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

Author: Lydia Antonatos, LMHC

Lydia Angelica Antonatos LMHC

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

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

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What Is Problem-Solving Therapy?

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

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

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

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

Techniques Used in Problem-Solving Therapy

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

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

Creating Collaboration

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

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

Psychoeducation

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

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

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

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

Rehearsal & Practice

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

Positive Reinforcement & Feedback

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

Use of Analogies & Metaphors

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

What Can Problem-Solving Therapy Help With?

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

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

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

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

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

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Problem-Solving Therapy Examples

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

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

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

Psychiatric Patients

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

Adherence to Other Treatments

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

Benefits of Problem-Solving Therapy

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

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

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

How to Find a Therapist Who Practices Problem-Solving Therapy

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

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

Are There Special Certifications to Provide PST?

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

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

Questions to Ask a Therapist When Considering Problem-Solving Therapy

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

Here are some key questions to ask before starting PST:

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

How Much Does Problem-Solving Therapy Cost?

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

What to Expect at Your First PST Session

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

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

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Is Problem-Solving Therapy Effective?

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

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

How Is PST Different From CBT & SFT?

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

Problem-Solving Therapy Vs. Cognitive-Behavioral Therapy

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

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

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

Problem-Solving Therapy Vs. Solution-Focused Therapy

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

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

Final Thoughts

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

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For Further Reading

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

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

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

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

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

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

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

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

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

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

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

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Cognitive Behavioral Therapy

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

Posted February 2, 2022 | Reviewed by Ekua Hagan

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Problem-solving is one technique used on the behavioral side of cognitive-behavioral therapy.
The problem-solving technique is an iterative, five-step process that requires one to identify the problem and test different solutions.
The technique differs from ad-hoc problem-solving in its suspension of judgment and evaluation of each solution.

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

The problem-solving technique

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

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

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

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

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

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

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

Advantages of the problem-solving technique

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

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

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

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

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

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Open Access

Peer-reviewed

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

Roles Conceptualization, Writing – original draft

Affiliation Centre for Evidence and Implementation, London, United Kingdom

Roles Data curation

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

Kristina Metz,
Jane Lewis,
Jade Mitchell,
Sangita Chakraborty,
Bryce D. McLeod,
Ludvig Bjørndal,
Robyn Mildon,
Aron Shlonsky

Published: August 29, 2023
https://doi.org/10.1371/journal.pone.0285949
Peer Review
Reader Comments

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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https://doi.org/10.1371/journal.pone.0285949.g001

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).

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.

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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PMC10464969

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

Kristina Metz

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

2 Centre for Evidence and Implementation, London, United Kingdom

Jade Mitchell

Sangita chakraborty, bryce d. mcleod.

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

Ludvig Bjørndal

Robyn mildon.

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

Aron Shlonsky

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

Associated Data

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

Introduction

Identification and selection of studies

Study selection

Data extraction

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Object name is pone.0285949.g001.jpg

Risk of bias assessment

An external file that holds a picture, illustration, etc.
Object name is pone.0285949.g002.jpg

Study designs and characteristics

Study design.

