An Evaluation of Online Method of Levels Therapy with Young People

Background: Adolescence is an influential stage in a person’s life, where they may experience significant psychological distress. Multiple youth-led reports and a youth-consulted framework (THRIVE) emphasise the importance of challenging the current diagnostic system and promoting accessible client and needs-led psychological support. Method of Levels (MoL) is a transdiagnostic, client- and needs-led therapy which appears to align with these reports and principles. Studies have not yet explored the utility of MoL with young people in ‘late adolescence’ (ages 16-19), or evaluated the delivery of MoL in an online videoconferencing setting.

Aims: This study aimed to explore the patterns of attendance, effectiveness, and participant experiences (i.e. acceptability, accessibility and helpfulness) of online
MoL with young people in ‘late adolescence.’

Methods: This study adopted a quantitative, within-subjects pretest-posttest design. Late adolescents aged 16-19 (N=25) were recruited and offered to engage with online MoL. Participants completed self-report questionnaires pre-intervention, at completion of therapy and at a one-week and four-week follow-ups. Open-text feedback questions were used to explore perceptions of the participant-led practices of online MoL. Descriptive statistics described the patterns of attendance and a Repeated Measures ANOVA tested for changes in the symptom-, process- and life-functioning-based measures. The reliable change index determined the reliability of changes in symptom-based measures. Descriptive statistics of feedback on the acceptability, accessibility, and helpfulness of online MoL were examined.

Results: Mean attendance was between 3-4 online MoL sessions. Scores on ‘goal conflict reorganisation’ (ROC) followed significant linear and quadratic trends over time. A statistically significant cubic trend was found for life-functioning (ORS) scores across time. The reliable change scores between pre-intervention and 1-weekfollow-up suggested a moderate to high practical significance for both symptombased measures (GAD-7 and PHQ-9). Participants reported various patient-led aspects of MoL as acceptable, accessible and helpful (e.g. control over session direction, self-scheduling, online sessions).

Discussion: Online MoL appears to be a useful intervention for older adolescents, and may provide a more efficient, accessible and helpful alternative to current disorder-focused approaches. The occurrence of changes in process- and life-functioning based measures (without significant changes in symptom-based measures) also supports discourse around shifting the current diagnostic approach to psychological distress, and calls into question how change in psychological distress is meaningfully measured in mental health.