problem solving techniques psychotherapy

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?
• 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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7 Solution-Focused Therapy Techniques and Worksheets (+PDF)

It has analyzed a person’s problems from where they started and how those problems have an effect on that person’s life.

Out of years of observation of family therapy sessions, the theory and applications of solution-focused therapy developed.

Let’s explore the therapy, along with techniques and applications of the approach.

Before you read on, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises will 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:

5 solution-focused therapy techniques, handy sft worksheets (pdf), solution-focused therapy interventions, 5 sft questions to ask clients, solution-focused brief therapy (sfbt techniques), 4 activities & exercises, best sft books, a take-home message.

Solution-focused therapy is a type of treatment that highlights a client’s ability to solve problems, rather than why or how the problem was created. It was developed over some time after observations of therapists in a mental health facility in Wisconsin by Steve de Shazer and Insoo Kim Berg and their colleagues.

Like positive psychology, Solution Focused Therapy (SFT) practitioners focus on goal-oriented questioning to assist a client in moving into a future-oriented direction.

Solution-focused therapy has been successfully applied to a wide variety of client concerns due to its broad application. It has been utilized in a wide variety of client groups as well. The approach presupposes that clients have some knowledge of what will improve their lives.

The following areas have utilized SFT with varying success:

• relationship difficulties
• drug and alcohol abuse
• eating disorders
• anger management
• communication difficulties
• crisis intervention
• incarceration recidivism reduction

Goal clarification is an important technique in SFT. A therapist will need to guide a client to envision a future without the problem with which they presented. With coaching and positive questioning, this vision becomes much more clarified.

With any presenting client concern, the main technique in SFT is illuminating the exception. The therapist will guide the client to an area of their life where there is an exception to the problem. The exception is where things worked well, despite the problem. Within the exception, an approach for a solution may be forged.

The ‘miracle question’ is another technique frequently used in SFT. It is a powerful tool that helps clients to move into a solution orientation. This question allows clients to begin small steps toward finding solutions to presenting problems (Santa Rita Jr., 1998). It is asked in a specific way and is outlined later in this article.

Experiment invitation is another way that therapists guide clients into solution orientation. By inviting clients to build on what is already working, clients automatically focus on the positive. In positive psychology, we know that this allows the client’s mind to broaden and build from that orientation.

Utilizing what has been working experimentally allows the client to find what does and doesn’t work in solving the issue at hand. During the second half of a consultation with a client, many SFT therapists take a break to reflect on what they’ve learned during the beginning of the session.

Consultation breaks and invitations for more information from clients allow for both the therapist and client to brainstorm on what might have been missed during the initial conversations. After this break, clients are complemented and given a therapeutic message about the presenting issue. The message is typically stated in the positive so that clients leave with a positive orientation toward their goals.

Here are four handy worksheets for use with solution-focused therapy.

• Miracle worksheet
• Exceptions to the Problem Worksheet
• Scaling Questions Worksheet
• SMART+ Goals Worksheet

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Compliments are frequently used in SFT, to help the client begin to focus on what is working, rather than what is not. Acknowledging that a client has an impact on the movement toward a goal allows hope to become present. Once hope and perspective shift occurs, a client can decide what daily actions they would like to take in attaining a goal.

Higher levels of hope and optimism can predict the following desirable outcomes (Peterson & Seligman, 2004):

• achievement in all sorts of areas
• freedom from anxiety and depression
• improved social relationships
• improved physical well being

Mind mapping is an effective intervention also used to increase hope and optimism. This intervention is often used in life coaching practices. A research study done on solution-focused life coaching (Green, Oades, & Grant, 2006) showed that this type of intervention increases goal striving and hope, in addition to overall well-being.

Though life coaching is not the same as therapy, this study shows the effectiveness of improving positive behavior through solution-focused questioning.

Mind mapping is a visual thinking tool that helps structure information. It helps clients to better analyze, comprehend, and generate new ideas in areas they might not have been automatically self-generated. Having it on paper gives them a reference point for future goal setting as well.

Empathy is vital in the administration of SFBT. A client needs to feel heard and held by the practitioner for any forward movement to occur. Intentionally leaning in to ensure that a client knows that the practitioner is engaged in listening is recommended.

Speaking to strengths and aligning those strengths with goal setting are important interventions in SFT. Recognizing and acknowledging what is already working for the client validates strengths. Self-recognition of these strengths increases self-esteem and in turn, improves forward movement.

The questions asked in Solution-Focused Therapy are positively directed and in a goal-oriented stance. The intention is to allow a perspective shift by guiding clients in the direction of hope and optimism to lead them to a path of positive change. Results and progress come from focusing on the changes that need to be made for goal attainment and increased well being.

1. Miracle Question

Here is a clear example of how to administer the miracle question. It should be delivered deliberately. When done so, it allows the client to imagine the miracle occurring.

“ Now, I want to ask you a strange question. Suppose that while you are sleeping tonight and the entire house is quiet, a miracle happens. The miracle is that the problem which brought you here is solved. However, because you are sleeping, you don’t know that the miracle has happened. So, when you wake up tomorrow morning, what will be different that will tell you that a miracle has happened and the problem which brought you here is solved? ” (de Shazer, 1988)

2. Presupposing change questions

A practitioner of solution-focused therapy asks questions in an approach derived way.

Here are a few examples of presupposing change questions:

“What stopped complete disaster from occurring?” “How did you avoid falling apart.” “What kept you from unraveling?”

3. Exception Questions

Examples of exception questions include:

1. Tell me about times when you don’t get angry. 2. Tell me about times you felt the happiest. 3. When was the last time that you feel you had a better day? 4. Was there ever a time when you felt happy in your relationship? 5. What was it about that day that made it a better day? 6. Can you think of a time when the problem was not present in your life?

4. Scaling Questions

These are questions that allow a client to rate their experience. They also allow for a client to evaluate their motivation to change their experience. Scaling questions allow for a practitioner to add a follow-up question that is in the positive as well.

An example of a scaling question: “On a scale of 1-10, with 10 representing the best it can be and one the worst, where would you say you are today?”

A follow-up question: “ Why a four and not a five?”

Questions like these allow the client to explore the positive, as well as their commitment to the changes that need to occur.

5. Coping Questions

These types of questions open clients up to their resiliency. Clients are experts in their life experience. Helping them see what works, allows them to grow from a place of strength.

“How have you managed so far?” “What have you done to stay afloat?” “What is working?”

3 Scaling questions from Solution Focused Therapy – Uncommon Practitioners

The main idea behind SFBT is that the techniques are positively and solution-focused to allow a brief amount of time for the client to be in therapy. Overall, improving the quality of life for each client, with them at the center and in the driver’s seat of their growth. SFBT typically has an average of 5-8 sessions.

During the sessions, goals are set. Specific experimental actions are explored and deployed into the client’s daily life. By keeping track of what works and where adjustments need to be made, a client is better able to track his or her progress.

A method has developed from the Miracle Question entitled, The Miracle Method . The steps follow below (Miller & Berg, 1996). It was designed for combatting problematic drinking but is useful in all areas of change.

• State your desire for something in your life to be different.
• Envision a miracle happening, and your life IS different.
• Make sure the miracle is important to you.
• Keep the miracle small.
• Define the change with language that is positive, specific, and behavioral.
• State how you will start your journey, rather than how you will end it.
• Be clear about who, where, and when, but not the why.

A short selection of exercises which can be used

1. Solution-focused art therapy/ letter writing

A powerful in-session task is to request a client to draw or write about one of the following, as part of art therapy :

• a picture of their miracle
• something the client does well
• a day when everything went well. What was different about that day?
• a special person in their life

2. Strengths Finders

Have a client focus on a time when they felt their strongest. Ask them to highlight what strengths were present when things were going well. This can be an illuminating activity that helps clients focus on the strengths they already have inside of them.

A variation of this task is to have a client ask people who are important in their lives to tell them how they view the client’s strengths. Collecting strengths from another’s perspective can be very illuminating and helpful in bringing a client into a strength perspective.

3. Solution Mind Mapping

A creative way to guide a client into a brainstorm of solutions is by mind mapping. Have the miracle at the center of the mind map. From the center, have a client create branches of solutions to make that miracle happen. By exploring solution options, a client will self-generate and be more connected to the outcome.

4. Experiment Journals

Encourage clients to do experiments in real-life settings concerning the presenting problem. Have the client keep track of what works from an approach perspective. Reassure the client that a variety of experiments is a helpful approach.

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These books are recommended reads for solution-focused therapy.

1. The Miracle Method: A Radically New Approach to Problem Drinking – Insoo Kim Berg and Scott D. Miller Ph.D.

The Miracle Method by Scott D. Miller and Insoo Kim Berg is a book that has helped many clients overcome problematic drinking since the 1990s.

By utilizing the miracle question in the book, those with problematic drinking behaviors are given the ability to envision a future without the problem.

Concrete, obtainable steps in reaching the envisioned future are laid out in this supportive read.

Available on Amazon .

2. Solution Focused Brief Therapy: 100 Key Points and Techniques – Harvey Ratney, Evan George and Chris Iveson

Solution Focused Brief Therapy: 100 Key Points and Techniques is a well-received book on solution-focused therapy. Authors Ratner, George, and Iveson provide a concisely written and easily understandable guide to the approach.

Its accessibility allows for quick and effective change in people’s lives.

The book covers the approach’s history, philosophical underpinnings, techniques, and applications. It can be utilized in organizations, coaching, leadership, school-based work, and even in families.

The work is useful for any practitioner seeking to learn the approach and bring it into practice.

3. Handbook of Solution-Focused Brief Therapy (Jossey-Bass Psychology) – Scott D. Miller, Mark Hubble and Barry L. Duncan

It includes work from 28 of the lead practitioners in the field and how they have integrated the solution-focused approach with the problem-focused approach.

It utilizes research across treatment modalities to better equip new practitioners with as many tools as possible.

4. More Than Miracles: The State of the Art of Solution -Focused Therapy  (Routledge Mental Health Classic Editions) – Steve de Shazer and Yvonne Dolan

It allows the reader to peek into hundreds of hours of observation of psychotherapy.

It highlights what questions work and provides a thoughtful overview of applications to complex problems.

Solution-Focused Therapy is an approach that empowers clients to own their abilities in solving life’s problems. Rather than traditional psychotherapy that focuses on how a problem was derived, SFT allows for a goal-oriented focus to problem-solving. This approach allows for future-oriented, rather than past-oriented discussions to move a client forward toward the resolutions of their present problem.

This approach is used in many different areas, including education, family therapy , and even in office settings. Creating cooperative and collaborative opportunities to problem solve allows mind-broadening capabilities. Illuminating a path of choice is a compelling way to enable people to explore how exactly they want to show up in this world.

Thanks for reading!

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

• de Shazer, S. (1988). Clues: Investigating solutions in brief therapy. New York, NY: W.W. Norton and Co.
• Green, L. S., Oades, L. G., & Grant, A. M. (2006). Cognitive-behavioral, solution-focused life coaching: Enhancing goal striving, well-being, and hope. The Journal of Positive Psychology, 1 (3), 142-149.
• Miller, S. D., & Berg, I. K. (1996). The miracle method: A radically new approach to problem drinking. New York, NY: W.W. Norton and Co.
• Peterson, C., & Seligman, M. E. P., (2004).  Character strengths and virtues: A handbook and classification (Vol. 1). New York, NY: Oxford University Press.
• Santa Rita Jr, E. (1998). What do you do after asking the miracle question in solution-focused therapy. Family Therapy, 25( 3), 189-195.

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Problem Solving

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Introduction & Theoretical Background

Problem Solving is a helpful intervention whenever clients present with difficulties, dilemmas, and conundrums, or when they experience repetitive thought such as rumination or worry. Effective problem solving is an essential life skill and this Problem Solving worksheet is designed to guide adults through steps which will help them to generate solutions to ‘stuck’ situations in their lives. It follows the qualities of effective problem solving outlined by Nezu, Nezu & D’Zurilla (2013), namely: clearly defining a problem; generation of alternative solutions; deliberative decision making; and the implementation of the chosen solution.

The therapist’s stance during problem solving should be one of collaborative curiosity. It is not for the therapist to pass judgment or to impose their preferred solution. Instead it is the clinician’s role to sit alongside clients and to help them examine the advantages and disadvantages of their options and, if the client is ‘stuck’ in rumination or worry, to help motivate them to take action to become unstuck – constructive rumination asks “How can I…?” questions instead of “Why…?” questions.

In their description of problem solving therapy Nezu, Nezu & D’Zurilla (2013) describe how it is helpful to elicit a positive orientation towards the problem which involves: being willing to appraise problems as challenges; remain optimistic that problems are solvable; remember that successful problem solving involves time and effort.

Therapist Guidance

• What is the nature of the problem?
• What are my goals?
• What is getting the way of me reaching my goals?
• “Can you think of any ways that you could make this problem not be a problem any more?”
• “What’s keeping this problem as a problem? What could you do to target that part of the problem?”
• “If your friend was bothered by a problem like this what might be something that you recommend they try?”
• “What would be some of the worst ways of solving a problem like this? And the best?”
• “How would Batman solve a problem like this?”
• Consider short term and long-term implications of each strategy
• Implications may relate to: emotional well-being, choices & opportunities, relationships, self-growth
• The next step is to consider which of the available options is the best solution. If you do not feel positive about any solutions, the choice becomes “Which is the least-worst?”. Remember that “even not-making-a-choice is a form of choice”.  
• The last step of problem solving is putting a plan into action. Rumination, worry, and being in the horns of a dilemma are ‘stuck’ states which require a behavioral ‘nudge’ to become unstuck. Once you have put your plan into action it is important to monitor the outcome and to evaluate whether the actual outcome was consistent with the anticipated outcome.

