Problem Solving Therapy (PST) is a brief and focused psychological intervention.

Geared to promote the adoption and effective application of adaptive problem-solving attitudes and skills. Usually provided over a series of between four and eight sessions.

An effective treatment for highly diverse populations of adolescents and adults with a wide range of psychological, behavioral, and health disorders. Originally outlined by DZurilla and Goldfried (1971) Refined and revised over the years by DZurilla, Nezu, and their associates

Goals of PST:
Increase patients insight of the link between

their current symptoms and their current problems in living. Increase patients ability to clearly define their problems and set concrete and realistic goals Teach patients a specific, structured problem-solving procedure

Goals of PST:
Increase pleasant, social and physical

activities Produce positive experiences of patients own ability to solve problems, thereby increasing their confidence and feelings of self-control

Often called The Seven Steps of PST.

1. Problem Orientation 2. Recognize and Identify 3. Selecting and Defining 4. Generating Solutions 5. Decision Making 6. SMART Action Plan 7. Review Progress

1.

Problem Orientation

Clients attitude to solving problems. Made up of a client's thoughts and feelings about problems in general, and thoughts and feelings about their own ability to solve problems.
a. Positive Orientation b. Negative Orientation

1.

Problem Orientation
a. Positive Orientation x Tendency to appraise problems as challenges x Believes that problems are solvable x Confidence with own ability to solve problems x Understand that successful problem solving can involve significant effort x View negative emotions as part of the process which is ultimately helpful

1.

Problem Orientation
b. Negative Orientation x Tendency to view problems as threats x Expect problems to be generally unsolvable x Doubts ability to solve problems successfully x Becomes frustrated and upset when faced with problems or confronted with negative emotions

1.

Problem Orientation

Serves as a motivational function

Positive Orientation. Can engender positive affect and
approach motivation, which in turn can facilitate later adaptive problem-solving efforts (e.g., willingness to attend to difficult situations rather than avoid them).

Negative Orientation. Can foster negative affect (e.g.,

depressive symptoms and avoidance motivation), which can later serve to inhibit subsequent problem-solving attempts.

2.

Recognize and Identify

x x x

Clarify and Define the problems.

Aims to teach clients how to recognize when a problem exists Teach them to correctly identify it and begin to solve it May sound obvious but not always straightforward to achieve

3.

Selecting and Defining a Clear Problem

Select one clear problem to work on and then define it.

The more clearly a problem is defined, the easier it is to find possible solutions.

4.

Gathering Solutions

Identify possible solutions and brainstorming. Generate as many possibilities and alternative solutions to the problem at hand without evaluating their potential usefulness.
x x Increases the likelihood of coming up with an effective solution. Each idea should be relevant to the problem

5.

Decision Making

x x x

Aims to find a solution that will be effective

More in depth look at solutions generated during the brainstorm Weighing up of advantages and disadvantages of potential solutions Makes a decision about which one to implement

6.

Creating And Implementing a SMART Action Plan

S M A R T

Specific Measurable Attainable Relevant Time-bound

6.

Creating And Implementing a SMART Action Plan

The client should create and then implement, or carry out, an action plan Outline the step by step process to follow Break the plan down into small, achievable steps Include a time target for each step, and a review date

7.

Reviewing Progress

x x x x

Evaluate the outcome.

If they are underway with their plan Whether the plan is having the desired impact on resolving the problem Whether any more needs to be done in relation to the problem Any areas of the client's problem solving skills that need to be fine tuned

Refers to the core cognitive-behavioral activities that people engage in when attempting to cope with problems in living.

There are three different coping styles that have been identified:
1. Rational Problem Solving (adaptive) 2. Impulsivity/Carelessness(maladaptive) 3. Avoidance (maladaptive)

1.

Rational Problem Solving

Systematic and well-planned application of specific skills Makes distinct contributions toward the discovery of an adaptive solution or coping response

2.

Impulsivity/Carelessness

Can lead to ineffective or unsuccessful problem resolution Characterized by impulsive, hurried, and careless attempts at problem resolution Actively attempts to apply various strategies to address problems - such attempts are narrow, hurried, and incomplete

2.

