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What Is Problem-Solving Therapy?

Verywell / Madelyn Goodnight

Problem-Solving Therapy Techniques

How effective is problem-solving therapy, things to consider, how to get started.

Problem-solving therapy is a brief intervention that provides people with the tools they need to identify and solve problems that arise from big and small life stressors. It aims to improve your overall quality of life and reduce the negative impact of psychological and physical illness.

Problem-solving therapy can be used to treat depression , among other conditions. It can be administered by a doctor or mental health professional and may be combined with other treatment approaches.

At a Glance

Problem-solving therapy is a short-term treatment used to help people who are experiencing depression, stress, PTSD, self-harm, suicidal ideation, and other mental health problems develop the tools they need to deal with challenges. This approach teaches people to identify problems, generate solutions, and implement those solutions. Let's take a closer look at how problem-solving therapy can help people be more resilient and adaptive in the face of stress.

Problem-solving therapy is based on a model that takes into account the importance of real-life problem-solving. In other words, the key to managing the impact of stressful life events is to know how to address issues as they arise. Problem-solving therapy is very practical in its approach and is only concerned with the present, rather than delving into your past.

This form of therapy can take place one-on-one or in a group format and may be offered in person or online via telehealth . Sessions can be anywhere from 30 minutes to two hours long. 

Key Components

There are two major components that make up the problem-solving therapy framework:

• Applying a positive problem-solving orientation to your life
• Using problem-solving skills

A positive problem-solving orientation means viewing things in an optimistic light, embracing self-efficacy , and accepting the idea that problems are a normal part of life. Problem-solving skills are behaviors that you can rely on to help you navigate conflict, even during times of stress. This includes skills like:

• Knowing how to identify a problem
• Defining the problem in a helpful way
• Trying to understand the problem more deeply
• Setting goals related to the problem
• Generating alternative, creative solutions to the problem
• Choosing the best course of action
• Implementing the choice you have made
• Evaluating the outcome to determine next steps

Problem-solving therapy is all about training you to become adaptive in your life so that you will start to see problems as challenges to be solved instead of insurmountable obstacles. It also means that you will recognize the action that is required to engage in effective problem-solving techniques.

Planful Problem-Solving

One problem-solving technique, called planful problem-solving, involves following a series of steps to fix issues in a healthy, constructive way:

• Problem definition and formulation : This step involves identifying the real-life problem that needs to be solved and formulating it in a way that allows you to generate potential solutions.
• Generation of alternative solutions : This stage involves coming up with various potential solutions to the problem at hand. The goal in this step is to brainstorm options to creatively address the life stressor in ways that you may not have previously considered.
• Decision-making strategies : This stage involves discussing different strategies for making decisions as well as identifying obstacles that may get in the way of solving the problem at hand.
• Solution implementation and verification : This stage involves implementing a chosen solution and then verifying whether it was effective in addressing the problem.

Other Techniques

Other techniques your therapist may go over include:

• Problem-solving multitasking , which helps you learn to think clearly and solve problems effectively even during times of stress
• Stop, slow down, think, and act (SSTA) , which is meant to encourage you to become more emotionally mindful when faced with conflict
• Healthy thinking and imagery , which teaches you how to embrace more positive self-talk while problem-solving

What Problem-Solving Therapy Can Help With

Problem-solving therapy addresses life stress issues and focuses on helping you find solutions to concrete issues. This approach can be applied to problems associated with various psychological and physiological symptoms.

Mental Health Issues

Problem-solving therapy may help address mental health issues, like:

• Chronic stress due to accumulating minor issues
• Complications associated with traumatic brain injury (TBI)
• Emotional distress
• Post-traumatic stress disorder (PTSD)
• Problems associated with a chronic disease like cancer, heart disease, or diabetes
• Self-harm and feelings of hopelessness
• Substance use
• Suicidal ideation

Specific Life Challenges

This form of therapy is also helpful for dealing with specific life problems, such as:

• Death of a loved one
• Dissatisfaction at work
• Everyday life stressors
• Family problems
• Financial difficulties
• Relationship conflicts

Your doctor or mental healthcare professional will be able to advise whether problem-solving therapy could be helpful for your particular issue. In general, if you are struggling with specific, concrete problems that you are having trouble finding solutions for, problem-solving therapy could be helpful for you.

Benefits of Problem-Solving Therapy

The skills learned in problem-solving therapy can be helpful for managing all areas of your life. These can include:

• Being able to identify which stressors trigger your negative emotions (e.g., sadness, anger)
• Confidence that you can handle problems that you face
• Having a systematic approach on how to deal with life's problems
• Having a toolbox of strategies to solve the issues you face
• Increased confidence to find creative solutions
• Knowing how to identify which barriers will impede your progress
• Knowing how to manage emotions when they arise
• Reduced avoidance and increased action-taking
• The ability to accept life problems that can't be solved
• The ability to make effective decisions
• The development of patience (realizing that not all problems have a "quick fix")

Problem-solving therapy can help people feel more empowered to deal with the problems they face in their lives. Rather than feeling overwhelmed when stressors begin to take a toll, this therapy introduces new coping skills that can boost self-efficacy and resilience .

Other Types of Therapy

Other similar types of therapy include cognitive-behavioral therapy (CBT) and solution-focused brief therapy (SFBT) . While these therapies work to change thinking and behaviors, they work a bit differently. Both CBT and SFBT are less structured than problem-solving therapy and may focus on broader issues. CBT focuses on identifying and changing maladaptive thoughts, and SFBT works to help people look for solutions and build self-efficacy based on strengths.

This form of therapy was initially developed to help people combat stress through effective problem-solving, and it was later adapted to address clinical depression specifically. Today, much of the research on problem-solving therapy deals with its effectiveness in treating depression.

Problem-solving therapy has been shown to help depression in: 

• Older adults
• People coping with serious illnesses like cancer

Problem-solving therapy also appears to be effective as a brief treatment for depression, offering benefits in as little as six to eight sessions with a therapist or another healthcare professional. This may make it a good option for someone unable to commit to a lengthier treatment for depression.

Problem-solving therapy is not a good fit for everyone. It may not be effective at addressing issues that don't have clear solutions, like seeking meaning or purpose in life. Problem-solving therapy is also intended to treat specific problems, not general habits or thought patterns .

In general, it's also important to remember that problem-solving therapy is not a primary treatment for mental disorders. If you are living with the symptoms of a serious mental illness such as bipolar disorder or schizophrenia , you may need additional treatment with evidence-based approaches for your particular concern.

Problem-solving therapy is best aimed at someone who has a mental or physical issue that is being treated separately, but who also has life issues that go along with that problem that has yet to be addressed.

For example, it could help if you can't clean your house or pay your bills because of your depression, or if a cancer diagnosis is interfering with your quality of life.

Your doctor may be able to recommend therapists in your area who utilize this approach, or they may offer it themselves as part of their practice. You can also search for a problem-solving therapist with help from the American Psychological Association’s (APA) Society of Clinical Psychology .

If receiving problem-solving therapy from a doctor or mental healthcare professional is not an option for you, you could also consider implementing it as a self-help strategy using a workbook designed to help you learn problem-solving skills on your own.

During your first session, your therapist may spend some time explaining their process and approach. They may ask you to identify the problem you’re currently facing, and they’ll likely discuss your goals for therapy .

Keep In Mind

Problem-solving therapy may be a short-term intervention that's focused on solving a specific issue in your life. If you need further help with something more pervasive, it can also become a longer-term treatment option.

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Shang P, Cao X, You S, Feng X, Li N, Jia Y. Problem-solving therapy for major depressive disorders in older adults: an updated systematic review and meta-analysis of randomized controlled trials .  Aging Clin Exp Res . 2021;33(6):1465-1475. doi:10.1007/s40520-020-01672-3

Cuijpers P, Wit L de, Kleiboer A, Karyotaki E, Ebert DD. Problem-solving therapy for adult depression: An updated meta-analysis . Eur Psychiatry . 2018;48(1):27-37. doi:10.1016/j.eurpsy.2017.11.006

Nezu AM, Nezu CM, D'Zurilla TJ. Problem-Solving Therapy: A Treatment Manual . New York; 2013. doi:10.1891/9780826109415.0001

Owens D, Wright-Hughes A, Graham L, et al. Problem-solving therapy rather than treatment as usual for adults after self-harm: a pragmatic, feasibility, randomised controlled trial (the MIDSHIPS trial) .  Pilot Feasibility Stud . 2020;6:119. doi:10.1186/s40814-020-00668-0

Sorsdahl K, Stein DJ, Corrigall J, et al. The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: A randomized controlled trial . Subst Abuse Treat Prev Policy . 2015;10(1):46. doi:doi.org/10.1186/s13011-015-0042-1

Margolis SA, Osborne P, Gonzalez JS. Problem solving . In: Gellman MD, ed. Encyclopedia of Behavioral Medicine . Springer International Publishing; 2020:1745-1747. doi:10.1007/978-3-030-39903-0_208

Kirkham JG, Choi N, Seitz DP. Meta-analysis of problem solving therapy for the treatment of major depressive disorder in older adults . Int J Geriatr Psychiatry . 2016;31(5):526-535. doi:10.1002/gps.4358

Garand L, Rinaldo DE, Alberth MM, et al. Effects of problem solving therapy on mental health outcomes in family caregivers of persons with a new diagnosis of mild cognitive impairment or early dementia: A randomized controlled trial . Am J Geriatr Psychiatry . 2014;22(8):771-781. doi:10.1016/j.jagp.2013.07.007

Noyes K, Zapf AL, Depner RM, et al. Problem-solving skills training in adult cancer survivors: Bright IDEAS-AC pilot study .  Cancer Treat Res Commun . 2022;31:100552. doi:10.1016/j.ctarc.2022.100552

Albert SM, King J, Anderson S, et al. Depression agency-based collaborative: effect of problem-solving therapy on risk of common mental disorders in older adults with home care needs . The American Journal of Geriatric Psychiatry . 2019;27(6):619-624. doi:10.1016/j.jagp.2019.01.002

By Arlin Cuncic, MA Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.

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Problem-Solving Therapy: How It Works & What to Expect

Author: Lydia Antonatos, LMHC

Lydia Angelica Antonatos LMHC

Lydia has over 16 years of experience and specializes in mood disorders, anxiety, and more. She offers personalized, solution-focused therapy to empower clients on their journey to well-being.

