problem solving therapy pdf

Problem-Solving Therapy

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• First Online: 18 November 2015
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• Sherry A. Beaudreau 2 , 3 , 4 ,
• Christine E. Gould 2 , 3 ,
• Erin Sakai 2 &
• J. W. Terri Huh 2 , 3  

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Behavioral intervention ; Skills-based therapy ; Treatment

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

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Sherry A. Beaudreau, Christine E. Gould, Erin Sakai & J. W. Terri Huh

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Beaudreau, S.A., Gould, C.E., Sakai, E., Huh, J.W.T. (2015). Problem-Solving Therapy. In: Pachana, N. (eds) Encyclopedia of Geropsychology. Springer, Singapore. https://doi.org/10.1007/978-981-287-080-3_90-1

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

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

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

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

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

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

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

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

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

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

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

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

Cognitive Behavioral Therapy

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

Posted February 2, 2022 | Reviewed by Ekua Hagan

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

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

The problem-solving technique

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

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

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

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

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

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

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

Advantages of the problem-solving technique

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

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

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

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

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

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10 Best Problem-Solving Therapy Worksheets & Activities

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

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

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

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

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

This Article Contains:

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

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

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

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

Can it help with depression?

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

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

The major concepts

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

PST is based on two overlapping models:

Social problem-solving model

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

The model includes three central concepts:

• Social problem-solving
• The problem
• The solution

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

Relational problem-solving model

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

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

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

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

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

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

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

Problem-solving therapy – Baycrest

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

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

Is PPT appropriate?

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

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

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

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

Five problem-solving steps

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

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

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

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

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Positive self-statements

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

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

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

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.

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Problem Solving Therapy Improves Effortful Cognition in Major Depression

Chenguang jiang.

1 Wuxi Mental Health Center Affiliated to Nanjing Medical University, Wuxi, China

Hongliang Zhou

2 Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China

Zhenhe Zhou

Associated data.

The datasets generated for this study are available on request to the corresponding author.

Background: Effortful cognition processing is an intentionally initiated sequence of cognitive activities, which may supply top-down and goal-oriented reassessment of specific stimuli to regulate specific state-driven responses contextually, whereas automatic cognitive processing is a sequence of cognitive activities that is automatically initiated in response to an input configuration. The effortful–automatic perspective has implications for understanding the nature of the clinical features of major depressions. The aim of this study was to investigate the influence of problem solving therapy (PST) on effortful cognition in major depression (MD).

Methods: The participants included an antidepressant treatment (AT) group ( n = 31) or the combined antidepressant treatment and PST (CATP) group ( n = 32) and healthy controls (HCs) ( n = 30). Hamilton Depression Rating Scale (HAMD, 17-item version) and the face–vignette task (FVT) were measured for AT group and CATP group at baseline (before the first intervention) and after 12 weeks of interventions. The HC group was assessed with the FVT only once. At baseline, both patients and HCs were required to complete the basic facial emotion identification test (BFEIT).

Results: The emotion identification accuracy of the HC group was higher than that of the patient group when they performed BFEIT; patients with MD present poor FVT performances; compared to the antidepressant treatment, PST plus antidepressant treatment decreased HAMD scores and improved FVT performances in patients with MD.

Conclusions: Patients with MD present effortful cognition dysfunction, and PST can improve effortful cognitive dysfunction. These findings suggest that the measurement of effortful cognition might be one of the indexes for the therapeutic effect of PST in MD.

Introduction

Major depression (MD) is a common mental disorder with a higher disability rate, affecting 10–15% of the worldwide population every year. To date, some antidepressants, including several typical antidepressants and several atypical antidepressants, have been used to treat major depression; however, only 60–70% of patients respond to antidepressant treatment. Furthermore, 10–30% of these patients exhibit treatment-resistant symptoms such as suicidal thought, a low mood, a decline in interest, and a loss of happiness ( 1 ).

To improve the symptoms of MD, several treatment options have been developed, such as switching therapies, augmentation, combination, optimization, psychotherapies, modified electro-convulsive therapy (MECT), repetitive transcranial magnetic stimulation therapies, deep brain stimulation therapies, vagal nerve stimulation therapies, light-based therapies, acupuncture treatment, and yoga; these approaches have been considered and tailored for individual patients ( 2 – 4 ). Most important for the improvement of depressed patients' symptoms, many studies had reported that physical activity interventions are helpful to improve major depressive disorders because physical activity is associated with many mental health benefits ( 5 – 11 ). Assessments to determine symptom improvement for patients with MD often depend on decreased total Hamilton Depression Rating Scale (HAMD, 17 or 24 items) scores.

