What is SelfRegulation Theory

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What is Self-Regulation Theory Why is it
Important for CBT?

• Dr Warren Mansell
• University of Manchester

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Plan

• The History of Self-Regulation
• Self-Regulation in Psychology
• Why is it important for CBT?
• Examples of self-regulation theories in
  psychology
• The benefits of a Control Theory approach
• Related theory research on bipolar disorder

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Example of a Definition

• Self-regulation refers to the exercise of
  control over oneself, especially with regard to
  bringing the self in line with preferred (thus
  regular) standards. Such processes can be found
  deep in nature.
• Vohs Baumeister (2004)
• The Handbook of Self-Regulation

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Self-Regulation Deep in Nature

• Self-regulation in plant animal physiology
  (Bernard, 1878)
• Homeostasis of temperature, ion concentrations,
  hormone levels, etc (Cannon, 1932)
• Examples within psychology

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Self-Regulation in 19th Century

• Every ascending form of organic life, moreover,
  tends more and more to realise the one
  culminating purpose to which all the lower
  spheres of organisation perpetually tend- that,
  namely, of producing an independent individual,
  containing in it the power of self-regulation,
  and capable of reacting in opposition to the
  outward impulses of nature
• Morell (1853) Elements of Psychology
• See William James (1890) John Dewey (1896)

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20th Century Cybernetics

• Research on self-regulation was greatly
  influenced by cybernetic theory, which showed how
  even inanimate mechanisms can regulate themselves
  by making adjustments according to programmed
  goals or standards.
• Vohs Baumeister (2004)
• The Handbook of Self-Regulation

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Control Engineering
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What is Cybernetics?

• Basis in control engineering
• Based on ancient greek cyber meaning steersman
  or governor
• Wiener (1948) "the science of control and
  communication in the animal and the machine"
• Utilises negative feedback

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Self-regulationThe negative feedback loop
(e.g. Wiener, 1948 Pribram et al., 1960 Powers
et al., 1960)
REFERENCE VALUE, e.g. touching glass
Organism
COMPARATOR, e.g. 5cm
PERCEPTION, e.g. 5cm from glass
OUTPUT, e.g. move arm muscles
CONTROLLED VARIABLE e.g. proximity to glass
Environment
ENVIRONMENTAL DISTURBANCE, e.g. person moves glass
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Why is self-regulation theory important for CBT?

• Interpersonal control as a developmental factor
• Loss of control as a consequence
• Mental control as a maintenance process
• Reduced interpersonal control during therapy,
  i.e. collaboration or client-centred
• Control of ones life as an outcome
• These are transdiagnostic factors (cf Harvey et
  al., 2004)

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Interpersonal control

• Overcontrolling parenting implicated in the
  development of psychopathology
• e.g. Large-scale reviews by Chorpita Barlow
  (1998) Rapee (1997)
• High Expressed Emotion relatives show greater
  control over others
• Hooley Campbell (2002) control by family
  members predicts relapse in schizophrenia

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Loss of control

• Loss of control and Fear of Loss of Control
  implicated in
• Eating disorders (Fairburn et al., 2003)
• Bipolar Disorder (Mansell, 2006)
• Panic Disorder (Cloitre et al., 1992)
• Social Phobia (Cloitre et al., 1992)
• Alcohol Substance Dependence (Bechara, 2005)
• Depression (Learned helplessness)
• Psychosis (e.g. thought disorder)
• Many other disorders

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Intrapersonal/mental control

• Thought Suppression as a maintenance process
  (e.g. Purdon, 1999 Wegner 1994)
• Thought Control as a maintenance process (e.g.
  Reynolds Wells, 1999)
• Experiential Avoidance Control is the problem
  (Hayes, 2004)

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Reduced Control in CBT

• The relationship is collaborative, i.e. equal
  control
• The client sets their own goals
• Alliance predicts positive outcome (Krupnik et
  al., 2006 Horvath Bedi, 2002)
• Further research needed

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Control during Recovery

• Autonomous motivation stronger predictor of
  outcome than alliance (Zuroff et al., 2007)
• Empowerment involved in recovery
• Sense of Purpose associated with recovery and
  well-being (Brown et al., 2008 Nygren et al.
  2005)
• Reclaiming life (Clark Ehlers, 2000)
• Heading towards chosen values (Hayes, 2004)
• A higher order sense of control in contrast to
  rigidly controlling thoughts and feelings?

