Problem solving

Worrying is a natural response to life's problems. But when it takes over and we can start to feel overwhelmed, it can really help to take a step back and break things down.

Learning new ways to work through your problems can make them feel more manageable, and improve your mental and physical wellbeing.

Video: Problem solving

The tips in this video can help you to find strategies and solutions for tackling the problems that can be solved, and learning how to manage and cope with those that cannot.

Steps and strategies to help you solve problems

1. focus on your values.

Feeling like you have lots of problems to solve in different areas of your life can make it difficult to know how and where to start.

A great way to focus is to write down a few areas of your life that are most important to you right now – for example, a relationship, finances or a long-term goal like studying or developing your career.

This can make it easier to prioritise which problems to tackle.

2. Tackle problems with possible solutions first

It's important to work out if your problem can be solved or is a "hypothetical worry" – things that are out of your control even though you might think about them often.

They might be based on something that happened in the past that cannot be changed or a worry about the future that starts with "what if…".

Ask yourself whether a problem can be dealt with by doing something practical. If the answer is no, it's a hypothetical worry.

Make a list of your problems, and work out which are solvable and which are hypothetical.

3. Set aside time to work through solvable problems

Set aside 5 or 10 minutes to think about possible solutions for one of your solvable problems.

Try to be as open-minded as you can, even if some ideas feel silly. Thinking broadly and creatively is often when the best solutions come to mind.

It may feel difficult at first but, over time, this approach can start to feel easier.

Once you have some ideas, think through or write down:

  • the pros and cons of each solution
  • whether it's likely to work
  • if you have everything you need to try it

4. Make a plan

The next step is to choose a solution you want to try and make a plan for putting it into action. Try to be specific:

  • What are you going to do?
  • Do you need the support of anybody else?
  • How much time do you need?
  • When will you do it?

5. Try 'worry time'

Not all of our problems can be solved right away, but it can be difficult to switch off and stop ourselves from dwelling on them.

Using the "worry time" technique to stick to a short set time – say 10 to 15 minutes in the evening – for worrying can make this much easier to manage.

You can learn more about the worry time technique on tackling your worries .

6. Find time to relax

Worrying about our problems can make it harder to relax, but there are lots of things you can try to help you clear your mind and feel calmer.

The most important thing is to find what works for you. It might be getting active, spending time on an existing hobby or trying a new one, or techniques like mindfulness, meditation or our progressive muscle relaxation exercise.

Video: Progressive muscle relaxation

This video will guide you through an exercise to help you recognise when you're starting to get tense, and relax your body and mind.

7. Review and reflect

Once you start trying new approaches to solving and managing problems, consider setting aside time to review what went well with your solutions or anything else you noticed.

Make notes of the problems you face and any strategies you use to overcome them. This can come in handy later on and also be a good reminder of what works best for you.

Ticking off on a checklist any problems you manage to solve is a great way to recognise your achievements and boost your confidence.

8. Give journaling a go

Sometimes getting our thoughts out of our head – and down onto paper, our phones or anything else – is a great way to stop our worries and "what ifs" from spiralling out of control.

Expressing ourselves in this way can also make it easier to spot when our thoughts are unhelpful and we may benefit from a more balanced outlook. Give it a go to see if this works for you.

More self-help CBT techniques you can try

Bouncing back from life's challenges.

Taking steps to stay on top of your mental wellbeing and build resilience can really help you deal with problems when times are tougher. Learn more, and see tips and techniques you can use.

problem solving skills mental health

Tackling your worries

problem solving skills mental health

Facing your fears

problem solving skills mental health

Staying on top of things

Find more ideas to try in self-help CBT techniques

  • Open access
  • Published: 24 August 2021

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

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

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

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Metrics details

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

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

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

Conclusions

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

Peer Review reports

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

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

figure 1

Dimensions of Problem-Solving (PS) Ability

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

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

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

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

Scoping review

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

Search strategy

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

Inclusion and exclusion criteria

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

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

figure 2

PRISMA Flow Chart of the Study Selection Process

Data extraction and synthesis

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

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

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

Exploratory Meta-analysis

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

Quality assessment

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

Statistical analysis

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

Selection and inclusion of studies

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

Clinical trials of PST

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

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

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

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

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

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

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

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

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

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

PS training in clinical practice guidelines

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

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

Meta-analysis

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

figure 3

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

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

Overall quality of the evidence

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

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

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

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

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

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

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

Strengths and limitations

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

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

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

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

Availability of data and materials

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

Abbreviations

Avoidance style

Beck Depression Inventory

Centre for Addiction and Mental Health

Cognitive behavioural therapy

Children’s Depression Rating Scale—Revised

Center for Epidemiologic Studies Depression Scale

Clinical Global Impression Scale—Improvement

Cumulative Index to Nursing and Allied Health Literature

Clinical practice guideline

Adolescent Coping with Depression [intervention name]

Dialectical behaviour therapy

Grading of Recommendations Assessment, Development, and Evaluation

Impulsivity/Carelessness Style

Interpersonal psychotherapy

The Kiddie Schedule for Affective Disorders and Schizophrenia

Lifeskills training

Major depressive disorder

Medical Literature Analysis and Retrieval System Online

Negative problem orientation

Nondirective supportive therapy

Positive problem orientation

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

  • Problem solving

Problem-solving training

Problem-Solving Therapy

Randomized controlled trial

Research ethics board

Risk of bias

Rational problem-solving style

Systemic Behaviour Family Therapy

Strengths and Difficulties Questionnaire

Solution-Focused Brief Therapy

Social Problem-Solving Inventory Revised

Selective serotonin reuptake inhibitors

Treatment for Adolescents with Depression Study

Treatment of Resistant Depression in Adolescents

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Ministerio de Salud. Guía Clínica Depresión en personas de 15 años y más [Internet]. Santiago, Chile; 2013. Available from: https://www.minsal.cl/portal/url/item/7222754637c08646e04001011f014e64.pdf . Accessed 20 Dec 2020.f

Cincinnati Children's Hospital Medical Center. Best Evidence Statement (BESt): Treatment of Children and Adolescents With Major Depressive Disorder (MDD) During the Acute Phase. Cincinnati: Cincinnati Children's Hospital Medical Center; 2010.

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Acknowledgments

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

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

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Authors and affiliations.

Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada

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

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

Karolin R. Krause

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

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

Independent Family Doctor, Toronto, ON, Canada

Benjamin W. C. Chan

Hospital for Sick Children, Toronto, ON, Canada

Peter Szatmari

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Contributions

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

Corresponding author

Correspondence to Karolin R. Krause .

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Formal approval by a Research Ethics Board was not required, as youth were consulted as research partners rather than research subjects and provided no individual data.

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Supplementary Information

Additional file 1..

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

Additional file 2.

Search Strategy.

Additional file 3.

List of Studies Included in the Scoping Review.

Additional file 4.

Characteristics of Included Clinical Practice Guidelines.

Additional file 5.

Additional Data and Outputs from the Meta-Analysis.

Additional file 6.

Risk of Bias Assessment and GRADE Appraisal.

Additional file 7.

Illustration of Insights from the Consultation of Youth Advisors.

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

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Published : 24 August 2021

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

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  • Adolescence
  • Active ingredient

BMC Psychiatry

ISSN: 1471-244X

problem solving skills mental health

Problem solving self-help guide

Work through a self-help guide for problem solving based on Cognitive Behavioural Therapy (CBT).

Navigate self-help guide

1. introduction, 2. identifying problems, 3. types of problem - activity 1, 4. recognising there's a problem, 5. barriers to problem-solving, 6. activity 2 – writing your problem list, 7. activity 3 - focusing on one problem, 8. activity 4 - pros and cons, 9. choosing a solution, 10. plan your chosen solution - activity 5, 11. how did it go, 12. next steps.

Section 1 of 12

Urgent help

This self-help guide is intended for people with mild-to-moderate mental health issues.

If you're feeling distressed, in a state of despair, suicidal or in need of emotional support you can phone NHS 24 on 111.

For an emergency ambulance phone 999.

This self-help guide is intended for people with mild-to-moderate symptoms of depression.

It’s easy to feel overwhelmed by problems, particularly if you’re experiencing mental health difficulties. This guide:

  • provides step-by-step advice on how to solve problems
  • gives you a set of skills to help manage problems in the future

This guide is based on Cognitive Behavioural Therapy (CBT). CBT helps you to examine how you think about your life, and challenge negative automatic thoughts to free yourself from unhelpful thought and behaviour patterns.

How to use the problem solving self-help guide

Working through this guide can take around 30 to 40 minutes, but you should feel free to work at your own pace.

Work through the guide on your device, using the “Next” button to move forward and use the “Previous” button instead of the Back button in your browser. To type in a graphic or diary, click or tap the part you’d like to fill in and use your keyboard as usual.

If you’d like to save the guide and return to it later, you’ll need to save it as a PDF on your device before you leave the page. You can then continue filling it out on the PDF. We don’t use a login feature on our mental health self-help guides for privacy reasons.

If you’d like to print the guide at any time, you’ll find an option to save and print the whole guide, including the parts you have added, in each section.

Section 2 of 12

When you solve a problem, it increases your confidence and makes you feel more able to solve problems in future. When you feel overwhelmed, it’s easy to forget that you already have the ability to solve problems – it’s how you’ve coped with life so far. This guide is designed to help you tap into that ability and boost your confidence.

Finding the hidden problem

Sometimes you can’t tell what the problem that’s affecting you most actually is – you might feel stuck and unable to think of anything that would help.

Here are 2 examples of hidden problems:

Work was becoming stressful for Paul after a new computer system was put in place. He’d been confident at work before, but was now finding it hard to get out of bed to go into the office. All his colleagues seemed to be managing fine, but Paul was making lots of mistakes. When his boss asked how he was doing, Paul felt like he had to say he was fine, as he was worried about being sacked. At home, his girlfriend had noticed a change in his mood – he wasn’t keen to go out or do anything they used to enjoy.

Mandy was a single parent. She looked after her sister’s child as well as her own 12-year-old daughter, Lizzie. She also cared for her elderly mum, who was unwell. Mandy found it difficult to find time for herself, and always felt like her house was a mess and cleaning was never done. She found herself becoming irritable, especially when people asked her to do things or asked her what was wrong. Mandy was angry that no one seemed to understand how busy she was.

From these examples, you may be able to see how sometimes problems can become overwhelming and hard to identify, while at other times you can see them clearly. In this guide you’ll continue to work on identifying your own problems, and work out a series of steps to solve them.

Section 3 of 12

There are a large number of different types of problem. Have a look at this list and see which type – or types – your problem could be.

  • relationships – for example, difficulties getting along with your partner/spouse, falling out of touch with friends, or feeling alone and isolated
  • money – for example, struggling to manage bills or afford different expenses, increasing debts,  or feeling pressure to spend money you can’t afford
  • lifestyle issues – for example, drinking too much alcohol, not eating healthily, not having time for your interests, or not having time to keep in touch with friends and loved ones
  • work/education – for example, trouble doing well at work or meeting deadlines
  • addiction issues – for example alcohol, drugs, or gambling
  • managing health – for example, organising GP and dentist appointments, or getting enough exercise
  • illness or disability – for example, dealing with a chronic illness or having a disability
  • family responsibilities – for example, being there for family commitments, organising childcare, helping with lots of requests from family, or being a carer

Use the boxes below to type any problems you might experience that fall under these categories.

Section 4 of 12

Paul’s girlfriend helped him talk about his job more. He explained that he hated his job because he couldn’t get used to the new computer system and was always worried about making a mistake. Paul told her he felt like he had to stay late at work to avoid falling behind, and that meant he was too tired to go out when he got home.

Paul recognised he was so unhappy at work because he was terrified he’d make a mistake with the new computer system. He also recognised that trying to cope by staying late at work was causing another problem – he was too tired to do the things he enjoyed when he got home. This was making him more unhappy.

Mandy didn’t want to let anyone know how she was feeling, but one Saturday her sister asked if Mandy could drop her child off at a birthday party for her. Mandy lost her temper, and was shocked by how angry and upset she felt. Once she calmed down, she decided it was time to sit down and think about what was really going on.

Mandy recognised that all the different tasks she had to do for other people, and all the demands on her time, were making her feel frustrated and irritable. They were also making it hard to fit everything in. Mandy recognised that she found it hard to say no to other people. This left her feeling angry when she ended up with very little time to do her own tasks, or take time for herself to do things she enjoyed.

Think about your own situation. You’ve reached a point where you need to take action, which is why you’re completing this guide. Where do you think would be a good place to start?

Section 5 of 12

Sometimes it feels like it’s impossible to even start solving your problems, but that’s not the case. Here are some common challenges.

Avoiding the problem

Paul had been avoiding bringing up the difficulties he was having with his girlfriend or his boss, because he didn’t want anyone to criticise him or think he wasn’t good enough at his job. This meant his boss didn’t know what the problem was when he noticed Paul taking longer with his tasks, and he didn’t know how to help. It also meant Paul’s girlfriend didn’t know why he wasn’t interested in activities in the evening anymore.

Mandy had been avoiding thinking about her problems, as she didn’t feel she had enough time. Instead, she was concentrating on everything she had to do every day, so she felt like she was coping. This meant she had little time for herself and other people didn’t realise she was finding it hard to cope.

Take a few minutes to think about whether you’ve been avoiding thinking about what your problem is. The next part of this guide will give you the chance to write out a list of your problems.

Feeling like you have too many problems

Writing a list of your problems helps to break your difficulties down so you can deal with one at a time. It also helps you to feel less overwhelmed.

You know what the problems are, but not the solutions

It’s okay if you don’t know the solutions just now. This approach gives you a structure you can use to find possible solutions that are realistic for you. It’s important to be patient with yourself – you don’t have to have all the answers straight away.

"Everything's fine in my life – I don't know why I feel like this."

Sometimes you can’t always identify what the problem is – to a stranger, it might seem like your life is perfect. But problems can include how you feel about yourself and your life too.

Do you ever do any of these things?

  • put yourself down – think negative thoughts about yourself
  • think negatively – always worry about what might go wrong rather than think about what might go right
  • feel like everything has to be perfect – set yourself unrealistically high standards, so nothing you do ever feels “good enough”

These thinking problems can also be tackled by the methods in this guide.