References And Further Reading

• Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979). Cognitive therapy of depression . New York: Guilford. Nezu, A. M., Nezu, C. M., D’Zurilla, T. J. (2013). Problem-solving therapy: a treatment manual . New York: Springer.
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Problem-Solving Therapy

• Reference work entry
• First Online: 01 January 2017
• pp 1874–1883
• Cite this reference work entry

• Sherry A. Beaudreau 2 , 3 , 4 ,
• Christine E. Gould 2 , 5 ,
• Erin Sakai 6 &
• J. W. Terri Huh 6 , 7  

101 Accesses

Behavioral intervention; Skills-based therapy; Treatment

Problem-solving therapy (PST), developed by Nezu and colleagues, is a non-pharmacological, empirically supported cognitive-behavioral treatment (D’Zurilla and Nezu 2006 ; Nezu et al. 1989 ). The problem-solving framework draws from a stress-diathesis model, namely, that life stress interacts with an individual’s predisposition toward developing a psychiatric disorder. The driving model behind PST posits that individuals who experience difficulty solving life’s problems or coping with stressors of everyday living struggle with psychiatric symptoms more often than individuals considered as good problem solvers. This psychological treatment teaches a step-by-step approach to the process of identifying and implementing adaptive solutions for daily problems. By teaching individuals to solve their problems more effectively and efficiently, this model assumes that their stress and related psychiatric symptoms will...

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Sherry A. Beaudreau & Christine E. Gould

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Christine E. Gould

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Beaudreau, S.A., Gould, C.E., Sakai, E., Huh, J.W.T. (2017). Problem-Solving Therapy. In: Pachana, N.A. (eds) Encyclopedia of Geropsychology. Springer, Singapore. https://doi.org/10.1007/978-981-287-082-7_90

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48 Problem Solving

Department of Psychological and Brain Sciences, University of California, Santa Barbara

• Published: 03 June 2013
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Problem solving refers to cognitive processing directed at achieving a goal when the problem solver does not initially know a solution method. A problem exists when someone has a goal but does not know how to achieve it. Problems can be classified as routine or nonroutine, and as well defined or ill defined. The major cognitive processes in problem solving are representing, planning, executing, and monitoring. The major kinds of knowledge required for problem solving are facts, concepts, procedures, strategies, and beliefs. Classic theoretical approaches to the study of problem solving are associationism, Gestalt, and information processing. Current issues and suggested future issues include decision making, intelligence and creativity, teaching of thinking skills, expert problem solving, analogical reasoning, mathematical and scientific thinking, everyday thinking, and the cognitive neuroscience of problem solving. Common themes concern the domain specificity of problem solving and a focus on problem solving in authentic contexts.

The study of problem solving begins with defining problem solving, problem, and problem types. This introduction to problem solving is rounded out with an examination of cognitive processes in problem solving, the role of knowledge in problem solving, and historical approaches to the study of problem solving.

Definition of Problem Solving

Problem solving refers to cognitive processing directed at achieving a goal for which the problem solver does not initially know a solution method. This definition consists of four major elements (Mayer, 1992 ; Mayer & Wittrock, 2006 ):

Cognitive —Problem solving occurs within the problem solver’s cognitive system and can only be inferred indirectly from the problem solver’s behavior (including biological changes, introspections, and actions during problem solving). Process —Problem solving involves mental computations in which some operation is applied to a mental representation, sometimes resulting in the creation of a new mental representation. Directed —Problem solving is aimed at achieving a goal. Personal —Problem solving depends on the existing knowledge of the problem solver so that what is a problem for one problem solver may not be a problem for someone who already knows a solution method.

The definition is broad enough to include a wide array of cognitive activities such as deciding which apartment to rent, figuring out how to use a cell phone interface, playing a game of chess, making a medical diagnosis, finding the answer to an arithmetic word problem, or writing a chapter for a handbook. Problem solving is pervasive in human life and is crucial for human survival. Although this chapter focuses on problem solving in humans, problem solving also occurs in nonhuman animals and in intelligent machines.

How is problem solving related to other forms of high-level cognition processing, such as thinking and reasoning? Thinking refers to cognitive processing in individuals but includes both directed thinking (which corresponds to the definition of problem solving) and undirected thinking such as daydreaming (which does not correspond to the definition of problem solving). Thus, problem solving is a type of thinking (i.e., directed thinking).

Reasoning refers to problem solving within specific classes of problems, such as deductive reasoning or inductive reasoning. In deductive reasoning, the reasoner is given premises and must derive a conclusion by applying the rules of logic. For example, given that “A is greater than B” and “B is greater than C,” a reasoner can conclude that “A is greater than C.” In inductive reasoning, the reasoner is given (or has experienced) a collection of examples or instances and must infer a rule. For example, given that X, C, and V are in the “yes” group and x, c, and v are in the “no” group, the reasoning may conclude that B is in “yes” group because it is in uppercase format. Thus, reasoning is a type of problem solving.

Definition of Problem

A problem occurs when someone has a goal but does not know to achieve it. This definition is consistent with how the Gestalt psychologist Karl Duncker ( 1945 , p. 1) defined a problem in his classic monograph, On Problem Solving : “A problem arises when a living creature has a goal but does not know how this goal is to be reached.” However, today researchers recognize that the definition should be extended to include problem solving by intelligent machines. This definition can be clarified using an information processing approach by noting that a problem occurs when a situation is in the given state, the problem solver wants the situation to be in the goal state, and there is no obvious way to move from the given state to the goal state (Newell & Simon, 1972 ). Accordingly, the three main elements in describing a problem are the given state (i.e., the current state of the situation), the goal state (i.e., the desired state of the situation), and the set of allowable operators (i.e., the actions the problem solver is allowed to take). The definition of “problem” is broad enough to include the situation confronting a physician who wishes to make a diagnosis on the basis of preliminary tests and a patient examination, as well as a beginning physics student trying to solve a complex physics problem.

Types of Problems

It is customary in the problem-solving literature to make a distinction between routine and nonroutine problems. Routine problems are problems that are so familiar to the problem solver that the problem solver knows a solution method. For example, for most adults, “What is 365 divided by 12?” is a routine problem because they already know the procedure for long division. Nonroutine problems are so unfamiliar to the problem solver that the problem solver does not know a solution method. For example, figuring out the best way to set up a funding campaign for a nonprofit charity is a nonroutine problem for most volunteers. Technically, routine problems do not meet the definition of problem because the problem solver has a goal but knows how to achieve it. Much research on problem solving has focused on routine problems, although most interesting problems in life are nonroutine.

Another customary distinction is between well-defined and ill-defined problems. Well-defined problems have a clearly specified given state, goal state, and legal operators. Examples include arithmetic computation problems or games such as checkers or tic-tac-toe. Ill-defined problems have a poorly specified given state, goal state, or legal operators, or a combination of poorly defined features. Examples include solving the problem of global warming or finding a life partner. Although, ill-defined problems are more challenging, much research in problem solving has focused on well-defined problems.

Cognitive Processes in Problem Solving

The process of problem solving can be broken down into two main phases: problem representation , in which the problem solver builds a mental representation of the problem situation, and problem solution , in which the problem solver works to produce a solution. The major subprocess in problem representation is representing , which involves building a situation model —that is, a mental representation of the situation described in the problem. The major subprocesses in problem solution are planning , which involves devising a plan for how to solve the problem; executing , which involves carrying out the plan; and monitoring , which involves evaluating and adjusting one’s problem solving.

For example, given an arithmetic word problem such as “Alice has three marbles. Sarah has two more marbles than Alice. How many marbles does Sarah have?” the process of representing involves building a situation model in which Alice has a set of marbles, there is set of marbles for the difference between the two girls, and Sarah has a set of marbles that consists of Alice’s marbles and the difference set. In the planning process, the problem solver sets a goal of adding 3 and 2. In the executing process, the problem solver carries out the computation, yielding an answer of 5. In the monitoring process, the problem solver looks over what was done and concludes that 5 is a reasonable answer. In most complex problem-solving episodes, the four cognitive processes may not occur in linear order, but rather may interact with one another. Although some research focuses mainly on the execution process, problem solvers may tend to have more difficulty with the processes of representing, planning, and monitoring.

Knowledge for Problem Solving

An important theme in problem-solving research is that problem-solving proficiency on any task depends on the learner’s knowledge (Anderson et al., 2001 ; Mayer, 1992 ). Five kinds of knowledge are as follows:

Facts —factual knowledge about the characteristics of elements in the world, such as “Sacramento is the capital of California” Concepts —conceptual knowledge, including categories, schemas, or models, such as knowing the difference between plants and animals or knowing how a battery works Procedures —procedural knowledge of step-by-step processes, such as how to carry out long-division computations Strategies —strategic knowledge of general methods such as breaking a problem into parts or thinking of a related problem Beliefs —attitudinal knowledge about how one’s cognitive processing works such as thinking, “I’m good at this”

Although some research focuses mainly on the role of facts and procedures in problem solving, complex problem solving also depends on the problem solver’s concepts, strategies, and beliefs (Mayer, 1992 ).

Historical Approaches to Problem Solving

Psychological research on problem solving began in the early 1900s, as an outgrowth of mental philosophy (Humphrey, 1963 ; Mandler & Mandler, 1964 ). Throughout the 20th century four theoretical approaches developed: early conceptions, associationism, Gestalt psychology, and information processing.

Early Conceptions

The start of psychology as a science can be set at 1879—the year Wilhelm Wundt opened the first world’s psychology laboratory in Leipzig, Germany, and sought to train the world’s first cohort of experimental psychologists. Instead of relying solely on philosophical speculations about how the human mind works, Wundt sought to apply the methods of experimental science to issues addressed in mental philosophy. His theoretical approach became structuralism —the analysis of consciousness into its basic elements.

Wundt’s main contribution to the study of problem solving, however, was to call for its banishment. According to Wundt, complex cognitive processing was too complicated to be studied by experimental methods, so “nothing can be discovered in such experiments” (Wundt, 1911/1973 ). Despite his admonishments, however, a group of his former students began studying thinking mainly in Wurzburg, Germany. Using the method of introspection, subjects were asked to describe their thought process as they solved word association problems, such as finding the superordinate of “newspaper” (e.g., an answer is “publication”). Although the Wurzburg group—as they came to be called—did not produce a new theoretical approach, they found empirical evidence that challenged some of the key assumptions of mental philosophy. For example, Aristotle had proclaimed that all thinking involves mental imagery, but the Wurzburg group was able to find empirical evidence for imageless thought .

Associationism

The first major theoretical approach to take hold in the scientific study of problem solving was associationism —the idea that the cognitive representations in the mind consist of ideas and links between them and that cognitive processing in the mind involves following a chain of associations from one idea to the next (Mandler & Mandler, 1964 ; Mayer, 1992 ). For example, in a classic study, E. L. Thorndike ( 1911 ) placed a hungry cat in what he called a puzzle box—a wooden crate in which pulling a loop of string that hung from overhead would open a trap door to allow the cat to escape to a bowl of food outside the crate. Thorndike placed the cat in the puzzle box once a day for several weeks. On the first day, the cat engaged in many extraneous behaviors such as pouncing against the wall, pushing its paws through the slats, and meowing, but on successive days the number of extraneous behaviors tended to decrease. Overall, the time required to get out of the puzzle box decreased over the course of the experiment, indicating the cat was learning how to escape.

Thorndike’s explanation for how the cat learned to solve the puzzle box problem is based on an associationist view: The cat begins with a habit family hierarchy —a set of potential responses (e.g., pouncing, thrusting, meowing, etc.) all associated with the same stimulus (i.e., being hungry and confined) and ordered in terms of strength of association. When placed in the puzzle box, the cat executes its strongest response (e.g., perhaps pouncing against the wall), but when it fails, the strength of the association is weakened, and so on for each unsuccessful action. Eventually, the cat gets down to what was initially a weak response—waving its paw in the air—but when that response leads to accidentally pulling the string and getting out, it is strengthened. Over the course of many trials, the ineffective responses become weak and the successful response becomes strong. Thorndike refers to this process as the law of effect : Responses that lead to dissatisfaction become less associated with the situation and responses that lead to satisfaction become more associated with the situation. According to Thorndike’s associationist view, solving a problem is simply a matter of trial and error and accidental success. A major challenge to assocationist theory concerns the nature of transfer—that is, where does a problem solver find a creative solution that has never been performed before? Associationist conceptions of cognition can be seen in current research, including neural networks, connectionist models, and parallel distributed processing models (Rogers & McClelland, 2004 ).

Gestalt Psychology

The Gestalt approach to problem solving developed in the 1930s and 1940s as a counterbalance to the associationist approach. According to the Gestalt approach, cognitive representations consist of coherent structures (rather than individual associations) and the cognitive process of problem solving involves building a coherent structure (rather than strengthening and weakening of associations). For example, in a classic study, Kohler ( 1925 ) placed a hungry ape in a play yard that contained several empty shipping crates and a banana attached overhead but out of reach. Based on observing the ape in this situation, Kohler noted that the ape did not randomly try responses until one worked—as suggested by Thorndike’s associationist view. Instead, the ape stood under the banana, looked up at it, looked at the crates, and then in a flash of insight stacked the crates under the bananas as a ladder, and walked up the steps in order to reach the banana.

