problem solving therapy (pst)

Join our Newsletter

Get helpful tips and the latest information

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

Author: Lydia Antonatos, LMHC

Lydia Angelica Antonatos LMHC

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

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

Find the perfect therapist for you, with BetterHelp.

If you don’t click with your first match, you can easily switch therapists. BetterHelp has over 20,000 licensed therapists who provide convenient and affordable online therapy. BetterHelp starts at $65 per week. Take a Free Online Assessment  and get matched with the right therapist for you.

What Is Problem-Solving Therapy?

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

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

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

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

Techniques Used in Problem-Solving Therapy

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

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

Creating Collaboration

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

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

Psychoeducation

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

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

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

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

Rehearsal & Practice

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

Positive Reinforcement & Feedback

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

Use of Analogies & Metaphors

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

What Can Problem-Solving Therapy Help With?

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

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

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

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

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

Top Rated Online Therapy Services

BetterHelp  – Best Overall

“BetterHelp is an online therapy platform that quickly connects you with a licensed counselor or therapist and earned 4 out of 5 stars.”   Visit BetterHelp  

Talkspace - Best For Insurance

Talkspace accepts many insurance plans including Optum, Cigna, and Aetna. Typical co-pay is $30, but often less. Visit Talkspace

Problem-Solving Therapy Examples

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

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

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

Psychiatric Patients

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

Adherence to Other Treatments

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

Benefits of Problem-Solving Therapy

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

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

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

How to Find a Therapist Who Practices Problem-Solving Therapy

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

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

Are There Special Certifications to Provide PST?

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

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

Questions to Ask a Therapist When Considering Problem-Solving Therapy

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

Here are some key questions to ask before starting PST:

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

How Much Does Problem-Solving Therapy Cost?

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

What to Expect at Your First PST Session

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

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

Would you like to try therapy?

Find a supportive and compassionate therapist ! BetterHelp has over 20,000 licensed therapists who provide convenient and affordable online therapy. BetterHelp starts at $65 per week. Take a Free Online Assessment  and get matched with the right therapist for you.

Is Problem-Solving Therapy Effective?

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

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

How Is PST Different From CBT & SFT?

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

Problem-Solving Therapy Vs. Cognitive-Behavioral Therapy

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

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

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

Problem-Solving Therapy Vs. Solution-Focused Therapy

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

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

Final Thoughts

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

Additional Resources

To help our readers take the next step in their mental health journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy is compensated for marketing by the companies included below.

Online Therapy 

BetterHelp – Get support and guidance from a licensed therapist. BetterHelp has over 20,000 therapists who provide convenient and affordable online therapy. Take A Free Online Assessment and get matched with the right therapist for you. Free Assessment

Online Psychiatry

Hims / Hers If you’re living with anxiety or depression, finding the right medication match may make all the difference. Connect with a licensed healthcare provider in just 12 – 48 hours. Explore FDA-approved treatment options and get free shipping, if prescribed. No insurance required. Get Started

Medication + Therapy

Brightside Health – Together, medication and therapy can help you feel like yourself, faster. Brightside Health treatment plans start at $95 per month. United Healthcare, Anthem, Cigna, and Aetna accepted. Following a free online evaluation and receiving a prescription, you can get FDA approved medications delivered to your door. Free Assessment

Starting Therapy Newsletter

A free newsletter for those interested in learning about therapy and how to get the most benefits out of therapy. Get helpful tips and the latest information. Sign Up

Choosing Therapy Directory 

You can search for therapists by specialty,  experience, insurance, or price, and location. Find a therapist today .

For Further Reading

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

What Is Exposure and Response Prevention Therapy?

ERP therapy alters OCD’s pattern by addressing both obsessions and compulsions. In ERP, an individual is encouraged to confront the stimuli that trigger distress related to their obsessions while also resisting the urge to perform compulsions in an attempt to reduce their distress.

Why is ERP So Expensive?

There are hundreds of OCD tests and “OCD quizzes” online. Some aim to help people self-diagnose; others turn obsessive-compulsive disorder into a joke. Either way, a vast majority of these are not helpful and probably create more problems than solutions.

Problem-Solving Therapy Infographics

A free newsletter for those interested in starting therapy. Get helpful tips and the latest information.

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

Beaudreau, S. A., Gould, C. E., Sakai, E., & Terri Huh, J. W. (2017). Problem-Solving Therapy. In N. A. Pachana (Ed.), Encyclopedia of geropsychology : with 148 figures and 100 tables . Singapore: Springer.

Broerman, R. (2018). Diathesis-Stress Model. In T. Shackleford & V. Zeigler-Hill (Eds.), Encyclopedia of Personality and Individual Differences (Living Edition, pp. 1–3). Springer, Cham. https://doi.org/10.1007/978-3-319-28099-8_891-1

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

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

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

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

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

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

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

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

Your Voice Matters

Can't find what you're looking for.

Request an article! Tell ChoosingTherapy.com’s editorial team what questions you have about mental health, emotional wellness, relationships, and parenting. The therapists who write for us love answering your questions!

Leave your feedback for our editors.

Share your feedback on this article with our editors. If there’s something we missed or something we could improve on, we’d love to hear it.

Our writers and editors love compliments, too. :)

FOR IMMEDIATE HELP CALL:

Medical Emergency: 911

Suicide Hotline: 988

© 2024 Choosing Therapy, Inc. All rights reserved.

• Bipolar Disorder
• Therapy Center
• When To See a Therapist
• Types of Therapy
• Best Online Therapy
• Best Couples Therapy
• Best Family Therapy
• Managing Stress
• Sleep and Dreaming
• Understanding Emotions
• Self-Improvement
• Healthy Relationships
• Student Resources
• Personality Types
• Guided Meditations
• Verywell Mind Insights
• 2024 Verywell Mind 25
• Mental Health in the Classroom
• Editorial Process
• Meet Our Review Board
• Crisis Support

What Is Problem-Solving Therapy?

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

Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.

Verywell / Madelyn Goodnight

Problem-Solving Therapy Techniques

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

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

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

At a Glance

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

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

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

Key Components

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

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

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

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

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

Planful Problem-Solving

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

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

Other Techniques

Other techniques your therapist may go over include:

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

What Problem-Solving Therapy Can Help With

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

Mental Health Issues

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

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

Specific Life Challenges

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

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

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

Benefits of Problem-Solving Therapy

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

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

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

Other Types of Therapy

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

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

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

• Older adults
• People coping with serious illnesses like cancer

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

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

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

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

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

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

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

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

Keep In Mind

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

Get Help Now

We've tried, tested, and written unbiased reviews of the best online therapy programs including Talkspace, BetterHelp, and ReGain. Find out which option is the best for you.

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

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

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

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

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

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

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

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

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

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

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

Problem-Solving Therapy

Streaming options.

• Description
• Contributor bios
• Suggested resources
• Video details

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

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

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

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

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

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

Social Problem Solving and Psychopathology

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

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

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

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

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

Problem-Solving Therapy Goals

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

You may also like

Cognitive Behavioral Therapy for Depression

The Basics of Group Therapy

Constructive Therapy in Practice

Pregnancy Loss

Relational Savoring

Legal Notice

Not a mental health professional.

View APA videos for the public

10 Best Problem-Solving Therapy Worksheets & Activities

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

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

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

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

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

This Article Contains:

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

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

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

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

Can it help with depression?

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

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

The major concepts

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

PST is based on two overlapping models:

Social problem-solving model

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

The model includes three central concepts:

• Social problem-solving
• The problem
• The solution

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

Relational problem-solving model

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

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

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

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

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

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

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

Problem-solving therapy – Baycrest

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

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

Is PPT appropriate?

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

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

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

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

Five problem-solving steps

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

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

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

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

Download 3 Free Positive Psychology Exercises (PDF)

Enhance wellbeing with these free, science-based exercises that draw on the latest insights from positive psychology.

Download 3 Free Positive Psychology Tools Pack (PDF)

By filling out your name and email address below.

Positive self-statements

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

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

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

5 Worksheets and workbooks

Problem-solving self-monitoring form.

Answering the questions in the Problem-Solving Self-Monitoring Form provides the therapist with necessary information regarding the client’s overall and specific problem-solving approaches and reactions (Dobson, 2011).

Ask the client to complete the following:

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

Reactions to Stress

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

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

What Are Your Unique Triggers?

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

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

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

Problem-Solving worksheet

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

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

Getting the Facts

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

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

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

2 Helpful Group Activities

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

Generating Alternative Solutions and Better Decision-Making

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

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

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

Visualization

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

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

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

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

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

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

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

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

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

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

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

Find the book on Amazon .

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

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

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

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

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

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

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

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

If you’re looking for more science-based ways to help others enhance their wellbeing, check out this signature collection of 17 validated positive psychology tools for practitioners. Use them to help others flourish and thrive.

17 Top-Rated Positive Psychology Exercises for Practitioners

Expand your arsenal and impact with these 17 Positive Psychology Exercises [PDF] , scientifically designed to promote human flourishing, meaning, and wellbeing.

Created by Experts. 100% Science-based.

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

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

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

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

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

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

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

Share this article:

Article feedback

What our readers think.

Thanks for your information given, it was helpful for me something new I learned

Let us know your thoughts Cancel reply

Your email address will not be published.

Save my name, email, and website in this browser for the next time I comment.

Related articles

The Empty Chair Technique: How It Can Help Your Clients

Resolving ‘unfinished business’ is often an essential part of counseling. If left unresolved, it can contribute to depression, anxiety, and mental ill-health while damaging existing [...]

29 Best Group Therapy Activities for Supporting Adults

As humans, we are social creatures with personal histories based on the various groups that make up our lives. Childhood begins with a family of [...]

47 Free Therapy Resources to Help Kick-Start Your New Practice

Setting up a private practice in psychotherapy brings several challenges, including a considerable investment of time and money. You can reduce risks early on by [...]

