What is Problem-Solving Therapy?
Problem-Solving
Therapy (PST) is an evidenced-based intervention for treating both adult and
late-life depression. Based on research identifying ineffective problem-solving
ability to be an important vulnerability factor for depression, PST fosters
adoption and implementation of adaptive problem-solving attitudes and behaviors
as a means of effectively coping with stressful life events.
Problem-solving
treatment is a relatively new psychological intervention for depression. It is
a brief and practical psychological intervention that has been found to be
effective in the treatment of depressive disorders in primary care. Depressive
disorders are known to be linked with stressful life events, and depressed
patients may be less able to cope with these stresses in a clear problem-focused
way.
The rationale for
problem-solving treatment is that symptoms are caused by everyday problems,
which can be resolved by the technique of problem-solving, and that resolution
of problems leads to reduction in symptoms.
Approach Details
Problem-solving
therapy (PST) teaches patients to more effectively generate solutions for
problems, such as interpersonal conflicts or the pursuit of goals. Therapists
help patients learn and effectively apply the steps of problem solving,
including:
1) Identifying
problems,
2) Setting
realistic goals,
3) Generating
multiple alternative solutions,
4) Selecting the
best solution from the alternatives,
5) Developing a
plan,
6) Implementing
the problem solving tactic, and
7) Evaluating the
efficacy of problem solving.
Types of Problem-Solving Therapy
There are three
general types of problem-solving therapy:
* Social
problem-solving therapy. This is a cognitive–behavioral process through which
patients identify effective solutions for coping with stressful, everyday
problems in social settings. Patients learn how to adapt, rather than employ a
single coping strategy.
* Problem-solving
for primary care settings. The therapy is provided by a primary care physician
rather than in an analyst’s office. Research shows that PST is a brief,
effective treatment for mild to moderate psychological disorders, including
depression.
* Self-examination
problem-solving therapy. This helps patients determine their major goals, asses
the problems that are getting in the way of those goals, and apply
problem-solving techniques as well as accept uncontrollable situations.
PST is a
short-term therapy (8-16 sessions) that can be provided in individual or group
format. PST for primary care settings is briefer and consists of 4 to 6
sessions. PST has also been applied to geriatric and medical populations. PST
has received empirical support as a treatment for depression, but some findings
are mixed. Nezu (2004) notes that outcomes are best when the problem-solving
orientation component of PST is included in addition to the skills training.
Social problem-solving therapy
According to
D'Zurilla and Nezu, problem solving consists of five skills. The first is
problem orientation, which is concerned with how one views his or her ability
to cope with a problem. The second is problem definition, which is concerned
with the specific and concrete definition of the problem, and setting
achievable and definable goals. The third skill, generation of alternative
solutions, involves creating various methods for solving problems and meeting
one's goals while withholding judgment on their effectiveness. The fourth
skill, decision making, involves a systematic process to select the best
solution for a problem from the list generated. The fifth and final skill,
solution implementation and evaluation, involves planning and initiation of
solutions, and subsequently evaluating the success of the solution.
The intervention is
delivered over ten to twelve sessions. The first session covers education about
depression and explication of the model. It is important to educate older
people about what depression is and how this therapy works because so many
older adults hold inaccurate ideas about depression and are afraid of
psychotherapy. After this introduction, the next five sessions focus on
teaching each of the skills. It is important that these skills be taught
sequentially, rather than all at once. Older people generally need a longer
period to process new information, and allowing more time for discussion of
each step facilitates learning. After each skill is taught and practiced, the
remaining sessions are spent using the model to solve the patient's problems.
Guided practice is particularly important in teaching new psychosocial skills.
The more opportunities older people have to practice new behavior, the more
likely they are to retain the skills and use them in the future.
Studies
Two studies have
evaluated the effectiveness of problem-solving treatment for major depression
in primary care settings in the United Kingdom. In these studies, problem-solving
treatment was delivered in six sessions over 12 weeks as an acute treatment for
depression. The first study found problem-solving to be similarly effective to amitriptyline,
in patients with major depression. There were also fewer patient dropouts with problem-solving
treatment (7%) than with amitriptyline (19%).
All patients receiving the problem-solving approach found it either
helpful or very helpful. The second study assessed whether the combination of
problem-solving treatment and antidepressant drugs (a selective serotonin
reuptake inhibitor antidepressant) was more effective than either treatment
given alone, in patients with major depression.
It also compared
delivery of the problem-solving technique by practice nurses and general practitioners.
Problem-solving treatment was equally effective when provided alone or in combination
with antidepressant therapy and when provided by nurses or general practitioners.
Applications
At present it is
unknown whether problem-solving treatment is effective in the long-term treatment
of depression, through reducing the rate of relapses or recurrence of illness.
Depression in primary care usually occurs in the context of psychosocial
problems, which may persist even if depressive symptoms resolve. As
problem-solving treatment teaches patients a technique to enable them to
resolve problems in a structured and logical way, it may protect patients
against future relapse. However, it is uncertain whether problem-solving
treatment is effective in older patients, or whether it is effective in
patients with depressive disorders other than major depression.
In addition to
depression, PST can help with the following conditions or situations:
* Anxiety.
* Stress.
* Deliberate
self-harm.
* Interpersonal
relationship problems.
* Unhappiness in
work, home, or love life.
Why Use PST?
* PST uses a
common sense approach to problem solving.
* PST has a brief
implementation period of six to eight 45-60 minute sessions over a period of no
more than six months.
* PST focuses on
the “here and now”.
* PST has a broad
application that can aptly address a range of social, financial and
health-related issues.
* PST has high
participant acceptance and satisfaction.
Limitations
Although research
shows that problem-solving therapy is an effective treatment for depression,
not every expert agrees that it’s the best therapy for the condition. “With
problem-solving therapy, you identify a circumscribed problem and together
figure out behavioral or actionable strategies,” says Jeffrey L. Binder, Ph.D.,
a professor of psychology at Argosy University in Atlanta.
“Depression—in
general—would be too broad a problem. You’d have to identify a particularly
negative symptom or set of symptoms of depression or a particular environmental
circumstance that is contributing to or causing the problem. The therapy is
focused on very concrete problems.”
Sources and additional information:
An atlas of
Depression by david S. Baldwin and Jon Birtwistle