Selected intervention



1	Bird et al., 2018 UK	Selective prevention Problem-related distress	MYLO: Online, individual problem-solving program Self-delivered Duration participants’ choice (minimum 15 minutes) Based on PCT principles	RCT N = 213	ELIZA text-based programme emulating Rogerian psychotherapy	University students aged 16–70 years Mean age: 22.08 years No inclusion criteria for depression	No significant change in depression on the DASS-21. Main effect of group: ( (1,157) = .16, n.s.). Interaction effect between time and group ( (2,314) = .39, n.s.) No significant change in problem-related distress (study developed rating), time x group interaction: (2,338) = 1.32, = .27 No significant change in participants’ ratings of problem resolution (study-developed rating). Main effect: ( (1,60) = 2.49, n.s.)	Some concerns
2	Chibanda et al., 2014 Zimbabwe	Secondary prevention Postnatal depression	PST: Group, face-to-face PST intervention Delivered by trainer peer counselors 2, 60-minute sessions per week for 6 weeks Based on Mynors-Wallis (2005)	RCT N = 58	Amitriptyline (antidepressant) and peer education	Women attending primary care clinics over the age of 18 Mean age: 25 years Met criteria for post-partum depression (DSM-IV)	Significant reduction in postnatal depression (EPDS) post intervention. PST group (M = 8.22, SD = 3.6), pharmacotherapy group (M = 10.7, SD = 2.7), = 0.0097.	Some concerns
3	Eskin et al., 2008 Turkey	Secondary prevention Depression	PST: Individual, face-to-face PST intervention Delivered by graduate clinical psychology students 6 weekly sessions Based on D’Zurilla and Goldfried (1971) and D’Zurilla and Nezu (1999)	RCT N = 46	WLC	High school and university students Mean age: 19.1 years Diagnosed with MDD (SCIV)	Significant reduction in depression at the end of treatment on the BDI (ANOVA (1, 42) = 10.3, < 0.01; adjusted effect size 1.6); HDRS ( (1, 42) = 37.7, < 0.0001; adjusted effect size 2.2) and suicide potential (SPS– (1, 42) = 7.3, < 0.05; adjusted effect size 0.21). No significant improvement in problem-solving skills on the PSI. Time x interaction effect: (1, 42) = 2.2, > 0.05. Main effect for time: (1, 42) = 6.4, < .05, with post-treatment scores being lower than pre-treatment. Follow-up PSI scores were significantly lower than pre-treatment (Z = 3.7, < 0.0001) and post-treatment PSI scores (Z = 2.0, 0.05). Significant post-treatment depression recovery, BDI: 77% of PST participants and 15.8% of control participants achieved full or partial recovery, x = 19.3, d.f. = 2, 0.0001; HDRS: 96.3% of PST participants and 21.1% of control participants achieved full or partial recovery, x = 31.1, d.f. = 2, < 0.0001. Follow-up BDI scores were statistically significantly lower than pre-treatment BDI scores (Z = 4.1, < 0.0001), but similar to post-treatment BDI scores (Z = 1.6, > 0.05). Follow-up HDRS scores were statistically significantly lower than pre-treatment HDRS scores (Z = 4.1, < 0.0001), but similar to post-treatment HDRS scores (Z = 0.1, > 0.05).	Some concerns
4	Fitzpatrick et al., 2005 US	Secondary prevention Suicidal ideation	Problem-orientation intervention: video focusing on PS and coping styles Self-delivered 35-minute video, one session with 2 modules to be completed Based on D’Zurilla and Nezu’s (1999) Problem-Solving Therapy manual	RCT N = 110	Single session video covering health issues including diet exercise and sleep	University students aged 18–24 years Mean age: 19.02 years With suicidal ideation (≥ 6 BSS or endorsing active ideation)	Both suicidal ideation–BSS (Z = 2.17) and depression -BDI (Z = 2.72) had significant decreases pre- and post-treatment. However, these changes diminished over time. At follow-up, BSS differences were no longer significant and BDI differences were significant but small (ETA ). No significant change in problem-solving skills or orientation SPSI-R.	Some concerns
5	Gaffney et al., 2014 UK	Selective prevention Problem-related distress	MYLO: Online, individual PS program Self-delivered Duration participants’ choice (average time 19.23 minutes) Based on PCT principles	Pilot RCT N = 48	ELIZA text-based programme emulating Rogerian psychotherapist	University students aged 18–32 years Mean age: 21.4 years No inclusion criteria for depression	No significant change in depression (DASS-21), time x group interaction: (1.24, 49.57) = .50, = .52 No significant change in problem-solving (study-developed rating), time x group interaction: (1, 40) = 3.62, = .06. No significant change in problem-related distress (study-developed rating), time x group interaction: (2, 80) = 1.00, = .37	Some concerns
6	Hoek et al., 2012 Netherlands	Indicated prevention Depression	PST: Individual, online PST intervention Delivered by mental health care professionals 5 weekly sessions	RCT N = 45	WLC	Recruitment through community and via parents treated for depression and anxiety aged 12–21 years Mean age: 16.07 years Self-report of mild or moderate depression and anxiety. Excluded severe depression (>40 on CES-D).	No significant change in depression (CES-D) after 4 months, group x time interaction: B = 0.54, SE = 1.14, = 0.637. Recovery from clinical depression (CES-D) effects were not significantly different between intervention and waiting list groups.)	Some concerns
7	Houston et al., 2017 US	Universal prevention Resilience	Resilience and Coping Intervention: Group-based, face-to-face intervention to identify thoughts, feelings and coping strategies using PS techniques. Delivered by trained social workers 3, 45-minute weekly sessions	RCT N = 129	TAU	University students aged 18–23 years Mean age: Not stated No inclusion criteria for depression	Significant reduction in depression (CES-D): F(1, 117) D = 5.36, p = .02; small effect size: Cohen’s ƒ = 0.05.	Some concerns