Read other articles by their category

• Body & Brain (53)
• Coaching & Application (58)
• Compassion (25)
• Counseling (51)
• Emotional Intelligence (23)
• Gratitude (18)
• Grief & Bereavement (21)
• Happiness & SWB (40)
• Meaning & Values (26)
• Meditation (20)
• Mindfulness (44)
• Motivation & Goals (46)
• Optimism & Mindset (34)
• Positive CBT (30)
• Positive Communication (22)
• Positive Education (48)
• Positive Emotions (32)
• Positive Leadership (19)
• Positive Parenting (16)
• Positive Psychology (34)
• Positive Workplace (37)
• Productivity (18)
• Relationships (45)
• Resilience & Coping (39)
• Self Awareness (21)
• Self Esteem (38)
• Strengths & Virtues (32)
• Stress & Burnout Prevention (34)
• Theory & Books (46)
• Therapy Exercises (37)
• Types of Therapy (64)

Problem-Solving Therapy (PST) is a cognitive-behavioral intervention that helps individuals manage the challenges and difficulties of life by improving their problem-solving skills. PST focuses on teaching clients to identify, prioritize, and effectively address problems in a systematic way. This approach encourages a proactive stance towards problem-solving, emphasizing the development of practical strategies that can be applied to both current and future challenges. By enhancing clients’ abilities to cope with stress and adversity, PST aims to reduce psychological distress and improve overall well-being.

Dr. Chelsea Sanders

• CLASSIFIEDS
• Advanced search

American Board of Family Medicine

Advanced Search

The Effectiveness of Problem-Solving Therapy for Primary Care Patients' Depressive and/or Anxiety Disorders: A Systematic Review and Meta-Analysis

• Find this author on Google Scholar
• Find this author on PubMed
• Search for this author on this site
• Figures & Data
• Info & Metrics

Background: There is increasing demand for managing depressive and/or anxiety disorders among primary care patients. Problem-solving therapy (PST) is a brief evidence- and strength-based psychotherapy that has received increasing support for its effectiveness in managing depression and anxiety among primary care patients.

Methods: We conducted a systematic review and meta-analysis of clinical trials examining PST for patients with depression and/or anxiety in primary care as identified by searches for published literature across 6 databases and manual searching. A weighted average of treatment effect size estimates per study was used for meta-analysis and moderator analysis.

Results: From an initial pool of 153 primary studies, 11 studies (with 2072 participants) met inclusion criteria for synthesis. PST reported an overall significant treatment effect for primary care depression and/or anxiety ( d = 0.673; P < .001). Participants' age and sex moderated treatment effects. Physician-involved PST in primary care, despite a significantly smaller treatment effect size than mental health provider only PST, reported an overall statistically significant effect ( d = 0.35; P = .029).

Conclusions: Results from the study supported PST's effectiveness for primary care depression and/or anxiety. Our preliminary results also indicated that physician-involved PST offers meaningful improvements for primary care patients' depression and/or anxiety.

• Anxiety Disorders
• Depressive Disorder
• Mental Health
• Primary Health Care
• Problem Solving
• Psychotherapy

Depressive and anxiety disorders are the 2 leading global causes of all nonfatal burden of disease 1 and the most prevalent mental disorders in the US primary care system. 2 ⇓ – 4 The proportion of primary care patients with a probable depressive and/or anxiety disorder ranges from 33% to 80% 2 , 5 , 6 ; primary care patients also have alarmingly high levels of co-/multi-morbidity of depressive, anxiety, and physical disorders. 7 Depression and anxiety among primary care patients contribute to: poor compliance with medical advice and treatment 8 ; deficits in patient–provider communication 9 ; reduced patient engagement in healthy behaviors 10 ; and decreased physical wellbeing. 11 , 12 Given the high prevalence of primary care depression and anxiety, and their detrimental effects on the qualities of primary care treatments and patients' wellbeing, it is important to identify effective interventions suitable to address primary care depression and anxiety.

Primary care patients with depression and/or anxiety are often referred out to specialty mental health care. 13 , 14 However, outcomes from these referrals are usually poor due to patients' poor adherence and their resistance to mental health treatment 15 , 16 . Therefore, it is critical to identify effective mental health interventions that can be delivered in primary care for patients' depression and/or anxiety. 17 , 18 During the past decade, a plethora of clinical trials have investigated different mental health interventions for depression and anxiety delivered in primary care. One of the most promising interventions that has received increasing support for managing depression and anxiety in primary care is Problem-Solving Therapy (PST).

Holding that difficulties with problem solving make people more susceptible to depression, PST is a nonpharmacological, competence-based intervention that involves a step-by-step approach to constructive problem solving. 19 , 20 Developed from cognitive-behavioral-therapy, PST is a short-term psychotherapy approach delivered individually or in group settings. The generic PST manual 19 contains 14 training modules that guides PST providers working with patients from establishing a therapeutic relationship to identifying and understanding patient-prioritized problems; from building problem-solving skills to eventually solving the problems. Focused on patient problems in the here-and-now, a typical PST treatment course ranges from 7 to 14 sessions and can be delivered by various health care professionals such as physicians, clinical social workers or nurse practitioners. Because the generic PST manual outlines the treatment formula in detail, providers may deliver PST after receiving 1 month of training. For example, 1 feasibility study on training residents in PST found that residents can provide fidelious PST after 7 weeks' training and reach moderate to high competence after 3 years of practicing PST. 21 PST also has a self-help manual available to clients when needed.

PST is a well-established, evidence-based intervention for depression in specialty mental health care and is receiving greater recognition for its effectiveness in treating depression and anxiety in primary care. Systematic and meta-analytic reviews of PST for depression consistently reported moderate to large treatment effects, ranging from d = 0.4 to d = 1.15. 22 ⇓ – 24 Several clinical trials indicated PST's clinical effectiveness in alleviating anxiety as well. 25 , 26 Most importantly, PST has been adapted for primary care settings (PST-PC) and can be delivered by a variety of health care providers with fewer number of sessions and shorter session length. These unique features make PST(-PC) an ideal psychotherapy for depressive and/or anxiety disorders in primary care.

Previous reviews of PST focused on its effectiveness for depression care, but with little attention to PST's effect on anxiety or comorbid depression anxiety. In addition, to our knowledge, no previous reviews of PST have focused on managing depressive and/or anxiety disorders in primary care. Although research demonstrates that PST has a strong evidence base for treating depression and/or anxiety in specialty mental health care settings, more research is needed to determine whether PST remains effective for treating depressive and/or anxiety disorders when delivered in primary care. To address this gap, we conducted a systematic review and meta-analysis on the effectiveness of PST for treating depressive and/or anxiety disorders with primary care patients.

Search Strategies

This review included searches in 6 electronic databases (Academic Search Complete, CINAHL, Medline, PsychINFO, PUBMED, and the Cochrane Library/Database) and 3 professional Web sites (Academy of Cognitive Therapy, IMPACT, Anxiety and Depression Association of America) for primary care depression and anxiety studies published between January 1900 and September 2016. We also E-mailed major authors of PST studies for feedback and input. Search terms of title and/or abstract searches included: [“PST” or “Problem-Solving Therapy” or “Problem Solving Therapy” or “Problem Solving”] AND [“Depression” or “Depressive” or “Anxiety” or “Panic” or “Phobia”] AND [“primarycare” or “primary care” or “PCP” or “Family Medicine” or “Family Doctor”]. We supplemented the procedure described above with a manual search of study references.

Eligibility Criteria

For inclusion in analyses, a study needed to be 1) a randomized-controlled-trial of 2) PST for 3) primary care patients' 4) depressive and/or anxiety disorders. For studies that examined face-to-face, in-person PST, the intervention must be delivered in primary care for inclusion. If studies examined tele-PST (eg, telephone delivery, video conferencing, computer-based), the intervention must be connected to patients' primary care services for a study to be included. For example, when a primary care physician prescribed computer-based PST at home for their patients, the study met inclusion criteria (as it was still considered managing depression “in primary care” in the present review). However, studies would be excluded if a primary care physician referred patients to an external mental health intervention. Finally, studies must document and report sufficient statistical information for calculating effect size for inclusion in the final analysis.

Data Abstraction and Coding

Two authors (AZ and JES) reviewed an initial pool of 153 studies and agreed to remove 65 studies based on title and 68 studies based on abstract, resulting in 20 studies for full-text review. To develop the final list, we excluded 6 studies after closer review of full-text and consultation with a third reviewer who is an established PST researcher. Lastly, we excluded 2 studies due to 1) a study with a design that blurred the effect of PST with other treatments and 2) unsuccessful contact with a study author to request data needed for calculating effect size. We used a final sample of 11 studies for meta-analysis. The PRISMA chart is presented in Figure 1 .

• Download figure
• Open in new tab

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) chart of literature search for Problem-solving therapy (PST) studies for treating primary care patients' depression and/or anxiety.

Statistical Analysis

This study conducted meta-analysis with the following procedures: 1) calculated a weighted average of effect size estimates per study for depression and anxiety separately (to ensure independence) 27 ; 2) synthesized an overall treatment effect estimate using fixed- or random-effects model based on a heterogeneity statistic (Q-statistic) 28 ; and 3) performed univariate meta-regression with a mixed-effects model for moderator analysis. 29 Although other more advanced statistical approaches allow inclusion of multiple treatment effect size estimates per study for data synthesis, like the Generalized Least Squares method 30 or the Robust Variance Estimation method 31 , this study employed a typical approach because of the relatively small sample and absence of study information required to conduct more advanced methods. Following procedures outlined by Cooper and colleagues 32 , we conducted all analyses with R software. 33 We chose to conduct analyses in R, rather than software specific to meta-analysis (eg, RevMan), because R allowed for more flexibility in statistical modeling (eg, small sample size correction). 34 Sensitivity analysis using Robust Variance Estimation did not significantly alter results estimated with the typical approach. And so this study presents results from only the typical approach for purposes of parsimony and clarity.