Problem solving therapy (PST) belongs to a type of cognitive behavioral therapy that mainly concentrates on training in appropriate problem-solving notions as well as skills. PST has been used for major depression ( 12 – 15 ). It has been confirmed that, in the depressed patient group, PST was equally effective as antidepressant treatments and more effective than no treatment and support or attention control patients ( 16 ). In clinical practice, the effective treatment program of PST in MD includes three aspects: [1] training in a positive problem orientation, [2] training in problem definition and formulation, the generation of alternatives, decision making, and solution implementation and verification, and [3] training in problem orientation plus problem definition and formulation, the generation of alternatives, decision making, and solution implementation and verification ( 16 ).

Cognitive function refers to mental processes involved in working memory, problem-solving, decision-making, the acquisition of knowledge, regulation of information, and reasoning. As a major symptom, cognitive function impairment is acknowledged as a clinical characteristic of major depression. Additionally, many studies of major depression have suggested a role for cognitive measures in predicting those at risk for poor outcomes ( 17 ). A previous study indicated that patients with major depression present negatively valanced emotional symptoms that are accompanied by cognitive deficits, and the emotional processing dysfunctions of the prefrontal cortex might lead to cognitive deficits in patients with MD ( 18 ). Adaptive emotional responding relies on both effortful cognition processing and automatic cognition processing. Effortful cognition processing is a controlled process and refers to an intentionally initiated sequence of cognitive activities, which may supply top-down as well as goal-oriented reassessment of emotional stimuli to regulate emotion-driven responses contextually ( 19 ). Effortful cognition was measured by the face–vignette task (FVT) ( 19 ). Relative to effortful cognitive processing, automatic cognitive processing is a sequence of cognitive activities that is automatically initiated in response to an input configuration ( 20 ). Automatic cognition processing requires near-zero attention for the task at hand and, in many instances, is executed in response to a specific stimulus.

Previous studies have shown that patients with MD present effortful cognitive dysfunction. For example, a previous study reported that, when patients with MD performed two contrasting cognitive tasks ( i.e ., one requiring sustained effort and information processing and the other requiring only superficial information processing that could be accomplished automatically), only the effort-demanding cognitive task was performed poorly ( 21 ). Additionally, two previous studies investigated the functions of automatic and effortful information processing in a visual search paradigm, and the results showed that the patients with MD exhibited longer reaction times on the tasks requiring more effortful information processing than the controls. However, there were no differences on tasks requiring automatic information processing ( 22 , 23 ).

Since cognitive function impairment plays a critical role in MD, the assessment of cognitive function is a better way to determine the treatment effect for MD. The effortful–automatic perspective has implications for understanding the nature of the clinical features of MD. Furthermore, the investigation of the influence of PST on effortful cognition in MD is helpful for improving the present understanding of the therapeutic mechanism and assess the therapeutic effect of PST. To date, no studies of PST on effortful cognition in MD have been reported. In this study, the participants included patients with MD and healthy controls (HCs). The MD group was treated with antidepressants or the combination of antidepressants with PST, and effortful cognition was rated by the FVT. The hypothesis of this study is that depressed patients display poor effortful cognition performance, and PST can improve effortful cognitive dysfunctions. The aim of this study was to investigate the effect of PST on effortful cognition in MD.

Materials and Methods

Time and setting.

This study was conducted in Wuxi Mental Health Center Affiliated to Nanjing Medical University, No. 156 Qianrong Road, Rongxiang Street, Binhu District, Wuxi City, P.R. China, from February 1, 2016 to February 27, 2020.

Diagnostic Approaches and Subjects

A total of 80 patients meeting the American Psychiatric Association's fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for major depression were recruited as the research group. The MD patients were randomly assigned to the antidepressant treatment (AT) group or the combined antidepressant treatment and PST (CATP) group. The allocation schedule was generated by using a list of random numbers. Thirty healthy persons were admitted to the HC group. All HCs had no personal history of mental disorders. Patients with MD were selected from Wuxi Mental Health Center Affiliated to Nanjing Medical University, No. 156 Qianrong Road, Rongxiang Street, Binhu District, Wuxi City, P.R. China; the normal controls were citizens of Wuxi City, Jiangsu Province, P.R. China, recruited by online and local community advertisements. Patients with MD and HC subjects were excluded from the study if they had been diagnosed with nicotine addiction or other psychoactive substance dependence, had suffered any systemic disease that may affect the central nervous system, or had received electroconvulsive therapy (including MECT) in the past 24 weeks. All patients and HC subjects were Chinese. All patients and HC subjects were paid 42.12 Euros plus travel costs.