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Examples of Self-Regulation Theories

• Gross (2001) - Affect regulation
• Situation selection situation modification
  attentional deployment cognitive change
  response modulation
• Wells Matthews (1994)
• Procedural beliefs manage intrusive experiences
  self-maintaining cycle
• Treatment challenge metacognitive beliefs
  enhance attentional control
• But how is the self-regulatory system organised?

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Carver Scheier (1981)

• Hierarchically organised control systems
• Powers (1973) explicitly considered the
  possibility that control systems can be
  interconnected hierarchically and argued that
  such an organisation underlies self-regulation in
  living systems. It is on his reasoning that we
  now build.
• The following 5 pages of Carver Scheiers
  article describe Powers (1973) theory
  Perceptual Control Theory (PCT)

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SYSTEM CONCEPT Be a responsible
person PRINCIPLE Follow through on
commitments PROGRAM Drive over and return the
notes RELATIONSHIP Drivingness SEQUENCE Make
a turn TRANSITION Turning of steering
wheel CONFIGURATION Fingers around rim of
wheel SENSATION Gripping INTENSITY Muscle
tensions
A Control System Hierarchy
Adapted from Carver Scheier (1981, 1982) based
on Powers (1973)
INPUT
Effect on environment
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I
A Control System Hierarchy in more detail.
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Principles of PCT(Powers et al., 1960 Powers,
1973 2005)

• Living organisms control their input, not their
  output
• Behaviour is the control of perception
• Complex, purposeful goals achieved through
  hierarchies of negative feedback loops
  automatic life is control
• Chronic, unresolved conflict at higher levels of
  control is responsible for psychological distress
  (transdiagnostic)

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PCT, Conflict Emotion (Powers, 1973 2006)

• Emotions can form controlled input (perception)
  output (e.g. preparation) of control systems
• Emotions imply conflict (i.e. a goal that is not
  immediately pursued through action)
• Control is unhelpful when it is reactive and
  creates internal conflict arbitrary control
• Control is helpful when it regulates lower
  systems towards higher ends (e.g. personal
  values)

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Reorganisation

• Conflict is reduced by reorganisation
• Trial-and-error changes in control system
  properties (Marken Powers, 1989)
• Occurs during learning
• Occurs at the appropriate level e.g. tying shoe
  lace low level
• Higher level reorganisation may be experienced
  as
• shifting perspectives, changing appraisals,
  seeing the bigger picture, reprioritising

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Revisiting Affect RegulationControl
Reorganisation at different levels?
Higher order goals Cognitive
change Situational selection Situational
modification Response modulation Attention
al deployment
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Advantages of a PCT approach

• Provides a detailed framework that allows working
  models to be constructed tested against
  real-world situations (Marken, 2009 Powers,
  2009)
• Is not specific to mood regulation wide range
  of publications across sociology, education,
  biology, neuroscience (www.pctweb.org)
• Leads to its own cognitive therapy Method of
  Levels (Powers, 1972 Carey, 2006)
• transdiagnostic highly accessible

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An Integrative Cognitive Model of Bipolar
Disorder(Mansell, Morrison, Reid, Lowens Tai,
2007)

• Mood swings are a consequence of multiple,
  conflicted, extreme, personal appraisals of
  changes in internal state
• Leads to internal conflict
• trying to exert extreme control over mood in
  opposing directions
• rather than pursuing long term goals irrespective
  of mood