Publication Bias, Risk of Bias and Quality of Studies

To detect publication bias, we used a funnel plot of effect size estimates graphed against their standard errors for visual investigation. To evaluate risk of bias, we used the Cochrane Collaboration's tool for assessing risk of bias in randomized trials 35 and the Quality Assessment of Controlled Intervention Studies to evaluate study quality. 36

Primary Studies

Eleven PST studies for primary care depression and/or anxiety reported a total sample size of 2072 participants. Participants' age averaged 50.1 and ranged from 24.5 to 71.8 years old. Ten studies reported participants' sex with an average of 35.6% male participants across all studies. Seven studies (63.6%) reported participants' racial background with most identified as non-Hispanic white (83.6%). Other racial/ethnic groups were poorly reported for meaningful summary. Five studies used active medication as a comparison, including 3 studies that used both active medication and placebo medication. The rest compared PST with treatment-as-usual while 2 studies used active control group (eg, video education material). Four studies involved physicians in some component of intervention delivery. PCPs provided PST in 2 studies; supervised and collaborated with depression care manager in 1 study, and collaborated with a primary care nurse in another. Ten studies reported an average of 6 PST sessions ( M = 6.1) ranging from 3 to 12 sessions. All but 1 study (n = 10) used individual PST and 2 studies used tele-health modalities to provide PST. All studies used standardized measures of depression and anxiety. Examples of the most common measures included: PHQ-9, CES-D, HAM-D, and BDI-II. Table 1 presents a detailed description of study characteristics.

• View inline

Study Characteristics for Problem-Solving Therapy as Intervention for Treating Depression and/or Anxiety Among Primary Care Patients ( n = 11)

Publication Bias, Risk of Bias, and Quality of Studies

The funnel plot ( Figure 2 ) did not indicate any clear sign of publication bias. Risk of bias ( Table 4 ) indicated an overall acceptable risk across studies included for review with blinding of participants and personnel, blinding of outcome assessment and incomplete outcome data most vulnerable to risk of bias. Quality of study assessment ( Table 5 ) indicated an overall satisfactory study quality with over half of studies (n = 6) achieving ratings of “Good” study quality.

Funnel Plot for Publication Bias in Problem-solving therapy (PST) Studies for Treating Primary Care Patients' Depression an/or Anxiety.

Meta-analysis and moderator analysis

Figure 3 presents a forest plot of treatment effects per study, including depression and anxiety measures. Table 3 presents subgroup analysis of overall treatment effect by moderator and Table 2 presents the results of meta-analysis and moderator analysis. Meta-analysis revealed an overall significant treatment effect of PST for primary care depression and/or anxiety ( d = 0.67; P < .001). Further investigation revealed no significant difference between the mean treatment effect of PST for depression versus anxiety in primary care ( d ( diff .) = −0.25; P = .317) while subgroup analysis revealed the overall treatment effect for anxiety was not significant ( d = 0.35; P = .226). Age was found to be a significant moderator (β 1 = 0.02; P = .012) for treatment outcomes, indicating that for each unit increase in participants' age, the overall treatment effect for primary are depression and/or anxiety are expected to increase by 0.02 (standard deviations). Neither participants' ethnic or racial backgrounds nor marital status significantly moderated the overall treatment outcome.

Forest Plot of PST Treatment Effect Size Estimates for Treating Primary Care Patients' Depression and/or Anxiety per Study.

PST for Treating Primary Care Patients' Depression and/or Anxiety; Results of Univariate Meta-regression

Results of Subgroup Analysis of Overall Treatment Effect (by Moderator) of PST for Treating Primary Care Patients' Depression and/or Anxiety

PST for Treating Primary Care Patients' Depression and/or Anxiety; Results of the Cochrane Collaboration's Tool for Assessing Risk of Bias *

Quality Assessment of Controlled PST Intervention Studies for Primary Care Patients' Depression and/or Anxiety ( n =11)

The overall treatment effect was not moderated by any treatment characteristics including: treatment modality (individual vs group PST), delivery methods (face-to-face vs tele-health PST), number of PST sessions and length of individual PST sessions. Subgroup analysis indicated an overall significant treatment effect of in-person PST ( d = 0.72; P < .001) but not of tele-PST ( d = 0.53; P = .097). However, the difference between the 2 was not statistically significant.

PST providers background and primary care physician's involvement significantly moderated the overall treatment effect size. Master's-level providers reported an overall treatment effect ( d = 1.57; P < .001) significantly higher than doctoral-level providers ( d = −1.33; P = .007). Both physician-involved and nonphysician involved PST reported significant overall treatment effect of PST for depression and/or anxiety in primary care ( d = 1.06; P < .001 and d = 0.35; P = .029, respectively). Moderator analysis further revealed that PST without physician involvement reported significantly greater treatment effects compared with physician-involved PST in primary care ( d = −0.71; P = .005). Results of subgroup and moderator analyses indicated that while the difference (in treatment effect) between physician and nonphysician involved PST in primary care were statistically significant, physician-involved PST was also statistically significant, thus practically meaningful.

Results of the study demonstrated a statistically significant overall treatment effect in outcomes of depression and/or anxiety for primary care patients receiving PST compared with patients in control groups. The outcome type—depression versus anxiety—failed to moderate treatment effect; only PST for depression reported a significant overall effect size. This could indicate that many studies primarily targeted depression and included anxiety measures as secondary outcomes. For this reason, we expect to find a greater treatment effect for primary care depression. It was unsurprising that treatment characteristics failed to moderate treatment effect size because most primary studies used PST-PC or its modified version; there was insufficient variation between studies (and moderators), yielding insignificant moderating coefficients.

Although delivery method did not moderate treatment effect reported in studies included in this review, significant effect was only reported by studies using face-to-face in-person PST but not by those with tele-PST modalities (n = 2). Although evidence for the effectiveness of tele-PST is established or increasing in a variety of settings 37 ⇓ – 39 most PST studies for primary care patients have used face-to-face, in-person PST. Our study further supported the use of face-to-face in-person PST for treating depression and anxiety among primary care patients. We recognize, however, that current and projected shortages in specialty mental health care provision, felt acutely in subspecialties such as geriatric mental health, necessitate more trials with PST tele-health modalities. 40

It is salient to note that, while nonphysician-involved PST studies reported significantly greater treatment effect than those involving physicians, PCP-involved studies also reported an overall significant effect size. Closer examination indicated that studies with physician-involved PST were either delivered by physicians or other nonmental health professionals (eg, registered nurses or depression care managers). Lack of sufficient PST training might explain the difference in treatment effect sizes being statistically significant. Yet, the fact that physician-involved PST studies reported an overall statistically significant effect size for primary care depression and/or anxiety suggested a meaningful treatment effect for clinical practice. When faced with a shortage of mental health professionals (eg, psychologists, clinical social workers, licensed professional counselors), our findings suggest physician-led or -supervised PST interventions could still improve primary care patients' depression and/or anxiety. Researchers are encouraged to further examine the treatment effect of PST delivered by mental health professionals in collaboration with primary care physicians.

This study has several weaknesses that are inherent to meta-analyses. There is no way to assure we included all studies despite adopting a comprehensive search and coding strategy (ie, file drawer problem). Second, while all studies in this meta-analysis seemed to have satisfactory methodological rigor, it is possible that internal biases within some studies may influence results. This study takes a quantitative meta-analysis approach which inherently neglects other study designs and methodologies that also provide valuable information about the effectiveness, feasibility, and acceptability of PST for treating primary care patients with depression. To ensure independence of data, this study used a weighted average of effect size estimates per study in synthesizing an overall treatment effect and conducting moderator analysis. While sensitivity analysis did not reveal significant differences from the reported results, we will not know for sure how our choice of statistical method might affect the results.

• Acknowledgments

The authors are grateful to Dr. Namkee Choi, Professor and the Louis and Ann Wolens Centennial Chair in Gerontology at the University of Texas at Austin Steve Hicks School of Social Work, for her mentorship and insightful comments during preparation of the manuscript.

This article was externally peer reviewed.

Funding: none.

Conflict of interest: none declared.

Ethics Review: This is a systematic review and meta-analysis based on de-identified aggregate study data. No human participants or animals were involved in this study. No ethics review was required.

To see this article online, please go to: http://jabfm.org/content/31/1/139.full .