Problem-solving therapy (PST) is an intervention with cognitive and behavioral influences used to assist individuals in managing life problems. Therapists help clients learn effective skills to address their issues directly and make positive changes. PST is used in various settings to address mental health concerns such as depression, anxiety, and more.

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What Is Problem-Solving Therapy?

Problem-solving therapy (PST) is based on a model that the body, mind, and environment all interact with each other and that life stress can interact with a person’s predisposition for developing a mental condition. 2 Within this context, PST contends that mental, emotional, and behavioral struggles stem from an ongoing inability to solve problems or deal with everyday stressors. Therefore, the key to preventing health consequences and improving quality of life is to become a better problem-solver. 3 , 4

The problem-solving model has undergone several revisions but upholds the value of teaching people to become better problem-solvers. Overall, the goal of PST is to provide individuals with a set of rational problem-solving tools to reduce the impact of stress on their well-being.

The two main components of problem-solving therapy include: 3 , 4

• Problem-solving orientation: This focuses on helping individuals adopt an optimistic outlook and see problems as opportunities to learn from, allowing them to believe they can solve problems.
• Problem-solving style: This component aims to provide people with constructive problem-solving tools to deal with different life stressors by identifying the problem, generating/brainstorming solution ideas, choosing a specific option, and implementing and reviewing it.

Techniques Used in Problem-Solving Therapy

PST emphasizes the client, and the techniques used are merely conduits that facilitate the problem-solving learning process. Generally, the individual, in collaboration and support from the clinician, leads the problem-solving work. Thus, a strong therapeutic alliance sets the foundation for encouraging clients to apply these skills outside therapy sessions. 4

Here are some of the most relevant guidelines and techniques used in problem-solving therapy:

Creating Collaboration

As with other psychotherapies, creating a collaborative environment and a healthy therapist-client relationship is essential in PST. The role of a therapist is to cultivate this bond by conveying a genuine sense of commitment to the client while displaying kindness, using active listening skills, and providing support. The purpose is to build a meaningful balance between being an active and directive clinician while delivering a feeling of optimism to encourage the client’s participation.

This tool is used in all psychotherapies and is just as essential in PST. Assessment seeks to gather facts and information about current problems and contributing stressors and evaluates a client’s appropriateness for PST. The problem-solving therapy assessment also examines a person’s immediate issues, problem-solving attitudes, and abilities, including their strengths and limitations. This sets the groundwork for developing an individualized problem-solving plan.

Psychoeducation

Psychoeducation is an integral component of problem-solving therapy and is used throughout treatment. The purpose of psychoeducation is to provide a client with the rationale for problem-solving therapy, including an explanation for each step involved in the treatment plan. Moreover, the individual is educated about mental health symptoms and taught solution-oriented strategies and communication skills.

This technique involves verbal prompting, like asking leading questions, giving suggestions, and providing guidance. For example, the therapist may prompt a client to brainstorm or consider alternatives, or they may ask about times when a certain skill was used to solve a problem during a difficult situation. Coaching can be beneficial when clients struggle with eliciting solutions on their own.

Shaping intervention refers to teaching new skills and building on them as the person gradually improves the quality of each skill. Shaping works by reinforcing the desired problem-solving behavior and adding perspective as the individual gets closer to their intended goal.

In problem-solving therapy, modeling is a method in which a person learns by observing. It can include written/verbal problem-solving illustrations or demonstrations performed by the clinician in hypothetical or real-life situations. A client can learn effective problem-solving skills via role-play exercises, live demonstrations, or short-film presentations. This allows individuals to imitate observed problem-solving skills in their own lives and apply them to specific problems.

Rehearsal & Practice

These techniques provide opportunities to practice problem-solving exercises and engage in homework assignments. This may involve role-playing during therapy sessions, practicing with real-life issues, or imaginary rehearsal where individuals visualize themselves carrying out a solution. Furthermore, homework exercises are an important aspect when learning a new skill. Ongoing practice is strongly encouraged throughout treatment so a client can effectively use these techniques when faced with a problem.

Positive Reinforcement & Feedback

The therapist’s task in this intervention is to provide support and encouragement for efforts to apply various problem-solving skills. The goal is for the client to continue using more adaptive behaviors, even if they do not get it right the first time. Then, the therapist provides feedback so the client can explore barriers encountered and generate alternate solutions by weighing the pros and cons to continue working toward a specific goal.

Use of Analogies & Metaphors

When appropriate, analogies and metaphors can be useful in providing the client with a clearer vision or a better understanding of specific concepts. For example, the therapist may use diverse skills or points of reference (e.g., cooking, driving, sports) to explain the problem-solving process and find solutions to convey that time and practice are required before mastering a particular skill.

What Can Problem-Solving Therapy Help With?

Although problem-solving therapy was initially developed to treat depression among primary care patients, PST has expanded to address or rehabilitate other psychological problems, including anxiety , post-traumatic stress disorder , personality disorders , and more.

PST theory asserts that vulnerable populations can benefit from receiving constructive problem-solving tools in a therapeutic relationship to increase resiliency and prevent emotional setbacks or behaviors with destructive results like suicide. It is worth noting that in severe psychiatric cases, PST can be effectively used when integrated with other mental health interventions. 3 , 4

PST can help individuals challenged with specific issues who have difficulty finding solutions or ways to cope. These issues can involve a wide range of incidents, such as the death of a loved one, divorce, stress related to a chronic medical diagnosis, financial stress , marital difficulties, or tension at work.

Through the problem-solving approach, mental and emotional distress can be reduced by helping individuals break down problems into smaller pieces that are easier to manage and cope with. However, this can only occur as long the person being treated is open to learning and able to value the therapeutic process. 3 , 4

Lastly, a large body of evidence has indicated that PST can positively impact mental health, quality of life, and problem-solving skills in older adults. PST is an approach that can be implemented by different types of practitioners and settings (in-home care services, telemedicine, etc.), making mental health treatment accessible to the elderly population who often face age-related barriers and comorbid health issues. 1 , 5, 6

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Problem-Solving Therapy Examples

Due to the versatility of problem-solving therapy, PST can be used in different forms, settings, and formats. Following are some examples where the problem-solving therapeutic approach can be used effectively. 4

People who suffer from depression often evade or even attempt to ignore their problems because of their state of mind and symptoms. PST incorporates techniques that encourage individuals to adopt a positive outlook on issues and motivate individuals to tap into their coping resources and apply healthy problem-solving skills. Through psychoeducation, individuals can learn to identify and understand their emotions influence problems. Employing rehearsal exercises, someone can practice adaptive responses to problematic situations. Once the depressed person begins to solve problems, symptoms are reduced, and mood is improved.

The Veterans Health Administration presently employs problem-solving therapy as a preventive approach in numerous medical centers across the United States. These programs aim to help veterans adjust to civilian life by teaching them how to apply different problem-solving strategies to difficult situations. The ultimate objective is that such individuals are at a lower risk of experiencing mental health issues and consequently need less medical and/or psychiatric care.

Psychiatric Patients

PST is considered highly effective and strongly recommended for individuals with psychiatric conditions. These individuals often struggle with problems of daily living and stressors they feel unable to overcome. These unsolved problems are both the triggering and sustaining reasons for their mental health-related troubles. Therefore, a problem-solving approach can be vital for the treatment of people with psychological issues.

Adherence to Other Treatments

Problem-solving therapy can also be applied to clients undergoing another mental or physical health treatment. In such cases, PST strategies can be used to motivate individuals to stay committed to their treatment plan by discussing the benefits of doing so. PST interventions can also be utilized to assist patients in overcoming emotional distress and other barriers that can interfere with successful compliance and treatment participation.

Benefits of Problem-Solving Therapy

PST is versatile, treating a wide range of problems and conditions, and can be effectively delivered to various populations in different forms and settings—self-help manuals, individual or group therapy, online materials, home-based or primary care settings, as well as inpatient or outpatient treatment.

Here are some of the benefits you can gain from problem-solving therapy:

• Gain a sense of control over your life
• Move toward action-oriented behaviors instead of avoiding your problems
• Gain self-confidence as you improve the ability to make better decisions
• Develop patience by learning that successful problem-solving is a process that requires time and effort
• Feel a sense of empowerment as you solve your problems independently
• Increase your ability to recognize and manage stressful emotions and situations
• Learn to focus on the problems that have a solution and let go of the ones that don’t
• Identify barriers that may hinder your progress

How to Find a Therapist Who Practices Problem-Solving Therapy

Finding a therapist skilled in problem-solving therapy is not any different from finding any qualified mental health professional. This is because many clinicians often have knowledge in cognitive-behavioral interventions that hold similar concepts as PST.

As a general recommendation, check your health insurance provider lists, use an online therapist directory , or ask trusted friends and family if they can recommend a provider. Contact any of these providers and ask questions to determine who is more compatible with your needs. 3 , 4

Are There Special Certifications to Provide PST?

Therapists do not need special certifications to practice problem-solving therapy, but some organizations can provide special training. Problem-solving therapy can be delivered by various healthcare professionals such as psychologists, psychiatrists, physicians, mental health counselors, social workers, and nurses.

Most of these clinicians have naturally acquired valuable problem-solving abilities throughout their career and continuing education. Thus, all that may be required is fine-tuning their skills and familiarity with the current and relevant PST literature. A reasonable amount of understanding and planning will transmit competence and help clients gain insight into the causes that led them to their current situation. 3 , 4

Questions to Ask a Therapist When Considering Problem-Solving Therapy

Psychotherapy is most successful when you feel comfortable and have a collaborative relationship with your therapist. Asking specific questions can simplify choosing a clinician who is right for you. Consider making a list of questions to help you with this task.

Here are some key questions to ask before starting PST:

• Is problem-solving therapy suitable for the struggles I am dealing with?
• Can you tell me about your professional experience with providing problem-solving therapy?
• Have you dealt with other clients who present with similar issues as mine?
• Have you worked with individuals of similar cultural backgrounds as me?
• How do you structure your PST sessions and treatment timeline?
• How long do PST sessions last?
• How many sessions will I need?
• What expectations should I have in working with you from a problem-solving therapeutic stance?
• What expectations are required from me throughout treatment?
• Does my insurance cover PST? If not, what are your fees?
• What is your cancellation policy?