8	Malik et al., 2021 India	Indicated prevention Common adolescent mental health problems	PS intervention: Individual face-to-face Delivered by college graduate counsellors with no formal training in psychological treatments 4–5, 30-minute sessions delivered over 2–3 weeks	RCT N = 251	PS booklets without counsellor treatment	High school students aged 12–20 years Mean age: 15.61 years Elevated mental health symptoms and distress/functional impairment (≥ 19 for boys and 20 for girls on SDQ Total Difficulties scale, ≥ 2 SDQ Impact Scale, > 1 month on SDQ chronicity index)	Significant reduction in psychosocial problems (YTP) at 12 months: adjusted mean difference = −0.75, 95% CI = [−1.47, −0.03], = 0.04. Significant reduction in mental health symptoms (SDQ Total Difficulties Score) at 12 months: adjusted mean difference = −1.73, 95% CI = [−3.47, 0.02], = 0.05. Significant intervention effect on both SDQ Total Difficulties and YTP scores over 12 months (SDQ Total Difficulties: adjusted mean difference = −1.23, 95% CI = [−2.37, −0.09]; d = 0.21, 95% CI = [0.05, 0.36]; = 0.03; YTP: adjusted mean difference = −0.98; 95% CI = [−1.51, −0.45]; d = 0.34, 95% CI = [0.19, 0.50]; < 0.001. Significant intervention effect on secondary outcomes including internalising symptoms (SDQ internalising symptoms subscale): adjusted mean difference = −0.76, 95% CI = [−1.42, −0.10]; d = 0.22, 95% CI = [0.06, 0.37]; = 0.03; impairment (SDQ impact score): adjusted mean difference = −0.51, 95% CI = [−0.93, −0.09]; d = 0.21, 95% CI = [0.06, 0.36]; = 0.02); and perceived stress (PSS-4): adjusted mean difference = −0.54 95% CI = [−1.00, −0.08]; d = 0.21, 95% CI = [0.06, 0.36]; = 0.02) over 12 months. No significant effect on wellbeing (SWEMWBS): adjusted mean difference = 1.16, 95% CI = [−0.07, 2.38]; d = 0.19, 95% CI = [0.04, 0.34]; = 0.06; externalising symptoms (SDQ externalising symptoms subscale): adjusted mean difference = −0.47, 95% CI = [−1.09, 0.14]; d = 0.14, 95% CI = [0.01, 0.30]; = 0.13; or remission adjusted mean difference = 1.47, 95% CI = [0.73, 2.96]; = 0.28 over 12 months.	Low risk of bias
9	Michelson et al., 2020 India	Indicated prevention Common adolescent mental health problems	PS intervention: Individual face-to-face Delivered by college graduate counsellors with no formal training in psychological treatments 4–5, 30-minute sessions delivered over 2–3 weeks	RCT N = 251	PS booklets without counsellor treatment	High school students aged 12–20 years Mean age: 15.61 years Elevated mental health symptoms (≥ 19 for boys and 20 for girls on SDQ Total Difficulties scale, ≥ 2 SDQ Impact Scale, > 1 month on SDQ chronicity index)	Significant reduction in psychosocial problems (YTP) at 6 weeks (adjusted mean difference = –1·01, 95% CI [–1·63, –0·38]; adjusted effect size = 0.36, 95% CI [0·11, 0·61], = 0·0015), and at 12 weeks (adjusted mean difference = –1.03, 95% CI [–1·60, –0·47]; adjusted effect size = 0.35, 95% CI [0.18, 0·54]; = 0·0004). No significant change in mental health symptoms (SDQ Total Difficulties score) at 6 weeks (adjusted mean difference = –0·86, 95% CI [–2·14, 0·41]; adjusted effect size = 0·16, 95% CI [0·09, 0.41]; = 0·18) or 12 weeks (adjusted mean difference = –1.12, 95% CI [–2.33, 0.10]; adjusted effect size = 0.20, 95% CI [0.02, 0.37], = 0.072. No significant change in internalising symptoms (SDQ Internalising symptoms subscale) at 12 weeks (adjusted mean difference = –0.61, 95% CI [–1.32, 0.09]; adjusted effect size = 0.18, 95% CI [0.002, 0.36], = 0.089.	Low risk of bias
10	Parker et al., 2016 Australia	Indicated prevention Depression	PST: Face-to-face; Not specified whether group or individual Delivered by research psychologists 6 weekly sessions Based on Mynors-Wallis (2005)	RCT N = 176	Control treatment based on general counselling principles informed by NICE guidelines for mild to moderate depression	Young people recruited from youth mental health services aged 15–25 years Mean age: 17.6 years Elevated symptoms not specific to depression indicating a mild disorder (K10 score ≥ 20)	No significant change in depression on the BDI-II (difference in change between interventions = 0.13, 95% CI [–3.10, 3.36], = 0.935) or on the MADRS (difference in change between interventions = 0.29, 95% CI [–2.66, 3.24], = 0.847.	Some concerns
11	Tezel & Gözüm, 2006 Turkey	Indicated prevention Postnatal depression	PST: Individual, face-to-face Delivered by nurse researchers 6, 30–50-minute weekly sessions Based on D’Zurilla and Goldfield (1971)	QED N = 62	Nursing intervention	Mothers vising postnatal care service Mean age: 24.6 years (care group); 25.4 years (training group) At risk of post-partum depression (>11 EPDS) but without major depressive symptoms	Significant reduction pre-test to post-test in depression (BDI) for PST ( = 5.462, < 0.05) and the nursing intervention ( = 10.062, < 0.05). However, the nursing intervention was significantly more effective than PST at reducing depressive symptoms ( = 4.529, < 0.05).	NA
12	Xavier et al., 2019 Brazil	Secondary prevention Suicidal behaviour	PST: Group, face-to-face Delivered by experienced psychologist 5, 120-minute weekly sessions Based on D’Zurilla and Nezu (2007) and Vazquez et al. 2015) [ ]	RCT N = 100	TAU	Poorly performing students aged 15–19 years recruited from 3 public schools Mean age: 17.2 years Met criteria for depression (≥ 16 CES-D) and high risk of suicide (score total ≥ 45 or critical item score ≥3 on ISO-30) but not major depression	Significant intervention effect for depression (CES-D) across time points: (3.58, 351.24) = 140.81, < .001, = 0.59). Post-treatment: = 28.00, = 5.60, 95% CI [4.57, -6.60]. 6-month follow-up: = 22.65, = 4.53, 9%% CI [3.72, -3.26]. Significant intervention effect for suicidal orientation (ISO-30): (3.39, 312.51) = 104.75, < .001, = 0.52. Significantly more participants no longer at risk of suicide in the PST group (96%) compared to the control group (0%) at post-test (x (1) = 92.3, 0.001) and at 6-moth follow-up (x (1) = 92.3, <0.001). Post-treatment: t = 30.29, d = 6.05, 95% CI [5.11–6.99]. 6-month follow-up: t = 14.08, d = 2.82, 95% CI [2.21, -3.41]. No significant difference in suicide plans or attempts ( = .495). global problem-solving skills and in functional problem-solving skills (SPSR-I) mediated the relationship between the experimental condition and the pre-/posttreatment change in suicidal orientation, with significant effects of mediation of 20.46, 95% CI [23.32, 57.35] and 13.99, 95% CI [33.18–57.96], respectively. These explained 34.5% and 23.6% of the total effect of the intervention on the change in suicidal orientation.	Low risk of bias