• Received for publication July 5, 2017.
• Revision received September 14, 2017.
• Accepted for publication September 27, 2017.
• Whiteford HA ,
• Degenhardt L ,
• Kroenke K ,
• Spitzer RL ,
• Williams JB ,
• Monahan PO ,
• Verhaak PF ,
• Hilbink-Smolders M ,
• Mitchell AJ ,
• Sherbourne CD ,
• Mussell M ,
• Schellberg D ,
• Clarke DM ,
• Schenker Y ,
• Stewart A ,
• Vander Weg MW
• Salovey P ,
• Rothman AJ ,
• Detweiler JB ,
• Williams JW
• Hunkeler EM ,
• Pincus HA ,
• Thielke S ,
• Richards D ,
• Gilbody S ,
• Grimshaw J ,
• Maguth Nezu C ,
• D'Zurilla TJ
• D'Zurilla TJ ,
• Dietrich AJ ,
• Seville JL ,
• Cuijpers P ,
• van Straten A ,
• Warmerdam L
• Kirkham JG ,
• Kleiboer A ,
• Seekles W ,
• Higgins JP ,
• Thompson SG
• Raudenbush SW
• Hedges LV ,
• Valentine JC
• Gleser LJ ,
• Harris LV ,
• Valentine ,
• 33. ↵ R Development Core Team . R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria . Vienna, Austria : R Foundation for Statistical Computing 2015 .
• Pustejovsky JE
• Altman DG ,
• Gøtzsche PC ,
• 36. ↵ National Heart, Lung, and Blood Institute . Quality assessment of controlled intervention studies . Systematic evidence reviews and clinical practice guideline . Available from: https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/rct .
• Marinucci ML ,
• Sirrianni L ,
• Wilson NL ,
• Cartreine JA ,
• Buckey JC ,
• Sandoval L ,
• Yarborough BJ
• Barret JE ,
• Williams JW ,
• Chibanda D ,
• Shetty AK ,
• Tshimanga M ,
• Stranix-Chibanda L ,
• Rusakaniko S
• Von Korff M ,
• Tamburrino M ,
• McCusker J ,
• Mynors-Wallis LM ,
• Dietrich AJ
• Reynolds CF III . ,
• Thomas SB ,
• Schmaling KB ,
• Dimidjian S ,
• Williams JW Jr . ,
• Barrett J ,
• Sullivan M ,
• Cornell J ,

In this issue

• Table of Contents
• Table of Contents (PDF)
• Cover (PDF)
• Index by author

Thank you for your interest in spreading the word on American Board of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Citation Manager Formats

• EndNote (tagged)
• EndNote 8 (xml)
• RefWorks Tagged
• Ref Manager

• Tweet Widget
• Facebook Like
• Google Plus One

Jump to section

Related articles.

• No related articles found.
• Google Scholar

Cited By...

• Global health reciprocal innovation to address mental health and well-being: strategies used and lessons learnt
• Psychologic Treatment of Depression Compared With Pharmacotherapy and Combined Treatment in Primary Care: A Network Meta-Analysis
• Brief behaviour change strategies for distressed patients in primary care
• Interventions Must Be Realistic to Be Useful and Completed in Family Medicine

More in this TOC Section

• Perinatal Depression: A Guide to Detection and Management in Primary Care
• Denosumab versus Bisphosphonates for Reducing Fractures in Postmenopausal Women with Osteoporosis: A Meta-Analysis
• Spondylolysis and Isthmic Spondylolisthesis: A Guide to Diagnosis and Management

Similar Articles

Today's Therapist

What Is Problem Solving Therapy and Who Can It Help

February 1, 2017 By TodaysTherapist

Stressful events are part of everyday life. For some, coping with the negative effects of these events can be difficult, whether stressors are considered large (such as the death of a loved one) or small (like making a mistake at work). Stressors can create or exacerbate psychological and physical health problems. Problem solving therapy can help individuals develop effective coping methods for dealing with stressors in their lives by providing structured goals and coaching adaptation skills for decision-making situations. While this article provides some facts on problem solving therapy, it is strongly advised that individuals considering problem solving therapy receive care from licensed professionals.

What Is Problem Solving Therapy?

Problem Solving Therapy (PST), or structured problem solving, is psychological treatment used to help clients manage stressful life events. Therapists employ behavioral and cognitive intervention techniques to assist clients in establishing and actualizing goals and creating effective problem-solving, stress management techniques. Clients are encouraged and guided in how to be more proactive in their daily lives and make decisions that help them achieve goals. Core components of PST are addressing problem orientation, explicitly defining problems the client faces, coming up with and evaluating solutions, and breaking problems down into achievable, reasonable, and ultimately less stressful steps.

Solving Problems Outcomes

PST involves finding ways for individuals to change the stressful nature of situations and how they respond to stressors. Generally, problem-solving outcomes are based upon problem-solving style and problem orientation . Problem orientation is the feelings and thoughts a person has about their problems and perceived ability to resolve them. A positive problem orientation generally leads the person to enhance problem-solving efforts while a negative problem orientation tends to lead to the person being inhibited in solving their problems. Problem-solving style is behavioral and cognitive activities targeted at coping with stressors. Those with ineffective styles tend to report having more stressors and negative life events.

Problem solving therapy is essentially a series of training sessions in learning how to utilize adaptive problem solving skills that help clients better deal with and/or resolve problems that arise in their daily lives. Clients learn how to make more effective decisions for themselves, come up with their own creative ways to solve problems, and identify barriers or obstacles that surface when trying to reach their goals and how best to negate these hurdles. The overall intended outcome is that a client will feel more confident in their decision-making and problem-solving techniques and will be able to carry on their solutions as independently as possible.

Medical Conditions and Problem Solving Therapy

PST can be used by General Practitioners (GPs) to help treat difficult medical conditions, such as chronic pain management. As with a therapist, GPs have clients identify problems they want solved, set up goals, have clients come up with solutions for how they would like to solve the problem, weigh pros and cons of each solution in order to select the best one, and implement the solution. Together, a GP and client can review how well the selected solution is working and make any necessary changes. Again, this article is to provide helpful information in learning about PST; it is, therefore, highly recommended that one seeks help from a licensed, well-reputed professional who can help implement and analyze PST goals.

Developing and Achieving Problem Solving Therapy Goals

Therapists and GPs tend to use PST with clients who seem to be having difficulties coping with stressful life situations that can become confusing and overwhelming. The goals of PST revolve around meeting four key therapy objectives:

• Improving the client’s positive orientation;
• Reducing the client’s negative orientation;
• Enhancing the client’s ability to identify what is causing a problem, coming up with a few potential solutions, conducting cost-benefit analysis to determine the best solution, implementing the solution, then analyzing the outcome;
• Reducing impulsive and ultimately ineffective methods for attempting to solve problems.

Since every client is a different person and has diverse needs, therapists and doctors try to allow as much creative and analytic processing by the client as possible, although PST relies on the four basic components mentioned in the list above.

Therapists and clients alike should be aware of several obstacles that can occur during the PST process, including the client experiencing cognitive overload, difficulties with emotional regulation, usage of ineffective or maladaptive problem solving styles, feelings of hopelessness leading to decreased motivation to follow through on goals, and difficulties removing oneself from negative moods or thought patterns.

Who Can Benefit from Problem Solving Therapy?

Problem solving therapy can be beneficial for many different people. Since there is flexibility in regard to treatment goals and methods for achieving them, PST can be used in a group setting or one-on-one with an individual client. Since negative stressors are scientifically linked to mental and physical health problems, problem solving therapy can be beneficial to almost anyone, so long as they are open to the idea of pursuing treatment and engaging in the process.

PST has been found to be an effective therapeutic method for clients who are dealing with a vast array of mental, physical and emotional conditions. These conditions include some personality disorders, major depressive disorder, suicidal ideation, generalized anxiety disorder, relationship issues, emotional duress, and medically-based issues that result in emotional and physical pain (such as fibromyalgia, Hashimoto’s and hypothyroidism, diabetes, and cancer).

Problem solving therapy is a widely-acknowledged tool used by therapists and general medical practitioners alike to help clients find proactive and reasonable ways to deal with the stressful events that occur in their lives. Overall, PST can help people find meaningful, creative, and adjustable ways of reaching their problem-resolution goals and ultimately lead to a better quality of living for those dealing with major physical and mental health concerns. Anyone considering PST should contact a trained medical or counseling professional to inquire about how this type of therapy could potentially suit their needs.

Image from depositphotos.com.

Issues by year

Advertising

Volume 41, Issue 9, September 2012

Problem solving therapy Use and effectiveness in general practice

Problem solving therapy has been described as pragmatic, effective and easy to learn. It is an approach that makes sense to patients and professionals, does not require years of training and is effective in primary care settings. 1 It has been described as well suited to general practice and may be undertaken during 15–30 minute consultations. 2

Problem solving therapy takes its theoretical base from social problem solving theory which identifies three distinct sequential phases for addressing problems: 3

• discovery (finding a solution)
• performance (implementing the solution)
• verification (assessing the outcome).

Initially, the techniques of social problem solving emerged in response to empirical observations including that people experiencing depression exhibit a reduced capacity to resolve personal and social problems. 4,5 Problem solving therapy specifically for use in primary care was then developed. 6

Problem solving therapy has been shown to be effective for many common mental health conditions seen by GPs, including depression 7–9 and anxiety. 10,11 Most research has focused on depression. In randomised controlled trials, when delivered by appropriately trained GPs to patients experiencing major depression, PST has been shown to be more effective than placebo and equally as effective as antidepressant medication (both tricyclics and selective serotonin reuptake inhibitors [SSRIs]). 7,8 A recent meta-analysis of 22 studies reported that for depression, PST was as effective as medication and other psychosocial therapies, and more effective than no treatment. 9 For patients experiencing anxiety, benefit from PST is less well established. It has been suggested it is most effective with selected patients experiencing more severe symptoms who have not benefited from usual GP care. 10 Problem solving therapy may also assist a group of patients often seen by GPs: those who feel overwhelmed by multiple problems but who have not yet developed a specific diagnosis.

Although PST has been shown to be beneficial for many patients experiencing depression, debate continues about the mechanism(s) through which the observed positive impact of PST on patient affect is achieved. Two mechanisms have been proposed: the patient improves because they achieve problem resolution, or they improve because of a sense of empowerment gained from PST skill development. 12 Perhaps both factors play a part in achieving the benefits of PST as a therapeutic intervention. The observed benefit of PST for patients experiencing anxiety may be due to problem resolution and consequent reduction in distress from anticipatory concern about the identified but unsolved problem.

It is important to note that, while in the clinical setting we may find ourselves attempting to solve problems for patients and to advise them on what we think they should do, 13 this is not PST. Essential to PST, as an evidence based therapeutic approach, is that the clinician helps the patient to become empowered to learn to solve problems for themselves. The GP's role is to work through the stages of PST in a structured, sequential way to determine and to implement the solution selected by the patient. These stages have been described previously. 14 Key features of PST are summarised in Table 1 .