Seven subjects in AT group and five subjects in CATP group were all diagnosed with bipolar disorder in the follow-up survey, and they were ultimately excluded from this study. Two subjects in AT group and three subjects in CATP group were also excluded from this study because they could not finish the follow-up assessment. Finally, the data from 31 subjects in AT group and 32 subjects in CATP group were used in the statistical analyses.

Measurements of Automatic and Effortful Cognition

Basic facial emotion identification test.

The basic facial emotion identification test (BFEIT) consists of eight examples of each of the seven basic facial emotions, e.g ., happy, angry, sad, fear, surprise, disgust, and calm, which were taken from the Chinese affective picture system ( 24 ). Male and female face pictures were balanced across each emotion category.

Face–Vignette Task

FVT was designed based on an effortful cognitive task that was used in the study on effortful vs . automatic emotional processing in patients with schizophrenia by Patrick et al. ( 19 ). E-Prime 2.0 software (Psychology software tools, INC, USA) was used to implement the experimental procedure. The face pictures were white and black photographs and included six emotional expressions, i.e ., happy, angry, sad, fear, surprise, and disgust, which were taken from the Chinese affective picture system ( 24 ). In each emotion, the male and female faces were equal. Within a given emotion category, the same identity was used only once. The situational vignettes communicated the six special emotions, i.e ., guilty, smug, hopeful, insulted, pain, and determined. Before the experiment, the intended emotion for each story (vignette) was verified by seven undergraduates, and the mean accuracy was 0.91 [standard deviation (SD) = 0.08], and the observed inter-rater reliability κ value was 0.75. The face–story pairs were matched such that each story was inconsistent with the facial expression according to the specially appointed emotional category ( e.g ., a happy facial expression paired with a smug story). Each specific emotion category depended on the situational context (see the listed example in Figure 1 ). The specially appointed face–story pairs included sad vs . guilty, happy vs . smug, fearful vs . painful, angry vs . determined, disgusted vs . insulted, and surprised vs . hopeful. During the FVT, the participants viewed a series of 24 face–story (vignette) pairs and were informed that each facial expression represented the subject of the vignette. The faces and vignettes were presented simultaneously. All participants were required to read the vignettes aloud. In each trial, all participants answered the question accompanied by face–vignette pairs through a specially appointed keypad in a multiple choice pattern. The 13 obtainable choices for each trial were as follows: angry, happy, sad, fearful, disgusted, surprised, smug, guilty, hopeful, determined, pain, insulted as well as no emotion.

Example of a trial on the face–vignette task. The situational vignettes in English are as follows: This is a story about a girl's birthday. The girl stayed in her room. She received a call from her beloved boyfriend: “You're waiting for me at home. I'll bring your favorite flowers to your birthday!” Several minutes later, she heard the knock of her boyfriend's arrival. The question was “What emotion is the person feeling?” Responding with “surprise” will be recorded as a face response and responding with “hopeful” will be recorded as a vignette response. Additionally, any other response will be recorded as a random response.

On the FVT, the responses of the participants were labeled as face responses, vignette responses, and random responses. The response data were converted to proportions, which were used for statistical analysis.

Problem Solving Therapy Procedure

The PST was performed as described in a previous study ( 25 ). All the patients with MD were scheduled for PST, which consists of six sessions administered every other week. The treatment sessions were conducted at the psychological therapy room of the Psychiatry Department. The PST was conducted by six psychotherapists, and visits were conducted by two psychiatric resident physicians. All the psychotherapists owned a therapy handbook and underwent training, including a short theoretical course, role playing in a clinical background as well as watching a training videotape. The PST includes three steps: [1] the patient's symptoms are linked with their problems in daily living, [2] the problems are defined and clarified, and [3] an attempt is made to solve the problems in a structured way. The sessions lasted 1 h for the first visit and half an hour for the subsequent visits.

Clinical Interventions and Clinical Assessment

Two psychiatric residents examined all the participants to confirm or exclude a major depression diagnosis based on DSM-5 criteria and to collect medication and sociodemographic data. A HAMD (17-item version) was applied to assess the depressive severity for patients. A decrease of more than 50% in HAMD (17-item version) scores from baseline to follow-up was defined as a treatment response, and HAMD (17-item version) scores <7 at follow-up were defined as clinical remission.