13	Brugha et al., 2000 UK	Indicated prevention Postnatal depression	Preparing for Parenthood: Group, face-to-face cognitive, PS, and social support intervention Delivered by nurses and occupational therapists 6, 120-minute weekly sessions Based on an international, collaborative review of the social support intervention literature (Brugha, 1995). [ ]	RCT N = 292	TAU	Mothers attending antenatal clinics aged 16–38 years Median age: 19 years Increased risk of post-natal depression (1+ items on modified GHQ)	No significant change in postnatal depression (EPDS: OR = 0.82, 95% CI [0.39, 1.75], = 0.61); GHQ-D: OR = 1.22, 95% CI [0.63, 2.39], = 0.55); SCAN ICD-10: OR = 0.48, 95% CI [0.12, 1.99], = 0.30). Intervention group significantly more likely to adopt an avoidant problem-solving style (OR = 2.23, 95% CI [1.23, 4.06], = .009). No significant group differences in confidence in ability to solve problems (OR = 0.69, 95% CI [0.25, 1.90], = 0.48) or belief in personal control when solving problems (OR = 1.13, 95% CI [0.64, 2.00], = 0.67).	Some concerns
14	Dietz et al., 2014 US	Secondary prevention Depression	SBFT aimed to treat family dysfunction and teach PS skills to families Delivered by trained therapists Phase 1 involved 12–16 weekly sessions, phase 2 involved 2–4 booster sessions	RCT N = 63	CBT or NST	Patients recruited from 2 mental health clinics aged 13–18 years Mean age: 15.6 years Met DSM criteria for MDD (≥ 13 BDI)	This report focused on whether the PS components of CBT and SFBT mediated the effectiveness of these interventions for remission of major depressive disorder. PS mediated the association between CBT, but not SFBT, and remission from depression such that there was no significant association between SBFT and remission status (K-SADS-P; Wald = 0.00, = 0.99) and there was a significant association between CBT and remission status (K-SADS-P; Wald = 4.64, = 0.03). CBT (B = 0.41, CI [.29, 1.67], = 2.85, = 0.0006) and SFBT (B = 0.30, CI [0.2, 1.47], = 2.07, = 0.04) were both associated with increased PS (video rating).	Some concerns
15	Gureje et al., 2019 Nigeria	Secondary prevention Perinatal depression	Individual, face-to-face PS intervention Delivered by primary maternal care providers 8, 30–45-minute initial weekly sessions, followed by 4, 30–45-minute fortnightly sessions, third stage with option of pharmacotherapy/specialist referral for patients with higher EPDS scores Adapted from PST-PC.	RCT N = 686	Enhanced care as usual including psycho-education and social support	Mothers attending childcare clinics aged 16–45 years Mean age: 24.7 years Met criteria for major depression (≥ 12 EPDS)	Significant reduction in depression symptoms (EPDS) at 6 months: between group adjusted mean difference over four follow-up time points: -0.8, 95% CI [-1.3, 0.2], p = 0.007. No significant difference in remission rate (EPDS): adjusted risk difference = 4%, 95% CI [-4.1%, 12.0%]. Significant increase in remission rate for subgroup of women with more severe baseline depression compared to control (OR = 2.29, 95% CI [1.01, 5.20,] p = 0.047).	Some concerns
16	Haeffel et al., 2017 US	Selective prevention Depression	Social Problem-Solving Therapy: Group, face-to-face intervention designed to increase social PS and social skills Delivered by trained correctional officers 10, 60-minute sessions Based on the Viewpoints manual (Guerra, Moore, & Slaby, 1995 [ ]; Guerra & Slaby, 1990 [ ]; Guerra & Williams, 2012).[ ]	RCT N = 296	TAU–psychosocial support	Juvenile detainees in state-run detention centres aged 11–16 years Mean age: 14.97 years No inclusion criteria for depression	No significant change in depression (CDI) compared to control: (1, 139) = 0.02, = 0.89, η . . Significant reduction in depression (CDI) for sub-group with higher intelligence and significant increase in depression for participants with lower intelligence: = -0.34, = -2.26, = 0.03, partial correlation = -.19, change in = .02. Simple slope gradient for those with higher and lower levels of intelligence was significantly different depending on intervention type: = –2.11, = 0.03, partial correlation = –.27; effect size in the medium range.	High risk of bias
17	Hallford & Mellor, 2016 Australia	Secondary prevention Depression	Cognitive Reminiscence Therapy: Individual, face-to-face cognitive therapy that included brief PST Delivered by registered provisional psychologist 6 weekly sessions Based on the protocol by Watt and Cappeliez (2000) [ ]	RCT N = 26	Brief evidence-based treatment	Young people recruited from a community youth mental health service aged 12–25 years Mean age: 20.8 years At least moderate depression (score ≥ 7 on DASS-21)	No significant reduction in depression (DASS-21: (1, 24) = 1.9, = 0.146)	Some concerns
18	Hood et al., 2018 US	Selective prevention Diabetes distress	Penn Resilience Program Type 1 Diabetes: Group, face-to-face resilience enhancing intervention with a focus on diabetes management. Teaches cognitive-behavioural, social, and PS skills. Delivered by masters-level clinicians 9, 90–120 minute bi-weekly sessions Adapted from the University of Pennsylvania Penn Resilience Program (Gillham et al., 2006)	RCT N = 264	Diabetes educational intervention	Patients from diabetes clinics aged 14–18 years Mean age: 15.74 years No inclusion criteria for depression—excluded with depression diagnosis or treatment	No significant reduction in depression (CDI). Symptoms remined stable over time across groups (slope intercept values > 0.05) and no significant group differences found (treatment-intercept and treatment-slope effect values > 0.05). No significant reduction in PS (SPSR-I) between groups ( >.05).	Some concerns
19	Kolko et al. (2000)	Secondary prevention Depression	SBFT aimed to treat family dysfunction and teach PS skills to families. Delivered by trained therapists Phase 1 involved 12–16 weekly sessions, phase 2 involved 2–4 booster sessions Based on Functional Family Therapy (Alexander & Parsons, 1982) [ ] and the PS model developed by Robin and Foster (1989) [ ]	RCT N = 107	CBT or NST	Patients recruited from 2 mental health clinics aged 13–18 years Mean age: 15.6 years Met DSM criteria for MDD (≥ 13 BDI)	No significant reduction in depression post treatment (BDI treatment x time interaction: < .08; DEP-13 treatment x time interaction: < .41) or after 24-months follow-up (BDI: < .62; DEP-13: < .92)	Some concerns
20	Makover et al., 2019 US	Secondary prevention Depression	High School Transition Program: Group and individual, face-to-face intervention designed to increase social and academic PS skills Delivered by trained mental health counsellors 12, 60 -minute group sessions followed by 4 individual booster sessions Based on CAST (Eggert et al., 2002) [ ]	RCT N = 497	Interview and clinical follow-up without active therapy	Middle and high school students in 8 and 9 grade Mean age: Not stated Met criteria for depression (score ≥ 15 on MFQ)	No significant reduction in depression (MFQ: (1) = 2.18, = .08)	Some concerns
21	Miklowitz et al., 2014 US	Secondary prevention Mood episodes (including BP and MDD)	Family-Focused Therapy: Face-to-face family-based sessions including psychoeducation, communication, and PS skills training. Delivered by trained therapists 21, 50-minute weekly/bi-weekly sessions	RCT N = 145	Pharmacotherapy	Adolescents with a DSM-IV-TR diagnosis of bipolar I or II disorder aged 12–18 years Mean age: 15.6 years Symptoms of at least moderate severity (a score >17 on the K-SADS Mania Rating Scale or a score >16 on the Depression Rating Scale)	No significant group differences in time No significant group differences in time free of mood symptoms (depressive or manic symptoms), or percentage of weeks with mood symptoms or depressive symptoms. Family-focused therapy had a greater increase from year 1 to year 2 than enhanced care in the proportion of weeks without mania/ hypomania symptoms (F = 4.02, df = 1, 87, p = 0.048) Family-focused treatment showed greater improvements in mean Psychiatric Status Rating Scale scores for mania/ hypomania across 3-month intervals than enhanced care (F = 1.98, df = 8, 742, p = 0.046)	Some concerns
22	Miklowitz et al., 2020 US	Secondary prevention Mood episodes (including BP and MDD)	Family-Focused Therapy: Face-to-face family-based sessions including psychoeducation, communication, and PS skills training Delivered by trained therapists 12, 60-minute weekly/bi-weekly sessions	RCT N = 127	Enhanced care (EC) including family and individual psychoeducation	High risk youths aged 9–17 years and their parents Mean age: 13.2 years Met DSM-IV/DSM-5 criteria for BD or MDD First or second degree relative with lifetime history of BD-I or BD-II Moderate current mood symptoms (prior week YMRS ≥ 11 or 2-week CDRS-R > 29)	No significant difference in time to recovery. In the Family Focused Therapy (FFT group), 47 of 61 participants (77.0%) recovered in a median of 24 weeks (95% CI, 17–33 weeks) compared with 43 of 66 (65.2%) in the EC group in 23 weeks (95% CI, 17–29 weeks) (log-rank χ2 = 0.01; = .93; unadjusted hazard ratio [HR] for FFT vs EC, 1.02; 95% CI, 0.67–1.54). Among participants who recovered (N = 90) FFT participants experienced longer times with- out a new mood episode than EC participants (unadjusted, treatment of the treated log-rank χ2 = 5.44; = .02; HR, 0.55; 95% CI, 0.48–0.92). The estimated median time from randomization to a new mood episode was 73 weeks (95% CI, 55–82 weeks) in the intent-to- treat sample (n = 127), with a median of 81 weeks (95% CI, 56–123 weeks) for those in the FFT group and 63 weeks (95% CI, 44–78 weeks) for those in the EC group. Patients in the FFT group had longer intervals of wellness before new mood episodes than patients in the EC group (χ2 = 4.44; = .03; HR, 0.59; 95% CI, 0.35–0.97) Significantly longer intervals between recovery and next mood episode (A-LIFE and PSRs: χ2 = 5.44; P = .02; hazard ratio, 0.55; 95% CI, 0.48–0.92;), and from randomisation to the next mood episode (A-LIFE and PSRs: χ2 = 4.44; P = .03; hazard ratio, 0.59; 95% CI, 0.35–0.97).	Low risk of bias
23	Noh, 2018 South Korea	Selective prevention Build resilience and reduce impact of trauma	Resilience enhancement program: Group, face-to-face intervention designed to increase resilience with a component on PS Delivered by the author and a psychiatric nurse 2, 90-minute sessions per week for 4 weeks	QED N = 32	TAU by youth shelters	Runaway youths from homeless shelters aged 12–21 years Mean age: 16.69 years No inclusion criteria for depression—excluded young people receiving psychiatric interventions	Significant reduction in depression (BDI-II) at post-test (beta = -5.33, = 0.036) but not at one-month follow-up (beta = -4.48, = 0.120).	NA
24	Psaros et al. 2022 South Africa	Secondary prevention Depression	PST: Individual, face-to-face PST plus LifeSteps adherence intervention Delivered by a trained lay counsellor 8 weekly sessions Based on PST (Bell & D’Zurilla, 2009; Nezu, Maguth Nezu & D’Zurilla 2013) [ ]	RCT N = 23	TAU	Pregnant women with HIV aged 18–45 years Median age: 24 years Met criteria for current major depressive episode (data from a structured clinical interview, self-report measure, and team consensus based on clinical impressions)	Significant reduction in depression (BDI-II) at post-test (beta = -5.33, = 0.036) but not at one-month follow-up (beta = -4.48, = 0.120).	Some concerns
25	Weissberg-Benchell et al., 2020 US	Selective prevention Diabetes distress	Penn Resilience Program Type 1 Diabetes: Group, face-to-face resilience enhancing intervention with a focus on diabetes management. Teaches cognitive-behavioural, social and PS skills. Delivered by masters-level clinicians 9, 90-120-minute bi-weekly sessions Adapted from the University of Pennsylvania Penn Resilience Program (Gillham et al., 2006) [ ]	RCT N = 264	Diabetes educational intervention	Patients from diabetes clinics aged 14–18 years Mean age: 15.7 years No inclusion criteria for depression—excluded with depression diagnosis or treatment	Stable depressive symptoms (CDI) from 0 to 16 months (slope : = 0.41, = 0.28, .139, β = 0.16; quadratic slope = 0.07, = 0.07, = .269, β = 0.10). Decline in depressive symptoms from 16 to 40 months (slope : -0.17, = 0.07, = .018, β = 0.20). The effect size of change in depressive symptoms from 16 to 40 months was = 0.12. Follow-up assessment of change in depressive symptoms from 16 to 40 months separated by intervention group indicated that there was a significant decline in depressive symptoms for the intervention participants, -0.31, = 0.11, = .005, β = -0.31, but not for control participants, -0.01, = 0.09, = .936, β = -0.01. No significant difference in depressive symptoms at 40 months, = -1.76, = 0.94, = .060, β = -0.13, = 0.23.	Some concerns