Using PST in general practice

Using PST, like any other treatment approach, depends on identifying patients for whom it may be useful. Patients experiencing a symptom relating to life difficulties, including relationship, financial or employment problems, which are seen by the patient in a realistic way, may be suitable for PST. Frequently, such patients feel overwhelmed and at times confused by these difficulties. Encouraging the patient to clearly define the problem(s) and deal with one problem at a time can be helpful. To this end, a number of worksheets have been developed. A simple, single page worksheet is shown in Figure 1 . A typical case study in which PST may be useful is presented in Table 2 . By contrast, patients whose thinking is typically characterised by unhelpful negative thought patterns about themself or their world may more readily benefit from cognitive strategies that challenge unhelpful negative thought patterns (such as cognitive behaviour therapy [CBT]). 15 Some problems not associated with an identifiable implementable solution, including existential questions related to life meaning and purpose, may not be suitable for PST. Identification of supportive and coping strategies along with, if appropriate, work around reframing the question may be more suitable for such patients.

Problem solving therapy may be used with patients experiencing depression who are also on antidepressant medication. It may be initiated with medication or added to existing pharmacotherapy. Intuitively, we might expect enhanced outcomes from combined PST and pharmacotherapy. However, research suggests this does not occur, with PST alone, medication alone and a combination of PST and medication each resulting in a similar patient outcomes.8 In addition to GPs, PST may be provided by a range of health professionals, most commonly psychologists. General practitioners may find they have a role in reinforcing PST skills with patients who developed their skills with a psychologist, especially if all Better Access Initiative sessions with the psychologist have been utilised.

The intuitive nature of PST means its use in practice is often straightforward. However, this is not always the case. Common difficulties using PST with patients and potential solutions to these difficulties have previously been discussed by the author 14 and are summarised in Table 3 . Problem solving therapy may also have a role in supporting marginalised patients such as those experiencing major social disadvantage due to the postulated mechanism of action of empowerment of patients to address symptoms relating to life problems. 12 of action includes empowerment of patients to address symptom causing life problems. Social and cultural context should be considered when using PST with patients, including conceptualisation of a problem, its significance to the patient and potential solutions.

General practitioners may be concerned that consultations that include PST will take too much time. 13 However, Australian research suggests this fear may not be justified with many GPs being able to provide PST to a simulated patient with a typical presentation of depression in 20 minutes. 15 Therefore, the concern over consultation duration may be more linked to established patterns of practice than the use of PST. Problem solving therapy may add an increased degree of structure to complex consultations that may limit, rather than extend, consultation duration.

Figure 1. Problem solving therapy patient worksheet

PST skill development for GPs

Many experienced GPs have intuitively developed valuable problem solving skills. Learning about PST for such GPs often involves refining and focusing those skills rather than learning a new skill from scratch. 13 A number of practical journal articles 16 and textbooks 10 that focus on developing PST skills in primary care are available. In addition, PST has been included in some interactive mental health continuing medical education for GPs. 17 This form of learning has the advantage of developing skills alongside other GPs.

Problem solving therapy is one of the Medicare supported FPS available to GPs. It is an approach that has developed from a firm theoretical basis and includes principles that will be familiar to many GPs. It can be used within the constraints of routine general practice and has been shown, when provided by appropriately skilled GPs, to be as effective as antidepressant medication for major depression. It offers an additional therapeutic option to patients experiencing a number of the common mental health conditions seen in general practice, including depression 7–9 and anxiety. 10,11

Conflict of interest: none declared.

• Gask L. Problem-solving treatment for anxiety and depression: a practical guide. Br J Psychiatry 2006;189:287–8. Search PubMed
• Hickie I. An approach to managing depression in general practice. Med J Aust 2000;173:106–10. Search PubMed
• D'Zurilla T, Goldfried M. Problem solving and behaviour modification. J Abnorm Psychol 1971;78:107–26. Search PubMed
• Gotlib I, Asarnow R. Interpersonal and impersonal problem solving skills in mildly and clinically depressed university students. J Consult Clin Psychol 1979;47:86–95. Search PubMed
• D'Zurilla T, Nezu A. Social problem solving in adults. In: Kendall P, editor. Advances in cognitive-behavioural research and therapy. New York: Academic Press, 1982. p. 201–74. Search PubMed
• Hegel M, Barrett J, Oxman T. Training therapists in problem-solving treatment of depressive disorders in primary care: lessons learned from the: "Treatment Effectiveness Project". Fam Syst Health 2000;18:423–35. Search PubMed
• Mynors-Wallis LM, Gath DH, Lloyd-Thomas AR, Tomlinson D. Randomised control trial comparing problem solving treatment with Amitryptyline and placebo for major depression in primary care. BMJ 1995;310:441–5. Search PubMed
• Mynors-Wallis LM, Gath DH, Day A, Baker F. Randomised controlled trial of problem solving treatment, antidepressant medication, and combined treatment for major depression in primary care. BMJ 2000;320:26–30. Search PubMed
• Bell A, D'Zurilla. Problem-solving therapy for depression: a meta-analysis. Clin Psychol Rev 2009;29:348–53. Search PubMed
• Mynors-Wallis L Problem solving treatment for anxiety and depression. Oxford: OUP, 2005. Search PubMed
• Seekles W, van Straten A, Beekman A, van Marwijk H, Cuijpers P. Effectiveness of guided self-help for depression and anxiety disorders in primary care: a pragmatic randomized controlled trial. Psychiatry Res 2011;187:113–20. Search PubMed
• Mynors- Wallis L. Does problem-solving treatment work through resolving problems? Psychol Med 2002;32:1315–9. Search PubMed
• Pierce D, Gunn J. GPs' use of problem solving therapy for depression: a qualitative study of barriers to and enablers of evidence based care. BMC Fam Pract 2007;8:24. Search PubMed
• Pierce D, Gunn J. Using problem solving therapy in general practice. Aust Fam Physician 2007;36:230–3. Search PubMed
• Pierce D, Gunn J. Depression in general practice, consultation duration and problem solving therapy. Aust Fam Physician 2011;40:334–6. Search PubMed
• Blashki G, Morgan H, Hickie I, Sumich H, Davenport T. Structured problem solving in general practice. Aust Fam Physician 2003;32:836–42. Search PubMed
• SPHERE a national mental health project. Available at www.spheregp.com.au [Accessed 17 April 2012]. Search PubMed

Also in this issue: Psychological strategies

Professional

Printed from Australian Family Physician - https://www.racgp.org.au/afp/2012/september/problem-solving-therapy © The Australian College of General Practitioners www.racgp.org.au

• Presidential Message
• Nominations/Elections
• Past Presidents
• Member Spotlight
• Fellow List
• Fellowship Nominations
• Current Awardees
• Award Nominations
• SCP Mentoring Program
• SCP Book Club
• Pub Fee & Certificate Purchases
• LEAD Program
• Introduction
• Find a Treatment
• Submit Proposal
• Dissemination and Implementation
• Diversity Resources
• Graduate School Applicants
• Student Resources
• Early Career Resources
• Principles for Training in Evidence-Based Psychology
• Advances in Psychotherapy
• Announcements
• Submit Blog
• Student Blog
• The Clinical Psychologist
• CP:SP Journal
• APA Convention
• SCP Conference

DIAGNOSIS: Depression TREATMENT: Problem-Solving Therapy for Depression

2015 est status : treatment pending re-evaluation very strong: high-quality evidence that treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings strong: moderate- to high-quality evidence that treatment improves symptoms or functional outcomes; not a high risk of harm; reasonable use of resources weak: low or very low-quality evidence that treatment produces clinically meaningful effects on symptoms or functional outcomes; gains from the treatment may not warrant resources involved insufficient evidence: no meta-analytic study could be identified insufficient evidence: existing meta-analyses are not of sufficient quality treatment pending re-evaluation, 1998 est status : strong research support strong: support from two well-designed studies conducted by independent investigators. modest: support from one well-designed study or several adequately designed studies. controversial: conflicting results, or claims regarding mechanisms are unsupported., strength of research support.

Find a Therapist specializing in Problem-Solving Therapy for Depression List your practice

Brief Summary

• Basic premise:  the manner in which people historically and currently cope with extant stressful events via effective social problem solving may affect the degree to which they will experience psychological distress
• Essence of therapy: Contemporary Problem-Solving Therapy, or PST, is a transdiagnostic intervention, generally considered to be under a cognitive-behavioral umbrella, that increases adaptive adjustment to life problems and stress by training individuals in several affective, cognitive, and behavioral tools. The training is aimed at several barriers to effective problem solving. Through experiential practice, PST helps people to train their brains to overcome common barriers to the way they react to and attempt to solve real-life problems.
• Length : approx. 12 sessions; however, effective changes have been observed in PST programs with as few as 4 sessions and may extend to long-term intervention when individuals have long-term and inflexible problem-solving styles or a high degree of emotional dysregulation.

Treatment Resources

Editors: Alexandra Greenfield, MS

Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice

Treatment Manuals / Outlines

Treatment manuals.

Treatment manuals available upon request for patients with depression and breast cancer, depression and heart failure, depression and hypertension, and veterans with housing instability (contact Dr. Arthur Nezu )

Books Available for Purchase Through External Sites

• Problem-Solving Therapy: A Treatment Manual (Nezu, Nezu, & D’Zurilla)

Measures, Handouts and Worksheets

• Problem-Solving Therapy Instructional Materials and Patient Handouts (Nezu, Nezu, & D’Zurilla)
• Social Problem-Solving Inventory-Revised (SPSI-R; D’Zurilla, Nezu, & Maydeu-Olivares)

Self-help Books

• Solving Life’s Problems: A 5-Step Guide to Enhanced Well-Being (Nezu, Nezu, & D’Zurilla)

Smartphone Apps

• Moving Forward (US Dept of Veterans Affairs & US Dept of Defense)

Video Demonstrations

Videos available for purchase through external sites.