HAMD (17-item version) and the FVT data were measured for the AT group and CATP group at baseline (before the first intervention, time 1) and after 12 weeks of interventions (time 2). The HC group was assessed using the face–vignette task only once. At baseline, both patients and HCs were required to complete the BFEIT.

Statistical Analysis

Data are presented as mean (SD), and all data were analyzed with Statistical Product and Service Solution 18.0 statistical software (SPSS 18.0, International Business Machines Corporation). Comparisons of the demographic data, basic facial emotion identification test scores, face response proportions, vignette response proportions, and random response proportions at baseline among patients and healthy controls were conducted using the method of one-way analysis of variance (ANOVA) or the chi-square test. Comparisons of HAMD (17-item version) scores, face response proportions, vignette response proportions, and random response proportions between baseline (time 1) and after 12 weeks of interventions (time 2) in the patient group were performed using 2 × 2 repeated-measures ANOVA. In this study, all alpha values of 0.05 were considered as statistically significant throughout. Cohen's d effect sizes were used for t -tests. The cutoff values for Cohen's d 's were defined as trivial effect size when d < 0.19, small effect size when 0.2 < d < 0.49, medium effect size when 0.5 < d < 0.79, and large effect size when d > 0.8. Partial eta-square (η p 2 ) effect sizes were used for F -tests. Similarly, the cutoff values for η p 2 were set as trivial effect size when η p 2 < 0.019, small effect size when 0.02 < η p 2 < 0.059, medium effect size when 0.06 < η p 2 < 0.139, and large effect size when η p 2 > 0.14. Phi (ϕ) effect sizes were used for chi-square test. The cutoff values for ϕ were set as trivial effect size when ϕ < 0.09, small effect size when 0.10 < ϕ < 0.29, medium effect size when 0.30 < ϕ < 0.49, and large effect size when ϕ > 0.50.

The Demographic Data of All Participants

The demographic data of the participants are described in Table 1 . No significant differences were observed in sex ratio, mean age, age range, or mean education years among the AT group, CATP group, and HC group.

Demographic characteristics and clinical data of all participants.

AT, antidepressant treatment; CATP, the combination of antidepressant treatment and PST; HC, healthy control; SD, standard deviation; η p 2 , partial eta-square .

Antidepressant Treatments

In the AT group, 20 patients with MD were antidepressant-naïve, and 11 patients with MD were antidepressant-free (six for at least 24 weeks and five for at least 4 weeks); patients with MD received fluoxetine ( n = 8), paroxetine ( n = 7), fluvoxamine ( n = 7), sertraline ( n = 6), or escitalopram ( n = 3). The mean fluoxetine-equivalent dose was 30.5 (8.8) mg/day. In the CATP group, 19 patients with MD were antidepressant-naïve, and 13 patients with MD were antidepressant-free (eight for at least 24 weeks and five for at least 4 weeks); patients with MD received fluoxetine ( n = 9), paroxetine ( n = 8), fluvoxamine ( n = 8), sertraline ( n = 3), or escitalopram ( n = 4). According to a previous report ( 26 ), the mean fluoxetine-equivalent dose was 30.1 (7.9) mg/day. Neither of the patient groups used concomitant medications.

Comparisons of BFEIT Performance Among the AT Group, CATP Group, and HC Group

As shown in Figure 2 , one-way ANOVA revealed that there were significant differences in BFEIT performance (emotion identification accuracy) among the AT group, CATP group, and HC group ( F 2,90 = 27.729, df = 2, η p 2 = 0.33, p = 0.000). Least square difference tests were performed as post hoc analyses and showed significant differences between the HC group, AT group, and CATP group (all p = 0.000). The emotion identification accuracy of the HC group was higher than that of the AT group or CATP group. However, no significant difference was observed between the AT group and the CATP group ( p = 0.951).

Comparisons of BFEIT performance among the AT group, CATP group, and HC group. BFEIT, basic facial emotion identification test; ATG, antidepressant treatment group; CATPG, the combination of antidepressant treatment and PST group; HC, healthy control; SD, standard deviation.