According to Kohler, the ape experienced a sudden visual reorganization in which the elements in the situation fit together in a way to solve the problem; that is, the crates could become a ladder that reduces the distance to the banana. Kohler referred to the underlying mechanism as insight —literally seeing into the structure of the situation. A major challenge of Gestalt theory is its lack of precision; for example, naming a process (i.e., insight) is not the same as explaining how it works. Gestalt conceptions can be seen in modern research on mental models and schemas (Gentner & Stevens, 1983 ).

Information Processing

The information processing approach to problem solving developed in the 1960s and 1970s and was based on the influence of the computer metaphor—the idea that humans are processors of information (Mayer, 2009 ). According to the information processing approach, problem solving involves a series of mental computations—each of which consists of applying a process to a mental representation (such as comparing two elements to determine whether they differ).

In their classic book, Human Problem Solving , Newell and Simon ( 1972 ) proposed that problem solving involved a problem space and search heuristics . A problem space is a mental representation of the initial state of the problem, the goal state of the problem, and all possible intervening states (based on applying allowable operators). Search heuristics are strategies for moving through the problem space from the given to the goal state. Newell and Simon focused on means-ends analysis , in which the problem solver continually sets goals and finds moves to accomplish goals.

Newell and Simon used computer simulation as a research method to test their conception of human problem solving. First, they asked human problem solvers to think aloud as they solved various problems such as logic problems, chess, and cryptarithmetic problems. Then, based on an information processing analysis, Newell and Simon created computer programs that solved these problems. In comparing the solution behavior of humans and computers, they found high similarity, suggesting that the computer programs were solving problems using the same thought processes as humans.

An important advantage of the information processing approach is that problem solving can be described with great clarity—as a computer program. An important limitation of the information processing approach is that it is most useful for describing problem solving for well-defined problems rather than ill-defined problems. The information processing conception of cognition lives on as a keystone of today’s cognitive science (Mayer, 2009 ).

Classic Issues in Problem Solving

Three classic issues in research on problem solving concern the nature of transfer (suggested by the associationist approach), the nature of insight (suggested by the Gestalt approach), and the role of problem-solving heuristics (suggested by the information processing approach).

Transfer refers to the effects of prior learning on new learning (or new problem solving). Positive transfer occurs when learning A helps someone learn B. Negative transfer occurs when learning A hinders someone from learning B. Neutral transfer occurs when learning A has no effect on learning B. Positive transfer is a central goal of education, but research shows that people often do not transfer what they learned to solving problems in new contexts (Mayer, 1992 ; Singley & Anderson, 1989 ).

Three conceptions of the mechanisms underlying transfer are specific transfer , general transfer , and specific transfer of general principles . Specific transfer refers to the idea that learning A will help someone learn B only if A and B have specific elements in common. For example, learning Spanish may help someone learn Latin because some of the vocabulary words are similar and the verb conjugation rules are similar. General transfer refers to the idea that learning A can help someone learn B even they have nothing specifically in common but A helps improve the learner’s mind in general. For example, learning Latin may help people learn “proper habits of mind” so they are better able to learn completely unrelated subjects as well. Specific transfer of general principles is the idea that learning A will help someone learn B if the same general principle or solution method is required for both even if the specific elements are different.

In a classic study, Thorndike and Woodworth ( 1901 ) found that students who learned Latin did not subsequently learn bookkeeping any better than students who had not learned Latin. They interpreted this finding as evidence for specific transfer—learning A did not transfer to learning B because A and B did not have specific elements in common. Modern research on problem-solving transfer continues to show that people often do not demonstrate general transfer (Mayer, 1992 ). However, it is possible to teach people a general strategy for solving a problem, so that when they see a new problem in a different context they are able to apply the strategy to the new problem (Judd, 1908 ; Mayer, 2008 )—so there is also research support for the idea of specific transfer of general principles.

Insight refers to a change in a problem solver’s mind from not knowing how to solve a problem to knowing how to solve it (Mayer, 1995 ; Metcalfe & Wiebe, 1987 ). In short, where does the idea for a creative solution come from? A central goal of problem-solving research is to determine the mechanisms underlying insight.

The search for insight has led to five major (but not mutually exclusive) explanatory mechanisms—insight as completing a schema, insight as suddenly reorganizing visual information, insight as reformulation of a problem, insight as removing mental blocks, and insight as finding a problem analog (Mayer, 1995 ). Completing a schema is exemplified in a study by Selz (Fridja & de Groot, 1982 ), in which people were asked to think aloud as they solved word association problems such as “What is the superordinate for newspaper?” To solve the problem, people sometimes thought of a coordinate, such as “magazine,” and then searched for a superordinate category that subsumed both terms, such as “publication.” According to Selz, finding a solution involved building a schema that consisted of a superordinate and two subordinate categories.

Reorganizing visual information is reflected in Kohler’s ( 1925 ) study described in a previous section in which a hungry ape figured out how to stack boxes as a ladder to reach a banana hanging above. According to Kohler, the ape looked around the yard and found the solution in a flash of insight by mentally seeing how the parts could be rearranged to accomplish the goal.

Reformulating a problem is reflected in a classic study by Duncker ( 1945 ) in which people are asked to think aloud as they solve the tumor problem—how can you destroy a tumor in a patient without destroying surrounding healthy tissue by using rays that at sufficient intensity will destroy any tissue in their path? In analyzing the thinking-aloud protocols—that is, transcripts of what the problem solvers said—Duncker concluded that people reformulated the goal in various ways (e.g., avoid contact with healthy tissue, immunize healthy tissue, have ray be weak in healthy tissue) until they hit upon a productive formulation that led to the solution (i.e., concentrating many weak rays on the tumor).

Removing mental blocks is reflected in classic studies by Duncker ( 1945 ) in which solving a problem involved thinking of a novel use for an object, and by Luchins ( 1942 ) in which solving a problem involved not using a procedure that had worked well on previous problems. Finding a problem analog is reflected in classic research by Wertheimer ( 1959 ) in which learning to find the area of a parallelogram is supported by the insight that one could cut off the triangle on one side and place it on the other side to form a rectangle—so a parallelogram is really a rectangle in disguise. The search for insight along each of these five lines continues in current problem-solving research.

Heuristics are problem-solving strategies, that is, general approaches to how to solve problems. Newell and Simon ( 1972 ) suggested three general problem-solving heuristics for moving from a given state to a goal state: random trial and error , hill climbing , and means-ends analysis . Random trial and error involves randomly selecting a legal move and applying it to create a new problem state, and repeating that process until the goal state is reached. Random trial and error may work for simple problems but is not efficient for complex ones. Hill climbing involves selecting the legal move that moves the problem solver closer to the goal state. Hill climbing will not work for problems in which the problem solver must take a move that temporarily moves away from the goal as is required in many problems.

Means-ends analysis involves creating goals and seeking moves that can accomplish the goal. If a goal cannot be directly accomplished, a subgoal is created to remove one or more obstacles. Newell and Simon ( 1972 ) successfully used means-ends analysis as the search heuristic in a computer program aimed at general problem solving, that is, solving a diverse collection of problems. However, people may also use specific heuristics that are designed to work for specific problem-solving situations (Gigerenzer, Todd, & ABC Research Group, 1999 ; Kahneman & Tversky, 1984 ).

Current and Future Issues in Problem Solving

Eight current issues in problem solving involve decision making, intelligence and creativity, teaching of thinking skills, expert problem solving, analogical reasoning, mathematical and scientific problem solving, everyday thinking, and the cognitive neuroscience of problem solving.

Decision Making

Decision making refers to the cognitive processing involved in choosing between two or more alternatives (Baron, 2000 ; Markman & Medin, 2002 ). For example, a decision-making task may involve choosing between getting $240 for sure or having a 25% change of getting $1000. According to economic theories such as expected value theory, people should chose the second option, which is worth $250 (i.e., .25 x $1000) rather than the first option, which is worth $240 (1.00 x $240), but psychological research shows that most people prefer the first option (Kahneman & Tversky, 1984 ).

Research on decision making has generated three classes of theories (Markman & Medin, 2002 ): descriptive theories, such as prospect theory (Kahneman & Tversky), which are based on the ideas that people prefer to overweight the cost of a loss and tend to overestimate small probabilities; heuristic theories, which are based on the idea that people use a collection of short-cut strategies such as the availability heuristic (Gigerenzer et al., 1999 ; Kahneman & Tversky, 2000 ); and constructive theories, such as mental accounting (Kahneman & Tversky, 2000 ), in which people build a narrative to justify their choices to themselves. Future research is needed to examine decision making in more realistic settings.

Intelligence and Creativity

Although researchers do not have complete consensus on the definition of intelligence (Sternberg, 1990 ), it is reasonable to view intelligence as the ability to learn or adapt to new situations. Fluid intelligence refers to the potential to solve problems without any relevant knowledge, whereas crystallized intelligence refers to the potential to solve problems based on relevant prior knowledge (Sternberg & Gregorenko, 2003 ). As people gain more experience in a field, their problem-solving performance depends more on crystallized intelligence (i.e., domain knowledge) than on fluid intelligence (i.e., general ability) (Sternberg & Gregorenko, 2003 ). The ability to monitor and manage one’s cognitive processing during problem solving—which can be called metacognition —is an important aspect of intelligence (Sternberg, 1990 ). Research is needed to pinpoint the knowledge that is needed to support intelligent performance on problem-solving tasks.

Creativity refers to the ability to generate ideas that are original (i.e., other people do not think of the same idea) and functional (i.e., the idea works; Sternberg, 1999 ). Creativity is often measured using tests of divergent thinking —that is, generating as many solutions as possible for a problem (Guilford, 1967 ). For example, the uses test asks people to list as many uses as they can think of for a brick. Creativity is different from intelligence, and it is at the heart of creative problem solving—generating a novel solution to a problem that the problem solver has never seen before. An important research question concerns whether creative problem solving depends on specific knowledge or creativity ability in general.

Teaching of Thinking Skills

How can people learn to be better problem solvers? Mayer ( 2008 ) proposes four questions concerning teaching of thinking skills:

What to teach —Successful programs attempt to teach small component skills (such as how to generate and evaluate hypotheses) rather than improve the mind as a single monolithic skill (Covington, Crutchfield, Davies, & Olton, 1974 ). How to teach —Successful programs focus on modeling the process of problem solving rather than solely reinforcing the product of problem solving (Bloom & Broder, 1950 ). Where to teach —Successful programs teach problem-solving skills within the specific context they will be used rather than within a general course on how to solve problems (Nickerson, 1999 ). When to teach —Successful programs teaching higher order skills early rather than waiting until lower order skills are completely mastered (Tharp & Gallimore, 1988 ).

Overall, research on teaching of thinking skills points to the domain specificity of problem solving; that is, successful problem solving depends on the problem solver having domain knowledge that is relevant to the problem-solving task.

Expert Problem Solving

Research on expertise is concerned with differences between how experts and novices solve problems (Ericsson, Feltovich, & Hoffman, 2006 ). Expertise can be defined in terms of time (e.g., 10 years of concentrated experience in a field), performance (e.g., earning a perfect score on an assessment), or recognition (e.g., receiving a Nobel Prize or becoming Grand Master in chess). For example, in classic research conducted in the 1940s, de Groot ( 1965 ) found that chess experts did not have better general memory than chess novices, but they did have better domain-specific memory for the arrangement of chess pieces on the board. Chase and Simon ( 1973 ) replicated this result in a better controlled experiment. An explanation is that experts have developed schemas that allow them to chunk collections of pieces into a single configuration.

In another landmark study, Larkin et al. ( 1980 ) compared how experts (e.g., physics professors) and novices (e.g., first-year physics students) solved textbook physics problems about motion. Experts tended to work forward from the given information to the goal, whereas novices tended to work backward from the goal to the givens using a means-ends analysis strategy. Experts tended to store their knowledge in an integrated way, whereas novices tended to store their knowledge in isolated fragments. In another study, Chi, Feltovich, and Glaser ( 1981 ) found that experts tended to focus on the underlying physics concepts (such as conservation of energy), whereas novices tended to focus on the surface features of the problem (such as inclined planes or springs). Overall, research on expertise is useful in pinpointing what experts know that is different from what novices know. An important theme is that experts rely on domain-specific knowledge rather than solely general cognitive ability.

Analogical Reasoning

Analogical reasoning occurs when people solve one problem by using their knowledge about another problem (Holyoak, 2005 ). For example, suppose a problem solver learns how to solve a problem in one context using one solution method and then is given a problem in another context that requires the same solution method. In this case, the problem solver must recognize that the new problem has structural similarity to the old problem (i.e., it may be solved by the same method), even though they do not have surface similarity (i.e., the cover stories are different). Three steps in analogical reasoning are recognizing —seeing that a new problem is similar to a previously solved problem; abstracting —finding the general method used to solve the old problem; and mapping —using that general method to solve the new problem.

Research on analogical reasoning shows that people often do not recognize that a new problem can be solved by the same method as a previously solved problem (Holyoak, 2005 ). However, research also shows that successful analogical transfer to a new problem is more likely when the problem solver has experience with two old problems that have the same underlying structural features (i.e., they are solved by the same principle) but different surface features (i.e., they have different cover stories) (Holyoak, 2005 ). This finding is consistent with the idea of specific transfer of general principles as described in the section on “Transfer.”

Mathematical and Scientific Problem Solving

Research on mathematical problem solving suggests that five kinds of knowledge are needed to solve arithmetic word problems (Mayer, 2008 ):

Factual knowledge —knowledge about the characteristics of problem elements, such as knowing that there are 100 cents in a dollar Schematic knowledge —knowledge of problem types, such as being able to recognize time-rate-distance problems Strategic knowledge —knowledge of general methods, such as how to break a problem into parts Procedural knowledge —knowledge of processes, such as how to carry our arithmetic operations Attitudinal knowledge —beliefs about one’s mathematical problem-solving ability, such as thinking, “I am good at this”

People generally possess adequate procedural knowledge but may have difficulty in solving mathematics problems because they lack factual, schematic, strategic, or attitudinal knowledge (Mayer, 2008 ). Research is needed to pinpoint the role of domain knowledge in mathematical problem solving.