• Problem-Solving Therapy (APA/Nezu & Nezu)

Clinical Trials

• Efficacy of a social problem-solving therapy approach for unipolar depression (Nezu, 1986)
• Improving depression outcomes in older adults with comorbid medical illness (Harpole et al., 2005)
• Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial (Unützer et al., 2002)
• Behavioral activation and problem-solving therapy for depressed breast cancer patients: Preliminary support for decreased suicidal ideation (Hopko et al., 2013)
• Effects of problem solving therapy on mental health outcomes in family caregivers of persons with a new diagnosis of mild cognitive impairment or early dementia: A randomized controlled trial (Garand et al., 2013)
• Problem-solving training for family caregivers of persons with traumatic brain injuries: A randomized controlled trial (Rivera et al., 2008)
• Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: Effect on disability (Alexopoulos et al., 2011)
• Six-month postintervention depression and disability outcomes of in-home telehealth problem-solving therapy for depressed, low-income, homebound older adults (Choi et al., 2014)
• Randomized controlled trial of collaborative care management of depression among low-income patients with cancer (Ell et al., 2008)
• The Pathways Study: A randomized trial of collaborative care in patients with diabetes and depression (Katon et al., 2004)
• Problem solving treatment and group psychoeducation for depression: Multicentre randomised controlled trial (Dowrick et al., 2000)
• Escitalopram and problem-solving therapy for prevention of poststroke depression: A randomized controlled trial (Robinson et al., 2000)
• Problem-solving therapy for relapse prevention in depression (Nezu & Nezu, 2010)
• Social problem-solving therapy for unipolar depression: An initial dismantling investigation (Nezu & Perri, 1989)
• Project Genesis: Assessing the efficacy of problem-solving therapy for distressed adult cancer patients (Nezu et al., 2003)

Meta-analyses and Systematic Reviews

• The efficacy of problem solving therapy in reducing mental and physical health problems: A meta-analysis (Malouff, Thorsteinsson, & Schutte, 2007)
• Problem solving therapies for depression: A meta-analysis (Cuijpers, van Straten, & Warmerdam, 2007)
• Problem-solving therapy for depression: A meta-analysis (Bell & D’Zurilla, 2009)
• Brief psychological therapies for anxiety and depression in primary care: Meta-analysis and meta-regression (Cape et al., 2010)
• Brief psychotherapy for depression: A systematic review and meta-analysis (Nieuwsma et al., 2012)
• Comparative efficacy of seven psychotherapeutic interventions for patients with depression: A network meta-analysis (Barth et al., 2013)
• Problem-solving therapy for depression in adults: A systematic review (Gellis & Kenaley, 2008)

Other Treatment Resources

• Moving Forward (free, interactive, 6-hour web program; US Dept of Veterans Affairs & US Dept of Defense)
• Social problem solving as a risk factor for depression (Nezu, Nezu, & Clark, 2008)
• Depression treatment for homebound medically ill older adults: Using evidence-based problem-solving therapy (Gellis & Nezu, 2011)

Thank you for supporting the Society of Clinical Psychology. To enhance our membership benefits, we are requesting that members fill out their profile in full. This will help the Division to gather appropriate data to provide you with the best benefits. You will be able to access all other areas of the website, once your profile is submitted. Thank you and please feel free to email the Central Office at  [email protected] if you have any questions

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• HHS Author Manuscripts

Problem-Solving Therapy in the Elderly

Dimitris n. kiosses.

Weill-Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College

George S. Alexopoulos

Opinion statement.

We systematically reviewed randomized clinical trials of problem-solving therapy (PST) in older adults. Our results indicate that PST led to greater reduction in depressive symptoms of late-life major depression than supportive therapy (ST) and reminiscence therapy. PST resulted in reductions in depression comparable with those of paroxetine and placebo in patients with minor depression and dysthymia, although paroxetine led to greater reductions than placebo. In home health care, PST was more effective than usual care in reducing symptoms of depression in undiagnosed patients. PST reduced disability more than ST in patients with major depression and executive dysfunction. Preliminary data suggest that a home-delivered adaptation of PST that includes environmental adaptations and caregiver involvement is efficacious in reducing disability in depressed patients with advanced cognitive impairment or early dementia. In patients with macular degeneration, PST led to improvement in vision-related disability comparable to that of ST, but PST led to greater improvement in measures of vision-related quality of life. Among stroke patients, PST participants were less likely to develop a major or minor depressive episode than those receiving placebo treatment, although the results were not sustained in a more conservative statistical analysis. Among patients with macular degeneration, PST participants had significantly lower 2-month incidence rates of major depression than usual care participants and were less likely to suffer persistent depression at 6 months. Finally, among stroke patients, PST participants were less likely to develop apathy than those receiving placebo treatment. PST also has been delivered via phone, Internet, and videophone, and there is evidence of feasibility and acceptability. Further, preliminary data indicate that PST delivered through the Internet resulted in a reduction in depression comparable with that of in-person PST in home-care patients. PST delivered via videophone results in an improvement in hospice caregivers' quality of life and a reduction in anxiety comparable to those of in-person PST. PST-treated patients with cognitive impairment may require additional compensatory strategies, such as written notes, memory devices, environmental adaptations, and caregiver involvement.

Introduction

Late-life depression worsens the outcomes of medical illnesses, promotes disability, increases expense, and complicates care by clouding the clinical picture and undermining treatment adherence, yet responds only modestly to pharmacotherapy [ 1 ]. Problem-solving therapy (PST) is a psychotherapy that has been used widely in psychiatry. Meta-analyses have highlighted the use of PST in a variety of conditions, including depressive disorders, conduct disorders, obesity, and substance abuse, across different populations (including children and young and older adults) and settings (including outpatient, home care, and primary care), and with different outcomes (including mental and physical health and quality of life) [ 2 , 3 ].

PST has two premises: 1) Finding the best possible solution to current everyday problems may reduce the experience of stress and improve peoples' lives, and 2) teaching people problem-solving skills will help them solve future problems. Because older adults experience many stressors in everyday life as a result of medical illnesses, losses, disability, and cognitive impairment, a hands-on approach using discrete and easily taught steps to solve problems is appealing and practical. PST includes the following steps: problem orientation, problem definition, generation of solutions (brainstorming), evaluations of solutions, selection of the best possible solution, and solution implementation and evaluation [ 4 , 5 ]. PST adaptations have been created for different groups of older adults (e.g., PST-ED for depressed patients with executive dysfunction and PATH for homebound depressed patients with advanced cognitive impairment) and settings (PST-PC [PST for primary care] and PST-HC [PST for home health care]).

In the past 5 years, an increasing number of articles utilizing PST for older adults has been reported ( Table 1 ). Our systematic review focuses on randomized clinical trials (RCTs) of PST in older adults, because RCTs are the state of the art for evidence-based practice and can provide class I and II levels of evidence. PST treatment studies focus on reducing depression and improving functioning and quality of life, whereas PST prevention studies concentrate on delaying the onset of major or minor depression.

CHS-PCF, Cardiovascular Health Study–Phenotypic Classification of Frailty; EN, exercise and nutrition program; MDD, major depressive disorder; NR, ; PATH, problem adaptation therapy; PBO, placebo; PST, problem-solving therapy; PST-HC, problem-solving therapy–home care; PST-PC, problem-solving therapy–primary care; RT, reminiscence therapy; ST, supportive therapy; ST-CI, supportive therapy for cognitively impaired older adults; TS, telephone support calls; UC, usual care; UC+E, usual care plus education; WLC, waiting-list condition.

Finally, ongoing clinical trials, not included in the current review, focus on using PST or adaptations of PST to a) reduce depression in low-income, homebound [ 6 ], medically ill older adults [ 7 , 8 ] and opiate abusers [ 9 ] or b) prevent the onset of depressive episodes in high-risk elders [ 10 ].

We searched PubMed (1966–2013), PsycNET (1840–2013), and Cochrane databases, emphasizing studies from the past 5 years. The searches were conducted using the following keywords: “problem solving therapy,” “PST,” “old*,” and “eld*” (the asterisk denotes any combination of the word). In addition, we selected appropriate studies from previously published meta-analyses and reviews. Inclusion criteria of studies were a) an RCT using problem-solving therapy [ 4 , 5 ], b) published in English, and c) with the average participant 60 years old or older. This review does not include interventions that included PST as only one aspect or step of the treatment (e.g., IMPACT, PEARL, or other stepped-cared programs), because PST was given in combination with other depression interventions and the relative effect of PST could not be determined. We identified 734 abstracts and potential articles through our searches, 15 of which were original RCTs that met our criteria; of those, 12 were published in the past 5 years (see Table 1 for the characteristics of the 15 RCTs). Two of 15 were prevention studies in patients with macular degeneration and stroke. The following treatment options are based mainly on results from the analyses of primary outcomes.

Diagnosed major depression

The results are based on four studies of PST [ 11• class I study, 12 – 14 ]. Two multisite studies [ 11• , 12 , 15 ] used a PST adaptation for depressed patients with executive dysfunction (PST-ED) and another study used a PST adaptation (PATH) for depressed patients with advanced cognitive impairment including dementia [ 14 ]. All studies used depression treatment as a control condition (reminiscence therapy [RT] [ 13 ]; supportive therapy [ST] [ 11• class I study, 12 , 14 ].

Despite the strong control condition, PST showed significantly greater reduction in depression post treatment. In one study [ 13 ], the benefits of group PST vs. group RT were maintained at 24 weeks.

