Profile: Dr Warren Mansell discusses Perceptual Control Theory
Dr Warren Mansell is a clinical psychologist, researcher and Reader at the University of Manchester. His principal areas of research focus are transdiagnostic interventions for mental health and Perceptual Control Theory. Recently he conducted research into ultra-brief interventions for dealing with distress. Psychology Tools talked to Warren about the benefits of PCT, why it’s time to move to more universal approaches, and his hope that in the future we can look after our mental health just as we look after our teeth.
The road to Perceptual Control Theory
What attracted you to clinical Psychology initially?
I wanted to find out whether everything I had learned really helped people in practice. Mental health problems affect every family in some way, and I wanted to show that what seemed to some people like a mysterious illness could be understood.
What led to your interest and focus on transdiagnostic approaches to CBT, and Perceptual Control Theory (PCT)?
When reading for my PhD in the 1990s, I saw quite how much all the cognitive models of different psychological disorders overlapped. It seemed clear to me that a transdiagnostic approach would be more parsimonious – scientifically and economically.
There needed to be a psychological framework that could bridge these different presentations of psychological distress. I set out to find one, dissatisfied with purely cognitive, behavioral, psychodynamic or humanistic approaches. I discovered PCT in a book called ‘Without Miracles’ by Gary Cziko, and when I read the key 1973 text on PCT, I knew I’d found the approach that was needed.
Pandemic aside, what does your balance between research, teaching, and clinical work look like?
It’s about equal time for each, but a lot of my clinical time is spent delivering training, supervision and group sessions rather than seeing individual clients at the moment.
Transdiagnostic thinking: It’s time for universal approaches
You’ve been involved with the transdiagnostic approach to CBT from the start. What excites you about this area?
It’s more than excitement. It feels like a necessity and a no-brainer to me. Why do it any other way?
What’s your take on progress in diagnosis-specific interventions vs transdiagnostic interventions?
There are lots of ways of comparing them, but maybe the simplest and most generous way is efficacy versus efficiency. Essentially, the more we invest time and money in multiple interventions to reduce disorder-specific symptoms in small groups of diagnosed patients, the more time and money is wasted not providing universal mental health and wellbeing interventions at a large scale to anyone who needs them.
It’s time to move to theories and interventions that are universal and see how they fare; we’ve done it the diagnostic way for over four decades and mental health issues have only got worse.
Over the time that you have been focused in this area, what about your approach has changed the most?
In the last few years I have become more focused in getting on with delivering universal interventions remotely and at a large scale, through online training, ultra-brief workplace interventions, and artificial conversational agents.
Looking ahead 20 years, what impact do you hope the transdiagnostic approach will have had on mental health treatments?
People will get help with their mental health difficulties as readily as they share their opinions on social media, get their car serviced and have their eyes and teeth checked.
Perceptual Control Theory
Could you give us a 2-minute outline of Perceptual Control Theory? How do you explain it to clients?
We don’t explain PCT to clients unless they ask because the point of the Method of Levels is to devote every minute to the clients’ priorities and perspective. We just get people talking, listen carefully and act on our instinctive curiosity. As you are asking, PCT is a theory of behavior, but it’s not a behaviorist theory!
According to PCT, our behavior is the ‘control of perception’. At any moment we vary our outputs to keep our inputs (what we sense and experience) the way we want them to be – getting them just right. To do this we have to utilize what’s in our environment, and we have to act against any disturbances to what we want. It’s a Goldilocks theory of life. We try to keep any experience that matters to us in a preferred state, whether this be the temperature of our porridge, the volume of our voice, or the level of anxiety we can endure.
Given that we need to control so many aspects of our life, our brain organizes them in a hierarchy. The longer term, more abstract perceptions – like being kind, or loyal, or honest – toward the top, and going down the hierarchy the goals get more concrete, right down to the control of how intensely we sense a signal from the environment, such as the brightness of a light, or the pressure of a hand grip.
When we are in control, we feel contented, but when important aspects of our life get out of control, we feel distressed. There are several reasons we can lose control, but the most pernicious is when we are in conflict. Conflict occurs when we have two or more different goals for the same experience. For example, if a person wants to describe a past assault in detail to the police to get justice, but they also want to never think about the assault to stay sane, they are in conflict.
Conflict is not illogical, and it can’t be solved through just adopting one of the two goals, or by advice or specific suggestions. To resolve it, there need to be changes in why these conflicting goals are set – this means going higher up in the hierarchy and staying there until a solution is found. In technical terms, it involves shifting and sustaining awareness to the source of the conflict to allow reorganization – an internal trial-and-error learning process – to change this higher-level goal system (for example by perceiving oneself and the relationship between one’s principles in new ways) until the conflict is resolved.
So, on the surface doing PCT in individual therapy – known as the Method of Levels – looks like a natural, attentive and productive conversation but on the inside we have a detailed architecture for why this works.
What do you think are the key benefits of the approach compared to other frameworks such as CBT or ACT?
PCT is based on a theory of how living organisms work that we have tested in studies ranging from qualitative coding of therapy, to experimental studies and computer simulations. It’s client-led rather than relying on developing a collaborative relationship and a shared understanding. It’s also flexible to what the client wants to talk about, and when and how long they want therapy. No specific techniques are required, and it will never change or get rebranded with different elements, so it’s easy to train people to use it.
What is most helpful clinically about the theory and how can clinicians use it to work more effectively with clients?