How Much Does Problem-Solving Therapy Cost?

The cost of problem-solving therapy can range from $25 to $150 depending on the number of sessions required, severity of symptoms, type of practice, geographic location, and provider’s experience level. However, if your insurance provider covers behavioral health, the out-of-pocket costs per session may be much lower. Medicare supports PST through professionally trained general health practitioners. 1

What to Expect at Your First PST Session

During the first session, the therapist will strive to build a connection and become familiar with you. You will be assessed through a clinical interview and/or questionnaires. During this process, the therapist will gather your background information, inquire about how you approach life problems, how you typically resolve them, and if problem-solving therapy is a suitable treatment for you. 3 , 4

Additionally, you will be provided psychoeducation relating to your symptoms, the problem-solving method and its effectiveness, and your treatment goals. The clinician will likely guide you through generating a list of the current problems you are experiencing, selecting one to focus on, and identifying concrete steps necessary for effective problem-solving. Lastly, you will be informed about the content, duration, costs, and number of therapy sessions the therapist suggests. 3 , 4

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Is Problem-Solving Therapy Effective?

Extensive research and studies have shown the efficacy of problem-solving therapy. PST can yield significant improvements within a short amount of time. PST is also useful for addressing numerous problems and psychological issues. Lastly, PST has shown its efficacy with different populations and age groups.

One meta-analysis of PST for depression concluded that problem-solving therapy was as efficient for reducing symptoms of depression as other types of psychotherapies and antidepressant medication. Furthermore, PST was significantly more effective than not receiving any treatment. 7 However, more investigation may be necessary about PST’s long-term efficacy in comparison to other treatments. 5,6

How Is PST Different From CBT & SFT?

Problem-solving, cognitive-behavioral, and solution-focused therapy belong to the cognitive-behavioral framework, sharing a common goal to modify thoughts, aptitudes, and behaviors to improve mental health and quality of life.

Problem-Solving Therapy Vs. Cognitive-Behavioral Therapy

Cognitive behavioral therapy (CBT) is a short-term psychosocial treatment developed under the premise that how we think affects how we feel and behave. CBT addresses problems arising from maladaptive thought patterns and seeks to challenge and modify these to improve behavioral responses and overall well-being. CBT is the most researched approach and preferred treatment in psychotherapy due to its effectiveness in addressing various problems like anxiety, sleep disorders, substance abuse, and more.

Like CBT, PST addresses mental, emotional, and behavioral issues. However, PST may provide a better balance of cognitive and behavioral elements.

Another difference between these two approaches is that PST mostly focuses on faulty thoughts about problem-solving orientation and modifying maladaptive behaviors that specifically interfere with effective problem-solving. Usually, PST is used as an integrated approach and applied as one of several other interventions in CBT psychotherapy sessions.

Problem-Solving Therapy Vs. Solution-Focused Therapy

Solution-focused therapy (SFT) , like PST, is a goal-directed, evidence-based brief therapeutic approach that encourages optimism, options, and self-efficacy. Similarly, it is also grounded on cognitive behavioral principles. However, it differs from problem-solving therapy because SFT is a semi-structured approach that does not follow a step-by-step sequential format. 8

SFT mainly focuses on solution-building rather than problem-solving, specifically looking at a person’s strengths and previous successes. SFT helps people recognize how their lives would differ without problems by exploring their current coping skills. Community mental health, inpatient settings, and educational environments are increasing the use of SFT due to its demonstrated efficacy. 8

Final Thoughts

Problem-solving therapy can be an effective treatment for various mental health concerns. If you are considering treatment, ask your doctor for recommendations or conduct your own research to learn more about this approach and other options available.

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For Further Reading

• 12 Strategies to Stop Using Unhealthy Coping Mechanisms
• Depression Therapy: 4 Effective Options to Consider
• CBT for Depression: How It Works, Examples, & Effectiveness

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Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy .

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Mehmet Eskin. (2013). Problem solving therapy in the clinical practice . Elsevier.

Nezu, A. M., Nezu, C. M., & D’Zurilla, T. J. (2013). Problem-Solving Therapy A Treatment Manual . Springer Publishing Company.

Cuijpers, P., et al. (2018). Problem-solving therapy for adult depression: An updated meta-analysis. European Psychiatry   48 , 27–37. https://doi.org/10.1016/j.eurpsy.2017.11.006

Kirkham, J. G., Choi, N., & Seitz, D. P. (2015). Meta-analysis of problem-solving therapy for the treatment of major depressive disorder in older adults. International Journal of Geriatric Psychiatry , 31 (5), 526–535. https://doi.org/10.1002/gps.4358

Bell, A. C., & D’Zurilla, T. J. (2009). Problem-solving therapy for depression: A meta-analysis. Clinical Psychology Review , 29 (4), 348–353. https://doi.org/10.1016/j.cpr.2009.02.003

Proudlock, S. (2017). The Solution Focused Way Incorporating Solution Focused Therapy Tools and Techniques into Your Everyday Work . Routledge.

Nezu, A. M., Nezu, C. M., & Gerber, H. R. (2019). (Emotion‐centered) problem‐solving therapy: An update. Australian Psychologist , 54 (5), 361–371. https://doi.org/10.1111/ap.12418

We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about  our editorial policies here .

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10 Best Problem-Solving Therapy Worksheets & Activities

Cognitive science tells us that we regularly face not only well-defined problems but, importantly, many that are ill defined (Eysenck & Keane, 2015).

Sometimes, we find ourselves unable to overcome our daily problems or the inevitable (though hopefully infrequent) life traumas we face.

Problem-Solving Therapy aims to reduce the incidence and impact of mental health disorders and improve wellbeing by helping clients face life’s difficulties (Dobson, 2011).

This article introduces Problem-Solving Therapy and offers techniques, activities, and worksheets that mental health professionals can use with clients.

Before you continue, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises explore fundamental aspects of positive psychology, including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.

This Article Contains:

What is problem-solving therapy, 14 steps for problem-solving therapy, 3 best interventions and techniques, 7 activities and worksheets for your session, fascinating books on the topic, resources from positivepsychology.com, a take-home message.

Problem-Solving Therapy assumes that mental disorders arise in response to ineffective or maladaptive coping. By adopting a more realistic and optimistic view of coping, individuals can understand the role of emotions and develop actions to reduce distress and maintain mental wellbeing (Nezu & Nezu, 2009).

“Problem-solving therapy (PST) is a psychosocial intervention, generally considered to be under a cognitive-behavioral umbrella” (Nezu, Nezu, & D’Zurilla, 2013, p. ix). It aims to encourage the client to cope better with day-to-day problems and traumatic events and reduce their impact on mental and physical wellbeing.

Clinical research, counseling, and health psychology have shown PST to be highly effective in clients of all ages, ranging from children to the elderly, across multiple clinical settings, including schizophrenia, stress, and anxiety disorders (Dobson, 2011).

Can it help with depression?

PST appears particularly helpful in treating clients with depression. A recent analysis of 30 studies found that PST was an effective treatment with a similar degree of success as other successful therapies targeting depression (Cuijpers, Wit, Kleiboer, Karyotaki, & Ebert, 2020).

Other studies confirm the value of PST and its effectiveness at treating depression in multiple age groups and its capacity to combine with other therapies, including drug treatments (Dobson, 2011).

The major concepts

Effective coping varies depending on the situation, and treatment typically focuses on improving the environment and reducing emotional distress (Dobson, 2011).

PST is based on two overlapping models:

Social problem-solving model

This model focuses on solving the problem “as it occurs in the natural social environment,” combined with a general coping strategy and a method of self-control (Dobson, 2011, p. 198).

The model includes three central concepts:

• Social problem-solving
• The problem
• The solution

The model is a “self-directed cognitive-behavioral process by which an individual, couple, or group attempts to identify or discover effective solutions for specific problems encountered in everyday living” (Dobson, 2011, p. 199).

Relational problem-solving model

The theory of PST is underpinned by a relational problem-solving model, whereby stress is viewed in terms of the relationships between three factors:

• Stressful life events
• Emotional distress and wellbeing
• Problem-solving coping

Therefore, when a significant adverse life event occurs, it may require “sweeping readjustments in a person’s life” (Dobson, 2011, p. 202).

• Enhance positive problem orientation
• Decrease negative orientation
• Foster ability to apply rational problem-solving skills
• Reduce the tendency to avoid problem-solving
• Minimize the tendency to be careless and impulsive

D’Zurilla’s and Nezu’s model includes (modified from Dobson, 2011):

• Initial structuring Establish a positive therapeutic relationship that encourages optimism and explains the PST approach.
• Assessment Formally and informally assess areas of stress in the client’s life and their problem-solving strengths and weaknesses.
• Obstacles to effective problem-solving Explore typically human challenges to problem-solving, such as multitasking and the negative impact of stress. Introduce tools that can help, such as making lists, visualization, and breaking complex problems down.
• Problem orientation – fostering self-efficacy Introduce the importance of a positive problem orientation, adopting tools, such as visualization, to promote self-efficacy.
• Problem orientation – recognizing problems Help clients recognize issues as they occur and use problem checklists to ‘normalize’ the experience.
• Problem orientation – seeing problems as challenges Encourage clients to break free of harmful and restricted ways of thinking while learning how to argue from another point of view.
• Problem orientation – use and control emotions Help clients understand the role of emotions in problem-solving, including using feelings to inform the process and managing disruptive emotions (such as cognitive reframing and relaxation exercises).
• Problem orientation – stop and think Teach clients how to reduce impulsive and avoidance tendencies (visualizing a stop sign or traffic light).
• Problem definition and formulation Encourage an understanding of the nature of problems and set realistic goals and objectives.
• Generation of alternatives Work with clients to help them recognize the wide range of potential solutions to each problem (for example, brainstorming).
• Decision-making Encourage better decision-making through an improved understanding of the consequences of decisions and the value and likelihood of different outcomes.
• Solution implementation and verification Foster the client’s ability to carry out a solution plan, monitor its outcome, evaluate its effectiveness, and use self-reinforcement to increase the chance of success.
• Guided practice Encourage the application of problem-solving skills across multiple domains and future stressful problems.
• Rapid problem-solving Teach clients how to apply problem-solving questions and guidelines quickly in any given situation.