Research on scientific problem solving shows that people harbor misconceptions, such as believing that a force is needed to keep an object in motion (McCloskey, 1983 ). Learning to solve science problems involves conceptual change, in which the problem solver comes to recognize that previous conceptions are wrong (Mayer, 2008 ). Students can be taught to engage in scientific reasoning such as hypothesis testing through direct instruction in how to control for variables (Chen & Klahr, 1999 ). A central theme of research on scientific problem solving concerns the role of domain knowledge.

Everyday Thinking

Everyday thinking refers to problem solving in the context of one’s life outside of school. For example, children who are street vendors tend to use different procedures for solving arithmetic problems when they are working on the streets than when they are in school (Nunes, Schlieman, & Carraher, 1993 ). This line of research highlights the role of situated cognition —the idea that thinking always is shaped by the physical and social context in which it occurs (Robbins & Aydede, 2009 ). Research is needed to determine how people solve problems in authentic contexts.

Cognitive Neuroscience of Problem Solving

The cognitive neuroscience of problem solving is concerned with the brain activity that occurs during problem solving. For example, using fMRI brain imaging methodology, Goel ( 2005 ) found that people used the language areas of the brain to solve logical reasoning problems presented in sentences (e.g., “All dogs are pets…”) and used the spatial areas of the brain to solve logical reasoning problems presented in abstract letters (e.g., “All D are P…”). Cognitive neuroscience holds the potential to make unique contributions to the study of problem solving.

Problem solving has always been a topic at the fringe of cognitive psychology—too complicated to study intensively but too important to completely ignore. Problem solving—especially in realistic environments—is messy in comparison to studying elementary processes in cognition. The field remains fragmented in the sense that topics such as decision making, reasoning, intelligence, expertise, mathematical problem solving, everyday thinking, and the like are considered to be separate topics, each with its own separate literature. Yet some recurring themes are the role of domain-specific knowledge in problem solving and the advantages of studying problem solving in authentic contexts.

Future Directions

Some important issues for future research include the three classic issues examined in this chapter—the nature of problem-solving transfer (i.e., How are people able to use what they know about previous problem solving to help them in new problem solving?), the nature of insight (e.g., What is the mechanism by which a creative solution is constructed?), and heuristics (e.g., What are some teachable strategies for problem solving?). In addition, future research in problem solving should continue to pinpoint the role of domain-specific knowledge in problem solving, the nature of cognitive ability in problem solving, how to help people develop proficiency in solving problems, and how to provide aids for problem solving.

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Further Reading

Baron, J. ( 2008 ). Thinking and deciding (4th ed). New York: Cambridge University Press.

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Sternberg, R. J. , & Ben-Zeev, T. ( 2001 ). Complex cognition: The psychology of human thought . New York: Oxford University Press.

Weisberg, R. W. ( 2006 ). Creativity . New York: Wiley.

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• Published: 24 August 2021

Problem-solving training as an active ingredient of treatment for youth depression: a scoping review and exploratory meta-analysis

• Karolin R. Krause   ORCID: orcid.org/0000-0003-3914-7272 1 , 2 ,
• Darren B. Courtney   ORCID: orcid.org/0000-0003-1491-0972 1 , 3 ,
• Benjamin W. C. Chan 4 ,
• Sarah Bonato   ORCID: orcid.org/0000-0002-5174-0047 1 ,
• Madison Aitken   ORCID: orcid.org/0000-0002-4921-5462 1 , 3 ,
• Jacqueline Relihan 1 ,
• Matthew Prebeg 1 ,
• Karleigh Darnay   ORCID: orcid.org/0000-0002-0395-8674 1 ,
• Lisa D. Hawke   ORCID: orcid.org/0000-0003-1108-9453 1 , 3 ,
• Priya Watson   ORCID: orcid.org/0000-0001-9753-6490 1 , 3 &
• Peter Szatmari   ORCID: orcid.org/0000-0002-4535-115X 1 , 3 , 5  

BMC Psychiatry volume  21 , Article number:  397 ( 2021 ) Cite this article

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Problem-solving training is a common ingredient of evidence-based therapies for youth depression and has shown effectiveness as a versatile stand-alone intervention in adults. This scoping review provided a first overview of the evidence supporting problem solving as a mechanism for treating depression in youth aged 14 to 24 years.

Five bibliographic databases (APA PsycINFO, CINAHL, Embase, MEDLINE, Web of Science) and the grey literature were systematically searched for controlled trials of stand-alone problem-solving therapy; secondary analyses of trial data exploring problem-solving-related concepts as predictors, moderators, or mediators of treatment response within broader therapies; and clinical practice guidelines for youth depression. Following the scoping review, an exploratory meta-analysis examined the overall effectiveness of stand-alone problem-solving therapy.

Inclusion criteria were met by four randomized trials of problem-solving therapy (524 participants); four secondary analyses of problem-solving-related concepts as predictors, moderators, or mediators; and 23 practice guidelines. The only clinical trial rated as having a low risk of bias found problem-solving training helped youth solve personal problems but was not significantly more effective than the control at reducing emotional symptoms. An exploratory meta-analysis showed a small and non-significant effect on self-reported depression or emotional symptoms (Hedges’ g = − 0.34; 95% CI: − 0.92 to 0.23) with high heterogeneity. Removing one study at high risk of bias led to a decrease in effect size and heterogeneity (g = − 0.08; 95% CI: − 0.26 to 0.10). A GRADE appraisal suggested a low overall quality of the evidence. Tentative evidence from secondary analyses suggested problem-solving training might enhance outcomes in cognitive-behavioural therapy and family therapy, but dedicated dismantling studies are needed to corroborate these findings. Clinical practice guidelines did not recommend problem-solving training as a stand-alone treatment for youth depression, but five mentioned it as a treatment ingredient.

Conclusions

On its own, problem-solving training may be beneficial for helping youth solve personal challenges, but it may not measurably reduce depressive symptoms. Youth experiencing elevated depressive symptoms may require more comprehensive psychotherapeutic support alongside problem-solving training. High-quality studies are needed to examine the effectiveness of problem-solving training as a stand-alone approach and as a treatment ingredient.

Peer Review reports

Depressive disorders are a common mental health concern in adolescence [ 1 , 2 , 3 ] and associated with functional impairment [ 4 ] and an increased risk of adverse mental health, physical health, and socio-economic outcomes in adulthood [ 5 , 6 , 7 , 8 ]. Early and effective intervention is needed to reduce the burden arising from early-onset depression. Several psychotherapies have proven modestly effective at reducing youth depression, including cognitive-behavioural therapy (CBT) and interpersonal therapy (IPT) [ 9 , 10 ]. Room for improvement remains; around half of youth do not show measurable symptom reduction after an average of 30 weeks of routine clinical care for depression or anxiety [ 11 ]. One barrier to greater impact is a lack of understanding of which treatment ingredients are most critical [ 12 , 13 ]. Identifying the “active ingredients” that underpin effective approaches, and understanding when and for whom they are most effective is an important avenue for enhancing impact [ 13 ]. Distilling interventions to their most effective ingredients while removing redundant content may also help reduce treatment length and cost, freeing up resources to expand service provision. Given that youth frequently drop out of treatment early [ 14 ], introducing the most effective ingredients at the start may also help improve outcomes.

One common ingredient in the treatment of youth depression is problem-solving (PS) training [ 15 ]. Problem solving in real-life contexts (also called social problem solving) describes “the self-directed process by which individuals attempt to identify [ …] adaptive coping solutions for problems, both acute and chronic, that they encounter in everyday living” (p.8) [ 16 ]. Within a relational/problem-solving model of stress and well-being, mental health difficulties are viewed as the result of maladaptive coping behaviours that cannot adequately safeguard an individual’s well-being against chronic or acute stressors [ 17 ]. According to a conceptual model developed by D’Zurilla and colleagues ([ 16 , 17 , 18 , 19 ]; see Fig.  1 ), effective PS requires a constructive and confident attitude towards problems (i.e., a positive problem orientation ), and the ability to approach problems rationally and systematically (i.e., rational PS style ). Defeatist or catastrophizing attitudes (i.e., a negative problem orientation ), passively waiting for problems to resolve (i.e., avoidant style ), or acting impulsively without thinking through possible consequences and alternative solutions (i.e., impulsive/careless style ) are considered maladaptive [ 16 , 18 , 20 ]. Empirical studies suggest maladaptive PS is associated with depressive symptoms in adolescents and young adults [ 21 , 22 , 23 , 24 , 25 ].

Dimensions of Problem-Solving (PS) Ability

Problem-Solving Therapy (PST) is a therapeutic approach developed by D’Zurilla and Goldfried [ 26 ] in the 1970s, to alleviate mental health difficulties by improving PS ability. Conceptually rooted in Social Learning Theory [ 27 ], PST aims to promote adaptive PS by helping clients foster an optimistic and self-confident attitude towards problems (i.e., a positive problem orientation), and by helping them develop and internalize four core PS skills: (a) defining the problem; (b) brainstorming possible solutions; (c) appraising solutions and selecting the most promising one; (d) implementing the preferred solution and reflecting on the outcome ([ 16 , 17 , 18 , 19 ]; see Fig. 1 ). PST is distinct from Solution-Focused Brief Therapy (SFBT), which has different conceptual roots and emphasizes the construction of solutions over the in-depth formulation of problems [ 28 ].

PS training is also a common ingredient of other psychosocial depression treatments [ 15 , 20 ], such as CBT and Dialectical Behaviour Therapy (DBT) [ 15 , 29 , 30 , 31 , 32 ] that typically focus on strengthening PS skills rather than problem orientation [ 20 ]. In IPT, PS training focuses on helping youth understand and resolve relationship problems [ 29 , 30 , 33 , 34 ]. PS training is also a common component of family therapy [ 35 ], cognitive reminiscence therapy [ 36 ], and adventure therapy [ 37 ]. The extent to which PS training in these contexts follows the conceptual model by D’Zurilla and colleagues varies. Hereafter, we will use the term PST (“Problem-Solving Therapy”) where problem-solving training constitutes a stand-alone intervention; and we will use the term “PS training” where it is mentioned as a part of other therapies or discussed more broadly as an active ingredient of treatment for youth depression.

Meta-analyses considering over 30 randomized control trials (RCTs) of stand-alone PST for adult depression suggest it is as effective as CBT and IPT, and more effective than waitlist or attention controls [ 38 , 39 , 40 ]. PST has been applied with children, adolescents, and young adults [ 41 , 42 , 43 , 44 , 45 , 46 ], but dedicated manuals for different developmental stages are not readily available. In an assessment of fit between evidence-based therapy components and everyday coping skills used by school children, PS skills were the third most frequently endorsed skill set in terms of frequency of habitual use and perceived effectiveness, suggesting these skills are highly transferable and relevant to youth [ 47 ]. PS training can be brief (i.e., involve fewer than 10 sessions) [ 38 ], and has been delivered to youth by trained clinicians [ 45 ], lay counsellors [ 46 ], and via online platforms [ 44 ]. It can also be adapted for primary care [ 40 ]. In light of its versatility and of its effectiveness in adults, PS training is a prime candidate for a treatment ingredient that deserves greater scrutiny in the context of youth depression. However, no systematic evidence synthesis has yet examined its efficacy and effectiveness in this population.

This study had two sequential parts. First, we conducted a mixed-methods scoping review to map the available evidence relating to PS training as an active ingredient for treating youth depression. Youth were defined as aged 14 to 24 years, broadly aligning with United Nations definitions [ 48 ]. In a subsequent step, we conducted an exploratory meta-analysis to examine the overall efficacy of free-standing PST, based on clinical trials identified in the scoping review.

Scoping review

Scoping review methodology was used to provide an initial overview of the available evidence [ 49 ]. The review was pre-registered on the Open Science Framework [ 50 ] and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) extension for Scoping Reviews checklist [ 51 ] (Additional File  1 ). The review was designed to integrate four types of literature: (a) qualitative studies reporting on young people’s experiences with PS training; (b) controlled clinical trials testing the efficacy of stand-alone PST; (c) studies examining PS-related concepts as predictors, moderators, or mediators of treatment response within broader therapeutic interventions (e.g., CBT); and (d) clinical practice guidelines (CPGs) for youth depression. In addition, the search strategy included terms designed to identify relevant conceptual articles that are discussed here as part of the introduction [ 52 ].

Search strategy

Five bibliographic databases (APA PsycINFO, CINAHL, Embase, MEDLINE, Web of Science) and the grey literature were systematically searched for (a) empirical studies published from database inception through June 2020, and (b) CPGs published between 2005 and July 2020. Reference lists of key studies were searched manually, and records citing key studies were searched using Google Scholar’s “search within citing articles” function [ 52 ]. The search strategy was designed in collaboration with a research librarian (SB) and combined topic-specific terms defining the target population (e.g., “depression”; “adolescent?”) and intervention (e.g., “problem-solving”) with methodological search filters combining database-specific subject headings (e.g., “randomized controlled trial”) and recommended search terms. The search for CPGs built upon a previous systematic search [ 53 , 54 ], which was updated and expanded to cover additional languages and databases. A multi-pronged grey literature search retrieved records from common grey literature databases and CPG repositories, websites of relevant associations, charities, and government agencies. The search strategy is provided in Additional File  2 .

