for the majority of the material described in these theories, even though they were derived from very different perspectives. These categories were mutuality, personhood, anxiety reduction and environmental considerations. Discussion The four categories identified in the thematic synthesis were reminiscent of Kitwood's theory of person-centred dementia care. Different interpretations of this finding are consider...
Many strategies have been recommended to support caregivers in communicating with people who live... more Many strategies have been recommended to support caregivers in communicating with people who live with dementia. However, less is known about what makes communication a good and meaningful experience from the perspective of people with dementia. Understanding this may enhance the person with dementia's sense of connectedness, strengthen their relationships, and facilitate person-centered care. The current review aimed to evaluate research that examined experiences of communication in people living with dementia. Studies that examined reports provided by people with dementia, healthcare professionals, and family caregivers were included. A mixed-methods systematic review was conducted using PsychINFO, MEDLINE, and EMBASE databases. After applying the eligibility criteria, 15 studies were included. Although eight of these recruited people with dementia, only one focused on their perspectives of communication experiences and the remaining studies focused on the perspectives of fami...
Behavioural and cognitive psychotherapy, Jan 25, 2018
Evidence for the efficacy of computer-based psychological interventions is growing. A number of s... more Evidence for the efficacy of computer-based psychological interventions is growing. A number of such interventions have been found to be effective, especially for mild to moderate cases. They largely rely on psychoeducation and 'homework tasks', and are specific to certain diagnoses (e.g. depression). This paper presents the results of a web-based randomized controlled trial of Manage Your Life Online (MYLO), a program that uses artificial intelligence to engage the participant in a conversation across any problem topic. Healthy volunteers (n = 213) completed a baseline questionnaire and were randomized to the MYLO program or to an active control condition where they used the program ELIZA, which emulates a Rogerian psychotherapist. Participants completed a single session before completing post-study and 2-week follow-up measures. Analyses were per protocol with intent to follow-up. Both programs were associated with improvements in problem distress, anxiety and depression p...
Psychology and Psychotherapy: Theory, Research and Practice
Distressing and pleasant/positive voices (auditory verbal hallucinations) are common in both clin... more Distressing and pleasant/positive voices (auditory verbal hallucinations) are common in both clinical and non-clinical voice-hearers. Identifying factors that contribute to emotional reactions to voices is essential for developing effective psychological interventions. Several theories propose that facilitation and interference with personal goals are important predictors of distress and well-being. This study examined whether voice-related distress is related to the degree to which voices interfere with personal goals, and whether pleasantness of voices is influenced by the extent to which they facilitate goals. Cross-sectional with clinical and non-clinical voice-hearers. Twenty-two clinical and 18 non-clinical voice-hearers completed interviews and self-report measures assessing (1) personal goals, (2) content, characteristics, and affective reactions to voices, and (3) ratings of the extent to which voices facilitated and/or interfered with achievement of important personal goals. Affective reactions were strongly correlated with measures of goal interference and goal facilitation. Regression analyses revealed that these associations remained significant when controlling for important covariates (e.g., participant grouping; content, frequency and duration of voices). Goal interference was specifically associated with distress, whereas goal facilitation specifically predicted perceived pleasantness of voices. This study provides a novel perspective on the factors that might contribute to distress in people who hear voices. The findings suggest that perceived impact of voices on valued personal goals may be an important contributor of voice-related distress. We propose that clinical assessments, formulations, and interventions could benefit from the careful analysis of the perceived impact of voices on goals. These findings suggest that variability in voice-related distress is closely linked to the perceived impact of voices on personal goals. These strong effects observed highlight the importance of considering the role of personal goals in future research on the psychological mechanisms leading to distress associated with voice hearing. Psychological assessments may benefit from the careful exploration of the impact of voice hearing on valued goals, and interventions promoting control over personal goals may be explored as treatment options for clients with distressing voices.
