Problems most frequently reported by young people in school counselling relate to family difficulties. During adolescence, conflict between parents and young people increases as young people move towards independence whilst still being reliant on parents. The quality of communication during this period has implications for young people’s well-being. The current study explored how the principles of perceptual control theory (PCT) could be used to develop a structured activity aimed at helping young people to talk to their parents about their goals and goal conflicts.

PCT proposes that individuals function well when they are able to control things that are important to them. Every individual has numerous goals/wants and if two or more are incompatible, conflict arises. The current study focused on supporting young people to explore conflict that might arise due to incompatible goals held by them and their parent. Six families (child and parent/carer) were recruited to try a goal-setting and monitoring activity. The activity was facilitated by a Method of Levels researcher over a 10-week period. There were two follow-up appointments at 2 and 4 months. Two families were retained for the entire study. On completion, four families provided qualitative feedback. On the basis of participants’ feedback, the activity was modified to incorporate discussions on incompatible goals. Two families piloted the modified activity and provided feedback. Both families completed the study. Results suggest that a parent–child activity using the principles of PCT is feasible and acceptable among parents and young people.

Many psychological therapies help clients to direct and sustain their awareness onto specific aspects of their problems to promote change. Yet, no theory-driven measure exists that can code moment-by-moment changes in awareness during a therapy session. It is known that awareness plays a crucial role in the process of change, but little is known about the underlying core processes. Perceptual Control Theory (PCT) offers a scientific explanation of psychological distress as loss of control and describes the role of awareness in processes responsible for restoring control by resolving any internal conflict. The Depth and Duration of Awareness Coding Scheme (D-DACS) was previously developed to capture the person’s current focus of awareness and its duration on the areas that from a PCT point of view are desirable in order to facilitate effective psychological change. The current research applies D-DACS to code three publicly available Method of Levels (MOL) therapy sessions delivered by an expert therapist and presents a visual representation of the client’s presumed attention in these sessions. The results showed that an average of 61.65% of the client’s attention was focused on the D-DACS areas, which is higher than the previous studies involving novel therapists. The produced visual representation of the clients’ presumed attention helps to examine the utility of this new coding scheme and further examine the validity of the underlying theory. Such work might help in examining effectiveness of therapy in meeting the underlying theoretical foundations of change. However, limitations and areas for improvement are also evident.

Recent advances in transdiagnostic cognitive therapy such as Method of Levels therapy have utilized perceptual control theory (PCT). The current study reports the development and preliminary investigations of the psychometric properties of a newly developed coding scheme – the Depth and Duration of Awareness Coding Scheme (D-DACS) – which utilizes PCT to code a client's awareness of their present moment experiences, counterproductive strategies (arbitrary control), goal conflict and higher-level goals. Fifty participants’ first therapy sessions were coded according to the D-DACS. For the purposes of inter-rater reliability analysis, 25% of sessions were co-coded and inter-rater reliability of the D-DACS was found to fall in the good range. Findings for the convergent validity of the D-DACS were mixed with the finding of a significant association between the D-DACS primary indices and a more global and subjective index of awareness as measured by the D-DACS, but a lack of association between the D-DACS primary indices and self-report measures that were somewhat conceptually related. Support for the predictive validity of the D-DACS primary indices in relation to the prediction of change in symptoms for a subset of the sample who returned for a second session (n = 35) was not found. Limitations to the D-DACS as it stands and to the current study are discussed. Considerations for future research that address such limitations are also discussed.

Background: 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). Aims: 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. Method: 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. Results: Analyses were per protocol with intent to follow-up. Both programs were associated with improvements in problem distress, anxiety and depression post-intervention, and again 2 weeks later, but MYLO was not found to be more effective than ELIZA. MYLO was rated as significantly more helpful than ELIZA, but there was no main effect of intervention on problem resolution. Conclusions: Findings are consistent with those of a previous smaller, laboratory-based trial and provide support for the acceptability and effectiveness of MYLO delivered over the internet for a non-clinical sample. The lack of a no-treatment control condition means that the effect of spontaneous recovery cannot be ruled out.

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 helpfulness and client process variables. Results: The design proved to be feasible. Concurrent validity was borne out through high correlations between constructs. A multi-level regression examined the independent contributions of client process variables to client perceived helpfulness. Client perceived control (b = 0.39, 95% CI .05 to 0.73), the ability to talk freely (b = 0.30, SE = 0.11, 95% CI .09 to 0.51) and therapist approach (b = 0.31, SE = 0.14, 95% CI .04 to 0.57) predicted client-rated helpfulness. Conclusions: We identify a feasible and acceptable method for studying continuous measures of helpfulness and their psychological correlates during a single therapy session.