Success in PST depends on the effectiveness of its implementation; using the right approach is crucial (Dobson, 2011).

Problem-solving therapy – Baycrest

The following interventions and techniques are helpful when implementing more effective problem-solving approaches in client’s lives.

First, it is essential to consider if PST is the best approach for the client, based on the problems they present.

Is PPT appropriate?

It is vital to consider whether PST is appropriate for the client’s situation. Therapists new to the approach may require additional guidance (Nezu et al., 2013).

Therapists should consider the following questions before beginning PST with a client (modified from Nezu et al., 2013):

• Has PST proven effective in the past for the problem? For example, research has shown success with depression, generalized anxiety, back pain, Alzheimer’s disease, cancer, and supporting caregivers (Nezu et al., 2013).
• Is PST acceptable to the client?
• Is the individual experiencing a significant mental or physical health problem?

All affirmative answers suggest that PST would be a helpful technique to apply in this instance.

Five problem-solving steps

The following five steps are valuable when working with clients to help them cope with and manage their environment (modified from Dobson, 2011).

Ask the client to consider the following points (forming the acronym ADAPT) when confronted by a problem:

• Attitude Aim to adopt a positive, optimistic attitude to the problem and problem-solving process.
• Define Obtain all required facts and details of potential obstacles to define the problem.
• Alternatives Identify various alternative solutions and actions to overcome the obstacle and achieve the problem-solving goal.
• Predict Predict each alternative’s positive and negative outcomes and choose the one most likely to achieve the goal and maximize the benefits.
• Try out Once selected, try out the solution and monitor its effectiveness while engaging in self-reinforcement.

If the client is not satisfied with their solution, they can return to step ‘A’ and find a more appropriate solution.

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Positive self-statements

When dealing with clients facing negative self-beliefs, it can be helpful for them to use positive self-statements.

Use the following (or add new) self-statements to replace harmful, negative thinking (modified from Dobson, 2011):

• I can solve this problem; I’ve tackled similar ones before.
• I can cope with this.
• I just need to take a breath and relax.
• Once I start, it will be easier.
• It’s okay to look out for myself.
• I can get help if needed.
• Other people feel the same way I do.
• I’ll take one piece of the problem at a time.
• I can keep my fears in check.
• I don’t need to please everyone.

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PST practitioners have many different techniques available to support clients as they learn to tackle day-to-day or one-off trauma.

5 Worksheets and workbooks

Problem-solving self-monitoring form.

Ask the client to complete the following:

• Describe the problem you are facing.
• What is your goal?
• What have you tried so far to solve the problem?
• What was the outcome?

Reactions to Stress

It can be helpful for the client to recognize their own experiences of stress. Do they react angrily, withdraw, or give up (Dobson, 2011)?

The Reactions to Stress worksheet can be given to the client as homework to capture stressful events and their reactions. By recording how they felt, behaved, and thought, they can recognize repeating patterns.

What Are Your Unique Triggers?

Helping clients capture triggers for their stressful reactions can encourage emotional regulation.

When clients can identify triggers that may lead to a negative response, they can stop the experience or slow down their emotional reaction (Dobson, 2011).

The What Are Your Unique Triggers ? worksheet helps the client identify their triggers (e.g., conflict, relationships, physical environment, etc.).

Problem-Solving worksheet

Imagining an existing or potential problem and working through how to resolve it can be a powerful exercise for the client.

Use the Problem-Solving worksheet to state a problem and goal and consider the obstacles in the way. Then explore options for achieving the goal, along with their pros and cons, to assess the best action plan.

Getting the Facts

Clients can become better equipped to tackle problems and choose the right course of action by recognizing facts versus assumptions and gathering all the necessary information (Dobson, 2011).

Use the Getting the Facts worksheet to answer the following questions clearly and unambiguously:

• Who is involved?
• What did or did not happen, and how did it bother you?
• Where did it happen?
• When did it happen?
• Why did it happen?
• How did you respond?

2 Helpful Group Activities

While therapists can use the worksheets above in group situations, the following two interventions work particularly well with more than one person.

Generating Alternative Solutions and Better Decision-Making

A group setting can provide an ideal opportunity to share a problem and identify potential solutions arising from multiple perspectives.

Use the Generating Alternative Solutions and Better Decision-Making worksheet and ask the client to explain the situation or problem to the group and the obstacles in the way.

Once the approaches are captured and reviewed, the individual can share their decision-making process with the group if they want further feedback.

Visualization

Visualization can be performed with individuals or in a group setting to help clients solve problems in multiple ways, including (Dobson, 2011):

• Clarifying the problem by looking at it from multiple perspectives
• Rehearsing a solution in the mind to improve and get more practice
• Visualizing a ‘safe place’ for relaxation, slowing down, and stress management

Guided imagery is particularly valuable for encouraging the group to take a ‘mental vacation’ and let go of stress.

Ask the group to begin with slow, deep breathing that fills the entire diaphragm. Then ask them to visualize a favorite scene (real or imagined) that makes them feel relaxed, perhaps beside a gently flowing river, a summer meadow, or at the beach.

The more the senses are engaged, the more real the experience. Ask the group to think about what they can hear, see, touch, smell, and even taste.

Encourage them to experience the situation as fully as possible, immersing themselves and enjoying their place of safety.

Such feelings of relaxation may be able to help clients fall asleep, relieve stress, and become more ready to solve problems.

We have included three of our favorite books on the subject of Problem-Solving Therapy below.

1. Problem-Solving Therapy: A Treatment Manual – Arthur Nezu, Christine Maguth Nezu, and Thomas D’Zurilla

This is an incredibly valuable book for anyone wishing to understand the principles and practice behind PST.

Written by the co-developers of PST, the manual provides powerful toolkits to overcome cognitive overload, emotional dysregulation, and the barriers to practical problem-solving.

Find the book on Amazon .

2. Emotion-Centered Problem-Solving Therapy: Treatment Guidelines – Arthur Nezu and Christine Maguth Nezu

Another, more recent, book from the creators of PST, this text includes important advances in neuroscience underpinning the role of emotion in behavioral treatment.

Along with clinical examples, the book also includes crucial toolkits that form part of a stepped model for the application of PST.

3. Handbook of Cognitive-Behavioral Therapies – Keith Dobson and David Dozois

This is the fourth edition of a hugely popular guide to Cognitive-Behavioral Therapies and includes a valuable and insightful section on Problem-Solving Therapy.

This is an important book for students and more experienced therapists wishing to form a high-level and in-depth understanding of the tools and techniques available to Cognitive-Behavioral Therapists.

For even more tools to help strengthen your clients’ problem-solving skills, check out the following free worksheets from our blog.

• Case Formulation Worksheet This worksheet presents a four-step framework to help therapists and their clients come to a shared understanding of the client’s presenting problem.
• Understanding Your Default Problem-Solving Approach This worksheet poses a series of questions helping clients reflect on their typical cognitive, emotional, and behavioral responses to problems.
• Social Problem Solving: Step by Step This worksheet presents a streamlined template to help clients define a problem, generate possible courses of action, and evaluate the effectiveness of an implemented solution.

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While we are born problem-solvers, facing an incredibly diverse set of challenges daily, we sometimes need support.

Problem-Solving Therapy aims to reduce stress and associated mental health disorders and improve wellbeing by improving our ability to cope. PST is valuable in diverse clinical settings, ranging from depression to schizophrenia, with research suggesting it as a highly effective treatment for teaching coping strategies and reducing emotional distress.

Many PST techniques are available to help improve clients’ positive outlook on obstacles while reducing avoidance of problem situations and the tendency to be careless and impulsive.

The PST model typically assesses the client’s strengths, weaknesses, and coping strategies when facing problems before encouraging a healthy experience of and relationship with problem-solving.

Why not use this article to explore the theory behind PST and try out some of our powerful tools and interventions with your clients to help them with their decision-making, coping, and problem-solving?

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .

• Cuijpers, P., Wit, L., Kleiboer, A., Karyotaki, E., & Ebert, D. (2020). Problem-solving therapy for adult depression: An updated meta-analysis. European P sychiatry ,  48 (1), 27–37.
• Dobson, K. S. (2011). Handbook of cognitive-behavioral therapies (3rd ed.). Guilford Press.
• Dobson, K. S., & Dozois, D. J. A. (2021). Handbook of cognitive-behavioral therapies  (4th ed.). Guilford Press.
• Eysenck, M. W., & Keane, M. T. (2015). Cognitive psychology: A student’s handbook . Psychology Press.
• Nezu, A. M., & Nezu, C. M. (2009). Problem-solving therapy DVD . Retrieved September 13, 2021, from https://www.apa.org/pubs/videos/4310852
• Nezu, A. M., & Nezu, C. M. (2018). Emotion-centered problem-solving therapy: Treatment guidelines. Springer.
• Nezu, A. M., Nezu, C. M., & D’Zurilla, T. J. (2013). Problem-solving therapy: A treatment manual . Springer.

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Cognitive Behavioral Therapy

Solving problems the cognitive-behavioral way, problem solving is another part of behavioral therapy..

Posted February 2, 2022 | Reviewed by Ekua Hagan

• What Is Cognitive Behavioral Therapy?
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• Find a therapist who practices CBT
• Problem-solving is one technique used on the behavioral side of cognitive-behavioral therapy.
• The problem-solving technique is an iterative, five-step process that requires one to identify the problem and test different solutions.
• The technique differs from ad-hoc problem-solving in its suspension of judgment and evaluation of each solution.

As I have mentioned in previous posts, cognitive behavioral therapy is more than challenging negative, automatic thoughts. There is a whole behavioral piece of this therapy that focuses on what people do and how to change their actions to support their mental health. In this post, I’ll talk about the problem-solving technique from cognitive behavioral therapy and what makes it unique.

The problem-solving technique

While there are many different variations of this technique, I am going to describe the version I typically use, and which includes the main components of the technique:

The first step is to clearly define the problem. Sometimes, this includes answering a series of questions to make sure the problem is described in detail. Sometimes, the client is able to define the problem pretty clearly on their own. Sometimes, a discussion is needed to clearly outline the problem.

The next step is generating solutions without judgment. The "without judgment" part is crucial: Often when people are solving problems on their own, they will reject each potential solution as soon as they or someone else suggests it. This can lead to feeling helpless and also discarding solutions that would work.