Method of Levels is a universal psychological therapy that does make a big difference to typical clinical practice. In essence it helps you to work with complexity by following simple principles, and in doing so helps you to tailor your approach to the individual but in a natural way that takes the pressure off constantly learning new techniques to do it the ‘right way’.
Can you give an example of how PCT is applied practically and why you would use it to treat a client with say, anxiety or depression, instead of CBT?
When doing Method of Levels, you just have two goals, but you follow them at all times: (1) ask about the problem and (2) ask about disruptions. The client takes the lead in describing a problem and you regularly ask questions to help them describe it in more depth and detail.
You also ask about disruptions which are things you notice – like pauses, changes in affect, emphasis of certain words – which might indicate that they have a fleeting or background thought that they’ve not yet put into words. Or they might not! It’s your job to ask. By keeping focused on them, you allow the client to control their discovery process and notice their conflicts and higher-level goals, and you make the chance of a spontaneous new perception more likely.
Through MOL, the ‘reappraisals’ or ‘insights’ you might see in CBT or other therapies seem to happen at the client’s pace which is often more regularly. I would use MOL rather than CBT because it means I can be geared entirely round my clients’ preferences and be more efficient than having to build a formulation, plan homework on my terms and switch between models.
Looking ahead 20 years, what impact do you hope this area will have had on mental health treatments?
I hope that this area of research and practice could lead to a situation in which most people don’t need specialist mental health treatments to resolve their longstanding problems, just as most of us in this century don’t need our teeth pulled out because of cleaning and regular check-ups.
Your paper ‘The 4Ds of Dealing With Distress – Distract, Dilute, Develop and Discover: An Ultra -Brief Intervention for Occupational and Academic Stress’ by Warren Mansell, Rebecca Urmson and Louise Mansell, was recently published. Can you give us a brief summary for those who don’t know about it?
It is a way to deliver the core messages for managing your own distress in a 90-minute online experiential workshop.
My wife co-directs a child clinical psychology social enterprise and increasingly was being approached by busy teachers, parents, foster carers, and mental health practitioners for a brief, focused intervention that catered to their own needs.
We saw that there were many ‘stress management’ programmes out there, but most were time intensive and eclectic, without core principles to guide them. We also wanted to capitalize on the advantages of online interventions – such as having more privacy to explore one’s problems out loud, rather than in a face-to-face group. We realized that the activities and techniques that other programmes use have a sometimes effective, but limited, role in helping people to regain short-term control of their experiences – such as breathlessness and tension.
We just needed a rubric – our 4Ds pyramid of Distract, Dilute, Develop and Discover – to show their place as a stepping-stone to, and from, the ‘deeper’ approaches that require open expression, natural curiosity and personal discovery – just as the Method of Levels provides.
We have had the opportunity to provide 4Ds to a wide range of professions in large online groups. We are getting feedback as we go along to continuously improve it and beginning on some more in-depth process and outcome evaluation.
Were there any elements in the findings that surprised you?
Maybe that many people preferred it online to in person, and how intuitive people found our rubric. We had based it on PCT, but we didn’t need to explain the theory in any detail.
What do you hope the practical clinical implications will be from this study?
The article is a theory and practice report rather than a research study, but we hope clinicians will be able to try out and get used to ultra-brief large-scale interventions as part of their offering to clients, and that 4Ds becomes part of a suite of what a PCT-informed mental health service can offer.
You stated that one aim was to create an approach that facilitated long term change (vs other programs that had been effective on a short-term basis). How effective were the “develop” and “discover” components at achieving longer term changes?
Let’s see when we do the long-term research!
Sadly, the majority of clinical psychologists never publish. What motivates you to carry out and publish research – what is different about you, what drives you? Do you value research over clinical practice?
It probably has something to do with the fact that I was a researcher for six years before a started training as a clinical psychologist. I have always been interested in the ‘public’ side of science, and what difference you can make by sharing ideas with a wide audience.
What is it about carrying out research that motivates you the most?
Ever since I came across PCT, it’s been about wanting to show other people what this theory, and the perspective on life it provides, can do for us, personally, and as a society, and using it creatively to develop technologies. This includes the 4Ds and the Take Control Course (a six session transdiagnostic group intervention), but also other work that I’ve been involved in on communication in dementia, conflict mediation, human performance, and robotics.
What’s valuable about your current professional balance (research/teaching etc?)
That I can still find plenty of time to have fun with my family and friends.
What are you working on now that makes you most excited? Can you tell us a little bit about it?
Yes. I’m completing a grant application to develop MYLO – an artificial therapist that works on your phone by emulating Method of Levels therapy. We’ve published some early studies on it, but we want to build its database of search terms and therapist questions and functionality so that people who can’t access face-to-face therapy have the opportunity to explore and resolve their problems.
Looking back and looking forward
If you could go back in time and give some advice to your younger self training as a clinician, what would it be? What do you wish you had known then that you know now?
Maybe that you always think you are working on the next ‘big thing’, but try to see it as a process, that takes at least 25 years and counting!
Is there a paper that you keep going back to, or which has provided particular insights for you?
Sorry to be predictable, but it’s Powers (1973), Behaviour: The Control of Perception.
What developments in psychological treatment, interventions or techniques do you think look really promising for the future?
I think that virtual reality has huge untapped research possibilities, but it’s less critical for future interventions than people think. Any intervention that makes simple, scientific principles of human nature accessible for anyone – not just academics and professionals – to apply in helping themselves and each other, will hold promise for the future.
Therapists interested in learning more about the Method Of Levels approach can explore:
- An accessible 2018 article by Warren Mansell in Revista de Psicoterapia
- A free online method of levels training video