Background: The value of clients’ reports of their experiences in therapy is widely recognized, y... more Background: The value of clients’ reports of their experiences in therapy is widely recognized, yet quantitative methodology has rarely been used to measure clients’ self-reported perceptions of what is helpful over a single session. Aims: A video-rating method using was developed to gather data at brief intervals using process measures of client perceived experience and standardized measures of working alliance (Session Rating Scale; SRS). Data were collected over the course of a single video-recorded session of cognitive therapy (Method of Levels Therapy; Carey, 2006; Mansell et al., 2012). We examined the acceptability and feasibility of the methodology and tested the concurrent validity of the measure by utilizing theory-led constructs. Method: Eighteen therapy sessions were video-recorded and clients each rated a 20-minute session of therapy at two-minute intervals using repeated measures. A multi-level analysis was used to test for correlations between perceived levels of help...
We integrate research on conflict, ambivalence, self-discrepancy and concordance.We propose a hie... more We integrate research on conflict, ambivalence, self-discrepancy and concordance.We propose a hierarchical reconceptualization of these four concepts.Goal conflict impacts negatively on well-being.Pursuing goals that achieve one’s fundamental needs promotes well-being.Conflict at higher levels in the hierarchy may be more detrimental to well-being.This paper reviews empirical evidence for associations between goal conflict, ambivalence, self-discrepancy, self-concordance and well-being. The research indicates that goal conflict, ambivalence and discrepancy impede well-being, whilst concordance promotes well-being. The evidence was strongest for ambivalence, self-discrepancy, and self-concordance, and weakest for goal conflict. A hierarchical conceptualisation of the four related constructs is presented. Goal conflict, ambivalence, and self-discrepancy may occur at different levels within a goal hierarchy, which ranges from abstract, high level goals to low-level, concrete goals. Self-concordance is conceptualised as a property of the goal hierarchy, where goals are un-conflicted and facilitate intrinsic motivations and needs. Conflict at multiple or higher levels in the hierarchy may pose greater problems for well-being.
Background Psychological interventions for bipolar disorders typically produce mixed outcomes and... more Background Psychological interventions for bipolar disorders typically produce mixed outcomes and modest effects. The need for a more effective intervention prompted the development of a new cognitive behavioural therapy, based on an integrative cognitive model ('Think Effectively About Mood Swings' [TEAMS] therapy). Unlike previous interventions, TEAMS addresses current symptoms and comorbidities, and helps clients achieve long-term goals. A pilot randomized controlled trial (the TEAMS trial) of the therapy has recently concluded. This study explored participants' experiences of TEAMS, recommendations for improvement and experiences of useful changes post-therapy. Methods Fourteen TEAMS therapy participants took part in semi-structured interviews. Their accounts were analysed using interpretative thematic analysis. Two researchers coded the dataset independently. Member checks were conducted of the preliminary themes. Results Two overarching themes; 'useful elements...
The integrative cognitive model provides a comprehensive account of bipolar disorder (BD) that, i... more The integrative cognitive model provides a comprehensive account of bipolar disorder (BD) that, if empirically supported, has important potential implications for psychological therapies. This article is the first to review the evidence for this model. We evaluate the evidence (up to 2017) for four hypotheses derived uniquely from the model: extreme positive and negative appraisals of internal states are associated with (1) risk of developing BD; (2) BD diagnosis; (3) relevant clinical and functional outcomes including hypomanic and depressive mood symptoms; and (4) outcomes over time. Research involving individuals with diagnosed mood disorders as well as non-clinical populations is reviewed. The hypotheses were broadly supported and several consistent findings were not accounted for by alternative psychological models of BD. The evidence base is limited by a relative paucity of prospective studies; only 6 of the 31 studies identified. Implications for theory, research and clinical...
There is limited evidence regarding the accuracy of inferences about intention. The research desc... more There is limited evidence regarding the accuracy of inferences about intention. The research described in this article shows how perceptual control theory (PCT) can provide a "ground truth" for these judgments. In a series of 3 studies, participants were asked to identify a person's intention in a tracking task where the person's true intention was to control the position of a knot connecting a pair of rubber bands. Most participants failed to correctly infer the person's intention, instead inferring complex but nonexistent goals (such as "tracing out two kangaroos boxing") based on the actions taken to keep the knot under control. Therefore, most of our participants experienced what we call "control blindness." The effect persisted with many participants even when their awareness was successfully directed at the knot whose position was under control. Beyond exploring the control blindness phenomenon in the context of our studies, we discuss...