If you can’t think of any problems that could explain while you feel this way, even after working through this guide, you should consider looking at  the other mental health self-help guides on NHS inform  if you haven’t already. You could also make an appointment with your GP to discuss things further. You can find a local GP using  Scotland’s Service Directory .

Section 6 of 12

The next step is writing out a list of your problems. You can either:

  • use the boxes below, and save and download the list to your device at the end of this guide
  • download a sh eet to your device

Please note:  If you decide to download a sheet to fill in, the text you add to that sheet will only be saved to your device. If you use an iPhone, the only way to edit the problem list is by using a PDF app on your device.

Here are some tips to make writing your problem list easier:

  • Remember there are no wrong answers   – even the small things, over time, can grow into big issues. Nothing you write in this list is too small.
  • Think about what’s really important to you – often when we’re struggling with things that seem small, it’s because we’re having trouble with areas of life that really matter to us.
  • Talking   – try to talk to someone you know well and trust. If there isn’t anyone you feel comfortable discussing your issues with, you could call a service like  Breathing Space .
  • If you need to, take a little time   – get away from the situation to allow yourself time to put things into perspective. Why not make yourself a cup of tea, or go for a walk? It’s often easier to see what the problem is when you’re not in the middle of it.

Section 7 of 12

The goal of writing a problem list is to pick one problem to work on at a time. After writing your problem list, the next step is to select the one you want to work on first.

Which one you choose is up to you but we suggest starting with the one that looks the easiest, or least distressing, to solve. You could also choose the one that you feel is the most important.

The next step is coming up with ideas for solving that problem.

Mandy chose the problem “not having enough time to relax”. While getting her ideas down, she came up with the following list, to help her find the time to do this.

  • Book Lizzie into an after-school club, like drama or dancing
  • Ask a friend or neighbour to watch Lizzie one evening a week
  • Forget about housework for the next 3 years
  • Ask Lizzie to help with some of the household chores
  • Find a gym with a class Lizzie could do and go together
  • Ask my sister for help with some of the things I have to do
  • Get more confident about saying “no” to doing things when I’m busy

Getting all your ideas out

Use the solution sheet below to start writing out possible solutions to the problem you’ve chosen. The idea is to think up as many ways as possible of solving it, not come up with the perfect answer right away.

It’s important to write down every suggestion you think of, even if it seems unrealistic or ridiculous. The idea is to free up your creative thinking – thinking freely can help you consider things you normally wouldn’t.

You can include things you’re already doing to try and solve the problem.

You don’t have to fill out every line – if you can only come up with 2 or 3 solutions, that’s fine.

Ignore the part about pros and cons for now – this will be covered in the next section.

Download a solution sheet you can print or fill out on your device

Please note:  the text you add to the solution sheet will only be saved to your device. If you use an iPhone, the only way to edit the solution sheet is by using a PDF app on your device.

Section 8 of 12

The next step is thinking about the pros (good things) and cons (bad things) of each solution you thought of. Writing these down can help.

As an example, here’s the list Mandy came up with for her chosen problem.

Problem:  not having enough time to relax.

Write the pros and cons of each solution in the boxes on your solution sheet.

Section 9 of 12

Listing the pros and cons should’ve made it easier for you to decide what to do next. If not, try reading over the list again and thinking of some more pros and cons for each solution.

Are you having difficulty choosing a solution?

There are a few things that can make it harder for you to decide on a solution.

No solution seems good enough

There’s no such thing as a perfect solution – if there was, it’s likely you’d have solved the problem already. Are you setting your standards too high?

Your solution might not be perfect, but it doesn’t have to be perfect to start making things better.

You're scared to make the wrong choice

There’s always a bit of guessing involved in choosing a solution, as we can’t look into the future and see what’s going to happen.

With a lot of problems, it’s better to do something different than leave things the way they are. Even if things don’t turn out the way you’d hoped, it’s still a good chance to learn something and practice these problem-solving skills. In the next steps you’ll also review whether your solution helped – if not, you can follow the steps to try a different solution.

Two suggestions seem equally good

If you can’t choose which looks best, it might not matter very much which one you choose – they could both work equally well. Try one and see how it goes.

"The more I think about choosing a solution, the more I worry."

Getting caught up in worry can end up becoming a problem on its own. If you find yourself getting stressed out by trying to think of a solution, there are a couple of things you can do.

  • do a relaxation exercise – you can find some  here
  • distract yourself – do something different for a little while, like watching TV or reading a book
  • decide to forget about the problem for a few hours or even a day – after you’ve had a break, you will feel better when you start thinking about it again
  • it could be a good idea to look at your problem list and start with one that feels less overwhelming, where it’s easier think of possible solutions
  • maybe a problem needs to be broken down more into simple steps to make it easier to think about solutions – for example, change “the house is a mess” to “the kitchen needs to be cleaned”

If you’re struggling to choose a solution and feel you’re getting caught up in worry, it might be worth visiting the  Depression  or  Anxiety  self-help guides on our site. If you’ve come to this guide from one of these, feel free to go back and work through it again if you think it’ll help.

We also have a lot of material on  coping with stress  that you might find helpful.

Section 10 of 12

It can be helpful to make a plan for the solution you’ve chosen. Once you lay out a step-by-step plan, taking action on your problem stops being a big task and becomes a number of smaller, more manageable tasks.

For example, Mandy decided to get more confident about saying no to things. You can see her action plan in the examples below.

Use the boxes below to write out your action plan step by step. You can save and download this at the end of the guide.

Or, if you prefer, you can download an action plan below to fill out on your device.

Download an action plan

Please note:  the text you add to the action plan PDF will only be saved to your device. If you use an iPhone, the only way to edit the action plan is by using a PDF app on your device.

Section 11 of 12

This is the time to reflect on how problem-solving went. Remember, even if your solution didn’t go the way you hoped, it’s important to keep using this approach until you feel confident.

1. The problem is solved

Well done! Your solution worked. Here are a couple of things to remember in future:

  • You might not be aware that you’ve solved your problem until you realise you haven’t thought about it in a while – that’s fine, and shows that you don’t have to dwell on problems to solve them.
  • It might be that things haven’t changed, or haven’t changed that much, but you’re now more able to deal with it.

2. The problem is slightly better

If the problem is slightly better, but not solved yet, there’s still a little more for you to do. There are a few things that could help:

  • Keep doing what you’re doing – your problem could be solved if you continue with your current plan of action.
  • Choose another solution from your list – have another look at your pros and cons list and see if another option could work better. Maybe a combination of two or more is the answer. You might even have another idea for a solution when you look at the list again.
  • Choose another goal – have another look at your problem list and see if there is something else you could work on for a while.
  • Choose a connected problem – if there’s another item on your problem list that could help solve the one you’re still working on, spend some time on that. You can return to the first problem later.

3. The problem isn’t better at all

If things aren’t any better, there are a few things you can do:

  • Think about whether your plan has had time to work – things might get better if you keep going.
  • Ask if anything at all is different – some things might be bad, but consider whether or not they were worse before you applied this problem-solving approach. The situation might have improved without you realising it.
  • Try another option – go back over your solutions list, and the pros and cons, and see if a different solution works better.
  • Check if you followed all the problem-solving steps correctly and, if needed, go back over some or all of the steps again.

If there still isn’t any improvement after you’ve done these things, don’t worry. If possible, discuss the problem with a person you trust, like a close friend or family member. You could also talk to someone anonymously using a service like  Breathing Space .

However it’s worked out, you should be proud of yourself for taking these steps. Keep using this problem-solving approach and it’ll get easier.

Section 12 of 12

Keep using the techniques from this guide – they’ll continue to help you. It’s important not to fall into old habits or forget how to use this problem-solving approach.

Remember that the problems you work on using these techniques don’t have to be big or life-changing – they can be day-to-day issues, or even decisions you need to make as part of work or study. The more you practice, the easier problem-solving will be.

Further help

If you’re feeling distressed, in a state of despair, suicidal or need emotional support you can phone NHS 24 on 111.

If you feel you need more help with your mental health, try speaking to your GP, or  search for mental health and wellbeing services in your area .

For information and advice when you’re feeling down, you can phone  Breathing Space  on 0800 83 85 87.

The Breathing Space phoneline is available:

  • 24 hours at weekends (6pm Friday to 6am Monday)
  • 6pm to 2am on weekdays (Monday to Thursday)

If you found this guide helpful and would like to do more work like this,  Living Life  offers a range of structured psychological interventions and therapies to improve mental health and wellbeing. This service is appointment-based and specifically for low mood, or mild/moderate depression or anxiety. Living Life are open Monday to Friday, from 1pm to 9pm, and you can phone them on 0800 328 9655 for an assessment appointment.

To learn more about coping with mental health issues,  visit our other mental health self-help guides on NHS inform .

For information that could help solve problems related to your health,  visit our Care, Support and Rights section .

To find services in your area that could help with a range of health and wellbeing issues, visit  Scotland’s Service Directory .

Section 1 of 17

This guide aims to help you:

  • find out if you could have symptoms of depression
  • understand more about depression
  • find ways to manage or overcome depression

How to use the depression self-help guide

Work through the guide on your device, using the "Next" button to move forward and use the "Previous" button instead of the Back button in your browser. To type in a graphic or diary, click or tap the part you’d like to fill in and use your keyboard as usual.

Last updated: 27 May 2021

Section 2 of 17

2. Symptoms of depression

Section 3 of 17

3. Symptoms of depression

Last updated: 4 March 2022

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Research Article

Problem-solving interventions and depression among adolescents and young adults: A systematic review of the effectiveness of problem-solving interventions in preventing or treating depression

Roles Conceptualization, Data curation, Formal analysis, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America

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Roles Conceptualization, Writing – original draft

Affiliation Centre for Evidence and Implementation, London, United Kingdom

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Roles Conceptualization, Writing – review & editing

Affiliation Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States of America

Roles Conceptualization, Methodology

Roles Conceptualization, Project administration, Writing – review & editing

Affiliation Centre for Evidence and Implementation, Melbourne, Victoria, Australia

Roles Conceptualization, Formal analysis, Methodology, Writing – original draft, Writing – review & editing

Affiliation Department of Social Work, Monash University, Melbourne, Victoria, Australia

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Fig 1

Problem-solving (PS) has been identified as a therapeutic technique found in multiple evidence-based treatments for depression. To further understand for whom and how this intervention works, we undertook a systematic review of the evidence for PS’s effectiveness in preventing and treating depression among adolescents and young adults. We searched electronic databases ( PsycINFO , Medline , and Cochrane Library ) for studies published between 2000 and 2022. Studies meeting the following criteria were included: (a) the intervention was described by authors as a PS intervention or including PS; (b) the intervention was used to treat or prevent depression; (c) mean or median age between 13–25 years; (d) at least one depression outcome was reported. Risk of bias of included studies was assessed using the Cochrane Risk of Bias 2.0 tool. A narrative synthesis was undertaken given the high level of heterogeneity in study variables. Twenty-five out of 874 studies met inclusion criteria. The interventions studied were heterogeneous in population, intervention, modality, comparison condition, study design, and outcome. Twelve studies focused purely on PS; 13 used PS as part of a more comprehensive intervention. Eleven studies found positive effects in reducing depressive symptoms and two in reducing suicidality. There was little evidence that the intervention impacted PS skills or that PS skills acted as a mediator or moderator of effects on depression. There is mixed evidence about the effectiveness of PS as a prevention and treatment of depression among AYA. Our findings indicate that pure PS interventions to treat clinical depression have the strongest evidence, while pure PS interventions used to prevent or treat sub-clinical depression and PS as part of a more comprehensive intervention show mixed results. Possible explanations for limited effectiveness are discussed, including missing outcome bias, variability in quality, dosage, and fidelity monitoring; small sample sizes and short follow-up periods.

Citation: Metz K, Lewis J, Mitchell J, Chakraborty S, McLeod BD, Bjørndal L, et al. (2023) Problem-solving interventions and depression among adolescents and young adults: A systematic review of the effectiveness of problem-solving interventions in preventing or treating depression. PLoS ONE 18(8): e0285949. https://doi.org/10.1371/journal.pone.0285949

Editor: Thiago P. Fernandes, Federal University of Paraiba, BRAZIL

Received: January 2, 2023; Accepted: May 4, 2023; Published: August 29, 2023

Copyright: © 2023 Metz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant methods and data are within the paper and its Supporting Information files.

Funding: This work was commissioned by Wellcome Trust and was conducted independently by the evaluators (all named authors). No grant number is available. Wellcome Trust had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The authors declare no financial or other competing interests, including their relationship and ongoing work with Wellcome Trust. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Depression among adolescents and young adults (AYA) is a serious, widespread problem. A striking increase in depressive symptoms is seen in early adolescence [ 1 ], with rates of depression being estimated to almost double between the age of 13 (8.4%) and 18 (15.4%) [ 2 ]. Research also suggests that the mean age of onset for depressive disorders is decreasing, and the prevalence is increasing for AYA. Psychosocial interventions, such as cognitive-behavioural therapy (CBT) and interpersonal therapy (IPT), have shown small to moderate effects in preventing and treating depression [ 3 – 6 ]. However, room for improvement remains. Up to half of youth with depression do not receive treatment [ 7 ]. When youth receive treatment, studies indicate that about half of youth will not show measurable symptom reduction across 30 weeks of routine clinical care for depression [ 8 ]. One strategy to improve the accessibility and effectiveness of mental health interventions is to move away from an emphasis on Evidence- Based Treatments (EBTs; e.g., CBT) to a focus on discrete treatment techniques that demonstrate positive effects across multiple studies that meet certain methodological standards (i.e., common elements; 9). Identifying common elements allows for the removal of redundant and less effective treatment content, reducing treatment costs, expanding available service provision and enhancing scability. Furthermore, introducing the most effective elements of treatment early may improve client retention and outcomes [ 9 – 13 ].