Standard procedure

• PST-ED [ 11• class I study, 12 ]: 12 sessions in 12 weeks delivered by doctoral-level clinical psychologists and licensed social workers.
• Home-delivered PATH (problem adaptation therapy) [ 14 ]: 12 sessions in 12 weeks delivered by doctoral-level clinical psychologists and licensed social workers.
• PST [ 13 ]: 12 weekly group sessions delivered by advanced graduate students in clinical psychology.

Special points

• Depressed older adults with executive dysfunction: Participants in PST-ED had a significantly greater reduction in depression than participants in ST over 12 weeks in two multisite studies. Cohen's d ranged from 1.08 [ 12 ] to 0.48 [ 11• class I study]. However, Cohen's d for the 2003 study by Alexopoulos et al. [ 12 ] must be interpreted with caution because of the small sample size.
• Depressed older adults with advanced cognitive impairment: Participants in home-delivered PATH had a significantly greater reduction in depression than participants in home-delivered ST. Cohen's d was 0.77, but it also must be interpreted with caution considering the small sample size (N = 30) [ 14 ].
• Participants in group PST show a greater reduction in depression at 3 months (post treatment) than participants in group RT and those in the wait-list control condition. Estimated Cohen's d between PST vs. RT was 1.08.

Minor depression, dysthymia, or depression symptoms

The results are based on three studies of PST-PC [ 16• class I study] in minor depression or dysthymia and PST-HC [ 17 , 18 ] in depression in home-care patients. Compared with usual care, PST had a greater reduction in depression in home-care patients; however, compared with paroxetine or placebo, PST had a reduction in depression similar to that of paroxetine and placebo in patients with dysthymia and minor depression.

• PST-PC: Six sessions in 11 weeks delivered by doctoral-level psychologists, social workers, and counselors with master's degrees.
• PST-HC: Six sessions in 6 [ 18 ] or 8 weeks [ 17 ] delivered by master's-level social workers.
• PST-PC participants had a reduction in depression comparable to that of participants in the placebo or paroxetine group among patients with dysthymia or minor depression.
• Among home-care patients with subthreshold depression and cardiovascular disease, participants in PST-HC had a significantly greater reduction in depression than usual-care participants.
• Among home-care patients with significant depressive symptoms, participants in PST-HC had a greater reduction in depression and greater improvement in quality of life over the course of 6 months than usual-care participants.

Prevention of depression and apathy

The results are based on two studies of prevention in patients with macular degeneration ([ 19• ] and [ 20 ] used the same sample) and stroke patients ([ 21• ] and [ 22 ] used the same sample). In one study, the outcome was prevention of a major depressive episode [ 19• class I study, 20 ], whereas in the other, the outcome was prevention of a major or minor episode of depression [ 21• class I study] or prevention of onset of apathy [ 22 ].

Stroke patients participating in PST were less likely to develop a major or minor depressive episode than those in the placebo group. This difference became nonsignificant in a more conservative analysis, which assumed that baseline patients who did not continue the study would have developed depression. Among patients with macular degeneration, PST participants had significantly lower 2-month incidence rates of major depression than usual-care participants and were less likely to suffer persistent depression at 6 months. In a recent analysis of the study sample of Robinson et al. [ 21• ] of the subjects who did not exhibit apathy at baseline, escitalopram or PST was significantly more effective in preventing new onset of apathy following stroke compared with placebo [ 22 ].

• Patients with macular degeneration [ 19• class I study, 20 ]: six sessions in 8 weeks delivered by nurses and master's-level counselors.
• Stroke patients [ 21• class I study, 22 ]: six sessions in the first 12 weeks and six reinforcement sessions in the following 9 months.
• Stroke study [ 21• class I study]: placebo participants were 2.2 times more likely than PST participants and 4.5 times more likely than escitalopram participants to develop depression.
• Stroke study [ 22 ] (outcome: onset of apathy): placebo participants were 3.47 times more likely than escitalopram patients and 1.84 times more likely than PST patients to develop apathy.

Functioning, frailty, and quality of life

The results are based on three studies of PST [ 12 , 15 , 14 ]. Two multisite studies [ 12 , 15 ] used PST-ED; the other study used PATH for depressed patients with advanced cognitive impairment including dementia [ 14 ]. All studies used depression treatment as a control condition (ST) [ 12 , 14 , 15 ].

PST participants had significantly greater reduction in disability at 12 weeks than ST participants in all three studies. In one study [ 15 ], the benefits of PST vs. ST were sustained between 12 and 36 weeks.

• PST-ED [ 12 , 15 ]: 12 sessions in 12 weeks delivered by doctoral-level clinical psychologists and licensed social workers.
• Home-delivered PATH (problem adaptation therapy) [ 14 ]: 12 sessions in 12 weeks delivered by a doctoral-level clinical psychologist and licensed social worker.

Exploratory analyses revealed that disability mediated the effects of depression at the end of treatment (12 weeks).

Targeted vision function

The results are based on only one study of patients with age-related macular degeneration [ 23 ]. PST participants did not have greater improvement in vision function than ST participants in the primary outcome measure at 3 months (end of treatment) or 6 months but had greater improvement in the secondary outcome of vision-related quality of life [ 23 ].

• Six sessions in 12 weeks delivered by therapists with a bachelor's or master's degree.
• PST targeting functional problems of vision loss and reducing the difficulty of vision-dependent tasks did not show significant improvement over ST at 3 and 6 months after baseline [ 23 ].
• PST showed greater improvement in the secondary outcome of vision-related quality of life compared with ST.

The results are based on only one study of frail community older adults [ 24 ]. Participants receiving PST did not have significant improvement in any of the frailty measures: weight loss, exhaustion, low activity level, slowness, and weakness.

• Six sessions in 3 months delivered by trained case managers.

Quality of life

The results are based on one study [ 25 ] focusing on a group of outpatients who screened positive for psychological problems by the Chinese version of the Hospital Anxiety and Depression Scale. PST-PC participants had improvement in health-related quality of life comparable with that of placebo participants who watched health education videos.

• PST-PC: three sessions in 6 weeks delivered by primary care doctors.

Although participants in PST-PC had significant improvement in the role-emotional and mental components of the SF-36 Health-Related Quality of Life assessment at week 6, whereas the placebo group did not, a mixed-effects analysis accounting for potential covariates and baseline measures did not show any difference between the two groups in any outcome.

Alternative deliveries

• Older adults who are homebound or live in rural areas may need alternative ways to deliver PST, such as phone, videophone, or Internet.
• Special considerations are required for patients with hearing and vision problems as well as patients with cognitive impairment.

The results are based on three studies of PST delivered through telephone [ 26 ], videophone [ 27 ], or Skype [ 28 ]. The subjects for each study were cancer patients [ 26 ], hospice caregivers [ 27 ], and home-care patients with depression [ 28 ].

• Telephone: varied number of sessions (based on negotiation with the patient) in 3 months delivered by nurse counselors.
• Videophone: three sessions in 20 days.
• Skype: six weekly sessions.

Special Points

• Delivering PST through phone, videophone, and Internet is feasible and acceptable to vulnerable older adults.
• PST counseling delivered over the phone to cancer patients showed greater improvement in certain coping areas than usual care, but there were no significant differences in reduction of depression or improvement in psychosocial adjustment.
• Videophone-delivered PST showed improvement in caregiver quality of life and reduction in anxiety compared with in-person PST.
• PST delivered through Skype demonstrated results comparable with those of in-person PST in homebound older adults, and both PST conditions showed a greater reduction in depression compared with a condition of support calls [ 28 ]. Among patients in the sample, 67% had major depressive disorder, 29% had minor depression, and 4% had dysthymia.

Considerations

Length of treatment.

• Ten of 15 studies had between 6 and 12 PST sessions in 12 weeks.
• The two prevention studies had six sessions in 8 or 12 weeks, and one of them [ 21• , 22 ] had six additional sessions in the following 9 months.

Therapists and treatment fidelity

• Therapists included those with a bachelor's or master's degree in social science, master's-level social workers, nurse counselors, advanced graduate students in clinical psychology, and doctoral-level clinical psychologists.
• Reviews of recorded sessions and notes were performed in 9 of 15 studies.

Race, education, and socioeconomic status

• The majority of participants in most studies were older Caucasian adults with at least 12 years of education. Two studies were conducted in Hong Kong [ 25 ] and in Taiwan [ 24 ]. Future research will focus on racially diverse participants, as well as those with limited education and low socioeconomic status.

Cognitive impairment and dementia

• Older adults with cognitive impairment also may need compensatory strategies, including written session notes, memory devices, environmental adaptations, and caregiver participation, to help them with their cognitive deficits.

Acknowledgments

This paper was supported in part by grants from the National Institute of Mental Health (R01 MH075897, R01 MH076829, and P30 MH085943 [to George S. Alexopoulos] and R01 MH091045 [to Dimitris N. Kiosses]) and an Alzheimer's Association Investigator Initiated Research Grant (to Dimitris N. Kiosses).

George S. Alexopoulos has served as a consultant for Pfizer and Otsuka, has received grants from Forest Laboratories, and has received payment for lectures, including service on speakers bureaus, from AstraZeneca, Avanir Pharmaceuticals, Novartis, and Sunovion.

Compliance with Ethics Guidelines: Conflict of Interest : Dimitris N. Kiosses declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent : This article does not contain any studies with human or animal subjects performed by any of the authors.

Contributor Information

Dimitris N. Kiosses, Weill-Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College.

George S. Alexopoulos, Weill-Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College.

Papers of particular interest have been highlighted as:

• Of importance

Problem Solving Therapy: PST in 3 Steps

• December 18, 2021
• No Comments

Problem solving therapy is a psychotherapy that focuses on the cognitive and emotional processes of an individual with the aim to solve their problems. The aim of this blog post is to explore how it works, who can benefit from it and what are its benefits. Problem solving therapy is a cognitive behavioral therapeutic approach that focuses on the present and future rather than the past.