Intolerance of Uncertainty (IU) has been shown to underlie a range of disorders. Technological advances have produced a decline in our development of an ability to wait in the face of uncertainty. The paper provides an update on empirical, theoretical and neural research in IU. Einstein's extended trandiagnostic model of IU is described. This model is based on control theory. The research update and IU model propose specific tools which can be implemented within transdiagnostic treatment approaches.

Background: Extreme appraisals of internal states correlate with and prospectively predict mood symptoms in adults, and discriminate individuals with bipolar disorder from individuals with unipolar depression and non-clinical controls. Aims: These findings required replication in adolescents. This study sought to investigate the relationships between appraisals of internal states, mood symptoms and risk for bipolar disorder in an adolescent sample. Method: A non-clinical sample (n = 98) of adolescents completed measures of mood symptoms, appraisals, and mania risk, alongside covariates. Results: Appraisals of internal states were associated with analogue bipolar symptoms, independently of impulsivity and responses to positive affect. Positive appraisals of activated mood states were uniquely associated with hypomania, whilst negative appraisals were uniquely associated with depression and irritability symptoms. Individuals who appraised activated states as both extremely positive and extremely negative were more likely to score at high or moderate risk for future mania. Conclusions: This study is the first to demonstrate associations between appraisals of internal states, analogue mood symptoms and mania risk in adolescents. Clinical implications are discussed.

Several theories suggest that goal conflict leads to loss of control, but few studies have tested this proposal objectively. A transdiagnostic approach to CBT based on Perceptual Control Theory proposes that conflict between superordinate goals is at the heart of loss of control, and in turn, psychological distress. This study used the example of goal conflict around eating in a non-clinical sample as proof-of-concept to test whether it predicted loss of control. We examined whether the conflict regarding reasons to eat tasty food (e.g. ‘Eating tasty food helps me feel better’) versus reasons not to eat tasty food (e.g. ‘I want to lose weight’) correlated with weight fluctuations over 6 weeks in 33 students. At baseline, higher levels of goal conflict were associated with greater state and trait food cravings, and more problems with control over eating. As predicted, people with higher levels of goal conflict showed greater weight fluctuation. The effect diminished when controlling for trait food craving, and exercise fluctuation remained an independent predictor. We discuss the implications for future research on goal conflict, and for interventions that raise awareness of goal conflict to improve wellbeing via the enhancement of self-control.

Background: Initial therapy appointments have high nonattendance rates yet the reasons remain poorly understood. Aims: This study aimed to identify positive and negative attitudes towards therapy that predicted initial attendance, informed by a perceptual control theory account of approach-avoidance conflicts in help-seeking. Method: A prospective study was conducted within a low intensity CBT service using first appointment attendance (n = 96) as an outcome. Measures included attitudes towards therapy, depression and anxiety scales, and demographic variables. Results: Endorsement of a negative attitude item representing concern about self-disclosure was independently predictive of nonattendance. Positive attitudes predicted increased attendance, especially endorsement of motives for self-reflection, but only among less depressed individuals. Conclusions: Self-disclosure concerns contribute to therapy avoidance and having goals for self-reflection may represent approach motivation for therapy; however, the latter has less impact among more highly depressed people.

This study aimed to examine how people change in order to achieve and maintain a personally comfortable weight and what changes for them as they change. Six students who changed to achieve and maintain a personally comfortable weight for a minimum of 1 year were recruited. Semi-structured interviews explored participants’ experiences of what changed and how they changed. The interviews were analysed using interpretative phenomenological analysis. Two superordinate themes emerged. The first was ‘awareness’ which contained the subthemes: unaware self, revelation, and conscious monitoring and maintenance of awareness. The second was ‘goals and needs’ which contained the subthemes: social- vs. self-acceptance, removing negative emotions, weight control vs. other life goals, and ideal vs. perceived health and appearance. The findings are discussed in relation to the existing literature on the development of eating problems, involving social acceptance, self-esteem, coping with negative moods, and weight control. Perceptual Control Theory was used to provide an explanation for how these participants changed and maintained their change.