Avoidance

Can also lead to ineffective or unsuccessful problem resolution Characterized by procrastination, passivity, and over-dependence on others to provide solutions

2.

Avoidance

Avoid problems rather than confronting them head on, wait for problems to resolve themselves, and attempt to shift the responsibility for solving ones problems to other people

Since the early 1980s, PST has been used as treatment for: Depression Depression in Older Adults Cancer Patients Self Harm Patients Combat Veterans

Mental retardation Obese Trying to Lose Weight Sex Offenders Diabetics More

PST is categorized into Five(5) main categories:

1. 2. 3. 4. 5.

Social Problem Solving Therapy Problem Solving Therapy for Primary Care Problem Solving Therapy for Older Adults Problem Solving Therapy for Cancer Problem Solving Therapy for Executive Dysfunction

1.

Social Problem Solving Therapy

x Designed for people living with depression

2.

Problem Solving Therapy for Primary Care

x Designed for people with minor depression

3.

Problem Solving Therapy for Older Adults

x x Designed for older adults living with depression Older adults may require different methods as younger ones

4.

Problem Solving Therapy for Cancer

x Designed adult cancer patients who were
experiencing significant psychological distress

5.

Problem Solving Therapy for Executive Dysfunction

x x Designed for depressed adult patients that may be resistant to conventional pharmacotherapy Non-pharmacological approaches addressing their behavioral deficits may reduce disability and experienced stress and improve depression.

PST vs. Reminiscence

Arean, et al, 1993 did a study on PST

compared to Reminiscence Therapy (RT) and Waiting List Control (WL).

x 90 patients randomized to PST, RT and WL, followed for 6 months. x Result: PST and RT were superior to WL. x PST had better treatment outcomes than RT acutely and 6 months post treatment

PST-PC for major depression versus amitriptyline and placebo. Mynors-Wallis, Gath
et al., 1995

PST-PC equal to AMI for treating major

depression GPs and Psychiatrist achieved comparable outcomes with PST-PC Lower drop out / greater satisfaction with PST-PC.

PST-PC against SRI and SRI + PST-PC.

Mynors-Wallis et al., 2000

x All groups improved equally over 12-weeks and maintained at 52-weeks FU. x PST + SRI was no more effective than either treatment alone. x No difference in outcome between GPs or nurses.

IMPACT Project
Collaborative care

model versus Usual Care. 11 sites throughout US. Enrolled 1801 primary care patients 60+. MDD or Dysthymia Followed for 2 years. Offered meds and PST-PC

PST-ED vs. Supportive Therapy

x 25 subjects
x No drop-outs x 1 PST, 2 ST were terminated, referred for pharmacotherapy

x Inclusion: Major depression (DSM-IV criteria), HDRS >18, MMSE >24, age >65, ED x Exclusion: other psychiatric disorders, suicidal ideation, severe medical illness, neurological disorders

ED Measures
Stroop Response Inhibition Task, raw scores for color-word < 26 Mattis DRS Initiation/ Perseveration, raw scores < 34

 Home

Based PST-PC: PEARLS

Ciechanowski et al, 2004

x 138 Minor / Dysthymia x PST-PC guided care management,with explicit physical and social activation x Home Based Care x Usual Care Control x PEARLS Superior to Usual Care x PEARLS 43% vs 15% with >50% Sx reduction x PEARLS 36% vs 12% complete remission x PEARLS improved function and emotional wellbeing

Problem Solving Therapy | University of Auckland

http://www.problemsolvingtherapy.ac.nz/index.php?p=home
http://nezulab.wordpress.com/2009/09/21/problem-solving-therapy/

Problem Solving Therapy | Nezu Clinical Health Psychology [PDF] Workshop pre-reading |

University of Auckland

http://www.problemsolvingtherapy.ac.nz/file.php/content/files/workshop_prereading.pdf

[PDF] Problem Solving Therapy: Research Overview

www.impact.ucla.edu

http://www.ucsfcme.com/2008/MPS08002/Arean_ProblemSolving.pdf

Problem-Solving Treatment and Coping Styles in Primary Care Minor Depression | Thomas E. Oxman, Mark T.
Hegel, Jay G. Hull, and Allen J. Dietrich

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2593861/