Comparisons of HAMD (17-Item Version) Scores Before and After Clinical Interventions

As shown in Figure 3 , using HAMD (17-item version) scores as dependent variables, a 2 × 2 repeated-measures ANOVA with group (AT group vs . CATP group) as a between-subjects factor and time point (time 1 vs . time 2) as a within-subjects factor revealed that the interaction effect for group × time point was not significant ( F 1,61 = 1.697, η p 2 = 0.003, p = 0.198); however, the main effect for time point was significant ( F 1,61 = 206.419, η p 2 = 0.35, p = 0.000), and the main effect for group was significant ( F 1,61 = 170.914, η p 2 = 0.18, p = 0.038). The 12-week interventions decreased HAMD (17-item version) scores in the two patient groups.

Comparisons of HAMD scores before and after clinical interventions between the AT group and CATP group. HAMD, Hamilton Depression Rating Scale (17-item version); ATG, antidepressant treatment group; CATPG, the combination of antidepressant treatment and PST group; time 1, baseline; time 2, after 12 weeks of intervention; SD, standard deviation.

There were significant differences in the remission rate between the CATP group (19/32) and the AT group (14/31); the remission rate in the CATP group was higher than that of the AT group (χ 2 = 6.123, ϕ = 0.29, p = 0.028). There were significant differences in the treatment response rate between the CATP group (25/32) and AT group (18/31); the treatment response rate in the CATP group was higher than that of the AT group (χ 2 = 4.370, ϕ = 0.26, p = 0.035).

Comparisons of FVT Performance Among the AT Group, CATP Group, and HC Group

Baseline level.

As shown in Table 2 , one-way ANOVA revealed that there were significant differences in face response proportions and vignette response proportions among the AT group, CATP group, and HC group ( F 2,90 = 27.861, 18.234, all df = 2; η p 2 = 0.32, 0.36, all p = 0.000). Least square difference tests were performed as post hoc analyses and showed significant differences between the HC group and AT group or between the HC group and the CATP group (all p = 0.000). The face response proportions of the HC group were lower than those of the AT group and CATP group, and the vignette response proportions of the HC group were higher than those of the AT group and CATP group. For the above-mentioned two variables, no differences between the AT group and CATP group were observed ( p = 0.951, 0.913).

Face–vignette task performances (%, SD) among the AT group, CATP group, and healthy control group.

AT, antidepressant treatment; CATP, the combination of antidepressant treatment and PST; Time 1, baseline; Time 2, after 12 weeks of interventions; F, face response proportions; V, vignette response proportions; R, random response proportions .

However, there were no significant differences in random response proportions among the AT group, CATP group, and HC group ( F 2,90 = 0.979, df = 2, η p 2 = 0.006, p = 0.380).

Before and After Interventions

As shown in Table 2 , using face response proportions, vignette response proportions, and random response proportions as dependent variables, a 2 × 2 repeated-measures ANOVA with group (AT group vs . CATP group) as the between-subjects factor and time point (time 1 vs . time 2) as the within-subjects factor was performed.

Face Response Proportions

The interaction effect for group × time point was significant ( F 1,61 =25.174, df =1, η p 2 = 0.30, p = 0.000), the main effect for time point was significant ( F 1,61 = 138.086, df = 1, η p 2 = 0.32, p = 0.000), and the main effect for group was significant ( F 1,61 = 4.853, df = 1, η p 2 = 0.24, p = 0.031).

Vignette Response Proportions

The interaction effect for group × time point was significant ( F 1,61 = 29.450, df = 1, η p 2 = 0.31, p = 0.000), the main effect for time point was significant ( F 1,61 = 144.130, df = 1, η p 2 = 0.32, p = 0.000), and the main effect for group was significant ( F 1,61 = 3.083, df = 1, η p 2 = 0.18, p = 0.041).

Random Response Proportions

The interaction effect for group × time point was not significant ( F 1,61 = 1.003, df = 1, η p 2 = 0.001, p = 0.320), the main effect for time point was not significant ( F 1,61 = 1.519, df = 1, η p 2 = 0.001, p = 0.223), and the main effect for group was not significant ( F 1,61 = 0.017, df = 1, η p 2 = 0.000, p = 0.897).

This study is the first to survey the effect of problem-solving therapy on effortful cognition in MD using FVT; measurements of the basic facial emotion identification were also conducted. Our data showed that the emotion identification accuracy of HCs was higher than that of patients with MD; patients with MD exhibited poor FVT performance. Compared to antidepressant treatment, PST plus antidepressant treatment resulted in lower HAMD (17-item version) scores and better FVT performance.