Notes: Psychiatric measures: A-LIFE = Adolescent Longitudinal Interval Follow-up Evaluation; BDI = Beck Depression Inventory; BDI-II = Beck Depression Inventory-II; BSS = Beck Suicide Scale; CDI = Children’s Depression Inventory; CDRS-R = Children’s Depression Rating Scale, Revised; CES-D = Centre for Epidemiological Studies Depression Scale; DASS-21 = Depression Anxiety Stress Scale-21; DEP13 = 13 items from Schedule for Affective Disorders and Schizophrenia for School-Age Children; DSM-IV = Diagnostic and Statistical Manual of Mental Health Disorders, fourth edition; DSM-IV-TR = Diagnostic and Statistical Manual of Mental Health Disorders, fourth edition, text revision; DSM-5 = Diagnostic and Statistical Manual of Mental Health Disorders, fifth edition; EPDS = Edinburgh Postnatal Depression Scale; GHQ = General Health Questionnaire; GHQ-D = General Health Questionnaire Depression Scale; HDRS = Hamilton Depression Rating Scale; ICD-10 = International Classification of Diseases, 10 th revision

ISO-30 = Inventory of Suicide Orientation; K10 = Kessler Psychological Distress Scale; K-SADS = Kiddie Schedule for Affective Disorders and Schizophrenia; MADRS = Montgomery-Åsberg Depression Rating Scale; MFQ = Mood and Feelings Questionnaire; PSRs = Psychiatric Status Ratings; PSS-4 = Perceived Stress Scale-4; SCAN = Schedules for Clinical Assessment in Neuropsychiatry; SCIV = Structured Clinical Interview Clinical Version for DSM-IV Axis 1; SDQ = Strengths and Difficulties Questionnaire; SPS = Suicide Probability Scale; SWEMWBS = Short Warwick–Edinburgh Mental Well-Being Scale; YMRS = Young Mania Rating Scale; YTP = Youth Top Problems

