Manchester Unite Goals To Relieve Distress
Posted on Jul 23, 2009 by Warren Mansell
I have been working with the ‘Manchester Node’ of the EROS grant to get our research up and running and to begin disseminating. Our team has already started growing –two half-time RAs, Becki Kelly and Miriam Samad, are working on the project day to day. We have three academic collaborators here – Sara Tai, Alex Wood and Fiona Ulph, who have been invaluable in providing conceptual debate and in the methodology of the work. I hope they will keep involved throughout the grant! We also have a number of research volunteers and students whose work will relate closely to the grant themes and help us get to the bottom of the clinical aspects of emotion regulation.
Our work is guided both by a recent cognitive model of affect regulation in bipolar disorders and mood swings (Mansell, Morrison, Reid, Lowens & Tai, 2007) and by Perceptual Control Theory (PCT; Powers, Clark & McFarland, 1960; Powers, 1973) and related self-regulatory approaches. There is some space for a healthy dose of evolution theory and humanism in there too!
Our first step was to test the idea of the importance of a combination of both low order and high order conflict on psychological distress. Low order conflict is often about resources and programs of behaviour (e.g. finishing course work and going out with friends) whereas high order conflict is usual about deeply held principles (e.g. being a liked by others and expressing one’s own needs). We proposed that only in the presence of higher order conflict is lower order conflict a real problem. We manage to show this by using measures of ambivalence as an indirect index of higher order conflict, and the ‘goal matrix’ method as a measure of low order conflict. They interact together so that if you are high on both, the person is more depressed and stressed. The real challenge now is to try to assess higher order conflict more directly – Paschal Sheeran has told us of some other methods. It is clearly difficult though – our theories tell us that it is the very fact the people are usually not aware of these conflicting principles they hold that keeps there problems going, and therapy is about helping them to notice this and build up a broader, ‘systems-concept’ level perception of their principles. That’s not easy to test!
We have many studies going at the moment. Probably the most helpful will be a diary and interview study where a small group of volunteers trace their emotion regulation over a week and then take part in an interview about it. We plan to use Interpretative Phenomenological Analysis (IPA) to analyse these interviews to get a clear idea of the pitfalls and advantages of emotion regulation. Our theories tell us that the goals behind emotion regulation strategy are what influence its effectiveness and capacity for either reducing, or exacerbating, distress, so we are going to ask a range of questions to try to access these. Our initial pilots are coming up with fascinating goals behind emotion regulation – for example, it looks like people control other peoples’ emotions often in order to control their own (e.g. telling jokes to raise the mood of the group to stop feeling upset oneself).
The big task then will be working out how to assess the higher order goals behind emotion regulation in a systematic way. We have begun to use the ‘goal matrix’ method by Emmons & King (1988), but we are coming up against some problems here (although the study will still be very useful, not the least because David Holman is working with us to produce the first ever ‘network’ analysis of the relationship between personal goals). In particular, our theories tell us that a small number (two or more) of high level personal goals (e.g. ‘to be honest’ vs ‘to be successful’; ‘to be brave’ vs ‘to show my weaknesses to others’) are more likely to be behind chronic distress, and moreoever, it is the arbitrary and relatively habitual ways that people try to suppress one goal over another (e.g. to push upsetting memories out of their mind so not to feel vulnerable even though those memories may be useful to know) that are a real problem (this is called arbitrary control in PCT). This style may have its roots in insensitive and overcontrolling parenting and social interaction (see the Reading and Oxford nodes of EROS). The higher the hierarchical level of this arbitrary control, the bigger the problem it is, so when people take on inflexible general rules it can have a bigger impact (e.g. ‘I must never show emotion’) than a low level attempt (e.g. to manage an isolated uncomfortable emotion). We are looking to find some methodologies, not anticipated in our original grant application, that allow us to assess these forms of conflict and arbitrary control – questionnaire based and laboratory based. We want to explore these in student and clinical (bipolar) populations. An existing scale called the Reorganisation of Conflict scale, developed by a Manchester Masters student, may pave the way, but any further ideas welcome!
We are all continuing our training in Method of Levels (MOL), a newly developed form of cognitive therapy that helps people to ‘go up levels’ to explore the conflicting goals driving their current problems to help them solve them or manage them better. This study is being led by Marijke, a clinical doctoral student. Timothy Bird, in his Masters work, is about to publish a study exploring the Method of Levels to provide some of the first clinical formulations and tests of validity of this approach.
Several other studies relating to the grant are emerging too. We have a range of work on the HAPPI scale (Hypomanic Attitudes and Positive Predictions Inventory) by Alyson Dodd in her PhD thesis – this scale predicts mood swings (i.e. poor emotion regulation) over time. Ruth Searson, another clinical doctorate student, has been delivering cognitive therapy based on our theoretical model with a case series of seven patients with bipolar disorder. The effects have been very promising, with four out of seven of the patients showing clinically significant recovery. We are hoping that these results sustain for the 6 month follow-up. On the other side of things, I have been liaising with a control systems engineer, Martin Brown, and our own in-house programmer, Yu Li, to build computer models of goal hierarchies to test some of our ideas. The early signs again are very exciting…
So, all in all, it’s very busy here in the ‘Manchester Node’ of the EROS grant. But that’s what it should be at this stage, and hopefully within a year or two the data will speak for itself and we will have a much clearer story to tell you.
Signing off for now,
Warren
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