Inclusion and exclusion criteria

Empirical studies were included if the mean participant age fell within the eligible range of 14 to 24 years, and at least 50% of participants showed above-threshold depressive or emotional symptoms on a validated screening tool. Controlled clinical trials had to compare the efficacy or effectiveness of PST as a free-standing intervention with a control group or waitlist condition. Secondary analyses were considered for their assessment of PS ability as a predictor, moderator, or mediator of treatment response if they reported on data from controlled clinical trials of broader therapy packages. Records were included as CPGs if labelled as practice guidelines, practice parameters, or consensus or expert committee recommendations, or explicitly aimed to develop original clinical guidance [ 53 , 54 ]; and if focused on indicated psychosocial treatments for youth depression (rather than prevention, screening, or pharmacological treatment). Doctoral dissertations were included. Conference abstracts, non-controlled trials, and prevention studies were excluded. Language of publication was restricted to English, French, German, and Spanish.

All records identified were imported into the EPPI-Reviewer 4.0 review software [ 55 ], and underwent a two-stage screening process (Fig.  2 ). Title and abstract screening was conducted in duplicate for 10% of the identified records, yielding substantial inter-rater agreement ( kappa  = .75 and .86, for empirical studies and CPGs, respectively). Of studies retained for full text screening, 20% were screened in duplicate, yielding substantial agreement ( kappa  = .68 and .71, for empirical studies and CPGs, respectively). Disagreements were resolved through discussion.

PRISMA Flow Chart of the Study Selection Process

Data extraction and synthesis

Data were extracted using templates tailored to each literature type (e.g., the Cochrane data collection form for RCTs). Information extracted included: citation details; study design; participant characteristics; and relevant qualitative or quantitative results. Additional information extracted from CPGs included the issuing authority, the target population, the treatment settings to which the guideline applied, and any recommendations in relation to PS training. Data from clinical trials and secondary analyses were extracted in duplicate, and any discrepancies were discussed and resolved. Data synthesis followed a five-step process of data reduction, display, comparison, conclusion drawing, and verification [ 56 ]. Scoping review findings were summarized in narrative format. In addition, effect sizes reported in PST trials for depression severity were entered into an exploratory meta-analysis (see below).

The Centre for Addiction and Mental Health (CAMH) implements a Youth Engagement Initiative that brings the voices of youth with lived experience of mental health difficulties into research and service design [ 57 , 58 , 59 ]. Two youth partners were co-investigators in this review and consulted with a panel of twelve CAMH youth advisors to inform the review process and help contextualize findings. Formal approval by a Research Ethics Board (REB) was not required, as youth were research partners rather than participants.

To incorporate a variety of perspectives, the review team convened for an inference workshop where emerging review findings and feedback from youth advisors were discussed and interpreted. The multidisciplinary team involved a methodologist; two child and adolescent psychiatrists with expertise in CBT, DBT, and IPT; a psychologist with expertise in parent-adolescent therapy; a research librarian; a family doctor; a biostatistician; a clinical epidemiologist; two youth research partners; and a youth engagement coordinator.

Exploratory Meta-analysis

Although meta-analyses are not typical components of scoping reviews [ 60 ], an exploratory meta-analysis was conducted following completion of the scoping review and narrative synthesis, to obtain an initial indication of the efficacy of stand-alone PST based on the clinical trials identified in the review. The PICO statement that guided the meta-analysis is shown in Table  1 .

Quality assessment

Risk of bias for included PST trials was appraised using the Cochrane Collaborations Risk of Bias (ROB) 2 tool [ 61 ]. Ratings were performed independently by two reviewers (KRK and MA), and consensus was formed through discussion. In addition, a Grading of Recommendations Assessment, Development, and Evaluation (GRADE) appraisal was conducted (using the GRADEpro software; [ 62 ] to characterize the quality of the overall evidence. The evidence was graded for risk of bias, imprecision, indirectness, inconsistency, and publication bias [ 63 ]. A GRADE of “high quality” indicates a high level of confidence that the true effect lies close to the estimate; “moderate quality” indicates moderate confidence; “low quality” indicates limited confidence; and “very low quality” indicates very little confidence in the estimate. ROB ratings and GRADE appraisal results are provided in Additional File  6 .

Statistical analysis

The meta-analysis was conducted using the meta suite of commands in Stata 16.1. Effect sizes (Hedges’ g) and their confidence intervals were calculated based on the mean difference in depression severity scores between the PST and control conditions at the first post-treatment assessment [ 64 ]. Hedges’ g is calculated by subtracting the post-treatment mean score of the intervention group from the score of the control group, and by dividing the mean difference by the pooled standard deviation. Effect sizes between g = 0.2 and 0.5 indicate a small effect; g = 0.5 to 0.8 indicates a moderate effect; and g ≥ 0.8 indicates a large effect. Effect sizes were adjusted using the Hedges and Olkin small sample correction [ 64 ]. Pooled effect sizes were computed using a random effects model to account for heterogeneity in intervention settings, modes of delivery, and participant age and depression severity. The I 2 statistic was computed as an indicator of effect size heterogeneity. Higgins et al. [ 65 ] suggest that an I 2 below 30% represents low heterogeneity while an I 2 above 75% represents substantial heterogeneity. Investigations of heterogeneity are unlikely to generate valuable insights in small study samples, with at least ten studies recommended for meta-regression [ 65 ]. We conducted limited exploratory subgroup analysis by computing a separate effect size after excluding studies with high risk of bias. We inspected the funnel plot and considered conducting Egger’s test to examine the likelihood and extent of publication bias [ 66 ].

Selection and inclusion of studies

The search for empirical studies identified 563 unique records (Fig. 2 ), of which 148 were screened in full. Inclusion criteria were met by four RCTs of free-standing PST and four secondary analyses of clinical trials investigating PS-related concepts as predictors, mediators, or moderators of treatment response. No eligible qualitative studies that explicitly examined youth experiences of PS training were identified. The search for CPGs identified 9691 unique records, of which 41 were subject to full text screening, and 23 were included in the review. Below we present scoping review findings for all literature types, followed by the results from the meta-analysis for stand-alone PST trials.

Clinical trials of PST

Characteristics of the included PST trials are shown in Table  2 . Studies were published between 2008 and 2020 and included 524 participants (range: 45 to 251), with a mean age of 16.7 years (range: 12–25; 48% female). Participants had a diagnosis of major depressive disorder (MDD; k  = 1), elevated anxiety or depressive symptoms ( k  = 1), or various mild presenting problems including depression ( k  = 2). Treatment covered PS skills but not problem orientation (i.e., youth’s problem appraisals) and was delivered face to face ( k =  3) or online ( k  = 1) in five to six sessions. PST was compared with waitlist controls ( k  = 2), PS booklets ( k =  1), and supportive counselling ( k  = 1). Risk of bias was rated as medium for two [ 44 , 45 ], and high for one study [ 43 ] due to concerns about missing outcome data and the absence of a study protocol.

Eskin and colleagues [ 43 ] randomized 53 Turkish high school and university students with MDD to six sessions of PST or a waitlist. The study reports a significant treatment effect on self-reported depressive symptoms (d = − 1.20; F [1, 42] = 10.3, p  < .01.), clinician-reported depressive symptoms (d = − 2.12; F [1, 42] = 37.7, p  < .001), and recovery rates, but not on self-reported PS ability (d = − 0.46; F [1, 42] = 2.2, p  > .05). Risk of bias was rated as high due to 37% of missing outcome data in the control group and the absence of a published trial protocol.

Michelson and colleagues [ 46 ] compared PST delivered by lay counsellors in combination with booklets, to PS booklets alone in 251 high-school students with mild mental health difficulties (53% emotional problems) in low-income communities in New Delhi, India. At six weeks, the intervention group showed significantly greater progress towards overcoming idiographic priority problems identified at baseline (d = 0.36, p  = .002), but no significant difference in self-reported mental health difficulties (d = 0.16, p  = .18). Results were similar at 12 weeks, including no significant difference in self-reported emotional symptoms (d = 0.18, p  = .089). As there was no long-term follow-up, it is unknown whether reduced personal problems translated into reduced emotional symptoms in the longer term. Perceived stress at six weeks was found to mediate treatment effect on idiographic problems, accounting for 15% of the overall effect at 12 weeks.

Two trials found no significant effect of PST on primary or secondary outcomes: Hoek and colleagues [ 44 ] randomized 45 youth with elevated depression or anxiety symptoms to five sessions of online PST or a waitlist control; Parker and colleagues [ 45 ] randomized 176 youth with mixed presenting problems (54% depression) to either PST with physical activity or PST with psychoeducation, compared with supportive counselling with physical activity or psychoeducation [ 45 ]. Drop-out from PST was high in both studies, ranging from 41.4% [ 45 ] to 72.7% [ 44 ].

PS-related concepts as predictors, moderators, or mediators of treatment response

The review identified four secondary analyses of RCT data that examined PS-related concepts as predictors, moderators, or mediators of treatment response (see Table  3 , below). Studies were published between 2005 and 2014 and included data from 761 participants with MDD diagnoses, and a mean age of 15.2 years (range: 12–18; 61.2% female).

A secondary analysis of data from the Treatment for Adolescents with Depression Study (TADS, n  = 439) [ 79 ] explored whether baseline problem orientation and PS styles were significant predictors or moderators of treatment response to Fluoxetine, CBT, or a combination treatment at 12 weeks [ 70 ]. Negative problem orientation and avoidant PS style each predicted less improvement in depression symptom severity ( p  = .001 and p  = .003, respectively), while positive problem orientation predicted greater improvement ( p  = .002). There was no significant moderation effect. Neither rational PS style nor impulsive-careless PS style predicted or moderated change in depressive symptoms.

A secondary analysis of data from the Treatment of Resistant Depression in Adolescents (TORDIA) study [ 80 ] examined the impact of specific CBT components on treatment response at 12 weeks in youth treated with a selective serotonin reuptake inhibitor (SSRI) in combination with CBT ( n  = 166) [ 71 ]. Youth who received PS training were 2.3 times ( p  = .03) more likely to have a positive treatment response than those not receiving this component. A significant effect was also observed for social skills training (Odds Ratio [OR] = 2.6, p  = .04) but not for seven other CBT components. PS and social skills training had the most equal allocation ratios between youth who received them (52 and 54%, respectively) and youth who did not. Balanced allocation provides maximum power for a given sample size [ 81 ]. With allocation ratios between 1:3 and 1:5, analysis of the remaining seven components may have been underpowered. Of further note, CBT components were not randomly assigned but selected based on individual clinical needs. The authors did not correct for multiple comparisons as part of this exploratory analysis.

Dietz and colleagues [ 73 ] explored the impact of social problem solving on treatment outcome based on data from a trial comparing CBT and Systemic Behaviour Family Therapy (SBFT) with elements of PS training on the one hand, with Non-Directive Supportive Therapy on the other hand ( n  = 63). Both CBT and SBFT were associated with significant improvements in young people’s interpersonal PS behaviour (measured by coding videotaped interactions between youth and their mothers) over the course of treatment (CBT: b* = 0.41, p  = .006; SBFT: b* = 0.30, p  = .04), which in turn were associated with higher rates of remission (Wald z = 6.11, p  = .01). However, there was no significant indirect effect of treatment condition via youth PS behaviour, and hence, no definitive evidence of a formal mediation effect [ 82 ].

Kaufman and colleagues [ 72 ] examined data from a trial comparing an Adolescent Coping with Depression (CWD-A) group-based intervention with a life-skills control condition in 93 youth with comorbid depression and conduct disorder. The secondary analysis explored whether change in six CBT-specific factors, including the use of PS and conflict resolution skills, mediated the effectiveness of CWD-A. There was no significant improvement in PS ability in CWD-A, compared with the control, and hence no further mediation analysis was conducted.

PS training in clinical practice guidelines

We identified 23 CPGs from twelve countries relevant to youth depression (see Additional File  4 ), issued by governments ( k  = 6), specialty societies ( k  = 3), health care providers ( k  = 4), independent expert groups ( k  = 2), and others, or a combination of these. Of these 23 CPGs, 15 mentioned PS training in relation to depression treatment for youth, as a component of CBT ( k  = 7), IPT ( k  = 4), supportive therapy or counselling ( k  = 3), family therapy ( k  = 1), DBT ( k  = 1), and psychoeducation ( k  = 1).

None of the reviewed CPGs recommended free-standing PST as a first-line treatment for youth depression. However, five CPGs mentioned PS training as a treatment ingredient or adjunct component in the context of recommending broader therapeutic approaches. The World Health Organization’s updated Mental Health Gap Action Programme guidelines recommended PS training as an adjunct treatment (e.g., in combination with antidepressant medication) for older adolescents [ 83 ]. A guideline by Orygen (Australia) suggested that for “persistent sub-threshold depressive symptoms (including dysthymia) or mild to moderate depression”, options should include “6–8 sessions of individual guided self-help based on the principles of CBT, including behavioural activation and problem-solving techniques” [ 84 ]. The Chilean Ministry of Health recommended supportive clinical care with adjunctive psychoeducation and PS tools, or supportive counselling for individuals aged 15 and older with mild depression (p. 52) [ 85 ]. The Cincinnati Children’s Hospital Medical Centre recommended four to eight sessions of supportive therapy for mild or uncomplicated depression, highlighting “problem solving coping skills” as one element of supportive therapy (p. 1) [ 86 ]. Fifth, the American Academy of Child and Adolescent Psychiatry’s 2007 practice parameter suggested each phase of treatment for youth depression should include psychoeducation and supportive management, which might include PS training (p. 1510) [ 87 ]. CPGs did not specify whether PS training should incorporate specific modules, or whether the term was used loosely to describe unstructured PS support.