Problem-solving measures: PSI = Problem Solving Inventory; SPSI = Social Problem-Solving Inventory; SPSI-R = Social Problem-Solving Inventory-Revised

Other terms: CAST = Coping and Support Training; CBT = Cognitive Behavioural Therapy; MYLO = Manage Your Life Online; NICE = National Institute of Health and Care Excellence; NST = Nondirective Supportive Therapy; PCT = Perceptual Control Therapy; PS = Problem Solving; PST = Problem-Solving Therapy; PST-PC = Problem-Solving Therapy for Pediatric Care; QED = Quasi-Experimental Design; RCT = Randomized Controlled Trial; SBFT = Systematic-Behavioural Family Therapy; TAU = Treatment As Usual; WLC = Waitlist Control; BP = Bipolar Disorder; MDD = major depressive disorder

Intervention delivery

Intervention setting and participants

Outcome measures

Universal prevention interventions

Selective prevention interventions

Indicated prevention interventions

Secondary prevention interventions

Reduction in suicidality

Mediators and moderators

Supporting information

Acknowledgments.

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

Funding Statement

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.

Data Availability

PLoS One. 2023; 18(8): e0285949.

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PONE-D-23-00042Problem-solving interventions and depression among adolescents and young adults: A systematic review of the effectiveness of problem-solving interventions in preventing or treating depression among 13-25-year-oldsPLOS ONE

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Reviewer #1: Thank you for providing a very well-written, clear, and detailed manuscript of a very interesting and worthwhile study. It was a pleasure to read and I commend you on your work. I have only a few minor comments which are mostly just points of proofreading:

- Some abbreviations in Table 1 are either not detailed before usage here, or in fact aren't expanded upon at all. Please check and detail abbreviations in your notes section (namely PST, PCT, PST-PC, NST, DSM). I recognise that readers may be familiar with some of these or could hazard a well-educated guess, but for ease of readability and for clarity it would be beneficial to amend this.

- It would be beneficial, if possible from your data, to add more detail about the ages of participant in Table 1, or to provide more details in your results section. You explained that some studies included under 13s and/or over 25s, but it is unclear which studies did so. It would also help the reader to assess the included literature more effectively if the mean/median age of participants (as per your inclusion criteria) was noted in the table.

- Lines 200-202 are unclear and confusing to read

- While I recognise the need for your review, I'm not entirely sold on your research question by your introduction section. Particularly, why you have chosen this specific intervention for this population. It may be beneficial to expand on the final paragraph (lines 83-95).

- It may be beneficial to also add your thoughts on what your results mean for clinical practitioners in your discussion. You provide some good recommendations for research, but general expansion here would be helpful.

These are the only minor edits I see as being required as your paper is strong. The results and conclusion are well written and thorough. Thank you also for providing detailed supplementary materials.

Best of luck with your ongoing work

Reviewer #2: The systematic review summarizes 25 studies concerning the efficacy of problem-solving interventions for preventing or treating depression. The topic is thoroughly examined, and the results provide insight into the development of evidence-based interventions and the enhancement of mental health outcomes for adolescents and young adults.

I have some minor concerns which I will elaborate on below:

1. The use of "13-25 years olds" in the title can be misleading as it implies a full age range rather than the mean or median age.

Introduction:

2. While the introduction is logically structured, it would be beneficial to introduce problem-solving (PS) as a technique for depression treatment early on. PS intervention is a key concept, yet it is not mentioned until the last paragraph.

3. The rationale for focusing on the effect of PS interventions on depression needs further clarification. What makes PS a more relevant technique than other techniques? I agree that maladaptive PS is associated with depressive symptoms (line 84), while the construct of PS as a coping strategy may be different from PS as an intervention technique.

4. The relationship between PS technique and evidence-based treatments is slightly confusing. EBTs such as CBT have shown small to moderate effects in preventing and treating depression (line 66), so emphasis might move to discrete treatment techniques such as PS (line 75). However, PS is usually a component of CBT, a technique used in multiple sessions. What might account for a part of the therapy being more effective than the entire therapy?

5. Line 90 refers to the complex relationship between PS and depression. Although details can be found in the results section, it would be clearer to provide a specific explanation here for “complex.”

Discussion:

6. In line 381, the authors “sought to determine in what way, in which contexts, and for whom PS appears to work in addressing depression.” However, outcomes are not discussed by context or study population. Studies conducted among students could differ from those conducted among peripartum women. Did the comparisons between contexts/populations bring forth any conclusions?

7. Among studies that found a significant reduction in depression, some reported that the effect was not sustained (e.g., line 262, line 268, line 302) while others reported the opposite (e.g., line 311, line 350). Is there a possible explanation for this discrepancy?

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Reviewer #2: Yes: Tianyue Mi

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Author response to Decision Letter 0

24 Apr 2023

See below. Also replicated in the "Response to Reviewers" document.

Thank you to the two reviewers for their thoughtful and comprehensive review of our manuscript. We have carefully considered all the comments and made requested modifications. As a result, we believe that the manuscript is improved.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #1: N/A

Response to Reviewer 1 comments:

Thank you for your keen eye and this suggestion. We have updated the manuscript to ensure that all acronyms in the table are in the notes section.

Thank you for this suggestion. We have added this information into the Table 1 under the “study population” information.

Thank you for this feedback. We have adjusted the sentence to hopefully increase comprehension. Please let us know if the sentence (now lines 198-199) is still unclear and/or confusing to read.

Thank you for this feedback. We have re-worked the introduction section to include more information on PS and its potential as an active ingredient for AYA depression treatment. Please see lines 71-94.

Thank you for this feedback. We have summarized the recommendations more clearly at the end of the paper. Please see lines 436-437 for clinical implications.

Thank you so much for the thorough and thoughtful review. We believe your comments aided to the creation of an improved manuscript.

Response to Reviewer 2 comments:

Thank you for this suggestion. We have edited the title to only include the reference to adolescents and young adults to be more fitting.

Thank you for this feedback. We have re-worked the introduction section to have PS introduced earlier in the introduction.

Thank you for this feedback. We have re-worked the introduction section to include more information on background treatments using PS amongst adults and its potential as an active ingredient for AYA depression treatment. Please see lines 71-94.