A potential common element for depression intervention is problem-solving (PS). PS refers to how an individual identifies and applies solutions to everyday problems. D’Zurilla and colleagues [ 14 – 17 ] conceptualize effective PS skills to include a constructive attitude towards problems (i.e., a positive problem-solving orientation) and the ability to approach problems systematically and rationally (i.e., a rational PS style). Whereas maladaptive patterns, such as negative problem orientation and passively or impulsively addressing problems, are ineffective PS skills that may lead to depressive symptoms [ 14 – 17 ]. Problem Solving Therapy (PST), designed by D’Zurilla and colleagues, is a therapeutic approach developed to decrease mental health problems by improving PS skills [ 18 ]. PST focuses on four core skills to promote adaptive problem solving, including: (1) defining the problem; (2) brainstorming possible solutions; (3) appraising solutions and selecting the best one; and (4) implementing the chosen solution and assessing the outcome [ 14 – 17 ]. PS is also a component in other manualized approaches, such as CBT and Dialectical Behavioural Therapy (DBT), as well as imbedded into other wider generalized mental health programming [ 19 , 20 ]. A meta-analysis of over 30 studies found PST, or PS skills alone, to be as effective as CBT and IPT and more effective than control conditions [ 21 – 23 ]. Thus, justifying its identification as a common element in multiple prevention [ 19 , 24 ] and treatment [ 21 , 25 ] programs for adult depression [ 9 , 26 – 28 ].

PS has been applied to youth and young adults; however, no manuals specific to the AYA population are available. Empirical studies suggest maladaptive PS skills are associated with depressive symptoms in AYA [ 5 , 17 – 23 ]. Furthermore, PS intervention can be brief [ 29 ], delivered by trained or lay counsellors [ 30 , 31 ], and provided in various contexts (e.g., primary care, schools [ 23 ]). Given PS’s versatility and effectiveness, PS could be an ideal common element in treating AYA depression; however, to our knowledge, no reviews or meta-analyses on PS’s effectiveness with AYA specific populations exist. This review aimed to examine the effectiveness of PS as a common element in the prevention and treatment of depression for AYA within real-world settings, as well as to ascertain the variables that may influence and impact PS intervention effects.

Identification and selection of studies

Searches were conducted using PsycInfo , Medline , and Cochrane Library with the following search terms: "problem-solving", “adolescent”, “youth”, and” depression, ” along with filters limiting results to controlled studies looking at effectiveness or exploring mechanisms of effectiveness. Synonyms and derivatives were employed to expand the search. We searched grey literature using Greylit . org and Opengrey . eu , contacted experts in the field and authors of protocols, and searched the reference lists of all included studies. The search was undertaken on 4 th June 2020 and updated on 11 th June 2022.

Studies meeting the following criteria were included: (a) the intervention was described by authors as a PS intervention or including PS; (b) the intervention was used to treat or prevent depression; (c) mean or median age between 13–25 years; and (d) at least one depression outcome was reported. Literature in electronic format published post 2000 was deemed eligible, given the greater relevance of more recent usage of PS in real-world settings. There was no exclusion for gender, ethnicity, or country setting; only English language texts were included. Randomized controlled trials (RCTs), quasi-experimental designs (QEDs), systematic reviews/meta-analyses, pilots, or other studies with clearly defined comparison conditions (no treatment, treatment as usual (TAU), or a comparator treatment) were included. We excluded studies of CBT, IPT, Acceptance and Commitment Therapy (ACT), Dialectical Behaviour Therapy (DBT), and modified forms of these treatments. These treatments include PS and have been shown to demonstrate small to medium effects on depression [ 13 , 14 , 32 ], but the unique contribution of PS cannot be disentangled. The protocol for this review was not registered; however, all data collection forms, extraction, coding and analyses used in the review are available upon inquiry from the first author.

Study selection

All citations were entered into Endnote and uploaded to Covidence for screening and review against the inclusion/exclusion criteria. Reviewers with high inter-rater reliability (98%) independently screened the titles and abstracts. Two reviewers then independently screened full text of articles that met criteria. Duplicates, irrelevant studies, and studies that did not meet the criteria were removed, and the reason for exclusion was recorded (see S1 File for a list of excluded studies). Discrepancies were resolved by discussion with the team leads.

Data extraction

Two reviewers independently extracted data that included: (i) study characteristics (author, publication year, location, design, study aim), (ii) population (age, gender, race/ethnicity, education, family income, depression status), (iii) setting, (iv) intervention description (therapeutic or preventative, whether PS was provided alone or as part of a more comprehensive intervention, duration, delivery mode), (v) treatment outcomes (measures used and reported outcomes for depression, suicidality, and PS), and (vi) fidelity/implementation outcomes. For treatment outcomes, we included the original statistical analyses and/or values needed to calculate an effect size, as reported by the authors. If a variable was not included in the study publication, we extracted the information available and made note of missing data and subsequent limitations to the analyses.

RCTs were assessed for quality (i.e., confidence in the study’s findings) using the Cochrane Risk of Bias 2.0 tool [ 33 ] which includes assessment of the potential risk of bias relating to the process of randomisation; deviations from the intended intervention(s); missing data; outcome measurement and reported results. Risk of bias pertaining to each domain is estimated using an algorithm, grouped as: Low risk; Some concerns; or High risk. Two reviewers independently assessed the quality of included studies, and discrepancies were resolved by consensus.

We planned to conduct one or more meta-analyses if the studies were sufficiently similar. Data were entered into a summary of findings table as a first step in determining the theoretical and practical similarity of the population, intervention, comparison condition, outcome, and study design. If there were sufficiently similar studies, a meta-analysis would be conducted according to guidelines contained in the Cochrane Collaboration Handbook of Systematic Reviews, including tests of heterogeneity and use of random effects models where necessary.

The two searches yielded a total number of 874 records (after the removal of duplicates). After title and abstract screening, 184 full-text papers were considered for inclusion, of which 25 studies met the eligibility criteria and were included in the systematic review ( Fig 1 ). Unfortunately, substantial differences (both theoretical and practical) precluded any relevant meta-analyses, and we were limited to a narrative synthesis.

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Risk of bias assessment

Risk of bias assessments were conducted on the 23 RCTs ( Fig 2 ; assessments by study presented in S1 Table ). Risk of bias concerns were moderate, and a fair degree of confidence in the validity of study findings is warranted. Most studies (81%) were assessed as ‘some concerns’ (N = 18), four studies were ‘low risk’, and one ‘high risk’. The most frequent areas of concern were the selection of the reported result (n = 18, mostly due to inadequate reporting of a priori analytic plans); deviations from the intended intervention (N = 17, mostly related to insufficient information about intention-to-treat analyses); and randomisation process (N = 13).

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https://doi.org/10.1371/journal.pone.0285949.g002

Study designs and characteristics

Study design..

Across the 25 studies, 23 were RCTs; two were QEDs. Nine had TAU or wait-list control (WLC) comparator groups, and 16 used active control groups (e.g., alternative treatment). Eleven studies described fidelity measures. The sample size ranged from 26 to 686 and was under 63 in nine studies.

Selected intervention.

Twenty interventions were described across the 25 studies ( Table 1 ). Ten interventions focused purely on PS. Of these 10 interventions: three were adaptations of models proposed by D’Zurilla and Nezu [ 20 , 34 ] and D’Zurilla and Goldfried [ 18 ], two were based on Mynors-Wallis’s [ 35 ] Problem-Solving Therapy (PST) guide, one was a problem-orientation video intervention adapted from D’Zurilla and Nezu [ 34 ], one was an online intervention adapted from Method of Levels therapy, and three did not specify a model. Ten interventions used PS as part of a larger, more comprehensive intervention (e.g., PS as a portion of cognitive therapy). The utilization and dose of PS steps included in these interventions were unclear. Ten interventions were primary prevention interventions–one of these was universal prevention, five were indicated prevention, and four were selective prevention. Ten interventions were secondary prevention interventions. Nine interventions were described as having been developed or adapted for young people.

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https://doi.org/10.1371/journal.pone.0285949.t001

Intervention delivery.

Of the 20 interventions, eight were delivered individually, eight were group-based, two were family-based, one was mixed, and in one, the format of delivery was unclear. Seventeen were delivered face-to-face and three online. Dosage ranged from a single session to 21, 50-minute sessions (12 weekly sessions, then 6 biweekly sessions); the most common session formar was once weekly for six weeks (N = 5).

Intervention setting and participants.

Seventeen studies were conducted in high-income countries (UK, US, Australia, Netherlands, South Korea), four in upper-middle income (Brazil, South Africa, Turkey), and four in low- and middle-income countries (Zimbabwe, Nigeria, India). Four studies included participants younger than 13 and four older than 25. Nine studies were conducted on university or high school student populations and five on pregnant or post-partum mothers. The remaining 11 used populations from mental health clinics, the community, a diabetes clinic, juvenile detention, and a runaway shelter.

Sixteen studies included participants who met the criteria for a depressive, bipolar, or suicidal disorder (two of these excluded severe depression). Nine studies did not use depression symptoms in the inclusion criteria (one of these excluded depression). Several studies excluded other significant mental health conditions.

Outcome measures.

Eight interventions targeted depression, four post/perinatal depression, two suicidal ideation, two resilience, one ‘problem-related distress’, one ‘diabetes distress’, one common adolescent mental health problem, and one mood episode. Those targeting post/perinatal depression used the Edinburgh Postnatal Depression Scale as the outcome measure. Of the others, six used the Beck Depression Inventory (I or II), two the Children’s Depression Inventory, three the Depression Anxiety Stress Scale-21, three the Centre for Epidemiologic Studies Depression Scale, one the Short Mood and Feelings Questionnaire, one the Hamilton Depression Rating Scale, one the depression subscale on the Schedule for Affective Disorders and Schizophrenia for School-Age Children, one the Strengths and Difficulties Questionnaire, one the Youth Top Problems Score, one the Adolescent Longitudinal Interval Follow-up Evaluation and Psychiatric Status Ratings, one the Kiddie Schedule for Affective Disorders and Schizophrenia, and one the Mini International Neuropsychiatric Interview.

Only eight studies measured PS skills or orientation outcomes. Three used the Social Problem-Solving Inventory-Revised, one the Problem Solving Inventory, two measured the extent to which the nominated problem had been resolved, one observed PS in video-taped interactions, and one did not specify the measure.

The mixed findings regarding the effectiveness of PS for depression may depend on the type of intervention: primary (universal, selective, or indicated), secondary or tertiary prevention. Universal prevention interventions target the general public or a population not determined by any specific criteria [ 36 ]. Selective prevention interventions target specific populations with an increased risk of developing a disorder. Indicated prevention interventions target high-risk individuals with sub-clinical symptoms of a disorder. Secondary prevention interventions include those that target individuals diagnosed with a disorder. Finally, tertiary prevention interventions refer to follow-up interventions designed to retain treatment effects. Outcomes are therefore grouped by intervention prevention type and outcome. Within these groupings, studies with a lower risk of bias (RCTs) are presented first. According to the World Health Organisation guidelines, interventions were defined as primary, secondary or tertiary prevention [ 36 ].

Universal prevention interventions

One study reported on a universal prevention intervention targeting resilience and coping strategies in US university students. The Resilience and Coping Intervention, which includes PS as a primary component of the intervention, found a significant reduction in depression compared to TAU (RCT, N = 129, moderate risk of bias) [ 37 ].

Selective prevention interventions

Six studies, including five RCTs and one QED, tested PS as a selective prevention intervention. Two studies investigated the impact of the Manage Your Life Online program, which includes PS as a primary component of the intervention, compared with an online programme emulating Rogerian psychotherapy for UK university students (RCT, N = 213, moderate risk of bias [ 38 ]; RCT, N = 48, moderate risk of bias [ 39 ]). Both studies found no differences in depression or problem-related distress between groups.

Similarly, two studies explored the effect of adapting the Penn Resilience Program, which includes PS as a component of a more comprehensive intervention for young people with diabetes in the US (RCT, N = 264, moderate risk of bias) [ 40 , 41 ]. The initial study showed a moderate reduction in diabetes distress but not depression at 4-, 8-, 12- and 16-months follow-up compared to a diabetes education intervention [ 40 ]. The follow-up study found a significant reduction in depressive symptoms compared to the active control from 16- to 40-months; however, this did not reach significance at 40-months [ 41 ].

Another study that was part of wider PS and social skills intervention among juveniles in state-run detention centres in the US found no impacts (RCT, N = 296, high risk of bias) [ 42 ]. A QED ( N = 32) was used to test the effectiveness of a resilience enhancement and prevention intervention for runaway youth in South Korea [ 43 ]. There was a significant decrease in depression for the intervention group compared with the control group at post-test, but the difference was not sustained at one-month follow-up.

Indicated prevention interventions

Six studies, including five RCTs and one QED, tested PS as an indicated prevention intervention. Four of the five RCTs tested PS as a primary component of the intervention. A PS intervention for common adolescent mental health problems in Indian high school students (RCT, N = 251, low risk of bias) led to a significant reduction in psychosocial problems at 6- and 12 weeks; however, it did not have a significant impact on mental health symptoms or internalising symptoms compared to PS booklets without counsellor treatment at 6- and 12-weeks [ 31 ]. A follow-up study showed a significant reduction in overall psychosocial problems and mental health symptoms, including internalizing symptoms, over 12 months [ 44 ]. Still, these effects no longer reached significance in sensitivity analysis adjusting for missing data (RCT, N = 251, low risk of bias). Furthermore, a 2x2 factorial RCT ( N = 176, moderate risk of bias) testing PST among youth mental health service users with a mild mental disorder in Australia found that the intervention was not superior to supportive counselling at 2-weeks post-treatment [ 30 ]. Similarly, an online PS intervention delivered to young people in the Netherlands to prevent depression (RCT, N = 45, moderate risk of bias) found no significant difference between the intervention and WLC in depression level 4-months post-treatment [ 45 ].

One RCT tested PS approaches in a more comprehensive manualized programme for postnatal depression in the UK and found no significant differences in depression scores between intervention and TAU at 3-months post-partum (RCT, N = 292, moderate risk of bias) [ 46 ].

A study in Turkey used a non-equivalent control group design (QED, N = 62) to test a nursing intervention against a PS control intervention [ 47 ]. Both groups showed a reduction in depression, but the nursing care intervention demonstrated a larger decrease post-intervention than the PS control intervention.

Secondary prevention interventions

Twelve studies, all RCTs, tested PS as a secondary prevention intervention. Four of the 12 RCTs tested PS as a primary component of the intervention. An intervention among women in Zimbabwe (RCT, N = 58, moderate risk of bias) found a larger decrease in the Edinburgh Postnatal Depression Scale score for the intervention group compared to control (who received the antidepressant amitriptyline and peer education) at 6-weeks post-treatment [ 48 ]. A problem-orientation intervention covering four PST steps and involving a single session video for US university students (RCT, N = 110, moderate risk of bias), compared with a video covering other health issues, resulted in a moderate reduction in depression post-treatment; however, results were no longer significant at 2-weeks, and 1-month follow up [ 49 ].