Meta-analysis

Each of the four RCTs of free-standing PST identified by the scoping review contributed one comparison to the exploratory meta-analysis of overall PST efficacy (see Fig.  3 ). Self-rated depression or emotional symptom severity scores were reported by all four studies and constituted the primary outcome for the meta-analysis. We conducted additional exploratory analysis for clinician-rated depression severity as reported in two studies [ 43 , 45 ]. The pooled effect size for self-reported depression severity was g = − 0.34 (95% CI: − 0.92 to 0.23). Heterogeneity was high ( I 2  = 88.37%; p  < .001). Due to the small number of studies included, analysis of publication bias via an examination of the funnel plot and tests of funnel plot asymmetry could not be meaningfully conducted [ 88 , 89 ]. The funnel plot is provided in Additional File  5 for reference (Fig. S3).

Forest Plot: Random Effects Model with Self-Reported Depression or Emotional Symptoms as Primary Outcome (Continuous)

To achieve the best possible estimate of the true effect size and reduce heterogeneity we computed a second model excluding the one study with high risk of bias (i.e., [ 43 ]). The resulting effect size was g = − 0.08 (95% CI: − 0.26 to 0.10), with no significant heterogeneity ( I 2  = 0.00%; p  = 0.72; see Fig. S1 in Additional File 5 ). The pooled effect size for clinician-rated depression severity was g = − 1.39 with a wide confidence interval (95% CI: − 4.03 to 1.42) and very high heterogeneity ( I 2  = 97.41%, p  < 0.001; see Fig. S2 in Additional File 5 ).

Overall quality of the evidence

According to the GRADE assessment, the overall quality of the evidence was very low, with concerns related to risk of bias, the inconsistency of results across studies, the indirectness of the evidence with regards to the population of interest (i.e., only one trial focused exclusively on youth with depression), and imprecision in the effect estimate (Table S4 in Additional File 6 ).

This scoping review aimed to provide a first comprehensive overview of the evidence relating to PS training as an active ingredient for treating youth depression. The evidence base relating to the efficacy of PST as a stand-alone intervention was scarce and of low quality. Overall, data from four trials suggested no significant effect on depression symptoms. The scoping review identified some evidence suggesting PS training may enhance treatment response in CBT. However, this conclusion was drawn from secondary analyses where youth were not randomized to treatment with and without PS training, and where primary studies were not powered to test these differences. Disproportionate exposure to comparator CBT components also limits these findings. PST was not recommended as a stand-alone treatment for youth depression in any of the 23 reviewed CPGs; however, one guideline suggested it could be provided alongside other treatments for older adolescents, and four suggested PS training as a component of low-intensity psychosocial interventions for youth with mild to moderate depression.

Given the limited evidence base, only tentative suggestions can be made as to when and for whom PS training is effective. The one PST trial with a low risk of bias enrolled high-school students from low-income communities in New Delhi, and found that PST delivered by lay counselors in combination with PST booklets was more effective at reducing idiographic priority problems than booklets alone, but not at reducing mental health symptoms [ 46 ]. Within a needs-based framework of service delivery (e.g., [ 90 ]), PST may be offered as a low-intensity intervention to youth who experience challenges and struggle with PS—including in low-resource contexts. Future research could explore whether PS training might be particularly helpful for youth facing socioeconomic hardship and related chronic stressors by attenuating potentially harmful impacts on well-being [ 91 ]. If findings are promising, PS training may be considered for targeted prevention (e.g., [ 42 ]). However, at this time there is insufficient evidence to support PS training on its own as an intervention aimed at providing symptom relief for youth experiencing depression.

The PST manual suggests cognitive overload, emotional dysregulation, negative thinking and hopelessness can interfere with PS [ 16 ]. Youth whose depression hinders their ability to engage in PST may require additional support through more comprehensive therapy packages such as CBT or IPT with PS training. In the TORDIA study [ 80 ], where PS training was found to be one of the most effective components, it was generally taught alongside cognitive restructuring, behavioural activation, and emotion regulation, which may have facilitated youths’ ability to absorb PS training [ 71 ]. The focus of these other CBT components on changing negative cognitions and attributions may fulfil a similar function as problem orientation modules in stand-alone PST. Research that is powered to explore such mechanisms is needed. Future research should also apply methodologies designed to identify the most critical elements in a larger treatment package (e.g., dismantling studies; or sequential, multiple assignment, randomized trials) to examine the role of PS training when delivered alongside other components. While one trial focusing on CBT components is currently underway [ 92 ], similar research is needed for other therapies (e.g., IPT, DBT, family therapy).

The included PST trials provided between five and six sessions and covered PS skills but not problem orientation. Meta-analyses of PST for adult depression suggest treatment effectiveness may be enhanced by longer treatment duration (≥ 10 sessions) [ 38 ], and coverage of problem orientation alongside PS skills [ 39 ]. As per the PST treatment manual, strengthening problem orientation fosters motivation and self-efficacy and is an important precondition for enhancing skills [ 93 , 94 ]. In addition, only one youth PST trial assessed PS ability at baseline [ 43 ]. A meta-analysis of PST for adult depression [ 39 ] suggests that studies including such assessments show larger effect sizes, with therapists better able to tailor PST to individual needs. Future research should seek to replicate these findings specifically for youth depression.

Drop out from stand-alone PST was high in two out of four studies, ranging from 41.4% [ 45 ] to 72.7% [ 44 ]. Since its development in the 1970s, PST has undergone several revisions [ 16 , 93 , 95 , 96 , 97 ] but tailoring to youth has been limited. To contextualize the review findings, the review team consulted a panel of twelve youth advisors at the Centre for Addiction and Mental Health (without sharing emerging findings so as not to steer the conversation). Most had participated in PS training as part of other therapies, but none had received formal PST. A key challenge identified by youth advisors was how to provide PS training that is universally applicable and relevant to different youth without being too generic, rigid or schematic; and how to accommodate youth perspectives, complex problems, and individual situations and dispositions. Youth advisors suggested reviewing and reworking PS training with youth in mind, to ensure it is youth-driven, strengths-based, comprehensive, and personalized (see Fig. S4 in Additional File  7 for more detail). Youth advisors emphasized that PS training should identify the root causes underpinning superficial problems and address these through suitable complementary intervention approaches, if needed.

Solution-focused brief therapy (SFBT) has emerged as an antithesis to PST where more emphasis is given to envisaging and constructing solutions rather than analysing problems [ 28 ]. This may be more consistent with youth preferences for strengths-based approaches but may provide insufficiently comprehensive problem appraisals. Future research should compare the effectiveness and acceptability of PST and SFBT and consider possible benefits of combining the advantages of both approaches, to provide support that is strengths-based and targets root problems. More generally, given the effectiveness of PST in adults, future studies could examine whether there are developmental factors that might contribute to reduced effectiveness in youth and should be considered when adapting PST to this age group.

Strengths and limitations

This scoping review applied a broad and systematic approach to study identification and selection. We searched five bibliographic databases, and conducted an extensive grey literature search, considering records published in four languages. Nevertheless, our search may have missed relevant studies published in other languages. We found only a small number of eligible empirical studies, several of which were likely underpowered. As stated above, studies analysing PS-related concepts as predictors, moderators, or mediators of treatment response within broader therapies were heterogenous and limited by design and sample size constraints.

Similarly, there was heterogeneity in recruitment and intervention settings, age groups, and delivery formats across the four RCTs of stand-alone PST, and the overall quality of the evidence was very low. As reflected in our GRADE appraisal, one important limitation was the indirectness of the available evidence: Only one PST trial focused specifically on youth with an MDD diagnosis, while the remaining three included youth with a mix of mental health problems. Although outcomes were reported in terms of depression or emotional symptom severity, this was not based on a subgroup analysis focused specifically on youth with depression. Impact on this group may therefore have been underestimated. In addition, the only PST trial with a low risk of bias did not administer a dedicated depression symptom scale. Instead, our exploratory meta-analysis included scores from the 5-item SDQ emotional problems subscale, which assesses unhappiness, worries, clinginess, fears, and somatic symptoms—and may not have captured nuanced change in depression severity [ 98 , 99 ]. Other concerns that led us to downgrade the quality of the evidence related to considerable risk of bias, with only one out of four studies rated as having a low risk; and imprecision with several studies involving very small samples. Due to the small number of eligible studies, it was not possible to identify the factors driving treatment efficacy via meta-regression. The long-term effectiveness of PS training, or the conditions under which long-term benefits are likely to be realized also could not be examined [ 38 ].

PS training is a core component of several evidence-based therapies for youth depression. However, the evidence base supporting its efficacy as a stand-alone treatment is limited and of low quality. There is tentative evidence suggesting PS-training may drive positive outcomes when provided alongside other treatment components. On its own, PS training may be beneficial for youth who are not acutely distressed or impaired but require support with tackling personal problems. Youth experiencing moderate or severe depressive symptoms may require more comprehensive psychotherapeutic support alongside PS training, as there is currently no robust evidence for the ability of free-standing PST to effectively reduce depression symptoms.

High-quality trials are needed that assess PST efficacy in youth with mild, moderate, and severe depression, in relation to both symptom severity and idiographic treatment goals or priority problems. These studies should examine the influence of treatment length and module content on treatment impact. Dedicated studies are also needed to shed light on the role of PS training as an active ingredient of more comprehensive therapies such as CBT, DBT, IPT, and family therapy. Future studies should include assessments of adverse events and of cost effectiveness. Given high drop-out rates in several youth PST trials, it is important to adapt PS training approaches and therapy manuals as needed, following a youth-engaged research and service development approach [ 57 ], to ensure their relevance and acceptability to this age group.

Availability of data and materials

All data generated or analysed during this study are included in this published article and its supplementary information files.

Abbreviations

Avoidance style

Beck Depression Inventory

Centre for Addiction and Mental Health

Cognitive behavioural therapy

Children’s Depression Rating Scale—Revised

Center for Epidemiologic Studies Depression Scale

Clinical Global Impression Scale—Improvement

Cumulative Index to Nursing and Allied Health Literature

Clinical practice guideline

Adolescent Coping with Depression [intervention name]

Dialectical behaviour therapy

Grading of Recommendations Assessment, Development, and Evaluation

Impulsivity/Carelessness Style

Interpersonal psychotherapy

The Kiddie Schedule for Affective Disorders and Schizophrenia

Lifeskills training

Major depressive disorder

Medical Literature Analysis and Retrieval System Online

Negative problem orientation

Nondirective supportive therapy

Positive problem orientation

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

• Problem solving

Problem-solving training

Problem-Solving Therapy

Randomized controlled trial

Research ethics board

Risk of bias

Rational problem-solving style

Systemic Behaviour Family Therapy

Strengths and Difficulties Questionnaire

Solution-Focused Brief Therapy

Social Problem-Solving Inventory Revised

Selective serotonin reuptake inhibitors

Treatment for Adolescents with Depression Study

Treatment of Resistant Depression in Adolescents

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Acknowledgments

We would like to thank the members of the Centre for Addiction and Mental Health (CAMH) youth advisory group for their valuable insights and suggestions. The systematic search for clinical practice guidelines presented in this review was based on a search strategy developed by Dr. Kathryn Bennett. We would like to thank Dr. Bennett for agreeing to the reuse of the strategy as part of this review. We would also like to thank the Cundill Centre for Child and Youth Depression for providing institutional support to this project.

This work was funded by a Wellcome Trust Mental Health Priority Area “Active Ingredients” commission awarded to KRK, DBC and PS, and the Centre for Addiction and Mental Health, Toronto, Canada.

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Karolin R. Krause, Darren B. Courtney, Sarah Bonato, Madison Aitken, Jacqueline Relihan, Matthew Prebeg, Karleigh Darnay, Lisa D. Hawke, Priya Watson & Peter Szatmari

Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, UK

Karolin R. Krause

Department of Psychiatry, University of Toronto, Toronto, ON, Canada

Darren B. Courtney, Madison Aitken, Lisa D. Hawke, Priya Watson & Peter Szatmari

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Contributions

KRK, DBC and PS formulated the research questions and designed the study. SB conducted the systematic search for clinical practice guidelines and the grey literature search, and advised on the search for retrieving empirical studies, which was led by KRK. KRK, DBC and BWCC performed the screening of records for inclusion criteria. Data extraction was performed by KRK and BWCC. The risk of bias assessment for included randomized control trials was conducted by KRK and MA. The youth consultation was led by JR, MP and KD with input from LDH and KRK. Data analysis was led by KRK. All authors contributed to the interpretation of emerging findings through an internal findings workshop and through several rounds of feedback on the draft manuscript, which was drafted by KRK. All authors have reviewed and approved the final manuscript.

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Correspondence to Karolin R. Krause .

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Supplementary Information

Additional file 1..

Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.

Additional file 2.

Search Strategy.

Additional file 3.

List of Studies Included in the Scoping Review.

Additional file 4.

Characteristics of Included Clinical Practice Guidelines.

Additional file 5.

Additional Data and Outputs from the Meta-Analysis.

Additional file 6.

Risk of Bias Assessment and GRADE Appraisal.

Additional file 7.

Illustration of Insights from the Consultation of Youth Advisors.

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Krause, K.R., Courtney, D.B., Chan, B.W.C. et al. Problem-solving training as an active ingredient of treatment for youth depression: a scoping review and exploratory meta-analysis. BMC Psychiatry 21 , 397 (2021). https://doi.org/10.1186/s12888-021-03260-9

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Published : 24 August 2021

DOI : https://doi.org/10.1186/s12888-021-03260-9

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7.3 Problem-Solving

Learning objectives.