This article considers the pros and cons of using Method of Levels (MOL), a therapy based on Perc... more This article considers the pros and cons of using Method of Levels (MOL), a therapy based on Perceptual Control Theory (PCT). Five concerns about PCT are that it is an early theory, is not well known, originates from outside psychology, implies that established theories are inaccurate and has a mechanistic approach. Five positive features are that it explains how ‘control’ works, takes a phenomenological perspective, is grounded in biology, integrates many disciplines and has an evidence base. Five features of MOL can raise caution: it is not well known, emphasizes intrinsic change, requires the therapist to let go of control, concentrate intensively and use alternative evaluations of outcome. There are major advantages: it is a simple process to learn; theory-practice links are clear, it is ‘ultra cognitive therapy’ – focused on the present moment, client-centred and enables shifting in perspective, promotes service empowerment, and has an evidence base. This article will help therapists make an informed choice about using MOL.
The Covid-19 crisis has clarified the demand for an ultra-brief single-session, online, theory-le... more The Covid-19 crisis has clarified the demand for an ultra-brief single-session, online, theory-led, empirically supported, psychological intervention for managing stress and improving well-being, especially for people within organizational settings. We designed and delivered “4Ds for Dealing with Distress” during the crisis to address this need. 4Ds unifies a spectrum of familiar emotion regulation strategies, resilience exercises, and problem-solving approaches using perceptual control theory and distils them into a simple four-component rubric (Distract–Dilute–Develop–Discover). In essence, the aim is to reduce distress and restore wellbeing, both in the present moment through current actions (distract or dilute), and through expressing longer-term goal conflicts (e.g., through talking, writing, and drawing) to discover new perspectives that arise spontaneously after sufficient time and consideration. The intervention is user-led in that it draws on users’ own idiosyncratic and pr...
Different meta-emotion strategies are often categorised as either adaptive (e.g. compassionate ca... more Different meta-emotion strategies are often categorised as either adaptive (e.g. compassionate care) or maladaptive (e.g. suppression). Yet some evidence indicates that the same strategy can be adaptive in one culture and maladaptive in another. We aimed to test whether meta-emotion strategies and their effects can in fact vary across different social contexts within the same individuals. A total of 140 students completed measures of meta-emotion strategies, satisfaction with life scale, and anxiety. Each scale was adapted for both the family home and the university home context. On average, the students had a lower level of interest in their emotions and adopted a tough control to a lesser extent when in the family home, compared to the university home context. At the individual level, some students used suppression more in the family home than the university home, whereas for others the effect was reversed. A series of multiple regressions showed the context specificity of meta-em...
Intrusive thoughts, flashbacks, panic attacks and sudden physiological arousal are each experienc... more Intrusive thoughts, flashbacks, panic attacks and sudden physiological arousal are each experienced as involuntary, are difficult to control, and lead to considerable distress. Such observations have led to the suggestion that anxiety disorders are associated with the operation of automatic information-processing biases. Clinical and experimental evidence for this proposal is reviewed and three different classes of routes to the development and modification of these automatic processes are described: an innate route, repetition/habituation, and conscious appraisal. The review focuses in particular on the third route, proposing that automatic processing biases can be altered by accessing and modifying conscious appraisals of internal and external events. Indirect evidence is provided by selective attention paradigms in anxiety, treatment studies and clinical observations, although further research will be necessary for a direct test of the pathway. The implications for the theory and...
Aim This review considers the theoretical literature concerning communication between a person wi... more Aim This review considers the theoretical literature concerning communication between a person with dementia and a person without dementia. Methods Theoretical accounts of communication between a person with dementia and a person without dementia were identified through database searches, hand searching of reference lists and contacting experts in the topic area. Results Twenty-one articles were included in the final review, yielding 18 different theoretical accounts of communication in the context of dementia. Thematic synthesis showed that four categories could account for the majority of the material described in these theories, even though they were derived from very different perspectives. These categories were mutuality, personhood, anxiety reduction and environmental considerations. Discussion The four categories identified in the thematic synthesis were reminiscent of Kitwood's theory of person-centred dementia care. Different interpretations of this finding are consider...