Compared to WLC, a study of an intervention for depression and suicidal proneness among high school and university students in Turkey (RCT, N = 46, moderate risk of bias) found large effect sizes on post-treatment depression scores for intervention participants post-treatment compared with WLC. At 12-month follow-up, these improvements were maintained compared to pre-test but not compared to post-treatment scores. Significant post-treatment depression recovery was also found in the PST group [ 12 ]. Compared to TAU, a small but high-quality (low-risk of bias) study focused on preventing suicidal risk among school students in Brazil (RCT, N = 100, low risk of bias) found a significant, moderate reduction in depression symptoms for the treatment group post-intervention that was maintained at 1-, 3- and 6-month follow-up [ 50 ].

Seven of the 12 RCTs tested PS as a part of a more comprehensive intervention. Two interventions targeted mood episodes and were compared to active control. These US studies focused on Family-Focused Therapy as an intervention for mood episodes, which included sessions on PS [ 51 , 52 ]. One of these found that Family-Focused Therapy for AYA with Bipolar Disorder (RCT, N = 145, moderate risk of bias) had no significant impact on mood or depressive symptoms compared to pharmacotherapy. However, Family-Focused Therapy had a greater impact on the proportion of weeks without mania/hypomania and mania/hypomania symptoms than enhanced care [ 53 ]. Alternatively, while the other study (RCT, N = 127, low risk of bias) found no significant impact on time to recovery, Family-Focused Therapy led to significantly longer intervals of wellness before new mood episodes, longer intervals between recovery and the next mood episode, and longer intervals of randomisation to the next mood episode in AYA with either Bipolar Disorder (BD) or Major Depressive Disorder (MDD), compared to family and individual psychoeducation [ 52 ].

Two US studies used a three-arm trial to compare Systemic-behavioural Family Therapy (SBFT) with elements of PS, to CBT and individual Non-directive Supportive therapy (NST) (RCT, N = 107, moderate risk of bias) [ 53 , 54 ]. One study looked at whether the PS elements of CBT and SFBT mediated the effectiveness of these interventions for the remission of MDD. It found that PS mediated the association between CBT, but not SFBT, and remission from depression. There was no significant association between SBFT and remission status, though there was a significant association between CBT and remission status [ 53 ]. The other study found no significant reduction in depression post-treatment or at 24-month follow-up for SBFT [ 54 ].

A PS intervention tested in maternal and child clinics in Nigeria RCT ( N = 686, moderate risk of bias) compared with enhanced TAU involving psychosocial and social support found no significant difference in the proportion of women who recovered from depression at 6-months post-partum [ 55 ]. However, there was a small difference in depression scores in favour of PS averaged across the 3-, 6-, 9-, and 12-month follow-up points. Cognitive Reminiscence Therapy, which involved recollection of past PS experiences and drew on PS techniques used for 12-25-year-olds in community mental health services in Australia (RCT, N = 26, moderate risk of bias), did not reduce depression symptoms compared with a brief evidence-based treatment at 1- or 2-month follow-up [ 56 ]. Additionally, the High School Transition Program in the US (RCT, N = 497, moderate risk of bias) aimed to prevent depression, anxiety, and school problems in youth transitioning to high school [ 57 ]. There was no reduction in the percentage of intervention students with clinical depression compared to the control group. Similarly, a small study focused on reducing depression symptoms, and nonadherence to antiretroviral therapy in pregnant women with HIV in South Africa (RCT, N = 23, some concern) found a significant reduction in depression symptoms compared to TAU, with the results being maintained at the 3-month follow-up [ 58 ].

Reduction in suicidality

Three studies measured a reduction in suicidality. A preventive treatment found a large reduction in suicidal orientation in the PS group compared to control post-treatment. In contrast, suicidal ideation scores were inconsistent at 1-,3- and 6- month follow-up, they maintained an overall lower score [ 50 ]. Furthermore, at post-test, significantly more participants in the PS group were no longer at risk of suicide. No significant differences were found in suicide plans or attempts. In a PST intervention, post-treatment suicide risk scores were lower than pre-treatment for the PST group but unchanged for the control group [ 12 ]. An online treatment found a moderate decline in ideation for the intervention group post-treatment compared to the control but was not sustained at a one-month follow-up [ 49 ].

Mediators and moderators

Eight studies measured PS skills or effectiveness. In two studies, despite the interventions reducing depression, there was no improvement in PS abilities [ 12 , 52 ]. One found that change in global and functional PS skills mediated the relationship between the intervention group and change in suicidal orientation, but this was not assessed for depression [ 50 ]. Three other studies found no change in depression symptoms, PS skills, or problem resolution [ 38 – 40 ]. Finally, CBT and SBFT led to significant increases in PS behaviour, and PS was associated with higher rates of remission across treatments but did not moderate the relationship between SBFT and remission status [ 53 ]. Another study found no changes in confidence in the ability to solve problems or belief in personal control when solving problems. Furthermore, the intervention group was more likely to adopt an avoidant PS style [ 46 ].

A high-intensity intervention for perinatal depression in Nigeria had no treatment effect on depression remission rates for the whole sample. Still, it was significantly effective for participants with more severe depression at baseline [ 55 ]. A PS intervention among juvenile detainees in the US effectively reduced depression for participants with higher levels of fluid intelligence, but symptoms increased for those with lower levels [ 42 ].The authors suggest that individuals with lower levels of fluid intelligence may have been less able to cope with exploring negative emotions and apply the skills learned.

This review has examined the evidence on the effectiveness of PS in the prevention or treatment of depression among 13–25-year-olds. We sought to determine in what way, in which contexts, and for whom PS appears to work in addressing depression. We found 25 studies involving 20 interventions. Results are promising for secondary prevention interventions, or interventions targeting clinical level populations, that utilize PS as the primary intervention [ 12 , 47 – 49 ]. These studies not only found a significant reduction in depression symptoms compared to active [ 48 , 49 ] and non-active [ 12 , 47 ] controls but also found a significant reduction in suicidal orientation and ideation [ 12 , 47 , 49 ]. These findings are consistent with meta-analyses of adult PS interventions [ 21 , 22 , 23 ], highlighting that PS interventions for AYA can be effective in real-world settings.

For other types of interventions (i.e., universal, selective prevention, indicated prevention), results were mixed in reducing depression. The one universal program was found to have a small, significant effect in reducing depression symptoms compared to a non-active control [ 37 ]. Most selective prevention programs were not effective [ 39 , 40 , 56 ], and those that did show small, significant effects had mixed outcomes for follow-up maintenance [ 41 , 42 ]. Most indicated prevention programs were not effective [ 30 , 31 , 45 – 47 ], yet a follow-up study showed a significant reduction in internalizing symptoms at 12-month post-treatment compared to an active control [ 44 ]. Given that these studies targeted sub-clinical populations and many of them had small sample sizes, these mixed findings may be a result of not having sufficient power to detect a meaningful difference.

Our review found limited evidence about PS skills as mediator or moderator of depression. Few studies measured improvements in PS skills; fewer still found interventions to be effective. The absence of evidence for PS abilities as a pathway is puzzling. It may be that specific aspects of PS behaviours and processes, such as problem orientation [ 59 ], are relevant. Alternatively, there may be a mechanism other than PS skills through which PS interventions influence depression.

Studies with PS as part of a wider intervention also showed mixed results, even amongst clinical populations. Although there was no clear rationale for the discrepancies in effectiveness between the studies, it is possible that the wider program dilutes the focus and impact of efficacious therapeutic elements. However, this is difficult to discern given the heterogeneity in the studies and limited information on study treatments and implementation factors. A broad conclusion might be that PS can be delivered most effectively with clinical populations in its purest PS form and may be tailored to a range of different contexts and forms, a range of populations, and to address different types of problems; however, this tailoring may reduce effectiveness.

Although the scale of impact is broadly in line with the small to moderate effectiveness of other treatments for youth depression [ 6 ], our review highlights shortcomings in study design, methods, and reporting that would allow for a better understanding of PS effectiveness and pathways. Studies varied in how well PS was operationalised. Low dosage is consistent with usage described in informal conversations with practitioners but may be insufficient for effectiveness. Fidelity was monitored in only half the studies despite evidence that monitoring implementation improves effectiveness [ 60 ]. There were references to implementation difficulties, including attrition, challenges in operationalizing online interventions, and skills of those delivering. Furthermore, most of the studies had little information about comorbidity and no analysis of whether it influenced outcomes. Therefore, we were unable to fully examine and conceptualize the ways, how and for whom PS works. More information about study populations and intervention implementation is essential to understand the potential of PS for broader dissemination.

Our review had several limitations. We excluded studies that included four treatments known to be effective in treating depression among AYA (e.g., CBT) but where the unique contribution of PS to clinical outcome could not be disentangled. Furthermore, we relied on authors’ reporting to determine if PS was included: details about operationalization of PS were often scant. Little evidence addressing the fit, feasibility, or acceptability of PS interventions was found, reflecting a limited focus on implementation. We included only English-language texts: relevant studies in other languages may exist, though our post-2000 inclusion criteria may limit this potential bias due to improved translation of studies to English over the years. Finally, the heterogeneity of study populations, problem severity, comparison conditions, outcome measures, and study designs, along with a relatively small number of included studies, limits confidence in what we can say about implementation and treatment outcomes.

Overall, our review indicates that PS may have the best results when implemented its purest form as a stand-alone treatment with clinical level AYA populations; tailoring or imbedding PS into wider programming may dilute its effectiveness. Our review also points to a need for continued innovation in treatment to improve the operationalizing and testing of PS, especially when included as a part of a more comprehensive intervention. It also highlights the need for study methods that allow us to understand the specific effects of PS, and that measure the frequency, dosage, and timing of PS to understand what is effective for whom and in what contexts.

Supporting information

S1 file. list of excluded studies..

https://doi.org/10.1371/journal.pone.0285949.s001

S2 File. PRISMA checklist.

https://doi.org/10.1371/journal.pone.0285949.s002

S1 Table. Individual risk of bias assessments using cochrane RoB2 tool by domain (1–5) and overall (6).

https://doi.org/10.1371/journal.pone.0285949.s003

Acknowledgments

All individuals that contributed to this paper are included as authors.

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Julie Radico Psy.D. ABPP

Self-Esteem

It’s ok you can’t solve every problem, trying to “fix" everything can leave you feeling like a failure..

Updated May 10, 2024 | Reviewed by Ray Parker

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  • Your intrinsic value is more than what you can do for other people.

You are still worthwhile and can be successful, even if you don’t have all the solutions.

  • Consider which decision will make you feel you’ve stayed true to your values.

In coaching others, I often discuss problem-solving strategies to help individuals think creatively and consider many options when they are faced with challenging situations.

Problem solving 1-2 includes the following:

  • Define the problem, identify obstacles, and set realistic goals .
  • Generate a variety of alternative solutions to overcome obstacles identified.
  • Choose which idea has the highest likelihood to achieve the goal.
  • Try out the solution in real-life and see if it worked or not.

Problem-solving strategies can be helpful in many situations. Thinking creatively and testing out different potential solutions can help you come up with alternative ways of solving your problems.

While many problems can be solved, there are also situations in which there is no “perfect” solution or in which what seems to be the best solution still leaves you feeling unsatisfied or like you’re not doing enough.

I encourage you to increase your comfort around the following three truths:

1. You can’t always solve everyone else’s problems.

2. You can’t always solve all of your own problems.

3. You are not a failure if you can’t solve every problem.

Source: Hans-Peter Gauster / Unsplash

You can’t always solve everyone else’s problems.

When someone around you needs help, do you feel compelled to find solutions to their problem?

Are you seen as the problem solver at your job or in your close relationships?

Does it feel uncomfortable for you to listen to someone tell you about a problem and not offer solutions?

There are times when others come to you because they know you can help them solve a problem. There are also times when the other person is coming to you not for a solution to their problem, but for support, empathy, and a listening ear.

Your relationships may be negatively impacted if others feel that you don’t fully listen and only try to “fix” everything for them. While this may feel like a noble act, it may lead the other person to feel like they have failed or that you think they are unable to solve their own problems.

Consider approaching such situations with curiosity by saying to the other person:

  • As you share this information with me, tell me how I can best support you.
  • What would be most helpful right now? Are you looking for an empathetic ear or want to brainstorm potential next steps?
  • I want to be sure I am as helpful as I can be right now; what are you hoping to get out of our conversation?

You can’t always solve all of your own problems.

We are taught from a young age that problems have a solution. For example, while solving word problems in math class may not have been your favorite thing to do, you knew there was ultimately a “right” answer. Many times, the real world is much more complex, and many of the problems that you face do not have clear or “right” answers.

You may often be faced with finding solutions that do the most good for the most amount of people, but you know that others may still be left out or feel unsatisfied with the result.

Your beliefs about yourself, other people, and the world can sometimes help you make decisions in such circumstances. You may ask for help from others. Some may consider their faith or spirituality for guidance. While others may consider philosophical theories.

Knowing that there often isn’t a “perfect” solution, you may consider asking yourself some of the following questions:

  • What’s the healthiest decision I can make? The healthiest decision for yourself and for those who will be impacted.
  • Imagine yourself 10 years in the future, looking back on the situation: What do you think the future-you would encourage you to do?
  • What would a wise person do?
  • What decision will allow you to feel like you’ve stayed true to your values?

You are not a failure if you can’t solve all of the problems.

If you have internalized feeling like you need to be able to solve every problem that comes across your path, you may feel like a failure each time you don’t.

It’s impossible to solve every problem.

problem solving skills mental health

Your intrinsic value is more than what you can do for other people. You have value because you are you.

Consider creating more realistic and adaptive thoughts around your ability to help others and solve problems.

Some examples include:

  • I am capable, even without solving all of the problems.
  • I am worthwhile, even if I’m not perfect.
  • What I do for others does not define my worth.
  • In living my values, I know I’ve done my best.

I hope you utilize the information above to consider how you can coach yourself the next time you:

  • Start to solve someone else’s problem without being asked.
  • Feel stuck in deciding the best next steps.
  • Judge yourself negatively.

1. D'zurilla, T. J., & Goldfried, M. R. (1971). Problem solving and behavior modification. Journal of abnormal psychology, 78(1), 107.

2. D’Zurilla, T. J., & Nezu, A. M. (2010). Problem-solving therapy. Handbook of cognitive-behavioral therapies, 3(1), 197-225.

