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.
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.
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.
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:
* 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.
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