Method of Levels therapy: A systematic review and case series of Method of Levels for people with a diagnosis of bipolar disorder

Abstract

The thesis, consisting of three papers, aimed to explore Method of Levels (MOL; Carey, 2006) as a transdiagnostic therapy applicable to a range of presenting problems and diagnoses. The review aimed to synthesise findings regarding the acceptability and effectiveness of MOL as an individual intervention. Systematic searches identified eighteen studies with diverse designs, but no randomised controlled trials designed to evaluate efficacy. A narrative synthesis was conducted. Acceptability, as indicated by participants, using measures of therapeutic alliance and satisfaction ratings, was generally good. However, the data were limited and there were issues regarding potential bias as many of the studies included therapists with a dual role as researcher. Medium to large effect sizes were found in the majority of included studies (78%). Many studies had small sample sizes and no control group, meaning results regarding effectiveness should be interpreted with caution. The empirical study aimed to explore the acceptability of MOL to service users with a diagnosis of bipolar disorder and consider the potential effectiveness of MOL in addressing mental health difficulties and distress for this service user group. Due to COVID-19 restrictions, delivery of therapy was required to be via videoconferencing. In light of this unexpected change, acceptability of videoconferencing was also examined. Group mean scores on the Working Alliance Inventory exceeded the specified cut-off, indicating acceptability of the MOL approach. Written feedback further indicated acceptability: helpful aspects included flexibility in scheduling appointments, having choice and control, promoting ownership, space to reflect and explore, and generating new perspectives. Participant feedback on quantitative and open-text feedback questionnaires suggested a good degree of satisfaction regarding the videoconferencing delivery. Seven of the ten participants showed reliable improvements on a measure of personal recovery (QPR). Improvements on measures of problem-specific distress (PSYCHLOPS), general distress (CORE-OM), and bipolar disorder symptoms (ISS) were also seen for some participants. Strengths and limitations are outlined in each paper, and consideration of implications for future research and clinical practice are also discussed. A critical evaluation of decision making and elaboration on limitations and recommendations are provided in paper three, alongside the author’s personal reflections.

Date of Award	31 Dec 2023
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Sara Tai (Supervisor) & Warren Mansell (Supervisor)