Julie Radico Psy.D. ABPP

Julie Radico, Psy.D. ABPP, is a board-certified clinical psychologist and coauthor of You Will Get Through This: A Mental Health First-Aid Kit.

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Cognitive Remediation Therapy: 13 Exercises & Worksheets

Cognitive Remediation Therapy

This can result in concentration, organizational, and planning difficulties that impact their quality of life and independent living.

Cognitive Remediation Therapy (CRT) helps by increasing awareness of intellectual difficulties and improving thinking skills. While originally designed for people with thinking problems associated with schizophrenia, it has also proven successful for those with other diagnoses (Bristol Mental Health, n.d.).

CRT works by encouraging a range of exercises and activities that challenge memory, flexible thinking, planning, and concentration problems.

This article explores CRT and its potential to help clients and includes techniques, activities, and worksheets to build effective therapy sessions.

Before you continue, we thought you might like to download our three Positive CBT Exercises for free . These science-based exercises will provide you with detailed insight into Positive CBT and give you the tools to apply it in your therapy or coaching.

This Article Contains:

What is cognitive remediation therapy (crt), how does cognitive remediation work, 8 techniques for your sessions, 7 exercises, activities, & games, 6 helpful worksheets and manuals, implementing online crt programs, 3 best software programs for helping your clients, a take-home message.

“Cognitive remediation is a behavioral treatment for people who are experiencing cognitive impairments that interfere with daily functioning” (Medalia, Revheim, & Herlands, 2009, p. 1).

Successful cognitive functions, including memory, attention, visual-spatial analysis, and abstract reasoning, are vital for engaging with tasks, the environment, and healthy relationships.

CRT improves cognitive processing and psychosocial functioning through behavioral training and increasing individual confidence in people with mental health disorders (Corbo & Abreu, 2018). Training interventions focus on the skills and supports required to “improve the success and satisfaction people experience in their chosen living, learning, working, and social environments” (Medalia et al., 2009, p. 2).

Exercises typically focus on specific cognitive functions, where tasks are repeated (often on a computer) at increasing degrees of difficulty. For example:

  • Paying attention
  • Remembering
  • Being organized
  • Planning skills
  • Problem-solving
  • Processing information

Based on the principles of errorless learning and targeted reinforcement exercises , interventions involve memory, motor dexterity, and visual reading tasks. Along with improving confidence in personal abilities, repetition encourages thinking about solving tasks in multiple ways (Corbo & Abreu, 2018).

While initially targeted for patients with schizophrenia, CRT is an effective treatment for other mental health conditions , including mood and eating disorders (Corbo & Abreu, 2018).

CRT is particularly effective when the cognitive skills and support interventions reflect the individual’s self-selected rehabilitation goals. As a result, cognitive remediation relies on collaboration, assessing client needs, and identifying appropriate opportunities for intervention (Medalia et al., 2009).

Cognitive remediation vs cognitive rehabilitation

CRT is one of several skill-training psychiatric rehabilitation interventions. And yet, cognitive remediation is not the same as cognitive rehabilitation (Tchanturia, 2015).

Cognitive rehabilitation typically targets neurocognitive processes damaged because of injury or illness and involves a series of interventions designed to retrain previously learned cognitive skills along with compensatory strategies (Tsaousides & Gordon, 2009).

Cognitive Remediation

While initially done in person, they can subsequently be performed remotely as required (Corbo & Abreu, 2018; Bristol Mental Health, n.d.).

Well-thought-out educational software provides multisensory feedback and positive reinforcement while supporting success, choice, and control of the learning process. Its design can target either specific cognitive functions or non-specific learning skills and mechanisms (Medalia et al., 2009).

CRT successfully uses the brain’s neuroplasticity and is often more effective in younger age groups who haven’t experienced the effects of long-term psychosis. It works by increasing activation and connectivity patterns within and across several brain regions involved in working memory and high-order executive functioning (Corbo & Abreu, 2018).

The Neuropsychological Educational Approach to Cognitive Remediation (NEAR) is one of several approaches that provide highly individualized learning opportunities. It allows each client to proceed at their own pace on tasks selected and designed to engage them and address their cognitive needs (Medalia et al., 2009).

NEAR and other CRT techniques are influenced by learning theory and make use of the following (Medalia et al., 2009):

  • Errorless learning Encouraging the client to learn progressively, creating a positive experience without relying on trial and error.
  • Shaping and positive feedback Reinforcing behaviors that approximate target behaviors (such as good timekeeping) and offering rewards (for example, monthly certificates for attendance).
  • Prompting Using open-ended questions that guide the client toward the correct response.
  • Modeling Demonstrating how to solve a problem.
  • Generalizing Learning how to generalize learned skills to other situations.
  • Bridging Understanding how to apply skills learned inside a session outside  in everyday life.

Encouraging intrinsic motivation (doing the tasks for the satisfaction of doing them rather than for external rewards) and task engagement are also essential aspects of successful CRT programs (Medalia et al., 2009).

Therapy is most effective when it successfully supports clients as they transfer learning skills into the real world.

problem solving skills mental health

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Cognitive remediation techniques must be selected according to the skills and needs of the client and typically fall into one of three major intervention categories (Medalia et al., 2009):

  • Planning exercises, such as planning a trip to the beach to practice cognitive strategies
  • Cueing and sequencing , such as adding signs or placing reminder notes at home to encourage completing everyday tasks (for example, brushing teeth)

Such techniques rely on several key principles, including “(1) teaching new, efficient, information processing strategies; (2) aiding the transfer of cognitive gains to the real world; and (3) modifying the local environment” (Medalia et al., 2009, p. 5).

  • Restorative approaches Directly target cognitive deficits by repeating task practices and gradually increasing difficulty and complexity; along with regular feedback, they encourage accurate and high levels of performance.

Practice is often organized hierarchically, as follows:

  • Elementary aspects of sensory processing (for example, improving auditory processing speed and accuracy)
  • High-order memory and problem-solving skills (including executive functioning and verbal skills)

This technique assumes a degree of neuroplasticity that, with training, results in a greater degree of accuracy in sensory representations, improved cognitive strategies for grouping stimuli into more meaningful groups, and better recall.

  • Repetition and reaching for increasing levels of task difficulty
  • Modeling other people’s positive behavior
  • Role-play  to re-enact experienced or imagined behavior from different perspectives
  • Corrective feedback to improve and correct unwanted or unhelpful behavior

Complex social cognitive processes are typically broken down into elemental skills for repetitive practice, role-play, and corrective feedback.

Professor Dame Til Wykes: cognitive remediation therapy

It is vital that activities within CRT are interesting and engaging for clients. They must foster the motivation required to persevere to the end of the task or game.

The following three games and puzzles are particularly valuable for children and adolescents (modified from Tchanturia, 2015):

SET

SET is a widely available card game that practices matching based on color, shape, shading, etc.

Clients must shift their thinking to identify multiple ways of categorizing and grouping cards, then physically sort them based on their understanding.

It may be helpful to begin with a limited set of cards to reduce the likelihood of the clients becoming overwhelmed by the game or finding it less enjoyable.

2. Rush Hour

Rush Hour

Rush Hour is another fun game that balances problem-solving skills with speed.

Puzzles start simple and increase in complexity, with additional elements involved. Skills developed include problem-solving and abstract thinking, and the game requires a degree of perseverance.

QBitz

Other activities require no specialist equipment and yet can be highly engaging and support clients in learning transferable skills (modified from Tchanturia, 2015).

  • Bigger picture thinking This involves the client picturing a shape in their minds or looking at one out of sight of the therapist. They then describe the shape (without naming it), while the therapist attempts to draw it according to the instructions. This practice is helpful with clients who get overwhelmed by detail and cannot see the bigger picture.
  • Word searches Word searches encourage the client to focus on relevant information and ignore everything else – an essential factor in central coherence. Such puzzles also challenge memory, concentration, and attention.
  • Last word response Last word response is a challenging verbal game promoting cognitive flexibility. The first player makes up and says a sentence out loud. Each subsequent player makes up a new sentence, starting with the last word of the previous player’s sentence. For example, ‘ I like cheese’ may be followed by the next player saying, ‘ Cheese is my favorite sandwich ingredient ,’ etc.
  • Dexterity Using your non-dominant hand once a week (for example, combing your hair or brushing your teeth) stimulates different parts of your brain, creating alternative patterns of neuron firing and strengthening cognitive functions.

The following therapy worksheets help structure Cognitive Remediation Therapy sessions and ensure that the needs of clients are met using appropriately targeted CRT interventions (modified from Medalia et al., 2009; Medalia & Bowie, 2016):

Client referral to CRT

The Cognitive Remediation Therapy Referral Form captures valuable information when a client is referred from another agency or therapist so that the new therapist can identify and introduce the most appropriate CRT interventions. The form includes information such as:

Primary reasons

Secondary reasons

  • Self-confidence
  • Working with others
  • Time management
  • Goal-directed activities

Cognitive Appraisal for CRT

The Cognitive Appraisal for CRT form is helpful for identifying and recording areas of cognitive processing that cause difficulty for the client and require focus during Cognitive Remediation Therapy sessions.

Clients are scored on their degree of difficulty with the following:

  • Paying attention during conversation
  • Maintaining concentration in meetings
  • Completing tasks once started
  • Starting tasks
  • Planning and organizing tasks and projects
  • Reasoning and solving problems

Software Appraisal for CRT

The Software Appraisal for CRT form helps assess which software would be most helpful in a specific Cognitive Remediation Therapy session. It provides valuable input for tailoring treatment to the needs of the client.

For example:

  • Level of reading ability required
  • Cognitive deficits addressed by the software
  • What is the multimedia experience like?
  • How much input is required by the therapist?

Appraisal records become increasingly important as more software is acquired for clients with various cognitive deficits from multiple backgrounds.

Software Usage for CRT

The Software Usage for CRT form helps keep track of the software clients have tried and how effectively it supports them as they learn, develop, and overcome cognitive deficits.

The client considers the software they use and whether they practiced the following areas of cognition:

  • Concentration
  • Processing speed
  • Multitasking
  • Logic and reasoning
  • Organization
  • Fast responses
  • Working memory

Thought Tracking During Cognitive Remediation Therapy

Thought Tracking During Cognitive Remediation Therapy is valuable for identifying and recording the client’s goals for that day’s Cognitive Remediation Therapy session and understanding how it relates to their overall treatment goals.

Planning to Meet Goals in CRT

The Planning to Meet Goals in CRT worksheet is for clients requiring support and practice in planning, goal-setting, and goal achievement.

Working with the client, answer the following prompts:

  • What goal or project are you working toward?
  • What date should it be completed by?
  • Are there any obstacles to overcome to complete the goal?
  • Are there any additional resources required?
  • Then consider the steps needed to achieve the goal.

Other free resources

Happy Neuron provides several other free resources that are available for download .

Implementing CRT Programs

Consider the five Cs when selecting online CRT programs (modified from Medalia et al., 2009):

  • Cognitive – What target deficits are being addressed?
  • Client – What interests and level of functioning does the client have?
  • Computer – What computing requirements and compatibility factors need to be considered?
  • Context – Does the software use real-world or fantasy activities and environments? Are they age and cognitive ability appropriate?
  • Choice – Is the learner given choice and options to adapt the activity to their preferences?

Once you’ve ordered the software, give it a thorough review to understand when it is most appropriate to use and with whom.

For online CRT programs to be effective as teaching tools and activities, they should include the following features (modified from Medalia et al., 2009, p. 53):

  • Intrinsically motivating
  • Active use of information
  • Multisensory strategies
  • Frequent feedback
  • Control over the learning process
  • Positive reinforcement
  • Application of newly acquired skills in appropriate contexts
  • Errorless learning – challenging yet not frustrating

Therapists must become familiar with each program’s content and processes so that targeted deficits are fully understood and clients are engaged without confusion or risk of failure.

problem solving skills mental health

17 Science-Based Ways To Apply Positive CBT

These 17 Positive CBT & Cognitive Therapy Exercises [PDF] include our top-rated, ready-made templates for helping others develop more helpful thoughts and behaviors in response to challenges, while broadening the scope of traditional CBT.

Created by Experts. 100% Science-based.

A great deal of software “targets different skills and offers a variety of opportunities for contextualization and personalization” (Medalia et al., 2009, p. 43).

We focus on three suppliers of extensive CRT software resources below (recommended by Medalia et al., 2009).

1. Happy Neuron

problem solving skills mental health

Happy Neuron provides a wide variety of online brain training exercises and activities to stimulate cognitive functioning in the following areas:

  • Visual-spatial

BrainHQ

When you’re performing well, the exercises become increasingly difficult.

The exercises are grouped into the following areas:

  • Brain speed
  • People skills
  • Intelligence

3. Games for the Brain

Games for the brain

Cognitive difficulties, such as challenges with paying attention, planning, remembering, and problem-solving, can further compound and exacerbate mental health issues

While initially created for schizophrenia, CRT is also valuable for other mental health problems, including eating and mood disorders. Treatments are effective in one-to-one and group sessions, and lessons can be transferred to the outside world, providing crucial gains for a client’s mental wellbeing and social interaction.

Through repeated and increasingly challenging skill-based interventions, CRT benefits cognitive functioning and provides confidence gains to its users. The treatment adheres to learning theory principles and targets specific brain processing areas such as motor dexterity, memory, and visual-spatial perception, along with higher-order functioning.

Involving clients in treatment choices increases the likelihood of ongoing perseverance, engagement, and motivation as activities repeat with increasing degrees of difficulty.

This article offers a valuable starting point for exploring CRT and its benefits, with several worksheets and forms to encourage effective treatment.

We hope you enjoyed reading this article. For more information, don’t forget to download our three Positive CBT Exercises for free .

  • Bristol Mental Health. (n.d.). Cognitive remediation therapy: Improving thinking skills . Retrieved December 15, 2021, from http://www.awp.nhs.uk/media/424704/cognitive-remediation-therapy-022019.pdf
  • Corbo, M., & Abreu, T. (2018). Cognitive remediation therapy: EFPT psychotherapy guidebook . Retrieved December 15, 2021, from https://epg.pubpub.org/pub/05-cognitive-remediation-therapy/release/3
  • Medalia, A., & Bowie, C. R. (2016). Cognitive remediation to improve functional outcomes . Oxford University Press.
  • Medalia, A., Revheim, N., & Herlands, T. (2009). Cognitive remediation for psychological disorders: Therapist guide . Oxford University Press.
  • Tchanturia, K. (2015). Cognitive remediation therapy (CRT) for eating and weight disorders . Routledge.
  • Tsaousides, T., & Gordon, W. A. (2009). Cognitive rehabilitation following traumatic brain injury: Assessment to treatment. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine , 76 (2), 173-181.