The third step is evaluating the advantages and disadvantages of each solution. This is the step where judgment comes back.

Fourth, the client picks the most feasible solution that is most likely to work and they try it out.

The fifth step is evaluating whether the chosen solution worked, and if not, going back to step two or three to find another option. For step five, enough time has to pass for the solution to have made a difference.

This process is iterative, meaning the client and therapist always go back to the beginning to make sure the problem is resolved and if not, identify what needs to change.

Advantages of the problem-solving technique

The problem-solving technique might differ from ad hoc problem-solving in several ways. The most obvious is the suspension of judgment when coming up with solutions. We sometimes need to withhold judgment and see the solution (or problem) from a different perspective. Deliberately deciding not to judge solutions until later can help trigger that mindset change.

Another difference is the explicit evaluation of whether the solution worked. When people usually try to solve problems, they don’t go back and check whether the solution worked. It’s only if something goes very wrong that they try again. The problem-solving technique specifically includes evaluating the solution.

Lastly, the problem-solving technique starts with a specific definition of the problem instead of just jumping to solutions. To figure out where you are going, you have to know where you are.

One benefit of the cognitive behavioral therapy approach is the behavioral side. The behavioral part of therapy is a wide umbrella that includes problem-solving techniques among other techniques. Accessing multiple techniques means one is more likely to address the client’s main concern.

Salene M. W. Jones, Ph.D., is a clinical psychologist in Washington State.

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Guided Discovery

Problem-Solving Therapy Integrated Within the Socratic Method

• Original Paper
• Published: 27 November 2012
• Volume 43 , pages 73–82, ( 2013 )

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• James C. Overholser 1  

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Guided discovery involves a therapeutic dialogue that is designed to assist clients in finding their own solutions to their problems. An integration of problem-solving therapy and the Socratic method can help clients to develop their own coping skills. Problem-solving therapy provides a useful framework for helping clients to manage many of the problems they typically encounter. The Socratic method provides a useful therapeutic style to promote self-guided discovery and self-regulation. Strategies from the Socratic method can be used to guide the process of the therapeutic dialogue, while the stages of problem-solving serve as the structure for the content of therapy sessions. Therapy can be structured according to five main stages: (1) Help clients establish a realistic and adaptive attitude toward common life problems; (2) Define problems in terms of specific and realistic goals; (3) Help clients to generate a wide variety of coping options; (4) Guide clients through a process of rational decision-making in order to select the best coping options, and (5) Implement the plan and evaluate its effectiveness. A systematic series of questions can be used to facilitate the client’s self-evaluation of different problems, goals, and coping efforts. The process helps to promote client autonomy and self-guided action. When problem-solving therapy is integrated within the Socratic method, clients can learn to approach most problems in a logical, thoughtful, and self-directed manner.

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5 Problem-Solving Therapy: Theory and Practice

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Problem-solving therapy (PST) is a psychosocial intervention that teaches clients to cope with the stress of “here-and-now” problems in order to reduce negative health and mental health outcomes. In this chapter, the six stages of PST—problem orientation, problem definition, solution generation, decision-making, solution implementation, and outcome evaluation—are explained and exemplified via vignettes. Areas for which problem-solving therapy has been found useful are summarized, including depression, anxiety, relationship difficulties, and distress related to medical problems such as cancer and diabetes. The chapter describes contexts for practice, including primary care and home care, as well as adaptations for the use of PST with older adults. Finally, a case example of a problem-solving intervention with an unemployed depressed older man is presented to illustrate this approach.

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Problem-Solving Therapy

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In Problem-Solving Therapy , Drs. Arthur Nezu and Christine Maguth Nezu demonstrate their positive, goal-oriented approach to treatment. Problem-solving therapy is a cognitive–behavioral intervention geared to improve an individual's ability to cope with stressful life experiences. The underlying assumption of this approach is that symptoms of psychopathology can often be understood as the negative consequences of ineffective or maladaptive coping.

Problem-solving therapy aims to help individuals adopt a realistically optimistic view of coping, understand the role of emotions more effectively, and creatively develop an action plan geared to reduce psychological distress and enhance well-being. Interventions include psychoeducation, interactive problem-solving exercises, and motivational homework assignments.

In this session, Christine Maguth Nezu works with a woman in her 50s who is depressed and deeply concerned about her son's drug addiction. Dr. Nezu first assesses her strengths and weaknesses and then helps her to clarify the problem she is facing so she can begin to move toward a solution.

The overarching goal of problem-solving therapy (PST) is to enhance the individual's ability to cope with stressful life experiences and to foster general behavioral competence. The major assumption underlying this approach, which emanates from a cognitive–behavioral tradition, is that much of what is viewed as "psychopathology" can be understood as consequences of ineffective or maladaptive coping behaviors. In other words, failure to adequately resolve stressful problems in living can engender significant emotional and behavioral problems.

Such problems in living include major negative events (e.g., undergoing a divorce, dealing with the death of a spouse, getting fired from a job, experiencing a major medical illness), as well as recurrent daily problems (e.g., continued arguments with a coworker, limited financial resources, diminished social support). How people resolve or cope with such situations can, in part, determine the degree to which they will likely experience long-lasting psychopathology and behavioral problems (e.g., clinical depression, generalized anxiety, pain, anger, relationship difficulties).

For example, successfully dealing with stressful problems will likely lead to a reduction of immediate emotional distress and prevent long-term psychological problems from occurring. Alternatively, maladaptive or unsuccessful problem resolution, either due to the overwhelming nature of events (e.g., severe trauma) or as a function of ineffective coping attempts, will likely increase the probability that long-term negative affective states and behavioral difficulties will emerge.

Social Problem Solving and Psychopathology

According to this therapy approach, social problem solving (SPS) is considered a key set of coping abilities and skills. SPS is defined as the cognitive–behavioral process by which individuals attempt to identify or discover effective solutions for stressful problems in living. In doing so, they direct their problem-solving efforts at altering the stressful nature of a given situation, their reactions to such situations, or both. SPS refers more to the metaprocess of understanding, appraising, and adapting to stressful life events, rather than representing a single coping strategy or activity.

Problem-solving outcomes in the real world have been found to be determined by two general but partially independent processes—problem orientation and problem-solving style.

Problem orientation refers to the set of generalized thoughts and feelings a person has concerning problems in living, as well as his or her ability to successfully resolve them. It can either be positive (e.g., viewing problems as opportunities to benefit in some way, perceiving oneself as able to solve problems effectively), which serves to enhance subsequent problem-solving efforts, or negative (e.g.,viewing problems as a major threat to one's well-being, overreacting emotionally when problems occur), which functions to inhibit attempts to solve problems.

Problem-solving style refers to specific cognitive–behavioral activities aimed at coping with stressful problems. Such styles are either adaptive, leading to successful problem resolution, or dysfunctional, leading to ineffective coping, which then can generate myriad negative consequences, including emotional distress and behavioral problems. Rational problem solving is the constructive style geared to identify an effective solution to the problem and involves the systematic and planful application of specific problem-solving tasks. Dysfunctional problem-solving styles include (a) impulsivity/carelessness (i.e., impulsive, hurried, and incomplete attempts to solve a problem), and (b) avoidance (i.e.,avoiding problems, procrastinating, and depending on others to solve one's problems).

Important differences have been identified between individuals characterized as "effective" versus "ineffective" problem solvers. In general, when compared to effective problem solvers, persons characterized by ineffective problem solving report a greater number of life problems, more health and physical symptoms, more anxiety, more depression, and more psychological maladjustment. In addition, a negative problem orientation has been found to be associated with negative moods under both routine and stressful conditions, as well as pessimism, negative emotional experiences, and clinical depression. Further, persons with negative orientations tend to worry and complain more about their health.

Problem-Solving Therapy Goals

PST teaches individuals to apply adaptive coping skills to both prevent and cope with stressful life difficulties. Specific PST therapy objectives include

• enhancing a person's positive orientation
• fostering his or her application of specific rational problem-solving tasks (i.e., accurately identifying why a situation is a problem, generating solution alternatives, conducting a cost-benefit analysis in order to decide which ideas to choose to include as part of an overall solution plan, implementing the solution, monitoring its effects, and evaluating the outcome)
• reducing his or her negative orientation
• minimizing one's tendency to engage in dysfunctional problem-solving style activities (i.e., impulsively attempting to solve the problem or avoiding the problem)

PST interventions involve psychoeducation, interactive problem-solving training exercises, practice opportunities, and homework assignments intended to motivate patients to apply the problem-solving principles outside of the therapy sessions.

PST has been shown to be effective regarding a wide range of clinical populations, psychological problems, and the distress associated with chronic medical disorders. Scientific evaluations have focused on unipolar depression, geriatric depression, distressed primary-care patients, social phobia, agoraphobia, obesity, coronary heart disease, adult cancer patients, adults with schizophrenia, mentally retarded adults with concomitant psychiatric problems, HIV-risk behaviors, drug abuse, suicide, childhood aggression, and conduct disorder.

Moreover, PST is flexible with regard to treatment goals and methods of implementation. For example, it can be conducted in a group format, on an individual and couples basis, as part of a larger cognitive–behavioral treatment package, over the phone, as well as on the Internet. It can also be applied as a means of helping patients to overcome barriers associated with successful adherence to other medical or psychosocial treatment protocols (e.g., adhering to weight-loss programs, diabetes regulation).

Arthur M. Nezu, PhD, ABPP, is currently professor of psychology, medicine, and community health and prevention at Drexel University in Philadelphia. He is one of the codevelopers of a cognitive–behavioral approach to teaching social problem-solving skills and has conducted multiple RCTs testing its efficacy across a variety of populations. These populations include clinically depressed adults, depressed geriatric patients, adults with mental retardation and concomitant psychopathology, distressed cancer patients and their spousal caregivers, individuals in weight-loss programs, breast cancer patients, and adult sexual offenders.

Dr. Nezu has contributed to more than 175 professional and scientific publications, including the books Solving Life's Problems: A 5-Step Guide to Enhanced Well-Being , Helping Cancer Patients Cope: A Problem-Solving Approach , and Problem-Solving Therapy: A Positive Approach to Clinical Intervention . He also codeveloped the self-report measure Social Problem-Solving Inventory—Revised . Dr. Nezu is on numerous editorial boards of scientific and professional journals and a member of the Interventions Research Review Committee of the National Institute of Mental Health.