Many strategies have been recommended to support caregivers in communicating with people who live... more Many strategies have been recommended to support caregivers in communicating with people who live with dementia. However, less is known about what makes communication a good and meaningful experience from the perspective of people with dementia. Understanding this may enhance the person with dementia's sense of connectedness, strengthen their relationships, and facilitate person-centered care. The current review aimed to evaluate research that examined experiences of communication in people living with dementia. Studies that examined reports provided by people with dementia, healthcare professionals, and family caregivers were included. A mixed-methods systematic review was conducted using PsychINFO, MEDLINE, and EMBASE databases. After applying the eligibility criteria, 15 studies were included. Although eight of these recruited people with dementia, only one focused on their perspectives of communication experiences and the remaining studies focused on the perspectives of fami...
Behavioural and cognitive psychotherapy, Jan 25, 2018
Evidence for the efficacy of computer-based psychological interventions is growing. A number of s... more Evidence for the efficacy of computer-based psychological interventions is growing. A number of such interventions have been found to be effective, especially for mild to moderate cases. They largely rely on psychoeducation and 'homework tasks', and are specific to certain diagnoses (e.g. depression). This paper presents the results of a web-based randomized controlled trial of Manage Your Life Online (MYLO), a program that uses artificial intelligence to engage the participant in a conversation across any problem topic. Healthy volunteers (n = 213) completed a baseline questionnaire and were randomized to the MYLO program or to an active control condition where they used the program ELIZA, which emulates a Rogerian psychotherapist. Participants completed a single session before completing post-study and 2-week follow-up measures. Analyses were per protocol with intent to follow-up. Both programs were associated with improvements in problem distress, anxiety and depression p...
Psychology and Psychotherapy: Theory, Research and Practice
Distressing and pleasant/positive voices (auditory verbal hallucinations) are common in both clin... more Distressing and pleasant/positive voices (auditory verbal hallucinations) are common in both clinical and non-clinical voice-hearers. Identifying factors that contribute to emotional reactions to voices is essential for developing effective psychological interventions. Several theories propose that facilitation and interference with personal goals are important predictors of distress and well-being. This study examined whether voice-related distress is related to the degree to which voices interfere with personal goals, and whether pleasantness of voices is influenced by the extent to which they facilitate goals. Cross-sectional with clinical and non-clinical voice-hearers. Twenty-two clinical and 18 non-clinical voice-hearers completed interviews and self-report measures assessing (1) personal goals, (2) content, characteristics, and affective reactions to voices, and (3) ratings of the extent to which voices facilitated and/or interfered with achievement of important personal goals. Affective reactions were strongly correlated with measures of goal interference and goal facilitation. Regression analyses revealed that these associations remained significant when controlling for important covariates (e.g., participant grouping; content, frequency and duration of voices). Goal interference was specifically associated with distress, whereas goal facilitation specifically predicted perceived pleasantness of voices. This study provides a novel perspective on the factors that might contribute to distress in people who hear voices. The findings suggest that perceived impact of voices on valued personal goals may be an important contributor of voice-related distress. We propose that clinical assessments, formulations, and interventions could benefit from the careful analysis of the perceived impact of voices on goals. These findings suggest that variability in voice-related distress is closely linked to the perceived impact of voices on personal goals. These strong effects observed highlight the importance of considering the role of personal goals in future research on the psychological mechanisms leading to distress associated with voice hearing. Psychological assessments may benefit from the careful exploration of the impact of voice hearing on valued goals, and interventions promoting control over personal goals may be explored as treatment options for clients with distressing voices.
Background: The value of clients’ reports of their experiences in therapy is widely recognized, y... more Background: The value of clients’ reports of their experiences in therapy is widely recognized, yet quantitative methodology has rarely been used to measure clients’ self-reported perceptions of what is helpful over a single session. Aims: A video-rating method using was developed to gather data at brief intervals using process measures of client perceived experience and standardized measures of working alliance (Session Rating Scale; SRS). Data were collected over the course of a single video-recorded session of cognitive therapy (Method of Levels Therapy; Carey, 2006; Mansell et al., 2012). We examined the acceptability and feasibility of the methodology and tested the concurrent validity of the measure by utilizing theory-led constructs. Method: Eighteen therapy sessions were video-recorded and clients each rated a 20-minute session of therapy at two-minute intervals using repeated measures. A multi-level analysis was used to test for correlations between perceived levels of help...