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What our readers think.

Sam DiVincenzo

To my surprise this is a treatment that has not been discussed in the area I live and work. I just stumbled upon this when I was researching cognitive impairments with schizophrenia. I currently work on a team with multiple mental health professionals that go out into the community, to work with people diagnosed with Schizophrenia. It seems like most of what we do is manage and monitor symptoms. Are you aware of anyone or any agency in Buffalo, NY that uses this method of treatment? I am trying to figure out how to get trained and use it in practice, if that is possible. Any help will be greatly appreciated.

Sheila Berridge

This looks like the treatment my daughter needs. She has struggled for years with the cognitive problems associated with depression. How do we find a therapist near us who can use these techniques?

Nicole Celestine, Ph.D.

I’m sorry to read that your daughter is struggling. You can find a directory of licensed therapists here (and note that you can change the country setting in the top-right corner). You’ll also find that there are a range of filters to help you drill down to the type of support you need: https://www.psychologytoday.com/us/therapists

I hope you find the help you need.

– Nicole | Community Manager

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problem solving skills mental health

3 Positive CBT Exercises (PDF)

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Why Is Problem-solving an Important Skill to Address Mental Health?

Problems that we cannot solve take a toll on our mental well-being . When we can’t get rid of a problem, it stresses us out. We lose sleep. We couldn’t even eat properly. That’s when our physical and mental health starts to decline . We feel stressed by the simplest of things. A small problem can lead to a bigger problem when left unsolved. We end up feeling depressed and hopeless because there seems to be no way out of the problem.

But when you learn how to solve your problems efficiently, you can also remove the stressors in your life. You will begin to learn how to cope with these problems, and you will soon find out that it’s easier to face them than run away from them. After all, no matter what you do, your problems are going to hound you.

What if the problems are not easily fixed?

There are problems, of course, that will be hard to address. Marriage problems are on the top of that list. Whenever you deal with issues in your personal relationship, you sometimes feel like there is no way out. No matter where you look, there will be consequences from your actions. There is, however, one particular step that you need to take when the matters get too serious—you have to call an  attorney from a family law firm . The attorney will guide you through the process of solving your marital problems.

Sometimes, you don’t even have to deal with the problem on your own. It’s through legal means. While the solution is complicated and expensive, what’s important is there is a way to solve the issue legally. Even problems in your workplace can be solved through legal means, so make sure you’re aware of your rights at work and at home.

Better functioning, improved productivity

When you can deal with the challenges that you face in your personal and professional life, you will be more productive at work. Stress will not weigh you down. You will also be better at dealing with your personal relationships when you have fewer problems and issues to think about. A problem-free life? Is that possible? Not really possible, but problems can be better managed.

Closer relationships with family, friends, and co-workers

People who cannot deal with problems often find themselves isolated from their family, friends, and co-workers. They become moody because of the stress of running away from their problems. But you can enjoy your relationships better when you have the skills to solve your problems, from small ones to complicated ones. You will become a better version of yourself, someone who can forge lasting relations with other people, even with your co-workers.

Higher Self-esteem

When you are confident with your ability to handle your problems, that will translate into everything you do. You will be more confident at work and in your personal relationships. You’re going to be more outgoing, too. This will improve not only your self-esteem but your social skills, too. You will be confident among your peers. That will create a positive impact on your mental health because your problem-solving skills will arm you with the tools you need to socialize, build camaraderie in the workplace, and improve your well-being.

Higher Life Satisfaction

Aren’t you more satisfied with life when you are free from worries? People tend to wallow in their sorrow when they don’t have any idea how to deal with their problems. However, once you have a “formula” of how to manage the issues that you face at work and home, then you will also have a better understanding of what makes you happy. Although you cannot always avoid situations that might lead to even bigger problems (since that is no way to live your life), you can arm yourself with the skills you need to be happier and more fulfilled.

Problems create stress in your life when you have no idea how to deal with them. Most people wouldn’t know how to solve or even face their problems. That’s normal because who really has a Ph.D. in problem-solving? But as you go through life and face challenges left and right, you need to find a “formula” that works for you. What is it that works for you? Do you need time to think, or are you the kind of person who acts immediately? Do you find it more satisfying when you face a problem head-on or when you take time off at first before dealing with it?

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Reasons for hope

Solutions for the mental health crisis emerge through innovative research, diagnostics and treatments

By Nina Bai

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Photography by Leslie Williamson

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It’s the spring of hope for mental health, astir with novel discoveries, life-changing therapies and more openness than ever before — yet, for many, it feels like the winter of despair. The pandemic years, that crucible of stress, isolation and uncertainty, fueled and exposed mental health problems. In 2022, nearly 1 in 4 American adults (about 59 million people) said they experienced a mental illness in the previous year, but only half of those afflicted reported receiving any mental health treatment.

Among children and adolescents, the prevalence of mental illness, which had been steadily creeping upward, jumped during the pandemic, according to the U.S. Substance Abuse and Mental Health Services Administration. In 2019, 15.7% of American adolescents aged 12-17 reported experiencing a major depressive episode in the past year. In 2022, that number was 19.5%. That same year, 13.4% of adolescents — just over 1 in 8 — seriously thought about killing themselves.   

And even as the pandemic has stoked demand for mental health care, it also has worn down the mental health workforce, already short-handed, with early retirements and widespread burnout. Access to affordable, effective interventions remains a daunting barrier. People face long waiting lists and lack of insurance coverage. Many treatable conditions remain undiagnosed because people lack a way to obtain assessments. 

Yet, below this perfect storm of mental health crisis, there is a strong undercurrent of hope that begins in the lab. Research is leading the way toward treatments that are more effective, more personalized and more accessible.

“The manner in which we know the brain now, compared with what we knew in previous decades, is incredibly different,” said Victor Carrión , MD, the John A. Turner, MD, Endowed Professor for Child and Adolescent Psychiatry and vice chair of the department of psychiatry and behavioral sciences.

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Direct impact on patients

New imaging technologies allow researchers to see the neural circuitry that goes awry in neuropsychiatric disorders, lab-grown clumps of brain tissue — known as organoids — can simulate the impact of genetics in autism, and artificial intelligence can surmise signals that predict the onset of depression and anxiety.

Moreover, these discoveries, rather than moving slowly through specialist silos, can now rapidly inform new treatments. “Collaboration is vital for translation, and our departmental awards and programs promote and emphasize synergy between research and clinical practice,” said Laura Roberts , MD, the Katharine Dexter McCormick and Stanley McCormick Memorial Professor and chair of the department of psychiatry and behavioral sciences.

“Our bench scientists doing tremendous research also work alongside our clinicians to make sure that new knowledge translates to the clinical setting and has a direct impact on patient care,” she said.

Researchers developing transcranial magnetic stimulation, for example, work with clinicians who treat patients with severe depression to design clinical trials, and their techniques are informed by teams inventing new ways to measure the flow of brain signals and those building virtual reality models of the brain.

A clearer understanding of the biology of mental health disorders not only leads to breakthrough treatments — but just as powerfully, helps dissipate stigma.

“There’s been a large shift in stigma in the past 25 years,” said Heather Gotham , PhD, clinical professor of psychiatry and behavioral sciences, who leads the coordination of a nationwide network of centers dedicated to implementing evidence-based mental health care.

The Mental Health Technology Transfer Center Network, funded by the Substance Abuse and Mental Health Services Administration, offers training in preventing school violence, substance use in the workplace, adolescent depression and more, and it offers support for mental health providers seeing refugees and asylum seekers.

“Collaboration is vital for translation, and our departmental awards and programs promote and emphasize synergy between research and clinical practice.” Laura Roberts, the Katharine Dexter McCormick and Stanley McCormick Memorial Professor and chair of the department of psychiatry and behavioral sciences

“One thing that’s made a difference is the greater understanding that mental health disorders and substance use disorders are chronic, relapsing disorders of the body, just like diabetes and heart disease,” Gotham said.

With this new awareness, more people want to be mental health literate. In the past few years, Gotham has seen a surge of interest, from a broader community, in the network’s online courses — from teachers, for example, who want to be more responsive to the needs of students and reduce stigma in the classroom.

Less stigma also means more money for research and mental health services. Funding for mental health has become a rare bipartisan issue. In 2022, Congress passed the Bipartisan Safer Communities Act, which has provided $245 million to fund mental health services like training for school personnel, first responders and law enforcement and expanding the 988 suicide and crisis lifeline.

Stanford Medicine researchers know that to make the most impact with their discoveries they must reach those who need help the most — through online symptom screenings, virtual therapy, group therapy, inclusive clinical trials and community interventions.

They are training mental health professionals locally and globally in new evidence-based techniques. Providers in more than 38 countries, for example, have been trained in cue-centered therapy, a 15-week treatment program developed at Stanford Medicine to help children and teens recover from chronic trauma. Recently, pro bono training in cue-centered therapy was provided to clinicians in Ukraine.

What gives Roberts hope is that a more open conversation on mental health is drawing together experts from different fields with a shared purpose. “It used to be that clinicians would stay in their clinical practice and refer to journals for new research, and researchers would stay in the lab and never see a patient — and we don’t have that now,” she said. “I see more openness and more flexibility from the current generation of researchers and clinicians.”

Read on in this issue of Stanford Medicine to learn about some of the ways Stanford Medicine researchers and clinicians are advancing the understanding of mental health and sharing that knowledge.

Nina Bai is a science writer in the Stanford Medicine Office of Communications.

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What Is Cognitive Behavioral Therapy (CBT)?

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

problem solving skills mental health

Rachel Goldman, PhD FTOS, is a licensed psychologist, clinical assistant professor, speaker, wellness expert specializing in eating behaviors, stress management, and health behavior change.

problem solving skills mental health

Verywell / Daniel Fishel

  • Effectiveness
  • Considerations
  • Getting Started

Cognitive behavioral therapy (CBT) is a type of psychotherapeutic treatment that helps people learn how to identify and change the destructive or disturbing thought patterns that have a negative influence on their behavior and emotions.

Cognitive behavioral therapy combines cognitive therapy with behavior therapy by identifying maladaptive patterns of thinking, emotional responses, or behaviors and replacing them with more desirable patterns.

Cognitive behavioral therapy focuses on changing the automatic negative thoughts that can contribute to and worsen our emotional difficulties, depression , and anxiety . These spontaneous negative thoughts also have a detrimental influence on our mood.

Through CBT, faulty thoughts are identified, challenged, and replaced with more objective, realistic thoughts.

Everything You Need to Know About CBT

This video has been medically reviewed by Steven Gans, MD .

Types of Cognitive Behavioral Therapy

CBT encompasses a range of techniques and approaches that address our thoughts, emotions, and behaviors. These can range from structured psychotherapies to self-help practices. Some of the specific types of therapeutic approaches that involve cognitive behavioral therapy include:

  • Cognitive therapy centers on identifying and changing inaccurate or distorted thought patterns, emotional responses, and behaviors.
  • Dialectical behavior therapy (DBT)  addresses destructive or disturbing thoughts and behaviors while incorporating treatment strategies such as emotional regulation and mindfulness.
  • Multimodal therapy suggests that psychological issues must be treated by addressing seven different but interconnected modalities: behavior, affect, sensation, imagery, cognition, interpersonal factors, and drug/biological considerations.
  • Rational emotive behavior therapy (REBT) involves identifying irrational beliefs, actively challenging these beliefs, and finally learning to recognize and change these thought patterns.

While each type of cognitive behavioral therapy takes a different approach, all work to address the underlying thought patterns that contribute to psychological distress.

Cognitive Behavioral Therapy Techniques

CBT is about more than identifying thought patterns. It uses a wide range of strategies to help people overcome these patterns. Here are just a few examples of techniques used in cognitive behavioral therapy. 

Identifying Negative Thoughts

It is important to learn what thoughts, feelings, and situations are contributing to maladaptive behaviors. This process can be difficult, however, especially for people who struggle with introspection . But taking the time to identify these thoughts can also lead to self-discovery and provide insights that are essential to the treatment process.

Practicing New Skills

In cognitive behavioral therapy, people are often taught new skills that can be used in real-world situations. For example, someone with a substance use disorder might practice new coping skills and rehearse ways to avoid or deal with social situations that could potentially trigger a relapse.

Goal-Setting

Goal setting can be an important step in recovery from mental illness, helping you to make changes to improve your health and life. During cognitive behavioral therapy, a therapist can help you build and strengthen your goal-setting skills .

This might involve teaching you how to identify your goal or how to distinguish between short- and long-term goals. It may also include helping you set SMART goals (specific, measurable, attainable, relevant, and time-based), with a focus on the process as much as the end outcome.

Problem-Solving

Learning problem-solving skills during cognitive behavioral therapy can help you learn how to identify and solve problems that may arise from life stressors, both big and small. It can also help reduce the negative impact of psychological and physical illness.

Problem-solving in CBT often involves five steps:

  • Identify the problem
  • Generate a list of potential solutions
  • Evaluate the strengths and weaknesses of each potential solution
  • Choose a solution to implement
  • Implement the solution

Self-Monitoring

Also known as diary work, self-monitoring is an important cognitive behavioral therapy technique. It involves tracking behaviors, symptoms, or experiences over time and sharing them with your therapist.

Self-monitoring can provide your therapist with the information they need to provide the best treatment. For example, for people with eating disorders, self-monitoring may involve keeping track of eating habits, as well as any thoughts or feelings that went along with consuming a meal or snack.

Additional cognitive behavioral therapy techniques may include journaling , role-playing , engaging in relaxation strategies , and using mental distractions .

What Cognitive Behavioral Therapy Can Help With

Cognitive behavioral therapy can be used as a short-term treatment to help individuals learn to focus on present thoughts and beliefs.