An award-winning psychologist, he was previously president of the Association for Advancement of Behavior Therapy, the Behavioral Psychology Specialty Council, the World Congress of Behavioral and Cognitive Therapies, and the American Board of Cognitive and Behavioral Psychology. He is a fellow of the American Psychological Association, the Association for Psychological Science, the Society for Behavior Medicine, the Academy of Cognitive Therapy, and the Academy of Cognitive and Behavioral Psychology. Dr. Nezu was awarded the diplomate in Cognitive and Behavioral Psychology from the American Board of Professional Psychology and currently serves as a trustee of that board.

He has been in private practice for over 25 years, and is currently conducting outcome studies to evaluate the efficacy of problem-solving therapy to treat depression among adults with heart disease.

Christine Maguth Nezu, PhD, ABPP, is currently professor of psychology, associate professor of medicine, and director of the masters programs in psychology at Drexel University in Philadelphia. She previously served as director of the APA-accredited Internship/Residency in Clinical Psychology, as well as the Cognitive–Behavioral Postdoctoral Fellowship Program, at the Medical College of Pennsylvania/Hahnemann University.

She is the coauthor or editor of more than 100 scholarly publications, including 15 books. Her publications cover a wide range of topics in mental health and behavioral medicine, many of which have been translated into a variety of foreign languages.

Dr. Maguth Nezu is currently the president-elect of the American Board of Professional Psychology, on the board of directors for the American Board of Cognitive and Behavioral Psychology, and on the board of directors for the American Academy of Cognitive and Behavioral Psychology. She is the recipient of numerous grant awards supporting her research and program development, particularly in the area of clinical interventions. She serves as an accreditation site visitor for APA for clinical training programs and is on the editorial boards of several leading psychology and health journals.

Dr. Maguth Nezu has conducted workshops on clinical interventions and case formulation both nationally and internationally. She is currently the North American representative to the World Congress of Cognitive and Behavioral Therapies. She holds a diplomate in Cognitive and Behavioral Psychology from the American Board of Professional Psychology and has been active in private practice for more than 20 years.

Her current areas of interest include the treatment of depression in medical patients, the integration of cognitive and behavioral therapies with patients' spiritual beliefs and practices, interventions directed toward stress, coping, and health, and cognitive behavior therapy and problem-solving therapy for individuals with personality disorders.

• D'Zurilla, T. J., & Nezu, A. M. (2007). Problem-solving therapy: A positive approach to clinical intervention (3rd ed.). New York: Springer Publishing Co.
• D'Zurilla, T. J., Nezu, A. M., & Maydeu-Olivares, A. (2002). Social Problem-Solving Inventory—Revised (SPSI-R): Technical manual . North Tonawanda, NY: Multi-Health Systems.
• Nezu, A. M. (2004). Problem solving and behavior therapy revisited. Behavior Therapy, 35 , 1–33.
• Nezu, A. M., & Nezu, C. M. (in press). Problem-solving therapy. In S. Richards & M. G. Perri (Eds.), Relapse prevention for depression . Washington, DC: American Psychological Association.
• Nezu, A. M., Nezu, C. M., & Clark, M. (in press). Problem solving as a risk factor for depression. In K. S. Dobson & D. Dozois (Eds.), Risk factors for depression . New York: Elsevier Science.
• Nezu, A. M., Nezu, C. M., & Perri, M. G. (2006). Problem solving to promote treatment adherence. In W. T. O'Donohue & E. Livens (Eds.), Promoting treatment adherence: A practical handbook for health care providers (pp. 135–148). New York: Sage Publications.
• Nezu, A. M., Nezu, C. M., & D'Zurilla, T. J. (2007). Solving life's problems: A 5-step guide to enhanced well-being . New York: Springer Publishing Co.
• Nezu, A. M., Nezu, C. M., Friedman, S. H., Faddis, S., & Houts, P. S. (1998). Helping cancer patients cope: A problem-solving approach . Washington, DC: American Psychological Association.
• Nezu, C. M., D'Zurilla, T. J., & Nezu, A. M. (2005). Problem-solving therapy: Theory, practice, and application to sex offenders. In M. McMurran & J. McGuire (Eds.), Social problem solving and offenders: Evidence, evaluation and evolution (pp. 103–123). Chichester, UK: Wiley.
• Nezu, C. M., Palmatier, A., & Nezu, A. M. (2004). Social problem-solving training for caregivers. In E. C. Chang, T. J. D'Zurilla, & L. J. Sanna (Eds.), Social problem solving: Theory, research, and training (pp. 223–238). Washington, DC: American Psychological Association.
• Cognitive–Behavioral Relapse Prevention for Addictions G. Alan Marlatt
• Cognitive–Behavioral Therapy With Donald Meichenbaum Donald Meichenbaum
• Depression With Older Adults Peter A. Lichtenberg
• Depression Michael D. Yapko
• Emotion-Focused Therapy for Depression Leslie S. Greenberg
• Relapse Prevention Over Time G. Alan Marlatt
• Behavioral Interventions in Cognitive Behavior Therapy: Practical Guidance for Putting Theory Into Action, Second Edition Richard F. Farmer and Alexander L. Chapman
• Experiences of Depression: Theoretical, Clinical, and Research Perspectives Sidney J. Blatt
• Preventing Youth Substance Abuse: Science-Based Programs for Children and Adolescents Edited by Patrick Tolan, José Szapocznik, and Soledad Sambrano

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The Use of Problem-Solving Therapy for Primary Care to Enhance Complex Decision-Making in Healthy Community-Dwelling Older Adults

Christopher m. nguyen.

1 Division of Cognitive Neuroscience, Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, IA, United States

2 Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States

Kuan-Hua Chen

3 Institute of Personality and Social Research, University of California, Berkeley, Berkeley, CA, United States

Natalie L. Denburg

Some older adults who are cognitively healthy have been found to make poor decisions. The vulnerability of such older adults has been postulated to be the result of disproportionate aging of the frontal lobes that contributes to a decline in executive functioning abilities among some older adults. The purpose of this study was to investigate whether decision-making performance in older adults can be enhanced by a psychoeducational intervention. Twenty cognitively and emotionally intact persons aged 65 years and older were recruited and randomized into two conditions: psychoeducational condition [Problem-Solving Therapy for Primary Care (PST-PC)] and no-treatment Control group. Participants in the psychoeducational condition each received four 45-min sessions of PST-PC across a 2-week period. The Iowa Gambling Task (IGT) was administered as the outcome measure to the treatment group, while participants in the Control group completed the IGT without intervention. A significant interaction effect was observed between group status and the trajectory of score differences across trials on the IGT. Particularly, as the task progressed to the last 20% of trials, participants in the PST-PC group significantly outperformed participants in the Control group in terms of making more advantageous decisions. These findings demonstrated that a four-session problem-solving therapy can reinforce aspects of executive functioning (that may have declined as a part of healthy aging), thereby enhancing complex decision-making in healthy older adults.

Introduction

The ability of older adults to make sound decisions regarding retirement, allocation of resources, living arrangements, health insurance, and medical procedures has a profound effect on the well-being of the individual as well as society, cumulatively. Even older adults who are cognitively healthy, without a neurodegenerative disease or mild cognitive impairment, have been found to make poor decisions ( Denburg et al., 2007 ). Specifically, some older adults fail to make advantageous decisions and become susceptible to scams, make poor financial decisions, or experience abuse of trust and get taken advantage of by others. These forms of financial exploitation have been reported to increase dramatically among older adults ( Lichtenberg et al., 2015 ).

The weaknesses in decision-making capacity among older adults have been postulated to be triggered by a distinct neurological change: disproportionate age-related decline of the frontal lobes of the brain ( West, 1996 ). In particular, the frontal lobe hypothesis of cognitive aging posits that cognitive abilities dependent on the frontal regions of the brain would experience a disproportionate age-related decline, whereas other functioning independent of the frontal lobes will remain relatively intact ( West, 1996 ). This theory has gained support from multiple neuroscience disciplines, including neuropsychology, neuroanatomy, and functional neuroimaging (see review by, Reuter-Lorenz et al., 2016 ). The reasons why some older adults are vulnerable and susceptible to making poor decisions have been examined thoroughly through neurobiological and behavioral mechanisms, and research on applied contexts has been important to understanding day-to-day decisions ( Hess et al., 2015 ). Much of the current research on aging and decision making in applied domains has focused on the implication of decisions in various contexts such as medical decision-making ( Leventhal et al., 2015 ), health-related decisions ( Liu et al., 2015 ), and consumer decision-making ( Carpenter and Yoon, 2015 ). Yet, research efforts examining interventions to enhance older adults decision-making abilities are lacking.

Deficits in decision-making may be a function of weaknesses in executive functioning. Specifically, executive functions involve abilities such as planning, organization, goal setting, initiation, and utilization of feedback and attention shifting – all essential skills necessary in the process of decision-making. A review of the treatment modalities revealed that Problem-Solving Therapy for Primary Care (PST-PC; Hegel and Arean, 2003 ) is one treatment modality to have demonstrated efficacy in managing such executive dysfunction ( Alexopoulous et al., 2003 ).

Problem-Solving Therapy for Primary Care was developed as an efficient modality to treat patients in busy primary care settings over the course of 4–8 sessions. It has been found that as few as three sessions of PST-PC could be beneficial ( Mynors-Wallis et al., 2000 ; Hegel et al., 2004 ; Arean et al., 2008 ). Trained specialists can deliver PST-PC after undergoing a brief training module ( Hegel et al., 2004 ; Arean et al., 2008 ). Furthermore, PST-PC has been demonstrated to be as effective when implemented by nurses and primary care physicians as compared to implementation by mental health professionals ( Mynors-Wallis et al., 2000 ; Unutzer et al., 2002 ). When comparing PST-PC with antidepressants among depressed patients, PST-PC has been shown to be just as efficacious in improving psychological symptoms and social functioning ( Mynors-Wallis et al., 1995 ). Furthermore, the effectiveness of PST-PC has been evaluated in several randomized-controlled trials to treat various psychological problems including depression, anxiety, and insomnia ( Dowrick et al., 2000 ; Mynors-Wallis et al., 2000 ).