We integrate research on conflict, ambivalence, self-discrepancy and concordance.We propose a hie... more We integrate research on conflict, ambivalence, self-discrepancy and concordance.We propose a hierarchical reconceptualization of these four concepts.Goal conflict impacts negatively on well-being.Pursuing goals that achieve one’s fundamental needs promotes well-being.Conflict at higher levels in the hierarchy may be more detrimental to well-being.This paper reviews empirical evidence for associations between goal conflict, ambivalence, self-discrepancy, self-concordance and well-being. The research indicates that goal conflict, ambivalence and discrepancy impede well-being, whilst concordance promotes well-being. The evidence was strongest for ambivalence, self-discrepancy, and self-concordance, and weakest for goal conflict. A hierarchical conceptualisation of the four related constructs is presented. Goal conflict, ambivalence, and self-discrepancy may occur at different levels within a goal hierarchy, which ranges from abstract, high level goals to low-level, concrete goals. Self-concordance is conceptualised as a property of the goal hierarchy, where goals are un-conflicted and facilitate intrinsic motivations and needs. Conflict at multiple or higher levels in the hierarchy may pose greater problems for well-being.
Background Psychological interventions for bipolar disorders typically produce mixed outcomes and... more Background Psychological interventions for bipolar disorders typically produce mixed outcomes and modest effects. The need for a more effective intervention prompted the development of a new cognitive behavioural therapy, based on an integrative cognitive model ('Think Effectively About Mood Swings' [TEAMS] therapy). Unlike previous interventions, TEAMS addresses current symptoms and comorbidities, and helps clients achieve long-term goals. A pilot randomized controlled trial (the TEAMS trial) of the therapy has recently concluded. This study explored participants' experiences of TEAMS, recommendations for improvement and experiences of useful changes post-therapy. Methods Fourteen TEAMS therapy participants took part in semi-structured interviews. Their accounts were analysed using interpretative thematic analysis. Two researchers coded the dataset independently. Member checks were conducted of the preliminary themes. Results Two overarching themes; 'useful elements...
The integrative cognitive model provides a comprehensive account of bipolar disorder (BD) that, i... more The integrative cognitive model provides a comprehensive account of bipolar disorder (BD) that, if empirically supported, has important potential implications for psychological therapies. This article is the first to review the evidence for this model. We evaluate the evidence (up to 2017) for four hypotheses derived uniquely from the model: extreme positive and negative appraisals of internal states are associated with (1) risk of developing BD; (2) BD diagnosis; (3) relevant clinical and functional outcomes including hypomanic and depressive mood symptoms; and (4) outcomes over time. Research involving individuals with diagnosed mood disorders as well as non-clinical populations is reviewed. The hypotheses were broadly supported and several consistent findings were not accounted for by alternative psychological models of BD. The evidence base is limited by a relative paucity of prospective studies; only 6 of the 31 studies identified. Implications for theory, research and clinical...
There is limited evidence regarding the accuracy of inferences about intention. The research desc... more There is limited evidence regarding the accuracy of inferences about intention. The research described in this article shows how perceptual control theory (PCT) can provide a "ground truth" for these judgments. In a series of 3 studies, participants were asked to identify a person's intention in a tracking task where the person's true intention was to control the position of a knot connecting a pair of rubber bands. Most participants failed to correctly infer the person's intention, instead inferring complex but nonexistent goals (such as "tracing out two kangaroos boxing") based on the actions taken to keep the knot under control. Therefore, most of our participants experienced what we call "control blindness." The effect persisted with many participants even when their awareness was successfully directed at the knot whose position was under control. Beyond exploring the control blindness phenomenon in the context of our studies, we discuss...
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Papers by Warren Mansell