CBT is used to treat a wide range of conditions, including:

  • Anger issues
  • Bipolar disorder
  • Eating disorders
  • Panic attacks
  • Personality disorders

In addition to mental health conditions, cognitive behavioral therapy has also been found to help people cope with:

  • Chronic pain or serious illnesses
  • Divorce or break-ups
  • Grief or loss
  • Low self-esteem
  • Relationship problems
  • Stress management

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Benefits of Cognitive Behavioral Therapy

The underlying concept behind CBT is that thoughts and feelings play a fundamental role in behavior. For example, a person who spends a lot of time thinking about plane crashes, runway accidents, and other air disasters may avoid air travel as a result.

The goal of cognitive behavioral therapy is to teach people that while they cannot control every aspect of the world around them, they can take control of how they interpret and deal with things in their environment.

CBT is known for providing the following key benefits:

  • It helps you develop healthier thought patterns by becoming aware of the negative and often unrealistic thoughts that dampen your feelings and moods.
  • It is an effective short-term treatment option as improvements can often be seen in five to 20 sessions.
  • It is effective for a wide variety of maladaptive behaviors.
  • It is often more affordable than some other types of therapy .
  • It is effective whether therapy occurs online or face-to-face.
  • It can be used for those who don't require psychotropic medication .

One of the greatest benefits of cognitive behavioral therapy is that it helps clients develop coping skills that can be useful both now and in the future.

Effectiveness of Cognitive Behavioral Therapy

CBT emerged during the 1960s and originated in the work of psychiatrist Aaron Beck , who noted that certain types of thinking contributed to emotional problems. Beck labeled these "automatic negative thoughts" and developed the process of cognitive therapy. 

Where earlier behavior therapies had focused almost exclusively on associations, reinforcements , and punishments to modify behavior, the cognitive approach addresses how thoughts and feelings affect behaviors.

Today, cognitive behavioral therapy is one of the most well-studied forms of treatment. It has been shown to be effective in the treatment of a range of mental conditions, including anxiety, depression, eating disorders, insomnia, obsessive-compulsive disorder , panic disorder, post-traumatic stress disorder , and substance use disorder.

  • Research indicates that cognitive behavioral therapy is the leading evidence-based treatment for eating disorders .
  • CBT has been proven helpful in those with insomnia, as well as those who have a medical condition that interferes with sleep, including those with pain or mood disorders such as depression.
  • Cognitive behavioral therapy has been scientifically proven to be effective in treating symptoms of depression and anxiety in children and adolescents.
  • A 2018 meta-analysis of 41 studies found that CBT helped improve symptoms in people with anxiety and anxiety-related disorders, including obsessive-compulsive disorder and post-traumatic stress disorder.
  • Cognitive behavioral therapy has a high level of empirical support for the treatment of substance use disorders, helping people with these disorders improve self-control , avoid triggers, and develop coping mechanisms for daily stressors.

CBT is one of the most researched types of therapy, in part, because treatment is focused on very specific goals and results can be measured relatively easily.

Verywell Mind's Cost of Therapy Survey , which sought to learn more about how Americans deal with the financial burdens associated with therapy, found that Americans overwhelmingly feel the benefits of therapy:

  • 80% say therapy is a good investment
  • 91% are satisfied with the quality of therapy they receive
  • 84% are satisfied with their progress toward mental health goals

Things to Consider With Cognitive Behavioral Therapy

There are several challenges that people may face when engaging in cognitive behavioral therapy. Here are a few to consider.

Change Can Be Difficult

Initially, some patients suggest that while they recognize that certain thoughts are not rational or healthy, simply becoming aware of these thoughts does not make it easy to alter them.

CBT Is Very Structured

Cognitive behavioral therapy doesn't focus on underlying, unconscious resistance to change as much as other approaches such as  psychoanalytic psychotherapy . Instead, it tends to be more structured, so it may not be suitable for people who may find structure difficult.

You Must Be Willing to Change

For cognitive behavioral therapy to be effective, you must be ready and willing to spend time and effort analyzing your thoughts and feelings. This self-analysis can be difficult, but it is a great way to learn more about how our internal states impact our outward behavior.

Progress Is Often Gradual

In most cases, CBT is a gradual process that helps you take incremental steps toward behavior change . For example, someone with social anxiety might start by simply imagining anxiety-provoking social situations. Next, they may practice conversations with friends, family, and acquaintances. By progressively working toward a larger goal, the process seems less daunting and the goals easier to achieve.

How to Get Started With Cognitive Behavioral Therapy

Cognitive behavioral therapy can be an effective treatment choice for a range of psychological issues. If you or someone you love might benefit from this form of therapy, consider the following steps:

  • Consult with your physician and/or check out the directory of certified therapists offered by the National Association of Cognitive-Behavioral Therapists to locate a licensed professional in your area. You can also do a search for "cognitive behavioral therapy near me" to find local therapists who specialize in this type of therapy.
  • Consider your personal preferences , including whether face-to-face or online therapy will work best for you.
  • Contact your health insurance to see if it covers cognitive behavioral therapy and, if so, how many sessions are covered per year.
  • Make an appointment with the therapist you've chosen, noting it on your calendar so you don't forget it or accidentally schedule something else during that time.
  • Show up to your first session with an open mind and positive attitude. Be ready to begin to identify the thoughts and behaviors that may be holding you back, and commit to learning the strategies that can propel you forward instead.

What to Expect With Cognitive Behavioral Therapy

If you're new to cognitive behavioral therapy, you may have uncertainties or fears of what to expect. In many ways, the first session begins much like your first appointment with any new healthcare provider.

During the first session, you'll likely spend some time filling out paperwork such as HIPAA forms (privacy forms), insurance information, medical history, current medications, and a therapist-patient service agreement. If you're participating in online therapy, you'll likely fill out these forms online.

Also be prepared to answer questions about what brought you to therapy, your symptoms , and your history—including your childhood, education, career, relationships (family, romantic, friends), and current living situation.

Once the therapist has a better idea of who you are, the challenges you face, and your goals for cognitive behavioral therapy, they can help you increase your awareness of the thoughts and beliefs you have that are unhelpful or unrealistic. Next, strategies are implemented to help you develop healthier thoughts and behavior patterns.

During later sessions, you will discuss how your strategies are working and change the ones that aren't. Your therapist may also suggest cognitive behavioral therapy techniques you can do yourself between sessions, such as journaling to identify negative thoughts or practicing new skills to overcome your anxiety .

If you are having suicidal thoughts, contact the  National Suicide Prevention Lifeline  at  988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

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

Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: A review of meta-analyses . Cognit Ther Res . 2012;36(5):427-440. doi:10.1007/s10608-012-9476-1

Merriam-Webster. Cognitive behavioral therapy .

Rnic K, Dozois DJ, Martin RA. Cognitive distortions, humor styles, and depression . Eur J Psychol. 2016;12(3):348-62. doi:10.5964/ejop.v12i3.1118

Lazarus AA, Abramovitz A. A multimodal behavioral approach to performance anxiety . J Clin Psychol. 2004;60(8):831-40. doi:10.1002/jclp.20041

Lincoln TM, Riehle M, Pillny M, et al. Using functional analysis as a framework to guide individualized treatment for negative symptoms . Front Psychol. 2017;8:2108. doi:10.3389/fpsyg.2017.02108

Ugueto AM, Santucci LC, Krumholz LS, Weisz JR. Problem-solving skills training . Evidence-Based CBT for Anxiety and Depression in Children and Adolescents: A Competencies-Based Approach . 2014. doi:10.1002/9781118500576.ch17

Lindgreen P, Lomborg K, Clausen L.  Patient experiences using a self-monitoring app in eating disorder treatment: Qualitative study .  JMIR Mhealth Uhealth.  2018;6(6):e10253. doi:10.2196/10253

Tsitsas GD, Paschali AA. A cognitive-behavior therapy applied to a social anxiety disorder and a specific phobia, case study . Health Psychol Res. 2014;2(3):1603. doi:10.4081/hpr.2014.1603

Kumar V, Sattar Y, Bseiso A, Khan S, Rutkofsky IH.  The effectiveness of internet-based cognitive behavioral therapy in treatment of psychiatric disorders .  Cureus . 2017;9(8):e1626.

Trauer JM, Qian MY, Doyle JS, Rajaratnam SMW, Cunnington D. Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis .  Ann Intern Med . 2015;163(3):191. doi:10.7326/M14-2841

Agras WS, Fitzsimmons-craft EE, Wilfley DE.  Evolution of cognitive-behavioral therapy for eating disorders .  Behav Res Ther . 2017;88:26-36. doi:10.1016/j.brat.2016.09.004

Oud M, De winter L, Vermeulen-smit E, et al.  Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis . Eur Psychiatry . 2019;57:33-45. doi:10.1016/j.eurpsy.2018.12.008

Carpenter J, Andrews L, Witcraft S, Powers M, Smits J, Hofmann S. Cognitive behavioral therapy for anxiety and related disorders: A meta‐analysis of randomized placebo‐controlled trials .  Depress Anxiety . 2018;35(6):502–14. doi:10.1002/da.22728

National Institute on Drug Abuse (NIDA).  Cognitive-behavioral therapy (alcohol, marijuana, cocaine, methamphetamine, nicotine) .

Gaudiano BA. Cognitive-behavioural therapies: Achievements and challenges . Evid Based Ment Health . 2008;11(1):5-7. doi:10.1136/ebmh.11.1.5

Beck JS. Cognitive Behavior Therapy: Basics and Beyond .

Coull G, Morris PG. The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: A systematic review . Psycholog Med . 2011;41(11):2239-2252. doi:10.1017/S0033291711000900

By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Morning Carpool

Morning Carpool

21 Mental Shifts to Boost Problem-Solving Skills and Become More Strategic

Posted: February 10, 2024 | Last updated: February 10, 2024

image credit: fizkes/Shutterstock <p><span>In 2019, Credit Suisse became entangled in a corporate espionage scandal. The bank spied on its former executives, raising serious questions about corporate governance. This scandal tarnished the bank’s reputation and led to high-profile resignations.</span></p>

Discover transformative mental shifts to supercharge your problem-solving skills. From embracing uncertainty to the power of daydreaming, prepare to change the way you tackle challenges forever!

image credit: g-stock-studio/shutterstock <p>While short power naps can be refreshing, long or irregular napping during the day can affect nighttime sleep. If you choose to nap, keep it early in the afternoon and under 20 minutes. This can help you get through the day without compromising your nightly sleep cycle.</p>

Embrace Uncertainty

Accept that not all answers are immediately clear. Uncertainty can be a powerful motivator rather than a source of stress. By embracing the unknown, we open ourselves up to a broader range of possibilities and solutions.

image credit: djile/Shutterstock <p><span>Understand when to avoid political discussions, especially if they lead to conflict. Set clear boundaries about what topics are off-limits in your interactions. This respects both parties’ comfort levels.</span></p>

Seek Diverse Perspectives

Look beyond your own experiences. Different perspectives can provide unique insights and spark innovative solutions. Engaging with people from various backgrounds allows you to see problems through a new lens and discover paths you might not have considered.

image credit: Standret/Shutterstock <p><span>No matter how hard you work, it never seems enough, and you aren’t receiving the positive feedback you crave. A pervasive sense of feeling undervalued and unacknowledged significantly contributes to burnout.</span></p>

Simplify the Complex

Break down big problems into smaller, manageable parts. When faced with a complex issue, deconstruct it to understand its fundamental components. This approach makes the problem less daunting and easier to tackle, leading to clearer, more effective solutions.

image credit: Stock 4you/Shutterstock <p><span>Life changes like marriage or having a child can affect your insurance needs. Failing to update your personal information can lead to inadequate coverage. Keeping your insurer informed ensures that your coverage meets your current needs.</span></p>

Adopt a Growth Mindset

Believe in your ability to learn and grow. A growth mindset encourages resilience and the pursuit of knowledge. Challenges are just undiscovered opportunities with potential for personal and professional development.

<p>Social issues are increasingly influencing corporate actions, and companies are making bold moves to address these challenges. From championing gender equality to reducing plastic waste, businesses are not just talking the talk; they’re walking the walk. Discover what other innovative strategies are shaping our corporate landscapes.</p>

Question Assumptions

Challenge the status quo. The barriers to solving a problem are often based on outdated or incorrect assumptions. By questioning the basis of your thinking, you can uncover new paths and innovative solutions.

image credit: Gumbariya/Shutterstock <p>Companies are embracing fair trade practices. They’re sourcing ethically, ensuring fair labor conditions, and supporting sustainable supply chains. This commitment to fairness helps producers and builds a more ethical business model. Fair trade is about respect and responsibility.</p>

Think in Reverse

Start with the desired outcome and work backward. This reverse-engineering approach forces you to think differently and can reveal insights you might have missed when approaching the problem linearly.

image credit: polkadot_photo/Shutterstock <p><span>The creative spark that used to light up your work is gone. You struggle to come up with new ideas and solutions. Your thinking feels stale and uninspired. This lack of creativity is a symptom of mental exhaustion.</span></p>

Embrace Failure as a Teacher

Learn from mistakes and change your perspective. Nobody likes to fail, but each failure provides valuable lessons that can guide future decisions and strategies. Failure isn’t the end but the beginning of understanding.

image credit: ground picture/shutterstock <p>Certain herbal teas, such as chamomile or peppermint, can have a soothing effect and are a great pre-bedtime ritual. These teas are caffeine-free and can be part of your unwinding process. Enjoying a warm cup can be incredibly relaxing.</p>

Harness the Power of Daydreaming

Let your mind wander. Sometimes, the best ideas come when you’re not actively trying to solve a problem. Allowing your mind to drift can lead to creative breakthroughs and unexpected solutions.

image credit: jakub-zak/shutterstock <p><span>Forgive yourself and others to release resentment and anger. Holding onto grudges drains emotional energy and hinders growth. Understand that everyone makes mistakes, including you. Forgiveness is a gift you give yourself.</span></p>

Practice Empathy

Understand others’ perspectives and needs. By putting yourself in someone else’s shoes, you can gain insights into the emotional and practical aspects of a problem, leading to more compassionate and effective solutions.

image credit: Kinga/Shutterstock <p>Blogging can be more than a hobby; it can be a highly profitable career. Bloggers earn money through advertising, sponsored content, and digital products. It requires dedication to producing consistent, high-quality content.</p>

Set Clear Goals

Define what success looks like. Clear goals provide direction and focus, making identifying the steps needed to solve a problem easier. They also help measure progress and keep you motivated.

image credit: ASTA-Concept/Shutterstock <p><span>Reduce the time spent in front of screens. Excessive screen time can lead to eye strain, poor sleep, and a sedentary lifestyle. Replace an hour of TV with a walk—a small change for a more active and engaged life.</span></p>