Background: Computerized self-help that has an interactive, conversational format holds several advantages, such as flexibility across presenting problems and ease of use. We designed a new program called MYLO that utilizes the principles of Method of Levels (MOL) therapy - based upon Perceptual Control Theory (PCT). Aims: We tested the efficacy of MYLO, tested whether the psychological change mechanisms described by PCT mediated its efficacy, and evaluated effects of client expectancy. Method: Forty-eight student participants were randomly assigned to MYLO or a comparison program ELIZA. Participants discussed a problem they were currently experiencing with their assigned program and completed measures of distress, resolution and expectancy preintervention, postintervention and at 2-week follow-up. Results: MYLO and ELIZA were associated with reductions in distress, depression, anxiety and stress. MYLO was considered more helpful and led to greater problem resolution. The psychological change processes predicted higher ratings of MYLO's helpfulness and reductions in distress. Positive expectancies towards computer-based problem solving correlated with MYLO's perceived helpfulness and greater problem resolution, and this was partly mediated by the psychological change processes identified. Conclusions: The findings provide provisional support for the acceptability of the MYLO program in a non-clinical sample although its efficacy as an innovative computer-based aid to problem solving remains unclear. Nevertheless, the findings provide tentative early support for the mechanisms of psychological change identified within PCT and highlight the importance of client expectations on predicting engagement in computer-based self-help.

Background: Nonattendance rates remain high for first therapy appointments, despite initiatives to increase access to psychological therapy. The reasons for nonattendance are poorly understood and studies of demographic and clinical predictors have produced conflicting findings. Aims: We aimed to pilot a method for investigating psychological factors associated with first appointment attendance in a primary care mental health service. Method: Questionnaires were completed by individuals at the point of referral to CBT with a low-intensity service in one general practice (n = 67), including a measure of beliefs, goals and attitudes towards therapy, as well as anxiety and depression scales. Subsequent attendance at the first appointment was used as an outcome. Results: Preliminary results showed that attendance was not associated with age or gender, severity of distress, or overall ratings for positive or negative attitudes towards therapy; although distress itself was associated with increased endorsement of negative attitudes. However, one specific psychological item, “Talking to a therapist will help me understand better how my mind works” had a significant association with subsequent attendance. Conclusions: The psychological factor that was associated with increased attendance may reflect the concept of psychological mindedness; however, this requires replication in a larger study. A full-scale study was deemed to be warranted based on this prospective design.

Background: Previous research has shown that tendencies to tenaciously pursue goals and flexibly adapt goals independently relate to well-being in adults in mid-to-late life, but research has not tested whether these tendencies interact. For example, tenacity may only predict well-being in combination with flexibility. This research tests whether these tendencies interact to predict changes in health-related outcomes.

Methods: A large cohort of people (n = 5,666), initially aged 55–56, completed measures of flexibility, tenacity, health-related outcomes (physical health, depression, hostility), as well as demographics. Participants provided follow-up data on all measures ten years later. Moderation analysis was used to test whether flexibility and tenacity interacted to predict changes in the health-related outcomes over the period.

Results: The interaction between tenacity and flexibility significantly predicted changes in depression, hostility, and physical ill-health symptoms over ten years, such that highly flexible and tenacious individuals experienced the largest decreases in symptoms of depression, hostility, and physical ill-health.

Conclusions: The interaction between flexibility and tenacity predicts greater well-being, such that one is most protective when an individual also scores highly on the other. The combination of flexibility and tenacity in the pursuit of personal goals may mean individuals can enjoy gains associated with goal pursuit without the detrimental effects of persevering in blocked goals.

Evidence clearly suggests that the therapeutic relationship is important to successful outcomes in psychotherapy. It is less clear as to why this might be the case. Throughout the literature, various factors such as warmth, empathy, compassion, unconditional positive regard, and openness are identified as key. The way in which factors such as warmth and empathy bring about an amelioration of psychological distress, however, is not entirely obvious. We suggest that one possible mechanism through which these factors become important is by helping to create an environment where clients can examine their problems freely. Furthermore, we propose that when the therapeutic relationship is therapeutic, clients feel comfortable to consider whatever comes into their mind; with any filtering or evaluating happening after the ideas have been expressed, and not before. Psychological processes identified as maintaining psychological distress (e.g. thought suppression, avoidance, rumination) block this capacity. Our suggestion is that as internal experiences are being examined, the client has an opportunity to become aware of facets of the problem that were previously unattended to; and to continue this process outside therapy. Through this awareness-raising process the client's problem can be reorganized via intrinsic learning processes to achieve a more contented state of mind.