This study also investigated the ability of patients with MD to employ contextual information when determining the intended or expressed or signified message of facial emotional expressions. In the FVT, target facial emotional expressions are preceded by stories describing situational messages which are discrepant in affective valence. What both patients with MD and HCs had judged reflects either the dominance of the emotional context or the facial emotional expression. Many studies on cognitive processing by patients with MD reported that depressive symptoms interfere with effortful processing, and the degree of interference is determined by the degree of effort required for the task, the severity of depression, and the valence of the stimulus material to be processed. However, depressive symptoms only interfere minimally with automatic processes ( 27 ).

Consistent with the findings of previous studies ( 21 – 23 ), our results showed that patients with MD could not utilize contextual information for specific face–vignette pairs. However, HCs more extensively made good judgments on emotion in line with contextual information, which indicates that patients with MD display poor effortful cognition performance. Cognition dysfunctions in MD include impairments of social cognition and neurocognition ( 28 , 29 ). Social cognition refers to a process or a function for an individual's mental operations underlying social behavior, while neurocognition refers to those basic information processing functions such as attention and executive processes. Effortful cognitive processing was involved in either social cognition or neurocognition. We verified our hypothesis, i.e ., patients with MD present effortful cognitive dysfunction.

In this study, we confirmed that PST plus antidepressant treatments leads to a greater reduction of depressive symptoms, a greater response rate, and a greater remission rate over a period of 12 weeks than antidepressant treatments only in patients with MD. We also indirectly verified our previous hypothesis, i.e ., PST can improve effortful cognitive dysfunction, namely, PST improved the severity of MD by improving effortful cognition. Our data provide supporting evidence for the conclusion that the facial affect processing ability could be a valuable predictor of successful social context integration in FVT in MD.

Conclusions

In conclusion, patients with MD present effortful cognitive dysfunction, and PST can improve effortful cognitive dysfunction. The measurement of effortful cognition might be one of the indexes for the therapeutic effect of PST in MD.

There are some limitations in the study. First, the findings must be considered preliminary due to the small sample size. Second, healthy controls were assessed with the FVT only once; therefore, the results of the FVT would be influenced by the practice effect in patients with MD. Future studies should augment the sample size and eliminate the practice effect to further confirm the relationship between effortful cognition and PST in MD. Finally, this study investigated the effect of PST plus antidepressant treatment on effortful cognition in MD. Therefore, no outcome of the pure PST effect on effortful cognition was obtained. The examination of the pure PST effect on effortful cognition in MD is necessary in a future study.

Data Availability Statement

Ethics statement.

The studies involving human participants were reviewed and approved by Affiliated Wuxi Mental Health Center of Nanjing Medical University. The patients/participants provided their written informed consent to participate in this study.

Author Contributions

CJ, HZ, and ZZ designed the study and wrote the paper. CJ, HZ, LC, and ZZ acquired and analyzed the data. All authors reviewed the content and approved the final version for publication.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

The authors would like to thank the Key Medical Talent Training Project of Jiangsu Province for providing support (project Grant No. ZDRCC2016019) for this research.

Funding. This research was supported by the Wuxi Taihu Talent Project (No. WXTTP2020008) and the Key Medical Talent Training Project of Jiangsu Province (No. ZDRCC2016019).

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• April 01, 2024 | VOL. 75, NO. 4 CURRENT ISSUE pp.307-398
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Comparative Effectiveness of Clinician- Versus Peer-Supported Problem-Solving Therapy for Rural Older Adults With Depression

• Brooke Hollister , Ph.D. ,
• Rebecca Crabb , Ph.D. ,
• Patricia Areán , Ph.D.

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Self-guided and peer-supported treatments for depression among rural older adults may address some common barriers to treatment. This pilot study compared the effect on depression of peer-supported, self-guided problem-solving therapy (SG-PST) with case management problem-solving therapy (CM-PST) among older adults in rural California.

Older adults with depression (N=105) received an introductory PST session with a clinician, followed by 11 sessions of CM-PST with a clinician (N=85) or SG-PST with a peer counselor (N=20).

Both interventions resulted in clinically significant improvement in depression by week 12. Depression scores in the CM-PST group dropped by 4.1 points more than in the SG-PST group between baseline and week 12 (95% CI=0.99–7.22, p<0.001, Hedges’s g=1.08).

Conclusions:

The results suggest that peer-supported SG-PST is a viable, acceptable option for rural older adults with depression as a second-line treatment if access to clinicians is limited.

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• Cited by None
• Peer-supported therapy, Problem-solving therapy, Senior peer counselors, Depression
• Rural older adults
• Geriatric psychiatry