Stay Curious

Ask questions and seek knowledge. A curious mind is always looking for new information and ideas, which can lead to innovative problem-solving strategies. Curiosity is the engine of achievement.

image credit: Monkey-Business-Images/Shutterstock <p><span>Seafood is a delicate choice for a dinner party, especially varieties known for their strong smell, like certain shellfish or aged fish. It’s important to consider that seafood can be a divisive choice, with some guests having strong aversions or allergies. Freshness and mild flavors are key when opting for seafood. Selecting dishes that are universally appealing helps ensure a positive dining experience.</span></p>

Use Analogies

Draw parallels from different areas. Analogies can help clarify complex problems by relating them to something more familiar. This can simplify the problem-solving process and spark creative solutions.

image credit: Stock-Asso/Shutterstock <p><span>Artificial Intelligence (AI) is now a key player in shaping foreign policy decisions. AI algorithms are used to analyze global trends, predict political shifts, and assist in crisis management. This integration of AI brings a new level of sophistication to diplomatic strategies, offering insights beyond human capabilities. As AI continues to evolve, it promises to redefine the landscape of international relations.</span></p>

Focus on the Process, Not Just the Outcome

Enjoy the journey of problem-solving. Focusing too much on the end result can lead to frustration and missed opportunities. By valuing the process, you can learn and adapt as you go, leading to more sustainable solutions.

image credit: Lee-Charlie/Shutterstock <p><span>Protect your investments with stop-loss orders, which automatically sell stocks at a predetermined level. This tool can limit your losses during sudden market drops. A stop-loss order is your safety net in the volatile market. It’s a strategy that offers peace of mind.</span></p>

Prioritize Effectively

Set deadlines for achieving your goals. Know what matters most. Not all aspects of a problem are equally important. By prioritizing the key factors, you can allocate your time and resources more effectively and achieve better results.

image credit: Dusan-Petkovic/Shutterstock <p><span>Working from home means missing out on company-provided perks like free coffee or gym memberships. To compensate, look for local deals or create your own home gym. Consider the value of these perks and find alternative ways to incorporate them into your life. Being creative can help maintain your lifestyle without breaking the bank.</span></p>

Build Resilience

Give yourself time to recover, then bounce back from setbacks. Resilience is crucial for problem-solving, as it allows you to keep going despite challenges and failures. Resilience turns problems into opportunities.

image credit: Evgeny-Atamanenko/Shutterstock <p><span>Whole grains are your friends. Foods like brown rice, barley, and whole wheat provide essential nutrients like fiber, B vitamins, and iron. Not only do they help maintain a healthy gut, but they also keep you fuller for longer. Try incorporating them into your meals in creative ways, like using quinoa in a salad or barley in a hearty soup.</span></p>

Cultivate Patience

Give solutions time to unfold. Sometimes, the best solutions emerge over time, and immediate answers aren’t always the best. Patience allows you to thoroughly explore options and make more considered decisions.

image credit: Fernanda_Reyes/Shutterstock <p><span>Overtraining isn’t just a physical issue; it can take a toll on your mental health as well. Engage in activities that relax and rejuvenate your mind, such as meditation, reading, or spending time in nature. Taking care of your mental health is just as important as physical recovery.</span></p>

Practice Reflection

Don’t overlook the power of self-reflection. Take time to think about what you’ve learned. Reflecting on your experiences and the outcomes of your problem-solving efforts can provide valuable insights and improve future strategies.

image credit: insta_photos/Shutterstock <p><span>Borrowing money to invest can amplify your gains, known as leveraging. If your investments grow, you can repay the loan and keep the surplus as a profit. However, if your investments tank, you’re left with debt and no means to cover it. “Using debt to invest can be like playing financial Russian roulette,” warns a financial blogger.</span></p>

Encourage Collaboration

Work with others to find solutions and share goals. Collaborating with a team can bring in a range of skills and perspectives that enhance the problem-solving process and lead to more effective solutions.

image credit: TimeImage Production/Shutterstock <p><span>Vietnam’s economic reforms have catapulted it into the global spotlight. Its rapidly growing economy, strategic location, and commitment to trade liberalization make it an attractive destination for foreign investment. With a young workforce and a focus on sectors like electronics and textiles, Vietnam is carving out a niche in the global market. Its journey from a war-torn country to a thriving economy is an inspiration to many.</span></p>

Visualize Success

Imagine the desired outcome. Visualization can be a powerful motivator to enhance your performance and guide your actions toward achieving your goals. Focusing on the end result in your mind’s eye can make it a reality.

image credit: fizkes/Shutterstock <p><span>If you’re a frequent traveler, don’t assume your coverage extends internationally. Many plans have limited or no coverage abroad. Understanding your international coverage can save you from exorbitant medical bills overseas.</span></p>

Adapt and Evolve

Be willing to change your approach. The most effective problem-solvers are flexible and open to new methods and ideas. Adapting your strategy in response to new information or challenges can lead to better solutions.

<p><span>Fitness after 50 can be fun and challenging. Discover innovative programs and learn how fitness after 50 can be a thrilling adventure of rejuvenation and discovery! No matter your age, you can transform your body.</span></p>

Maintain a Positive Attitude

Stay optimistic and focused. A positive outlook can keep you motivated and open to new ideas. An optimistic mindset can also make the problem-solving process more enjoyable and less daunting.

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problem solving skills mental health

Video games help teens with problem-solving skills, mental health, making friends, finds Pew study

Despite stereotypes which show gaming as an activity got loners, many teens have seen positive outcomes from their gaming experiences. 56% say it helped their problem solving skills, while 47% say it helped them make friends. 41%, learned how to work as a team read more

Video games help teens with problem-solving skills, mental health, making friends, finds Pew study

A recent study by the Pew Research Center has provided some fresh insights into the world of teenage gamers, which sheds light on how gaming impacts young minds and hence cannot be dismissed without a nuanced understanding of its effects.

According to the survey, a whopping 85 per cent of teens in the United States are engaged in video gaming in some form. Among them, 40 per cent proudly identify themselves as “gamers,” indicating the significance of gaming in today’s youth culture. However, there is a gender gap here — boys are more likely to play video games compared to girls.

The study further examines the frequency and platforms of gaming that are popular among teens.

Around 40 per cent of respondents report playing video games daily, while 20 per cent indulge several times a week. Consoles (73 per cent) and smartphones (70 per cent) are the primary gaming devices of choice, and a solid 25 per cent of teens are venturing into virtual reality gaming.

Despite stereotypes which show gaming as an activity for lovers, many teens have seen positive outcomes from their gaming experiences.

Over half of the surveyed teens claim that gaming has improved their problem-solving skills (56 per cent), while nearly half credit it with helping them make friends within gaming communities (47 per cent). Moreover, a significant proportion acknowledges the role of gaming in promoting collaboration and teamwork (41 per cent)

However, alongside these benefits, the study highlights several concerning trends associated with excessive gaming. A considerable portion of teens report experiencing sleep disturbances, with 41 per cent attributing these issues to their gaming habits. Additionally, some have seen a negative impact on academic performance (17 per cent), raising questions about the balance between gaming and scholastic responsibilities.

Perhaps most alarming are the findings related to online harassment within gaming communities. Nearly half of the surveyed teens report encountering some form of harassment from fellow gamers, ranging from verbal abuse to more severe instances of cyberbullying. Such experiences underscore the need for greater vigilance and intervention to ensure the safety and well-being of young gamers.

Despite the prevalence of gaming among teens, signs of shifting attitudes are evident. A significant proportion of respondents admit to reducing their gaming time in recent months, signalling a potential desire for alternative activities and hobbies.

This trend aligns with broader discussions around tech-related dependencies and the importance of promoting balanced lifestyles among youth.

As experts and parents navigate the complexities of teenage gaming, the Pew survey serves as a valuable resource for understanding both the positive and negative impacts of gaming on adolescents.

While video games offer unique opportunities for entertainment and skill development, proactive measures must be taken to address potential risks and promote responsible gaming habits among teens.

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Supporting Your Team’s Mental Health

Mental health has become a bigger priority for both employers and employees in recent years. But there’s still more work to be done to support people’s mental health at work. Here are some impactful strategies to prioritize. Avoid one-size-fits-all solutions. Different roles and responsibilities require different interventions. To better support your employees, address how, where, and […]

Mental health has become a bigger priority for both employers and employees in recent years. But there’s still more work to be done to support people’s mental health at work. Here are some impactful strategies to prioritize.

Source: This tip is adapted from “5 Strategies for Improving Mental Health at Work,” by Morra Aarons-Mele

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  2. 6 steps of the problem solving process

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  3. Problem-Solving Therapy: Definition, Techniques, and Efficacy

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  4. 8 Important Problem Solving Skills

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  5. Problem Solving

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  6. Mental health skills you can learn for your psychological toolbox

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COMMENTS

  1. Problem-Solving Therapy: Definition, Techniques, and Efficacy

    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.

  2. 10 Best Problem-Solving Therapy Worksheets & Activities

    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.

  3. Problem-Solving Strategies: Definition and 5 Techniques to Try

    In insight problem-solving, the cognitive processes that help you solve a problem happen outside your conscious awareness. 4. Working backward. Working backward is a problem-solving approach often ...

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

    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.

  5. Solving Problems the Cognitive-Behavioral Way

    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 ...

  6. Problem solving

    Problem solving. Worrying is a natural response to life's problems. But when it takes over and we can start to feel overwhelmed, it can really help to take a step back and break things down. Learning new ways to work through your problems can make them feel more manageable, and improve your mental and physical wellbeing.

  7. Problem-Solving Therapy

    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.

  8. Wellness Module 4: Problem-Solving

    We end up feeling frustrated, stressed or maybe even depressed and hopeless. Problem solving helps you deal more effectively with stressors in your life. Problem-solving may have a number of additional benefits, including: Better functioning at work or school. More satisfying relationships with friends, family and co-workers.

  9. Problem Solving: Definition, Skills, & Strategies

    Learning skills to improve problem-solving through problem-solving therapy has been shown to help a variety of physical and mental ailments including depression and emotional distress (Malouff et al., 2007). Other skills you can develop to increase your problem-solving abilities include creativity and analysis.

  10. Problem Solving Packet

    worksheet. Guide your clients and groups through the problem solving process with the help of the Problem Solving Packet. Each page covers one of five problem solving steps with a rationale, tips, and questions. The steps include defining the problem, generating solutions, choosing one solution, implementing the solution, and reviewing the ...

  11. Problem-solving training as an active ingredient of treatment for youth

    Problem-Solving Therapy (PST) is a therapeutic approach developed by D'Zurilla and Goldfried [] in the 1970s, to alleviate mental health difficulties by improving PS ability.Conceptually rooted in Social Learning Theory [], PST aims to promote adaptive PS by helping clients foster an optimistic and self-confident attitude towards problems (i.e., a positive problem orientation), and by ...

  12. PDF Problem-Solving Therapy: A Treatment Manual

    Straighten your head forward, pressing your chin to your chest. Feel the tension in your throat and the back of your neck (reader—pause for 3 seconds). Now relax . . . allow your head to return to a comfortable position. Let the relaxation spread over your shoulders (reader—pause for 3 seconds).

  13. Problem solving self-help guide

    The more you practice, the easier problem-solving will be. Further help. If you're feeling distressed, in a state of despair, suicidal or need emotional support you can phone NHS 24 on 111. If you feel you need more help with your mental health, try speaking to your GP, or search for mental health and wellbeing services in your area.

  14. Problem-solving interventions and depression among adolescents and

    PST focuses on four core skills to promote adaptive problem solving, including: (1) defining the problem; (2) brainstorming possible solutions ... Greco G, Sahu R, et al. Effectiveness and costs associated with a lay counselor-delivered, brief problem-solving mental health intervention for adolescents in urban, low-income schools in India: 12 ...

  15. Problem Solving Therapy Improves Effortful Cognition in Major

    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 ...

  16. It's OK You Can't Solve Every Problem

    Step 1. Define the problem and set realistic goals. Step 2. Generate alternative solutions to solve the problem. Step 3. Decide which ideas are the best. Step 4. Carry out the solution and ...

  17. Cognitive Remediation Therapy: 13 Exercises & Worksheets

    People experiencing mental health issues often have thinking and memory problems. This can result in concentration, organizational, and planning difficulties that impact their quality of life and independent living. ... High-order memory and problem-solving skills (including executive functioning and verbal skills) This technique assumes a ...

  18. Problem-solving Is an Important Skill for Mental Health

    This will improve not only your self-esteem but your social skills, too. You will be confident among your peers. That will create a positive impact on your mental health because your problem-solving skills will arm you with the tools you need to socialize, build camaraderie in the workplace, and improve your well-being.

  19. Problem Solving

    Consider your own behavior, as well as external factors. Define your problem. Be as clear and comprehensive as possible. If there are many parts to your problem, describe each of them. TIP: If you find it difficult to separate your emotions from the problem, try to complete this step from the perspective of an impartial friend.

  20. Mental health crisis solutions emerge

    In 2022, Congress passed the Bipartisan Safer Communities Act, which has provided $245 million to fund mental health services like training for school personnel, first responders and law enforcement and expanding the 988 suicide and crisis lifeline. Stanford Medicine researchers know that to make the most impact with their discoveries they must ...

  21. Cognitive Behavioral Therapy (CBT): Types, Techniques, Uses

    Problem-Solving . Learning problem-solving skills during cognitive behavioral therapy can help you learn how to identify and solve problems that may arise from life stressors, both big and small. It can also help reduce the negative impact of psychological and physical illness.

  22. 21 Mental Shifts to Boost Problem-Solving Skills and Become More Strategic

    Discover transformative mental shifts to supercharge your problem-solving skills. From embracing uncertainty to the power of daydreaming, prepare to change the way you tackle challenges forever!

  23. Video games help teens with problem-solving skills, mental health

    Despite stereotypes which show gaming as an activity got loners, many teens have seen positive outcomes from their gaming experiences. 56% say it helped their problem solving skills, while 47% say it helped them make friends. 41%, learned how to work as a team read more While the teens reported the ...

  24. Supporting Your Team's Mental Health

    Supporting Your Team's Mental Health. April 30, 2024. Print. Mental health has become a bigger priority for both employers and employees in recent years. But there's still more work to be done ...