Evaluating the feasibility and acceptability of Method of Levels therapy for people experiencing first-episode psychosis

Student thesis: Phd


Psychological interventions that target the core processes which are proposed to maintain distress across diagnostic categories might have advantages over disorder-specific approaches for people experiencing first-episode psychosis (FEP). This thesis aimed to evaluate the feasibility and acceptability of a transdiagnostic cognitive therapy called Method of Levels (MOL) for people experiencing FEP, and to consider whether adaptations are needed to support its implementation into routine practice. MOL is designed to ameliorate distress, rather than reduce symptoms. A related aim, therefore, was to increase our understanding of the sources of distress for this population. The results of the thesis will be used to inform decision making about the suitability of MOL for further testing in a larger clinical trial. The thesis comprises three studies described over four papers: (i) a qualitative metasynthesis exploring sources of distress in FEP (Chapter 3); (ii) a feasibility randomised controlled trial (RCT) of MOL for FEP (Chapters 4 and 5); and (iii) a qualitative study exploring experiences of receiving MOL amongst people with FEP (Chapter 6). The metasynthesis is the first review to address the question of what causes distress in people experiencing FEP from a first-person perspective. Following a systematic review, findings from qualitative studies (n = 33) were synthesised using thematic analysis. Sources of distress for this population were found to be diverse and multifaceted. The results suggest that practitioners who pay attention to wider sources of distress will be experienced as more helpful by people experiencing FEP. Participants (n = 36) were successfully recruited to the RCT and randomised to one of two conditions: treatment as usual (TAU) or TAU plus MOL. Retention at final follow up was 97%, substantially higher than the 80% threshold pre-specified as a successful feasibility outcome. This was the first study of its kind and the results provide evidence that it is feasible to recruit and retain participants experiencing FEP in a trial of MOL, suggesting that it is suitable for further testing in a larger trial. It also provides preliminary evidence of MOL’s acceptability for this population. A proportion of participants from the RCT (n = 12) were interviewed about their experience of receiving MOL. Results were analysed using thematic analysis. Four superordinate themes were identified: ‘The therapist’s approach’; ‘I was in control’; ‘Thinking and talking’; and ‘Looking at problems from a different perspective’. Engaging with MOL was predominantly perceived to be a helpful experience. The study provides additional evidence of the acceptability of MOL for people experiencing FEP. This thesis makes a novel contribution to the literature on psychotherapeutic interventions for people experiencing first-episode psychosis and increases our general understanding of the lived experiences of this population.
Date of Award31 Dec 2019
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorSara Tai (Supervisor) & Warren Mansell (Supervisor)


  • Randomised controlled trial
  • Psychosis
  • Early intervention
  • Method of Levels
  • Qualitative

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