A Transdiagnostic Approach to CBT using Method of Levels Therapy

Reorganization describes the way in which individuals develop new ways of achieving their goals through trial and error.

“Reorganization describes the way in which individuals develop new ways of achieving their goals through trial and error (Powers, 1973; Carey, 2006; Mansell et al., 2012).”

When individuals do not have sufficient control over their experiences, they experience error, a sense of discrepancy between their current experiences and the experiences they would like to have, which can result in psychological distress that may manifest in various ways depending on the individual's goals.

“Powers (2005) states that when individuals do not have sufficient control over their experiences, they experience error, which is defined as a sense of discrepancy between their current experiences and the experiences they would like to have. This sense of discrepancy can result in psychological distress that may manifest in various ways, depending on the individual’s goals (Mansell et al., 2012).”

Certain circumstances can affect an individual's ability to control their experiences, such as natural disasters or serious illness, and this loss of control is often distressing.

“Certain circumstances can affect an individual’s ability to control their experiences, such as natural disasters, or if the individual develops a serious illness, and this loss of control is often distressing (Powers, 2005; Mansell and Carey, 2009; Mansell et al., 2012).”

Goal conflict can occur at times when either an individual's goals change or their life circumstances change so that their goals are no longer compatible.

“Goal conflict can occur at times in an individual’s life when either their goals change, or their life circumstances change so that their goals are no longer compatible (Powers, 1973; Mansell et al., 2012; Carey et al., 2015).”

According to PCT, any areas of discrepancy between a current and desired experience automatically attract an individual's attention; by focusing on the discrepancy, they may gain new insights into ways of resolving it through reorganization.

“According to PCT, any areas of discrepancy between a current and desired experience automatically attracts an individual’s attention (Powers, 1973). By focusing on the discrepancy (problem), they may gain new insights into ways of resolving it through a process known as reorganization (Mansell et al., 2012).”

If the individual only focuses their attention on the level of the two conflicting goals, they may not reach a solution to their problem, and the resulting distress may increase their risk of suicide.

“However, if the individual only focuses their attention on the level of the two conflicting goals, they may not reach a solution to their problem (Carey, 2006; Mansell et al., 2012; Carey et al., 2015), and the resulting distress may increase their risk of suicide.”

Awareness of higher-level goals above the level of the goal conflict is necessary to enable the individual to identify the underlying purposes of the conflicting goals, and consequently re-evaluate new ways of achieving those goals.

“Awareness of higher-level goals which are above the level of the goal conflict is necessary to enable the individual to identify the underlying purposes of the conflicting goals, and consequently re-evaluate new ways of achieving those goals (Mansell et al., 2012; Carey et al., 2014a).”

These strategies prevent the individual's awareness from focusing on the level of the goal hierarchy where it needs to be, i.e., the level above the conflicting goals, so reorganization cannot take place.

“However, since these strategies prevent the individual’s awareness from focusing on the level of the goal hierarchy where it needs to be, i.e., the level above the conflicting goals, reorganization cannot take place (Mansell et al., 2012, 2015; Mansell and McEvoy, 2017).”

The continued sense of loss of control arising from the conflicting goals may result in individuals becoming more likely to experience a suicidal crisis.

“Therefore, the continued sense of loss of control arising from the conflicting goals (Mansell et al., 2012) may result in individuals becoming more likely to experience a suicidal crisis.”

If such a conflict remains unresolved, the individual will experience chronic loss of control of this important higher-level goal, which is likely to cause psychological distress.

“If such a conflict remains unresolved, the individual will experience chronic loss of control of this important higher-level goal, which is likely to cause psychological distress (Mansell et al., 2012).”

Since both types of goal are incompatible, this is another example of goal conflict, which can become chronic if it remains unresolved.

“Since both types of goal are incompatible, this is another example of goal conflict, which can become chronic if it remains unresolved (Carey, 2006; Mansell et al., 2012).”

An individual contemplating suicide can become so focused on the goal of ending their life, in order to regain control, that the consequences of suicide which conflict with other important life goals remain outside of their current awareness.

“However, our framework posits that an individual contemplating suicide can become so focused on the goal of ending their life, in order to regain control, that the consequences of suicide which conflict with other important life goals remain outside of their current awareness.”

Exclusive concentration upon ending one's life occurs when suicide as a means of regaining control becomes the focus of attention, often due to the chronic error arising from lost control of other goals.

“This exclusive concentration upon ending one’s life occurs when suicide as a means of regaining control becomes the focus of attention, often due to the chronic error arising from lost control of other goals (Powers, 2005; Carey, 2006; Mansell et al., 2012).”

Even though the loss of control resulting from goal conflict automatically attracts an individual's attention, for many people, their attention is naturally drawn away from any prolonged focus on the problem to other more wide-ranging priorities in their lives.

“Even though the loss of control resulting from goal conflict automatically attracts an individual’s attention, for many people, their attention is naturally drawn away from any prolonged focus on the problem to other more wide-ranging priorities in their lives (Mansell et al., 2012; Kelly et al., 2013).”

Ambivalence about suicide is due to the underlying goal conflict between one's reasons for living and reasons for dying, since conflict leads to loss of control.

“we posit that this is due to the underlying goal conflict between one’s reasons for living and reasons for dying, since conflict leads to loss of control (Powers, 1973; Mansell et al., 2012).”

The limited awareness resulting from moving one's awareness towards less distressing goals, such as by distracting oneself using alcohol, may be experienced as feelings of emotional numbing or dissociation.

“We also posit that the limited awareness resulting from moving one’s awareness towards less distressing goals, such as by distracting oneself using alcohol, may be experienced as feelings of emotional numbing or dissociation (Holmes et al., 2005; Mansell and Carey, 2012).”

Reduced attentional control, including the ability to inhibit responses, would be interpreted from a PCT perspective as a reduced ability to sustain or shift awareness between goals.

“Firstly, reduced attentional control, including the ability to inhibit responses (Richard-Devantoy et al., 2015; Thompson and Ong, 2018), would be interpreted from a PCT perspective as a reduced ability to sustain or shift awareness between goals (Mansell et al., 2012).”

Limited awareness depends on an individual's mental flexibility; in other words, their ability and willingness to shift their awareness to and sustain their attention on other goals.

“Limited awareness depends on an individual’s mental flexibility; in other words, their ability and willingness to shift their awareness to and sustain their attention on other goals (Mansell et al., 2012).”