Conflict and Psychosis

3189913768_0f6cdbe466_zRecently, I was lucky enough to be involved in making a short film about psychosis. The film was created by a group of service users and mental health professionals in collaboration with a professional film maker. The aim was to raise awareness about the lived experience of psychosis and let people know how to get help if they need it. You can watch the film by clicking here.

The film contains the personal accounts of people who have experienced psychosis, including descriptions of what it’s like to hear voices or hold beliefs that others find unusual. The people in the film also talk about the distress these experiences cause.

There is good evidence that many people in the general population have experiences such as hearing voices without it causing them any distress. However, for some people these experiences are extremely upsetting and have a profound impact on their quality of life. So, why is it that these experiences cause distress for some people but not others?

From a Perceptual Control Theory (PCT) perspective, psychological distress is a consequence of loss of control. This can occur in several ways, but one common reason for loss of control is goal conflict. This means that people are trying to achieve two or more incompatible goals at the same time. It should be said that all of us are constantly encountering conflicts in everyday life and most of the time we are able to resolve these without too much difficulty. Deciding what to wear, what to eat or what route to take to work, for example, are everyday conflicts that usually don’t cause us many problems.

However, sometimes we experience a conflict that is more difficult to resolve. What if you want to be open and honest with people, but you also worry that others will be judgemental? How about if you want to stand up for yourself, but at the same time it’s important for you to avoid upsetting others? Even some of the everyday conflicts that I described earlier can actually be a source of distress. What if you want to walk to work because it makes you feel healthy and independent, but a fear of being attacked stops you from doing this? According to PCT, conflicts which persist and prevent someone living their life the way they want are what cause distress.

Some of the people’s accounts in the psychosis film suggest that they are experiencing conflict. For example, one person describes how his unusual experiences started off as ‘a bit of laugh’ and as ‘some sort of spiritual gift’, but then they became more serious and distressing. From what he says, there were both positive and negative aspects to his experiences. Another person said that he ‘didn’t feel like “me” anymore’ and this was a problem for him. This suggests that the way he was experiencing ‘being me’ didn’t fit with the way he wanted this experience to be, again indicating some sort of conflict.

Method of Levels (MOL) is a psychological therapy based on PCT. It is a way of helping people become aware of conflict in order to reduce distress. One of the ways that MOL is different from other therapies is its focus on reducing psychological distress rather than symptoms. From a PCT point of view, things like hearing voices or feeling paranoid (symptoms) will only be a problem for someone if they clash with other important goals in the person’s life. For example, if someone thinks that their voice hearing helps them to stay safe, but they also worry that hearing voices is a sign that they are losing control, they are likely to experience some distress as a result. In this situation, it is not hearing voices itself that is the problem. Rather it’s the conflict between both wanting and not wanting to listen to the voice that is problem. MOL helps people to become aware of this conflict.

The Next Level trial is currently evaluating Method of Levels for people using Early Intervention in Psychosis services in Salford, Bolton and Trafford. I look forward to posting updates on this blog to let you know about the trial’s progress.

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