By the end of this section, you will be able to:

• Describe problem solving strategies
• Define algorithm and heuristic
• Explain some common roadblocks to effective problem solving

   People face problems every day—usually, multiple problems throughout the day. Sometimes these problems are straightforward: To double a recipe for pizza dough, for example, all that is required is that each ingredient in the recipe be doubled. Sometimes, however, the problems we encounter are more complex. For example, say you have a work deadline, and you must mail a printed copy of a report to your supervisor by the end of the business day. The report is time-sensitive and must be sent overnight. You finished the report last night, but your printer will not work today. What should you do? First, you need to identify the problem and then apply a strategy for solving the problem.

The study of human and animal problem solving processes has provided much insight toward the understanding of our conscious experience and led to advancements in computer science and artificial intelligence. Essentially much of cognitive science today represents studies of how we consciously and unconsciously make decisions and solve problems. For instance, when encountered with a large amount of information, how do we go about making decisions about the most efficient way of sorting and analyzing all the information in order to find what you are looking for as in visual search paradigms in cognitive psychology. Or in a situation where a piece of machinery is not working properly, how do we go about organizing how to address the issue and understand what the cause of the problem might be. How do we sort the procedures that will be needed and focus attention on what is important in order to solve problems efficiently. Within this section we will discuss some of these issues and examine processes related to human, animal and computer problem solving.

PROBLEM-SOLVING STRATEGIES

   When people are presented with a problem—whether it is a complex mathematical problem or a broken printer, how do you solve it? Before finding a solution to the problem, the problem must first be clearly identified. After that, one of many problem solving strategies can be applied, hopefully resulting in a solution.

Problems themselves can be classified into two different categories known as ill-defined and well-defined problems (Schacter, 2009). Ill-defined problems represent issues that do not have clear goals, solution paths, or expected solutions whereas well-defined problems have specific goals, clearly defined solutions, and clear expected solutions. Problem solving often incorporates pragmatics (logical reasoning) and semantics (interpretation of meanings behind the problem), and also in many cases require abstract thinking and creativity in order to find novel solutions. Within psychology, problem solving refers to a motivational drive for reading a definite “goal” from a present situation or condition that is either not moving toward that goal, is distant from it, or requires more complex logical analysis for finding a missing description of conditions or steps toward that goal. Processes relating to problem solving include problem finding also known as problem analysis, problem shaping where the organization of the problem occurs, generating alternative strategies, implementation of attempted solutions, and verification of the selected solution. Various methods of studying problem solving exist within the field of psychology including introspection, behavior analysis and behaviorism, simulation, computer modeling, and experimentation.

A problem-solving strategy is a plan of action used to find a solution. Different strategies have different action plans associated with them (table below). For example, a well-known strategy is trial and error. The old adage, “If at first you don’t succeed, try, try again” describes trial and error. In terms of your broken printer, you could try checking the ink levels, and if that doesn’t work, you could check to make sure the paper tray isn’t jammed. Or maybe the printer isn’t actually connected to your laptop. When using trial and error, you would continue to try different solutions until you solved your problem. Although trial and error is not typically one of the most time-efficient strategies, it is a commonly used one.

   Another type of strategy is an algorithm. An algorithm is a problem-solving formula that provides you with step-by-step instructions used to achieve a desired outcome (Kahneman, 2011). You can think of an algorithm as a recipe with highly detailed instructions that produce the same result every time they are performed. Algorithms are used frequently in our everyday lives, especially in computer science. When you run a search on the Internet, search engines like Google use algorithms to decide which entries will appear first in your list of results. Facebook also uses algorithms to decide which posts to display on your newsfeed. Can you identify other situations in which algorithms are used?

A heuristic is another type of problem solving strategy. While an algorithm must be followed exactly to produce a correct result, a heuristic is a general problem-solving framework (Tversky & Kahneman, 1974). You can think of these as mental shortcuts that are used to solve problems. A “rule of thumb” is an example of a heuristic. Such a rule saves the person time and energy when making a decision, but despite its time-saving characteristics, it is not always the best method for making a rational decision. Different types of heuristics are used in different types of situations, but the impulse to use a heuristic occurs when one of five conditions is met (Pratkanis, 1989):

• When one is faced with too much information
• When the time to make a decision is limited
• When the decision to be made is unimportant
• When there is access to very little information to use in making the decision
• When an appropriate heuristic happens to come to mind in the same moment

Working backwards is a useful heuristic in which you begin solving the problem by focusing on the end result. Consider this example: You live in Washington, D.C. and have been invited to a wedding at 4 PM on Saturday in Philadelphia. Knowing that Interstate 95 tends to back up any day of the week, you need to plan your route and time your departure accordingly. If you want to be at the wedding service by 3:30 PM, and it takes 2.5 hours to get to Philadelphia without traffic, what time should you leave your house? You use the working backwards heuristic to plan the events of your day on a regular basis, probably without even thinking about it.

Another useful heuristic is the practice of accomplishing a large goal or task by breaking it into a series of smaller steps. Students often use this common method to complete a large research project or long essay for school. For example, students typically brainstorm, develop a thesis or main topic, research the chosen topic, organize their information into an outline, write a rough draft, revise and edit the rough draft, develop a final draft, organize the references list, and proofread their work before turning in the project. The large task becomes less overwhelming when it is broken down into a series of small steps.

Further problem solving strategies have been identified (listed below) that incorporate flexible and creative thinking in order to reach solutions efficiently.

Additional Problem Solving Strategies :

• Abstraction – refers to solving the problem within a model of the situation before applying it to reality.
• Analogy – is using a solution that solves a similar problem.
• Brainstorming – refers to collecting an analyzing a large amount of solutions, especially within a group of people, to combine the solutions and developing them until an optimal solution is reached.
• Divide and conquer – breaking down large complex problems into smaller more manageable problems.
• Hypothesis testing – method used in experimentation where an assumption about what would happen in response to manipulating an independent variable is made, and analysis of the affects of the manipulation are made and compared to the original hypothesis.
• Lateral thinking – approaching problems indirectly and creatively by viewing the problem in a new and unusual light.
• Means-ends analysis – choosing and analyzing an action at a series of smaller steps to move closer to the goal.
• Method of focal objects – putting seemingly non-matching characteristics of different procedures together to make something new that will get you closer to the goal.
• Morphological analysis – analyzing the outputs of and interactions of many pieces that together make up a whole system.
• Proof – trying to prove that a problem cannot be solved. Where the proof fails becomes the starting point or solving the problem.
• Reduction – adapting the problem to be as similar problems where a solution exists.
• Research – using existing knowledge or solutions to similar problems to solve the problem.
• Root cause analysis – trying to identify the cause of the problem.

The strategies listed above outline a short summary of methods we use in working toward solutions and also demonstrate how the mind works when being faced with barriers preventing goals to be reached.

One example of means-end analysis can be found by using the Tower of Hanoi paradigm . This paradigm can be modeled as a word problems as demonstrated by the Missionary-Cannibal Problem :

Missionary-Cannibal Problem

Three missionaries and three cannibals are on one side of a river and need to cross to the other side. The only means of crossing is a boat, and the boat can only hold two people at a time. Your goal is to devise a set of moves that will transport all six of the people across the river, being in mind the following constraint: The number of cannibals can never exceed the number of missionaries in any location. Remember that someone will have to also row that boat back across each time.

Hint : At one point in your solution, you will have to send more people back to the original side than you just sent to the destination.

The actual Tower of Hanoi problem consists of three rods sitting vertically on a base with a number of disks of different sizes that can slide onto any rod. The puzzle starts with the disks in a neat stack in ascending order of size on one rod, the smallest at the top making a conical shape. The objective of the puzzle is to move the entire stack to another rod obeying the following rules:

• 1. Only one disk can be moved at a time.
• 2. Each move consists of taking the upper disk from one of the stacks and placing it on top of another stack or on an empty rod.
• 3. No disc may be placed on top of a smaller disk.

  Figure 7.02. Steps for solving the Tower of Hanoi in the minimum number of moves when there are 3 disks.

Figure 7.03. Graphical representation of nodes (circles) and moves (lines) of Tower of Hanoi.

The Tower of Hanoi is a frequently used psychological technique to study problem solving and procedure analysis. A variation of the Tower of Hanoi known as the Tower of London has been developed which has been an important tool in the neuropsychological diagnosis of executive function disorders and their treatment.

GESTALT PSYCHOLOGY AND PROBLEM SOLVING

As you may recall from the sensation and perception chapter, Gestalt psychology describes whole patterns, forms and configurations of perception and cognition such as closure, good continuation, and figure-ground. In addition to patterns of perception, Wolfgang Kohler, a German Gestalt psychologist traveled to the Spanish island of Tenerife in order to study animals behavior and problem solving in the anthropoid ape.

As an interesting side note to Kohler’s studies of chimp problem solving, Dr. Ronald Ley, professor of psychology at State University of New York provides evidence in his book A Whisper of Espionage  (1990) suggesting that while collecting data for what would later be his book  The Mentality of Apes (1925) on Tenerife in the Canary Islands between 1914 and 1920, Kohler was additionally an active spy for the German government alerting Germany to ships that were sailing around the Canary Islands. Ley suggests his investigations in England, Germany and elsewhere in Europe confirm that Kohler had served in the German military by building, maintaining and operating a concealed radio that contributed to Germany’s war effort acting as a strategic outpost in the Canary Islands that could monitor naval military activity approaching the north African coast.

While trapped on the island over the course of World War 1, Kohler applied Gestalt principles to animal perception in order to understand how they solve problems. He recognized that the apes on the islands also perceive relations between stimuli and the environment in Gestalt patterns and understand these patterns as wholes as opposed to pieces that make up a whole. Kohler based his theories of animal intelligence on the ability to understand relations between stimuli, and spent much of his time while trapped on the island investigation what he described as  insight , the sudden perception of useful or proper relations. In order to study insight in animals, Kohler would present problems to chimpanzee’s by hanging some banana’s or some kind of food so it was suspended higher than the apes could reach. Within the room, Kohler would arrange a variety of boxes, sticks or other tools the chimpanzees could use by combining in patterns or organizing in a way that would allow them to obtain the food (Kohler & Winter, 1925).

While viewing the chimpanzee’s, Kohler noticed one chimp that was more efficient at solving problems than some of the others. The chimp, named Sultan, was able to use long poles to reach through bars and organize objects in specific patterns to obtain food or other desirables that were originally out of reach. In order to study insight within these chimps, Kohler would remove objects from the room to systematically make the food more difficult to obtain. As the story goes, after removing many of the objects Sultan was used to using to obtain the food, he sat down ad sulked for a while, and then suddenly got up going over to two poles lying on the ground. Without hesitation Sultan put one pole inside the end of the other creating a longer pole that he could use to obtain the food demonstrating an ideal example of what Kohler described as insight. In another situation, Sultan discovered how to stand on a box to reach a banana that was suspended from the rafters illustrating Sultan’s perception of relations and the importance of insight in problem solving.

Grande (another chimp in the group studied by Kohler) builds a three-box structure to reach the bananas, while Sultan watches from the ground.  Insight , sometimes referred to as an “Ah-ha” experience, was the term Kohler used for the sudden perception of useful relations among objects during problem solving (Kohler, 1927; Radvansky & Ashcraft, 2013).

Solving puzzles.

   Problem-solving abilities can improve with practice. Many people challenge themselves every day with puzzles and other mental exercises to sharpen their problem-solving skills. Sudoku puzzles appear daily in most newspapers. Typically, a sudoku puzzle is a 9×9 grid. The simple sudoku below (see figure) is a 4×4 grid. To solve the puzzle, fill in the empty boxes with a single digit: 1, 2, 3, or 4. Here are the rules: The numbers must total 10 in each bolded box, each row, and each column; however, each digit can only appear once in a bolded box, row, and column. Time yourself as you solve this puzzle and compare your time with a classmate.

How long did it take you to solve this sudoku puzzle? (You can see the answer at the end of this section.)

   Here is another popular type of puzzle (figure below) that challenges your spatial reasoning skills. Connect all nine dots with four connecting straight lines without lifting your pencil from the paper:

Did you figure it out? (The answer is at the end of this section.) Once you understand how to crack this puzzle, you won’t forget.

   Take a look at the “Puzzling Scales” logic puzzle below (figure below). Sam Loyd, a well-known puzzle master, created and refined countless puzzles throughout his lifetime (Cyclopedia of Puzzles, n.d.).

What steps did you take to solve this puzzle? You can read the solution at the end of this section.

Pitfalls to problem solving.

   Not all problems are successfully solved, however. What challenges stop us from successfully solving a problem? Albert Einstein once said, “Insanity is doing the same thing over and over again and expecting a different result.” Imagine a person in a room that has four doorways. One doorway that has always been open in the past is now locked. The person, accustomed to exiting the room by that particular doorway, keeps trying to get out through the same doorway even though the other three doorways are open. The person is stuck—but she just needs to go to another doorway, instead of trying to get out through the locked doorway. A mental set is where you persist in approaching a problem in a way that has worked in the past but is clearly not working now.

Functional fixedness is a type of mental set where you cannot perceive an object being used for something other than what it was designed for. During the Apollo 13 mission to the moon, NASA engineers at Mission Control had to overcome functional fixedness to save the lives of the astronauts aboard the spacecraft. An explosion in a module of the spacecraft damaged multiple systems. The astronauts were in danger of being poisoned by rising levels of carbon dioxide because of problems with the carbon dioxide filters. The engineers found a way for the astronauts to use spare plastic bags, tape, and air hoses to create a makeshift air filter, which saved the lives of the astronauts.