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I am excelling and overcoming all my problems
I am about to make a fool of myself, get
controlled by people and relapse
Conflict
High Energy, Agitated, High Mood
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Modelling Mood Swings
Success!
Safety!
Failure!
Catastrophe!
INTERNAL STATE
De-activated
Highly Activated
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Conflict Between Appraisals Task (CBAT)(Dodd,
Mansell, Tai, Morrison, in prep)

• E-prime computer paradigm
• 2 levels of Activation (high/low)
• 4 domains of Internal State (cognitive,
  behavioural, physiological, affective)
• 3 types of Appraisal (self, others, world)
• 2 valences (positive negative)
• Conflict Total ve x ve

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Conflict Between Appraisals Task

• When I feel my thoughts are racing, I think that
  I am about to have a breakdown
• I DONT BELIEVE I BELIEVE THIS
• THIS AT ALL COMPLETELY
• 1 2 3 4 5 6
  7 8 9

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Conflict Between Appraisals TaskInteraction, p
valence on appraisals
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A Measure of Extreme Conflicting Appraisals of
Internal State

• HAPPI Hypomanic Attitudes and Positive
  Predictions Inventory
• Five different categories of appraisal, e.g.
• Self-activated When I feel really good, I
  known nothing can go wrong
• Catastrophic When I feel agitated and
  restless, I am about to have a breakdown
• Discriminates bipolar vs non-clinical controls
  (Mansell, 2006)

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Mean HAPPIControlling for age, education (both
ns), and current ISS symptoms p 33
ESRC Large Grant2008-2012
Emotion Regulation of Others and the Self (EROS)

• A Collaborative Research Network

Peter Totterdell (PI) Warren Mansell Brian
Parkinson David Holman Pasco Fearon Thomas
Webb Tom Farrow Andy Lane Paschal Shearan
Clinical Developmental Neuroscience Work
Social Health - Sports
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EROS Manchester Site

• Conflicting control of affect in non-clinical
  sample and in bipolar disorder (with Wood, Kelly,
  Samad, Ulph)
• Method of Levels case series and test of
  adherence validity in primary care (with
  Lansbergen, Tai, McEvoy)

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Summary

• Self-regulation theory and applications have a
  long history within and outside psychology
• Several important reasons to apply to CBT
• A range of contemporary theories
• Versatility utility of PCT substantial
  foundation across disciplines
• Further research needed within CBT

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Acknowledgements to Collaborators

• Alyson Dodd
• Ruth Searson
• Peter Taylor
• Gemma Paszek
• Sari Saatsi
• Sally Higginson
• Rebecca Pedley
• Nia Thomas
• Sarah Amelia Jones
• Karen Seal
• Helen Mannion
• Kim Drummond
• Timothy Bird
• Marijke Linbergen
• Maari Faruq
• Elizabeth Reilly
• Lars White
• Vaneeta Sadhnani
• Rosie Beck

• Alison Harvey
• Ed Watkins
• Roz Shafran
• Tim Carey
• Bill Powers
• Tony Morrison
• Sara Tai
• Graeme Reid
• Ian Lowens
• Steve Jones
• Alex Wood

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Further References

• Mansell, W., Carey, T. A. (in press). A century
  of psychology and psychotherapy. Is an
  understanding of control the missing link
  between theory, research and practice? Psychology
  and Psychotherapy Theory, Research and Practice.
• Carey, T. A., Carey, M., Mullan, R. J., Spratt,
  C. G. Spratt, M. B. (in press). Assessing the
  statistical, clinical, and personal significance
  of the Method of Levels. Behavioural and
  Cognitive Psychotherapy.
• Special Issue of the Cognitive Behaviour
  Therapist on control theory http//journals.cambr
  idge.org
• BABCP SIG on Control Theory
• www.pctweb.org
• warren.mansell_at_manchester.ac.uk