Thank you for this feedback and question. We have added information to the manuscript that discusses a meta-analysis on PS within adult populations that found Problem Solving Therapy (PST) to be as effective as CBT and IPT, and more effective than WLC. We have additionally added information around the potential benefits of distilling common elements with this AYA population. Please see lines 71-94.

Thank you for this feedback and question. Due to all the additional PS information added to the introduction, we removed this statement and only addressed in the discussion section.

Thank you for this feedback and question. Unfortunately, due to the heterogeneity in the study samples and settings as well as limited implementation factors discussed in the publications, these factors were unable to be explored. I added this limitation to lines 412-423.

Thank you for this question. Unfortunately, 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. This includes an explanation for the discrepancies in sustained effects.

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Reviewer #1: No

Reviewer #2: Yes: Tianyue Mi

Submitted filename: Response to Reviewers.docx

Decision Letter 1

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11 May 2023

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Problem-Solving Therapy

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

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

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

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

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

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

Social Problem Solving and Psychopathology

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

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

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

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

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

Problem-Solving Therapy Goals

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Published: 24 August 2021

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

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

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

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

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

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

Conclusions

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

Peer Review reports

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

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

Dimensions of Problem-Solving (PS) Ability

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

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

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

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

Scoping review

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

Search strategy

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

Inclusion and exclusion criteria

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

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

PRISMA Flow Chart of the Study Selection Process

Data extraction and synthesis

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

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

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

Exploratory Meta-analysis

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

Quality assessment

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

Statistical analysis

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

Selection and inclusion of studies

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

Clinical trials of PST

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

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

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

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

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

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

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

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

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

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

PS training in clinical practice guidelines

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

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

Meta-analysis

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

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

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

Overall quality of the evidence

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

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

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

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

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

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

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

Strengths and limitations

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

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

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

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

Availability of data and materials

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

Abbreviations

Avoidance style

Beck Depression Inventory

Centre for Addiction and Mental Health

Cognitive behavioural therapy

Children’s Depression Rating Scale—Revised

Center for Epidemiologic Studies Depression Scale

Clinical Global Impression Scale—Improvement

Cumulative Index to Nursing and Allied Health Literature

Clinical practice guideline

Adolescent Coping with Depression [intervention name]

Dialectical behaviour therapy

Grading of Recommendations Assessment, Development, and Evaluation

Impulsivity/Carelessness Style

Interpersonal psychotherapy

The Kiddie Schedule for Affective Disorders and Schizophrenia

Lifeskills training

Major depressive disorder

Medical Literature Analysis and Retrieval System Online

Negative problem orientation

Nondirective supportive therapy

Positive problem orientation

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

Problem solving

Problem-solving training

Problem-Solving Therapy

Randomized controlled trial

Research ethics board

Risk of bias

Rational problem-solving style

Systemic Behaviour Family Therapy

Strengths and Difficulties Questionnaire

Solution-Focused Brief Therapy

Social Problem-Solving Inventory Revised

Selective serotonin reuptake inhibitors

Treatment for Adolescents with Depression Study

Treatment of Resistant Depression in Adolescents

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Acknowledgments

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

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

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

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

Karolin R. Krause

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

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

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Contributions

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

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Correspondence to Karolin R. Krause .

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Supplementary Information

Additional file 1..

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

Additional file 2.

Search Strategy.

Additional file 3.

List of Studies Included in the Scoping Review.

Additional file 4.

Characteristics of Included Clinical Practice Guidelines.

Additional file 5.

Additional Data and Outputs from the Meta-Analysis.

Additional file 6.

Risk of Bias Assessment and GRADE Appraisal.

Additional file 7.

Illustration of Insights from the Consultation of Youth Advisors.

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

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Published : 24 August 2021

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

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

The therapist’s stance during problem solving should be one of collaborative curiosity. It is not for the therapist to pass judgment or to impose their preferred solution. Instead it is the clinician’s role to sit alongside clients and to help them examine the advantages and disadvantages of their options and, if the client is ‘stuck’ in rumination or

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What is the nature of the problem?
What are my goals?
What is getting the way of me reaching my goals?
“Can you think of any ways that you could make this problem not be a problem any more?”
“What’s keeping this problem as a problem? What could you do

References And Further Reading

Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979). Cognitive therapy of depression . New York: Guilford. Nezu, A. M., Nezu, C. M., D’Zurilla, T. J. (2013). Problem-solving therapy: a treatment manual . New York: Springer.
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The Effectiveness of Problem-Solving Therapy for Primary Care Patients' Depressive and/or Anxiety Disorders: A Systematic Review and Meta-Analysis

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

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

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

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

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

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

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

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

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

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

Search Strategies

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

Eligibility Criteria

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

Data Abstraction and Coding

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

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

Statistical Analysis

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

Publication Bias, Risk of Bias and Quality of Studies

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

Primary Studies

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

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

Publication Bias, Risk of Bias, and Quality of Studies

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

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

Meta-analysis and moderator analysis

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

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

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

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

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

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

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

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

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

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

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

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

Acknowledgments

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

This article was externally peer reviewed.

Funding: none.

Conflict of interest: none declared.

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

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

Received for publication July 5, 2017.
Revision received September 14, 2017.
Accepted for publication September 27, 2017.
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The Journal of the American Board of Family Medicine: 31 (1)

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22 Best Counseling Interventions & Strategies for Therapists

Counseling is highly beneficial, with “far-reaching effects in life functioning” (Cochran & Cochran, 2015, p. 7).

While therapeutic relationships are vital to a positive outcome, so too are the selection and use of psychological interventions targeting the clients’ capability, opportunity, motivation, and behavior (Michie et al., 2014).

This article introduces some of the best interventions while identifying the situations where they are likely to create value for the client, helping their journey toward meaningful, value-driven goals.

Before you continue, we thought you might like to download our three Goal Achievement Exercises for free . These detailed, science-based exercises will help you or your clients create actionable goals and master techniques to create lasting behavior change.

This Article Contains:

What is a counseling intervention, list of popular therapeutic interventions, how to craft a treatment plan 101, 13 helpful therapy strategies, interventions & strategies for career counseling, 2 best interventions for group counselors, resources from positivepsychology.com, a take-home message.