Problem-Solving Therapy for Primary Care has been demonstrated as an efficacious intervention to improve mood and cognitive functioning in elderly depressed patients ( Alexopoulous et al., 2003 ; Arean et al., 2008 , 2010 ). When compared with other treatment modalities such as cognitive-behavioral therapy and psychodynamic approaches, depressed older adults who were treated with PST-PC reported fewer depressive symptoms and improved functioning at 12 months and up to 24 months follow-up ( Arean et al., 2008 ). Elderly depressed patients receiving PST-PC treatments have exhibited reduction of symptoms, endorsed higher response rate to treatment, and greater remission rate when compared with those receiving a person-centered psychotherapy treatment approach ( Arean et al., 2010 ). Among depressed elderly patients with impairments in aspects of executive functioning, those receiving PST-PC treatments (versus supportive counseling) demonstrated greater improvement in generating alternative solutions and decision-making skills, in addition to reduced depressive symptoms and improved functioning ( Alexopoulous et al., 2003 ).

The purpose of this study was to investigate whether decision-making performance among healthy community-dwelling older adults can be improved by a brief four-session (approximately 2 weeks) problem-solving therapy modality. To our knowledge, this is one of the first studies to introduce a psychosocial intervention to enhance complex decision-making among healthy community-dwelling older adults in an outpatient context. PST-PC was specifically chosen due to its: 1) efficacy among older adults; 2) efficient protocol that can be delivered in four sessions (or in our case, about 2 weeks); and 3) effectiveness when implemented by trained individuals not in the field of mental health ( Arean, 2009 ). Morever, the cognitive changes associated with aging have demonstrated age-related effects in prefrontal brain structures contributing to weaknesses in aspects of executive functioning (e.g., planning, initiation, decision-making, and problem-solving), and thus the utilization of PST-PC as a possible compensatory strategy to address these deficits can be a valuable form of intervention. It was hypothesized that decision-making performance among healthy community-dwelling older adults would improve for those in the PST-PC condition when compared to participants in the no-treatment Control condition.

Materials and Methods

Participants.

Participants were included in the study if they were heathy, community-dwelling, aged 65 years and older, and cognitively and emotionally intact, and were excluded from the study if they had any major underlying medical conditions (e.g., cancer, cardiovascular disease, and movement disorder). Participants were recruited from a pool of participants involved in an ongoing project investigating the neural correlates of decision-making. These participants were evaluated extensively, with both clinical interview and comprehensive neuropsychological assessment, and thus were deemed cognitively and emotionally intact (after Tranel et al., 1997 ). Participants completed an informed consent process approved by an Institutional Review Board, and were financially compensated for their involvement. Twenty participants were randomly assigned to two groups: psychoeducational condition (PST-PC) and no-treatment Control group. The PST-PC group ( n = 10) had a mean age of 80.5 years [standard deviation (SD) = 3.5] and 50% males. The Control group ( n = 10) had a mean age of 80.0 years ( SD = 4.3) and 50% males.

All participants completed a 2-h comprehensive battery of neuropsychological tests to assess a broad range of cognitive abilities. A research assistant with training in neuropsychological assessment administered the test battery under the supervision of a neuropsychologist (NLD). Ten domains were assessed with the following administered instruments: general mental status (Folstein Mini-Mental State Examination; Folstein et al., 1975 ); estimated premorbid IQ (Wide Range Achievement Test-3; Wilkinson, 1993 ); verbal and non-verbal intellectual functioning (Wechsler Abbreviated Scale of Intelligence; Wechsler, 1999 ); attention and working memory (Wechsler Adult Intelligence Scale-III Working Memory Index; Wechsler, 1997 ); processing speed (Trail Making Test Part A; Spreen and Strauss, 1998 ); language (Controlled Oral Word Association Test; Benton and Hamsher, 1989 ); learning and memory [Rey Auditory Verbal Learning Test ( Rey, 1941 ) and Rey–Osterrieth Complex Figure Test ( Rey, 1964 )]; visuoperception (Benton Facial Discrimination Test; Benton et al., 1994 ); mental flexibility and set-shifting (Trail Making Test Part B; Spreen and Strauss, 1998 ); and mood (Beck Depression Inventory-II; Beck et al., 1996 ).

Participants randomized into the psychoeducational condition each completed four 45-min sessions of the PST-PC protocol during a 2-week period. A doctoral candidate in psychology (CMN) with training in cognitive-behavioral therapy delivered the PST-PC sessions following a manualized protocol to all participants under the supervision of a licensed clinical psychologist (NLD). Through a seven-step model of PST-PC ( Hegel and Arean, 2003 ), participants identified problems to be solved; discussed and evaluated different resolutions to reach desired goals; created action plans to accomplish determined goals; and evaluated their effectiveness in resolving designated problems. In the first session, the structure of the treatment process was outlined, and the seven stages of the problem-solving process were thoroughly discussed. In the second session, the participant selected one problem from the list generated in the first session to be resolved. The seven stages of PST-PC were integrated during the process of identifying the problem to be resolved and formation of the action plan. During the third session, participants evaluated the outcomes of their action plans. This session consisted of a discussion on how well they have integrated the seven stages of PST-PC toward the resolution of a designated problem to be resolved. If a participant successfully resolved the problem, a new problem was selected, and the process was discussed in the last session. If a participant was not successful in resolving a designated problem, the next session was used to further discuss progress or setbacks. The final session was used to review the participants’ progress and reinforce continued efforts in resolution of future problems ( Hegel and Arean, 2003 ).

All but one participant completed the PST-PC protocol at our clinic. For this one individual, the sessions were completed at their home due to limited mobility secondary to a recent orthopedic surgery. There was a 3- to 4-day interval between each of the four sessions. Participants were scheduled to complete the outcome measure within 3 days of completing the final PST-PC session. The participants from the Control group were recruited and scheduled to complete the outcome measure.

Manipulation Check

A manipulation check was applied to confirm that the seven stages of the PST-PC protocol was successfully implemented. At baseline and post-PST-PC sessions, participants were asked to respond to one open-ended essay-format question, as follows: “Please describe the process of problem-solving in detail, including all steps and the criteria for successfully completing each one.” All essays were scored using criteria designated in the 20-item Problem-Solving Treatment Knowledge Assessment (PST-KA; Cartreine et al., 2012 ), based on how well each essay discussed the stages of Problem-Solving Treatment (e.g., Identifying the Problem, Setting a Goal, Brainstorming Solutions, Selecting Solutions for Implementation, and Action Planning). Each item on the PST-KA was rated on a six-point scale (0–5; very poor to very good). The possible range of scores was 0–100, with higher scores indicating greater baseline knowledge/knowledge obtained (hereafter refered to as closure knowledge). Two research assistants who were blind to the time point of the completed essays completed the ratings. An average score was calculated across scores from the research assistants.

Decision-Making Outcome Measure

The Iowa Gambling Task (IGT; Bechara, 2007 ) is a measure of complex decision-making under ambiguity that features real-world aspects of reward, punishment, and unpredictability. The IGT is a computer-administered test comprised of 100 card selections from four decks of cards. On each trial, choosing a card gives an immediate monetary reward. At random points, the selection of some cards results in losing a sum of money. Two decks of cards are predetermined to offer a lower immediate gain and even lower long-term loss, yielding an overall net gain of money (i.e., referred to as “the good decks”). Alternatively, the other two decks are predetermined to offer a higher immediate gain but even higher long-term loss, yielding an overall net loss of money (i.e., referred to as “the bad decks”). Participants are not informed of the number of trials or the gain/loss patterns.

Performance on the IGT is often quantified by dividing the 100 trials into five distinct blocks of 20 trials each to examine participant’s learning curve ( Bechara, 2007 ). A score for each block is calculated by subtracting the number of selection from the good decks from the number of selections from the bad decks, while a total score for the IGT is calculated by subtracting the total number of selections from the bad decks from the total number of selections from the good deck. A positive total score indicates advantageous decision-making, whereas a negative total score indicates disadvantageous decision-making ( Bechara, 2007 ).

Statistical Analysis

Preliminary analysis examined the data for the presence of outliers. Independent samples t -tests were employed to examine differences between the participant groups on demographic variables, cognitive performance, and mood. Next, a paired-samples t -test was conducted to examine whether a mean difference existed in baseline and/or closure knowledge after four sessions of PST-PC. Finally, to explore the effects of PST-PC on the decision-making outcome measure, a 2x5 repeated measures analysis of variance (ANOVA) using group status (PST-PC versus Control) as the between-subjects factor and trial block (1–5) as the within-subjects factor was employed to evaluate performance on the IGT outcome measure by trial block.

The two participant groups did not significantly differ in terms of education, general mental status, estimated premorbid IQ, verbal and non-verbal intellectual functioning, attention and working memory, processing speed, language, learning and memory, visuoperception, mental flexibility and set-shifting, and mood. Demographic and cognitive characteristics are presented in Table ​ Table1 1 . A paired-samples t -test comparing pre- and post-intervention PST-KA scores of participants from the PST-PC group revealed a significant difference in the baseline knowledge assessment scores ( M = 22.0; SD = 13.3) as compared to the closure knowledge scores ( M = 38.8, SD = 19.6); t (9) = -2.3, p = 0.047. This implied that the seven stages of the PST-PC protocol was successfully implemented. A repeated measures ANOVA revealed a non-significant main effect for group on IGT scores, F (4,15) = 2.04, p = 0.097. Although there were no significant group differences with the overall IGT index, descriptive statistics revealed that four (of 10) participants in the Control group achieved an overall index in IGT scores that were below zero (range: -16 to -44), as compared to none from the PST group. Of note, IGT scores that were significantly below zero have been classified as an “Impaired” performance in past studies ( Denburg et al., 2005 ). A significant interaction effect was indicated between group status and the trajectory of score differences across the five trial blocks on the IGT, F (4,15) = 3.24, p = 0.017, which is indicative that group status had different effects on participant’s learning curve on the IGT trials, as presented in Figure ​ Figure1 1 . To explore this interaction, contrasts were performed for individual trial blocks, revealing a statistically significant difference between the two groups in advantages versus disadvantageous selections on the last block of the IGT, t (18) = -3.02, p = 0.007, d = 1.35, 95% CI [-22, -4]. Particularly, as the task progressed to the end, participants in the PST-PC group significantly outperformed participants in the Control group in terms of making more advantageous decisions in the last 20% of trials (or card selections 81–100).