Problem Solving Therapy  Steps

What is Problem Solving Therapy?

Problem solving therapy is a cognitive-behavioral technique intended to enhance an individual’s ability to deal with traumatic life events. The premise of problem solving therapy is that people cannot change what has happened, but they can learn to accept it and take control of their life.

Who developed Problem Solving Therapy?

Problem-solving therapy was developed by Jeffrey Young in 1987 as an integration of cognitive psychotherapy, rational emotive behavior therapy, and developmental theories such as Piaget’s theory of moral development.

Regardless of the time, the existence of a problem is often perceived as troubling. The problem is, in the most general sense, “the differences and obstacles between the current situation and the desired situation” (Nezu, Nezu and D ‘Zurilla, 2007).

According to D ‘Zurilla, Nezu, and Maydeu-Olivares’, who suggested the concept of social problem solving based on the fact that a human being is a social entity, the problem is “when a person needs to react to adapt in case of any life situation or task that needs to be accomplished. It occurs when there is no obvious or obviously effective response depending on the presence of obstacles. In fact, the problem arises when a person makes a “mistake in showing the effective and appropriate response” or “a difference between what he is currently in and what he wants to be”.

The existence of a problematic situation inevitably requires an effort for a solution. Therefore, the problem situation requires coping, dealing with obstacles, and more effort and especially change. In other words, it is necessary to act and change in order to reach the desired situation from the current situation. Changing can also be perceived as a difficult and disturbing process. At this point, people’s problem-solving styles may differ, whether effective or ineffective.

D’Zurilla and Nezu (1990) define social problem solving as the cognitive, affective, and behavioral process that the individual attempts and produces to find an effective way to cope with problem situations in daily life.

The main purpose of problem solving therapy is to teach people how to approach the problems they face and the strategies they will follow to solve the problems. From this point of view, problem solving therapy aims to both treat mental problems caused by the failure of the problems and prevent the occurrence of psychological problems.

Problem-solving therapy recognizes that any problems we experience are part of our lives. We can be sick at any moment, lose someone we love, be abandoned by our beloved, be fired from our job, be humiliated by others, suffer injustice. So the dream of a smooth world is unrealistic. The important thing is how we deal with them rather than the existence of problems.

The main starting point of problem solving therapy is that the problem solving skills of people who have mental problems are not sufficient and effective. Problem solving therapy, which is a cognitive-behavioral therapy model, focuses on the thoughts and behaviors of people. This method acknowledges that functional changes in thoughts and behaviors will be effective in the treatment of psychological problems.

Problem solving therapy is a cognitive-behavioral method. The importance of this is that the effectiveness of therapy has been proven by experimental studies. Scientific studies have shown that the inadequacies of people in their problem solving abilities are effective both in forming and maintaining psychopathologies. Therefore, problem solving therapy can be used both to overcome psychological problems caused by the problems experienced and to effectively deal with the problems.

Why Do We Need Problem Solving Therapy?

Some people may find it difficult to solve problems on their own, which can lead to frustration, anxiety, and even depression. Problem-solving therapy is a type of talk therapy that can help people learn how to solve problems in a healthy way.

The therapist will work with the patient to identify and understand the problem, brainstorm possible solutions, select the best solution, and put the plan into action. This type of therapy can be helpful for people who have difficulty coping with stress or who are dealing with a major life change.

Working with a therapist is beneficial because they will have access to tools that allow them to find the root causes of the problem. 

There is also often a misconnection in early childhood that leads people to seek this type of therapy which, again means they’re less likely to try and self-solve their own issues.

Effectiveness of Problem Solving Theory

Problem-solving therapy was created to assist customers to solve problems and improve their lives. It was later modified to focus on treating clinical depression specifically. Today, the majority of the research on problem-solving therapy is concerned with how effectively it can help people get over sadness.

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

• Elder people
• People coping with severe illnesses like cancer

Problem-solving therapy has also been found to be beneficial as a brief therapy for depression, with benefits seen after just six to eight sessions with a therapist or another healthcare professional. This may make it an appealing alternative for those who are unable to commit to a longer depression treatment.

Last Updated on December 10, 2022 by Lucas Berg

Your email address will not be published. Required fields are marked *

Table of Contents

Related post, what is pmdd and how does it affect mental health, the myth of napoleon complex in women and 9 most successful short women celebrities, family counseling services: everything you should know, privacy overview.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

Problem solving therapy for the depression-executive dysfunction syndrome of late life

Affiliation.

• 1 Department of Psychiatry, Weill Cornell Medical College, White Plains, NY 10605, USA. [email protected]
• PMID: 18213605
• DOI: 10.1002/gps.1988

Background: The 'depression executive dysfunction syndrome' afflicts a considerable number of depressed elderly patients and may be resistant to conventional pharmacotherapy. Non-pharmacological approaches addressing their behavioral deficits may reduce disability and experienced stress and improve depression.

Methods: This paper focuses on problem solving therapy (PST) because it targets concrete problems that can be understood by patients with executive dysfunction and trains patients to address them using an easy to comprehend structured approach.

Results: We suggest that PST is a suitable treatment for patients with the depression-executive dysfunction syndrome because it has been found effective in uncomplicated geriatric major depression and in other psychiatric disorders accompanied by severe executive dysfunction. Furthermore, PST can address specific clinical features of depressed patients with executive dysfunction, especially when modified to address difficulties with affect regulation, initiation and perseveration.

Conclusions: A preliminary study suggests that appropriately modified PST improves problem solving skills, depression and disability in elderly patients with the depression-executive dysfunction syndrome of late life. If these findings are confirmed, PST may become a therapeutic option for a large group of depressed elderly patients likely to be drug resistant.

PubMed Disclaimer

Similar articles

• [Depression and frontal dysfunction: risks for the elderly?]. Thomas P, Hazif Thomas C, Billon R, Peix R, Faugeron P, Clément JP. Thomas P, et al. Encephale. 2009 Sep;35(4):361-9. doi: 10.1016/j.encep.2008.03.012. Epub 2008 Oct 1. Encephale. 2009. PMID: 19748373 French.
• [Impairment of executive function in elderly patients with major unipolar depression: influence of psychomotor retardation]. Baudic S, Benisty S, Dalla Barba G, Traykov L. Baudic S, et al. Psychol Neuropsychiatr Vieil. 2007 Mar;5(1):65-71. Psychol Neuropsychiatr Vieil. 2007. PMID: 17412666 French.
• Attention and executive functions in remitted major depression patients. Paelecke-Habermann Y, Pohl J, Leplow B. Paelecke-Habermann Y, et al. J Affect Disord. 2005 Dec;89(1-3):125-35. doi: 10.1016/j.jad.2005.09.006. Epub 2005 Dec 1. J Affect Disord. 2005. PMID: 16324752
• Executive dysfunction in major depressive disorder. DeBattista C. DeBattista C. Expert Rev Neurother. 2005 Jan;5(1):79-83. doi: 10.1586/14737175.5.1.79. Expert Rev Neurother. 2005. PMID: 15853477 Review.
• [Executive functioning in unipolar depression: a review]. Fossati P, Ergis AM, Allilaire JF. Fossati P, et al. Encephale. 2002 Mar-Apr;28(2):97-107. Encephale. 2002. PMID: 11972136 Review. French.
• Cognitive outcomes are differentially associated with depression severity trajectories during psychotherapy treatment for late life major depressive disorder. Kassel MT, Rhodes E, Insel PS, Woodworth K, Garrison-Diehn C, Satre DD, Nelson JC, Tosun D, Mackin RS. Kassel MT, et al. Int J Geriatr Psychiatry. 2022 Aug;37(8):10.1002/gps.5779. doi: 10.1002/gps.5779. Int J Geriatr Psychiatry. 2022. PMID: 35822633 Free PMC article.
• Late Life Depression: The Essentials and the Essential Distinctions. Husain-Krautter S, Ellison JM. Husain-Krautter S, et al. Focus (Am Psychiatr Publ). 2021 Jul;19(3):282-293. doi: 10.1176/appi.focus.20210006. Epub 2021 Jul 9. Focus (Am Psychiatr Publ). 2021. PMID: 34690594 Free PMC article.
• Problem-Solving Therapy Effects on Suicidal Ideation: The Role of Reduction in Functional Disability. Szanto K, Gujral S. Szanto K, et al. Am J Geriatr Psychiatry. 2021 Jun;29(6):562-564. doi: 10.1016/j.jagp.2020.10.017. Epub 2020 Nov 4. Am J Geriatr Psychiatry. 2021. PMID: 33183949 Free PMC article. No abstract available.
• Interpersonal Psychotherapy for Late-life Depression and its Potential Application in China. Xu H, Koszycki D. Xu H, et al. Neuropsychiatr Dis Treat. 2020 Aug 7;16:1919-1928. doi: 10.2147/NDT.S248027. eCollection 2020. Neuropsychiatr Dis Treat. 2020. PMID: 32821108 Free PMC article. Review.
• Advances in Pharmacotherapy of Late-Life Depression. Beyer JL, Johnson KG. Beyer JL, et al. Curr Psychiatry Rep. 2018 Apr 7;20(5):34. doi: 10.1007/s11920-018-0899-6. Curr Psychiatry Rep. 2018. PMID: 29627920 Review.

Publication types

• Search in MeSH

Grants and funding

• K23 MH 69784/MH/NIMH NIH HHS/United States
• K24 MH 074717/MH/NIMH NIH HHS/United States
• MH 51956/MH/NIMH NIH HHS/United States
• P30 MH 68638/MH/NIMH NIH HHS/United States
• R25 MH 074500/MH/NIMH NIH HHS/United States
• UD2 SM 52643/SM/CMHS SAMHSA HHS/United States

LinkOut - more resources

Full text sources.

• Ovid Technologies, Inc.
• Genetic Alliance

• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.