   Researchers have investigated whether functional fixedness is affected by culture. In one experiment, individuals from the Shuar group in Ecuador were asked to use an object for a purpose other than that for which the object was originally intended. For example, the participants were told a story about a bear and a rabbit that were separated by a river and asked to select among various objects, including a spoon, a cup, erasers, and so on, to help the animals. The spoon was the only object long enough to span the imaginary river, but if the spoon was presented in a way that reflected its normal usage, it took participants longer to choose the spoon to solve the problem. (German & Barrett, 2005). The researchers wanted to know if exposure to highly specialized tools, as occurs with individuals in industrialized nations, affects their ability to transcend functional fixedness. It was determined that functional fixedness is experienced in both industrialized and nonindustrialized cultures (German & Barrett, 2005).

In order to make good decisions, we use our knowledge and our reasoning. Often, this knowledge and reasoning is sound and solid. Sometimes, however, we are swayed by biases or by others manipulating a situation. For example, let’s say you and three friends wanted to rent a house and had a combined target budget of $1,600. The realtor shows you only very run-down houses for $1,600 and then shows you a very nice house for $2,000. Might you ask each person to pay more in rent to get the $2,000 home? Why would the realtor show you the run-down houses and the nice house? The realtor may be challenging your anchoring bias. An anchoring bias occurs when you focus on one piece of information when making a decision or solving a problem. In this case, you’re so focused on the amount of money you are willing to spend that you may not recognize what kinds of houses are available at that price point.

The confirmation bias is the tendency to focus on information that confirms your existing beliefs. For example, if you think that your professor is not very nice, you notice all of the instances of rude behavior exhibited by the professor while ignoring the countless pleasant interactions he is involved in on a daily basis. Hindsight bias leads you to believe that the event you just experienced was predictable, even though it really wasn’t. In other words, you knew all along that things would turn out the way they did. Representative bias describes a faulty way of thinking, in which you unintentionally stereotype someone or something; for example, you may assume that your professors spend their free time reading books and engaging in intellectual conversation, because the idea of them spending their time playing volleyball or visiting an amusement park does not fit in with your stereotypes of professors.

Finally, the availability heuristic is a heuristic in which you make a decision based on an example, information, or recent experience that is that readily available to you, even though it may not be the best example to inform your decision . Biases tend to “preserve that which is already established—to maintain our preexisting knowledge, beliefs, attitudes, and hypotheses” (Aronson, 1995; Kahneman, 2011). These biases are summarized in the table below.

Were you able to determine how many marbles are needed to balance the scales in the figure below? You need nine. Were you able to solve the problems in the figures above? Here are the answers.

   Many different strategies exist for solving problems. Typical strategies include trial and error, applying algorithms, and using heuristics. To solve a large, complicated problem, it often helps to break the problem into smaller steps that can be accomplished individually, leading to an overall solution. Roadblocks to problem solving include a mental set, functional fixedness, and various biases that can cloud decision making skills.

References:

Openstax Psychology text by Kathryn Dumper, William Jenkins, Arlene Lacombe, Marilyn Lovett and Marion Perlmutter licensed under CC BY v4.0. https://openstax.org/details/books/psychology

Review Questions:

1. A specific formula for solving a problem is called ________.

a. an algorithm

b. a heuristic

c. a mental set

d. trial and error

2. Solving the Tower of Hanoi problem tends to utilize a  ________ strategy of problem solving.

a. divide and conquer

b. means-end analysis

d. experiment

3. A mental shortcut in the form of a general problem-solving framework is called ________.

4. Which type of bias involves becoming fixated on a single trait of a problem?

a. anchoring bias

b. confirmation bias

c. representative bias

d. availability bias

5. Which type of bias involves relying on a false stereotype to make a decision?

6. Wolfgang Kohler analyzed behavior of chimpanzees by applying Gestalt principles to describe ________.

a. social adjustment

b. student load payment options

c. emotional learning

d. insight learning

7. ________ is a type of mental set where you cannot perceive an object being used for something other than what it was designed for.

a. functional fixedness

c. working memory

Critical Thinking Questions:

1. What is functional fixedness and how can overcoming it help you solve problems?

2. How does an algorithm save you time and energy when solving a problem?

Personal Application Question:

1. Which type of bias do you recognize in your own decision making processes? How has this bias affected how you’ve made decisions in the past and how can you use your awareness of it to improve your decisions making skills in the future?

anchoring bias

availability heuristic

confirmation bias

functional fixedness

hindsight bias

problem-solving strategy

representative bias

trial and error

working backwards

Answers to Exercises

algorithm:  problem-solving strategy characterized by a specific set of instructions

anchoring bias:  faulty heuristic in which you fixate on a single aspect of a problem to find a solution

availability heuristic:  faulty heuristic in which you make a decision based on information readily available to you

confirmation bias:  faulty heuristic in which you focus on information that confirms your beliefs

functional fixedness:  inability to see an object as useful for any other use other than the one for which it was intended

heuristic:  mental shortcut that saves time when solving a problem

hindsight bias:  belief that the event just experienced was predictable, even though it really wasn’t

mental set:  continually using an old solution to a problem without results

problem-solving strategy:  method for solving problems

representative bias:  faulty heuristic in which you stereotype someone or something without a valid basis for your judgment

trial and error:  problem-solving strategy in which multiple solutions are attempted until the correct one is found

working backwards:  heuristic in which you begin to solve a problem by focusing on the end result

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How Couples Therapy Can Improve Your Relationship

Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.

Carly Snyder, MD is a reproductive and perinatal psychiatrist who combines traditional psychiatry with integrative medicine-based treatments.

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What Is Couples Therapy?

Types of couples therapy, what couples therapy can help with, effectiveness, things to consider, how to get started.

Couples therapy is a form of psychotherapy that can help you and your partner improve your relationship. If you are having relationship difficulties, you can seek couples therapy to help rebuild your relationship. It is helpful at any stage of your relationship, regardless of

“Couples therapy can address a wide range of relationship issues, including recurring conflicts , feelings of disconnection, an affair, issues related to sex, or difficulties due to external stressors,” says Brian Mueller , PhD, a psychologist at Columbia University Medical Center who specializes in couples therapy.

If you and your partner are going through a rough patch , couples therapy can help you work on your relationship. Your therapist can help you express your feelings, discuss issues with your partner, and resolve conflicts.

Couples therapy can help increase understanding, respect, affection, and intimacy between you and your partner, which can help you be happier together.

According to Mueller, there are numerous approaches to couples therapy, which can include:

• Emotionally focused therapy (EFT) : EFT focuses on improving the attachment and bonding between you and your partner. The therapist helps you understand and change patterns that lead to feelings of disconnection.
• Gottman method: This method involves addressing areas of conflict and equipping you and your partner with problem-solving skills. It aims to improve the quality of friendship and the level of intimacy between you and your partner. 
• Ellen Wachtel’s approach: This is a strength-based approach that involves focusing on the positive aspects of the relationship. It focuses on self-reflection rather than blame.
• Psychodynamic couple’s therapy : Psychodynamic therapy explores the underlying hopes and fears that motivate you and your partner, to help you understand each other better.
• Behavioral therapy : Also known as behavioral couples therapy (BCT), this form of therapy involves shaping behavior by reinforcing positive behaviors that promote stability and satisfaction, while discouraging behaviors that foster negativity.
• Cognitive behavioral therapy (CBT) : Also referred to as cognitive behavioral couples therapy (CBCT), this form of therapy involves identifying and changing thought patterns that negatively influence behavior.

Couples therapists often employ an integrated approach to treatment, borrowing techniques from different forms of therapy, depending on your needs.

These are some of the strategies a couples therapist might employ:

• Getting to know you:  “The therapist creates a sense of safety by getting to know you and your partner. They work actively and collaboratively with you to help you understand yourself and your partner better,” says Mueller.
• Identifying feelings : “The therapist helps you and your partner identify feelings and put them into words to one another,” says Mueller. 
• Exploring the past: Couples therapy can involve exploring your past, since that can help you better understand your fears, motivations, and behaviors in a relationship. It can also help address unresolved conflicts that affect your present.
• Focusing on solutions: Your therapist will work with you and your partner to resolve issues, correct negative behavior patterns, and focus on positive aspects of the relationship. 
• Teaching skills: Couples therapy can help teach you and your partner anger management , problem solving , and conflict resolution skills . The aim is to equip you and your partner with tools to help you deal with issues as they crop up.

Couples therapy can give you and your partner the opportunity to discuss and resolve issues related to several aspects of your relationship, which can include:

• Roles in the relationship: Couples therapy can help you examine the roles you and your partner play in the relationship and identify unhealthy dynamics . It can also help address differences in expectations.
• Beliefs and values: Couples therapy can help you and your partner discuss your beliefs, values, and religious sentiments and the implications of these aspects on your daily lives.
• Finances: Finances can be a major source of conflict in relationships. Couples therapy can help promote open dialogue and transparency around income and spending habits.
• Time spent together: You and your partner can address issues that have been sabotaging your time together. You can discuss activities that you enjoy doing together and how to make time spent together more enjoyable.
• Children: If you and your partner are not on the same page about whether or not you want to have children or how you would like to raise them, couples therapy can help you communicate these concerns. It can also help with stressors like difficulty conceiving or adopting children.
• Familial relationships: Couples therapy can help you and your partner work out issues stemming from conflicts with other family members , like parents, children, and siblings.
• Sex and intimacy: If you and your partner are having issues related to sex and intimacy, or infidelity, couples therapy can offer a safe space for you to share your feelings and needs.
• Health issues: Physical or mental health illnesses can be hard on you and your partner. Couples therapy can help you deal with the stress it puts on your relationship.
• External stressors: Therapy can also help you and your partner deal with conflicts caused by external factors, like work for instance, that can put stress on your relationship.

Benefits of Couples Therapy 

“People report feeling more connected to their partner and their own feelings, as well as more secure, spontaneous, and playful in the relationship. When people feel more secure in their relationship, they can become more assertive and adventurous in other parts of their life,” says Mueller.

Brain Mueller, PhD

Benefits of couples therapy include reduced relationship distress and increased relationship satisfaction.

These are some of the benefits couples therapy can offer:

• Understand each other better: Couples therapy can help you understand yourself and your partner better. It can help both of you express your feelings, hopes, fears, priorities, values, and beliefs.
• Identify relationship issues: Your therapist can help you and your partner identify issues that are leading to recurring conflicts, lack of trust , and feelings of disconnection, says Mueller.
• Improve communication skills: Therapy can help you and your partner communicate with each other. It can help you express yourself and ask for what you need without attacking or blaming your partner.
• Resolve conflicts: Your therapist can help you and your partner work through your issues and resolve them.
• Strengthen friendship and attachment: Couples therapy can help strengthen the friendship, attachment, bonding, and intimacy between you and your partner.
• Terminate dysfunctional behavior: Your therapist can identify dysfunctional behaviors and help eliminate them.
• Learn skills: Couples therapy is not a long-term form of therapy. Instead, it is a short-term therapy that aims to equip you and your partner with skills to help you prevent and manage conflicts that arise down the road.
• Improve relationship satisfaction: Couples therapy can help improve the overall quality of your relationship , so that you and your partner are happier together.

According to a 2014 summary, couples therapy can help with relationship satisfaction , communication, forgiveness, problem solving, and resolution of needs and feelings.

Emotionally focused therapy (EFT) particularly has strong research support across a wide range of concerns, according to Mueller. He says numerous studies have shown that couples who receive eight to 12 sessions of EFT report reduced distress and increased relationship satisfaction for both partners, with benefits lasting even two years after treatment.

Couples therapy ideally requires participation from you and your partner. However, if your partner is not open to it, you can also opt to do couples therapy alone, to better understand your relationship and how you can improve it.

If you and your partner undertake it together, you may find that one or both of you also need separate therapy sessions to help deal with the issues brought up in couples therapy.

If you or your partner are also dealing with other issues, like substance abuse for instance, your therapist might suggest specialized therapy for treatment.

If you or a loved one are a victim of domestic violence, contact the  National Domestic Violence Hotline  at  1-800-799-7233  for confidential assistance from trained advocates.

For more mental health resources, see our  National Helpline Database .

If you feel your relationship would benefit from couples therapy , discuss it with your partner and see if they’re open to it. If they’re resistant to it, explain why it’s important to you and how you think it might help your relationship.

The next step is to find a practitioner. Couples therapy is often provided by licensed therapists known as marriage and family therapists; however, other psychologists and psychiatrists may offer it as well. Friends or family might be able to suggest someone you can go to, or if you’re seeing a therapist for other reasons, they may be able to refer you to a specialist.

Check with your partner what days and timings work for them. Try to find a therapist who is conveniently located, if you and your partner prefer in-person sessions. Make sure the therapist takes your insurance plan . 

When you start therapy, you and your partner will probably have to fill out forms detailing your medical history and insurance information. You may also have to fill out questionnaires to help your therapist better understand your relationship, the issues you’re facing, and what you hope to gain from therapy.

Your therapist will work with you and your partner to outline the goals for therapy. While couples therapy typically involves joint sessions, your therapist may also do individual sessions with you or your partner. They may also assign homework.

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Canadian Agency for Drugs and Technologies in Health. Couples therapy for adults experiencing relationship distress: a review of the clinical evidence and guidelines . 2014.

By Sanjana Gupta Sanjana is a health writer and editor. Her work spans various health-related topics, including mental health, fitness, nutrition, and wellness.