Demographic and cognitive characteristics.

Iowa Gambling Task scores by trail block for PST-PC and Control groups. Decision-making performance on the IGT in PST-PC and Control participants, graphed as a function of trial block [±SEM (standard error of the mean)]. A significant interaction effect was indicated between group status and the trajectory of score differences across the five trial blocks on the IGT, revealing a statistically significant difference between the two groups in advantageous versus disadvantageous selections on the last block of the IGT, or during the last 20% of selections.

The purpose of this study was to investigate whether decision-making performance among healthy community-dwelling older adults could be improved as a result of a well-validated psychoeducational intervention. Twenty participants were recruited and randomized into two conditions: PST-PC and a no-treatment Control group. The theoretical framework of this study is based on a body of literature suggesting that a disproportionate deterioration of the frontal lobes during aging contributes to a decline in executive functioning abilities among some older adults ( West, 1996 ). Previous work from our laboratory have supported this “frontal lobe hypothesis,” revealing that seemingly healthy older adults often make disadvantageous decisions ( Denburg et al., 2005 , 2006 , 2007 ). Specifically, we have found that some older adults may experience a greater decline in non-memory-related cognitive functioning, such as problem-solving and mental flexibility, contributing to weaknesses in their decision-making abilities ( Denburg and Hedgcock, 2015 ). The findings from the current study demonstrated that a four-session (approximately 2 weeks) problem-solving therapy can reinforce aspects of executive functioning (that may have declined as a part of healthy aging), thereby enhancing decision-making abilities.

With regard to decision-making outcomes, the proportion of our participants with “impaired” and “unimpaired” performance on the IGT from the Control group is comparable to findings from previous studies using this classification. Specifically, Denburg et al. (2005 , 2006 ) defined “impaired” performance on the IGT as being significantly worse than performance at chance level, and found that approximately 25–35% of their older adult sample performed in the “impaired” range. Additionally, this finding is consistent with another study suggesting that a subset of older adults make less advantageous decisions when compared to younger adults ( Fein et al., 2007 ).

Interestingly, earlier findings by Bechara et al. (1997) have indicated that by the 80th card selection (out of 100), normal healthy young adults would reach a “conceptual period” during which they exhibited knowledge regarding optimal choices based on prior feedback and typically avoid the disadvantage selections. Notably, as the task progressed to the latter 20% of the task, participants in the PST-PC group significantly outperformed participants in the Control group in terms of making more advantageous decisions. Group differences emerged as the IGT progressed such that those in the PST-PC group learned to adapt to feedback that led to making more advantageous decisions. Alternatively, participants without the benefit of the PST-PC psychoeducation treatment (i.e., the Control group) shifted between decks and were inefficient in developing a strategy over time which may have contributed to the overall less advantageous choices than participants in the PST-PC group.

It has been postulated that individuals exhibiting difficulty in developing an advantageous and stable strategy over time on the IGT is likely to be related to weaknesses in aspects of executive functioning ( Okdie et al., 2016 ). Furthermore, an inflexibility in responding to negative feedback after a disadvantageous decision has been postulated to be related to poor executive functioning, which results in an individual being less likely to adapt to the feedback to choose more advantageous options ( Zamarian et al., 2008 ). The findings from this study suggests that PST-PC may be effective in generating an efficient learning process that contributes to advantageous decision-making outcomes.

The components taught during the various PST-PC sessions provide an opportunity for the individual to broadly strengthen executive skills referenced by Lezak et al. (2012) , such as emotional regulation, behavioral initiation, planning, organization, cognitive flexibility, and problem-solving. A person with weaknesses in executive dysfunction can be overwhelmed with complex tasks and situations, which can be remediated during the initial stages of PST-PC through a structured approach to problem solving (e.g., breaking down complex problems into small and manageable parts). Cognitive flexibility is facilitated during the brainstorming stages of PST-PC, where individuals are encouraged to generate multiple solutions toward a satisfactory resolution of a problem. Aspects of executive functioning such as planning and organization are facilitated during the middle phases of PST-PC, where individuals evaluate and compare solutions generated during the brainstorming step to determine the best selection to be implemented. Behavioral initiation is fostered through the development of an action plan during the later steps of PST-PC. Overall, the process of implementing the stages of PST-PC requires abstract problem-solving with inductive reasoning and flexible adjustment of responses based on feedback, and may have contributed to improved decision-making outcomes.

A psychoeducational approach such as PST-PC can contribute to increased self-efficacy among older adults and improve decision-making abilities. To illustrate, it has been suggested that interventions can be more efficacious when integrating older adults’ strengths, such as their life experiences, to increase self-efficacy (e.g., positivity, confidence, and motivation) ( Strough et al., 2015 ). Furthermore, to improve their sense of self-efficacy, individuals must be engaged in an activation process that facilitates the examination of his/her knowledge, skills, and confidence with respect to the relevant topic requiring a decision to be made, and then formulating a concrete action plan to be implemented ( Hibbard and Mahoney, 2010 ). The latter stages of PST-PC evoked this process, when participants were asked to evaluate and compare solutions generated through brainstorming, and to determine the best selection to be implemented as an action plan. Furthermore, solicited feedback from the participants revealed that the psychoeducational component of PST-PC provided during the initial sessions solidified and enhanced preexisting knowledge and approaches to problem-solving (i.e., promoting self-efficacy from life experiences), in addition to providing a structured approach to facilitate a more efficient process for resolving practical everyday challenges.

This is one of the first studies to adapt PST-PC for use as an intervention to enhance decision-making in healthy community-dwelling older adults. By contrast, much of the extant literature in facilitation of advantageous decision-making outcomes relies extensively on the use of decision aids, or interventions designed to assist in the deliberation between treatment options by provided content-related information (e.g., health-related information when choosing between medical treatment options) ( Stacey et al., 2014 ). While these decision aids have been found to be effective in increasing knowledge and risk perception as well as contributing to a more well-informed decision-making process, few studies have explicitly examined its effectiveness among older adults ( van Weert et al., 2016 ). Incidentally, a majority of participants in this study readily identified a common health-related theme (e.g., weight loss, managing high cholesterol, improving sleep hygiene, and managing chronic pain) when asked to identify a problem to be applied during the PST-PC protocol. Perhaps this is suggestive that PST-PC can be utilize as a modality to facilitate more active participation (as compared to decision aids) among older adults in enhancing aspects of complex decision-making processes in the healthcare arena.

This study is not without its limitations. Participants in our study were highly educated (e.g., 70% with 16 years of education and above) for an older adult sample and performed in the high average range on measures of general intellectual functioning. By contrast, the 2015 Census data reported that only 27% of the population 65 years of age and older had earned a bachelor’s degree or more ( He et al., 2005 ). Finally, the present study had a relatively small sample size and was homogenous in terms of race (i.e., all participants were non-Hispanic, white). These issues may limit the generalizability of our findings. Another limitation of the study is the utilization of a single laboratory measure of decision making. While the IGT has been a well-validated measure to detect decision-making deficits ( Bechara, 2007 ), decision-making is complex and multifaceted, and undoubtedly difficult to measure fully with any laboratory task. Future studies should validate the efficacy of PST-PC in enhancing decision-making outcomes among older adults in other applied tasks such as the Multiple Errands test ( Tranel et al., 2007 ) or the Financial Decision-Making test ( Shivapour et al., 2012 ).

Ethics Statement

This study was carried out in accordance with the approval of University of Iowa Institutional Review Board with written informed consent from all subjects.

Author Contributions

CMN and NLD: study concept, design, analysis, data interpretation, manuscript writing, data verification, and analysis. K-HC: study design.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer GD and handling Editor declared their shared affiliation.

Funding. This study was funded by American Psychological Association Science Directorate’s Dissertation Research Award to CMN.

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Problem solving therapy - use and effectiveness in general practice

Affiliation.

• 1 Department of Rural Health, Rural Health Academic Centre, the University of Melbourne, Ballarat, Victoria, Australia. [email protected]
• PMID: 22962642

Background: Problem solving therapy (PST) is one of the focused psychological strategies supported by Medicare for use by appropriately trained general practitioners.

Objective: This article reviews the evidence base for PST and its use in the general practice setting.

Discussion: Problem solving therapy involves patients learning or reactivating problem solving skills. These skills can then be applied to specific life problems associated with psychological and somatic symptoms. Problem solving therapy is suitable for use in general practice for patients experiencing common mental health conditions and has been shown to be as effective in the treatment of depression as antidepressants. Problem solving therapy involves a series of sequential stages. The clinician assists the patient to develop new empowering skills, and then supports them to work through the stages of therapy to determine and implement the solution selected by the patient. Many experienced GPs will identify their own existing problem solving skills. Learning about PST may involve refining and focusing these skills.

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• Behavioral Health

Making the Most Informed Choice: The SODAS Problem-Solving Model

Free exercise to aid young clients in decision making

David Pratt, PhD, MSW

• S ituation : What’s the problem? Be specific. Who is upset with whom and why? What’s the problem that’s going on? Who’s involved? How is it a problem for you?
• O ptions : Brainstorm two or three different options. There’s no such thing as a bad option when you are brainstorming options, so don’t hold back any options. Also, there’s always more than one option, so think of two or three options.
• D isadvantages : Every option has at least one disadvantage. It’s a good idea to think about the disadvantages of every option before you decide what to do. Identify one to three disadvantages for each option.
• A dvantages : There’s also at least one advantage to every option. Identify one to three advantages for every option.
• S elect One : After you’ve brainstormed several options and thought about the advantages and disadvantages of each one, select the option you think is the best. It’s up to you. There’s usually no perfect answer, so you just have to think it through and make the best selection you can. Then try it out and see how it goes. You can always use the SODAS method again if the option you selected doesn’t work out.

Ground Rule #1: There Is No Such Thing as a Bad Option When Brainstorming Options

Ground rule #2: there are always at least two options for every problem situation, ground rule #3: there must be at least one advantage and one disadvantage to every option, ground rule #4: the client always gets to select their preferred option.

Topic: Children & Adolescents | Cognitive Behavioral Therapy (CBT)

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