“Changing ingrained behavior patterns can be challenging” and must avoid or at least reduce the risk of reverting (Michie et al., 2014, p. 11).

The American Psychological Association (n.d., para. 1) describes an intervention as “any action intended to interfere with and stop or modify a process, as in treatment undertaken to halt, manage, or alter the course of the pathological process of a disease or disorder.”

Interventions are intentional behaviors or “change strategies” introduced by the counselor to help clients implement problem management and move toward goals (Nelson-Jones, 2014):

Counselor-centered interventions are where the counselor does something to or for the client, such as providing advice.
Client-centered interventions empower the client, helping them develop their capacity to intervene in their own problems (for example, monitoring and replacing unhelpful thinking).

Creating or choosing the most appropriate intervention requires a thorough assessment of the client’s behavioral targets, what is needed, and how best to achieve them (Michie et al., 2014).

The selection of the intervention is guided by the:

Nature of the problem
Therapeutic orientation of the counselor
Willingness and ability of the client to proceed

During counseling, various interventions are likely to be needed at different times. For that reason, counselors will require a broad range of techniques that fit the client’s needs, values, and culture (Corey, 2013).

In recent years, an increased focus has been on the use of evidence-based practice, where the choice and use of interventions is based on the best available research to make a difference in the lives of clients (Corey, 2013).

“Clients are hypothesis makers and testers” who have the reflective capacity to think about how they think (Nelson-Jones, 2014, p. 261).

Helping clients attend to their thoughts and learn how to instruct themselves more effectively can help them break repetitive patterns of insufficiently strong mind skills while positively influencing their feelings.

The following list includes some of the most popular interventions used in a variety of therapeutic settings (modified from Magyar-Moe et al., 2015; Sommers-Flanagan & Sommers-Flanagan, 2015; Cochran & Cochran, 2015; Corey, 2013):

Detecting and disputing demanding rules

Rigid, demanding thinking is identified by ‘musts,’ ‘oughts,’ and ‘shoulds’ and is usually unhelpful to the client.

For example:

I must do well in this test, or I am useless. People must treat me in the way I want; otherwise, they are awful.

Clients can be helped to dispute such thinking using “reason, logic, and facts to support, negate or amend their rules” (Nelson-Jones, 2014, p. 265).

Such interventions include:

Functional disputing Pointing out to clients that their thinking may stand in the way of achieving their goals
Empirical disputing Encouraging clients to evaluate the facts behind their thoughts
Logical disputing Highlighting the illogical jumps in their thinking from preferences to demands
Philosophical disputing Exploring clients’ meaning and satisfaction outside of life issues

Identifying automatic perceptions

Our perceptions greatly influence how we think. Clients can benefit from recognizing they have choices in how they perceive things and avoiding jumping to conclusions.

Creating self-talk Self-talk can be helpful for most clients and can target anger management, stress handling, and improving confidence. For example:

This is not the end of the world. I’ve done this before; I can do it well again.

Creating visual perceptions Building on the client’s existing visual images can be helpful in understanding and working through problematic situations (and their solutions).

One simple exercise to help clients see the strong relationship between visualizing and feeling involves asking clients to think of someone they love. Almost always, they form a mental image along with a host of feelings.

Visual relaxation is a powerful self-helping skill involving clients taking time out of their busy life to find calm through vividly picturing a real or imagined relaxing scene.

Creating better expectations

Clients’ explanatory styles (such as expecting to fail) can create self-fulfilling prophecies. Interventions can help by:

Assessing the likelihood of risks or rewards
Increasing confidence in the potential for success
Identifying coping skills and support factors
Time projection Imagery can help by enabling the client to step into a possible future where they manage and overcome difficult times or worrying situations.

For example, the client can imagine rolling forward to a time when they are successful in a new role at work or a developing relationship.

Creating realistic goals

Goals can motivate clients to improve performance and transition from where they are now to where they would like to be. However, it is essential to make sure they are realistic, or they risk causing undue pressure and compromising wellbeing.

The following interventions can help (Nelson-Jones, 2014):

Stating clear goals The following questions are helpful when clients are setting goals :

Does the goal reflect your values? Is the goal realistic and achievable? Is the goal specific? Is the goal measurable? Does the goal have a timeframe?

Helping clients to experience feelings

Counseling can influence clients’ emotions and their physical reactions to emotions by helping them (Nelson-Jones, 2014):

Experience feelings
Express feelings
Manage feelings
Empty chair dialogue This practical intervention involves the client engaging in an imaginary conversation with another person; it helps “clients experience feelings both of unresolved anger and also of weakness and victimization” (Nelson-Jones, 2014, p. 347).

The client may be asked to shift to the empty chair and play the other person’s part to explore conflict, interactions, and emotions more fully (Corey, 2013).

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“Counselors and counseling trainees make choices both concerning specific interventions and about interventions used in combination” (Nelson-Jones, 2014, p. 223).

Through early and continued engagement with the client throughout the counseling approach , the counselor and client set specific, measurable, and achievable goals and create a treatment plan with a defined intervention strategy (Dobson, 2010).

The treatment plan becomes a map, combining interventions to reach client goals and overcome problems – to get from where they are now to where they want to be. However, no plan should be too fixed or risk preventing the client’s progress in their ‘wished-for’ direction. Rather, it must be open for regular revisit and modification (Nelson-Jones, 2014).

Counseling and therapeutic treatment plans vary according to the approaches used and the client’s specific needs but should be strength-based and collaborative. Most treatment plans typically consider the following points (modified from GoodTherapy, 2019):

History and assessment – E.g., psychosocial history, symptom onset, past and present diagnoses, and treatment history
Present concerns – The current concerns and issues that led the client to counseling
Counseling contract – A summary of goals and desired changes, responsibility, and the counseling approach adopted
Summary of strengths – It can be helpful to summarize the client’s strengths, empowering them for goal achievement.
Goals – Measurable treatment goals are vital to the treatment plan.
Objectives – Goals are broken down into smaller, achievable outcomes that support achievement during counseling.
Interventions – Interventions should be planned early to support objectives and overall goals.
Tracking progress and outcomes – Regular treatment plan review should include updating progress toward goals.

While a vital aspect of the counseling process is to ensure that treatment takes an appropriate direction for the client, it is also valuable and helpful for clients and insurance companies to understand likely timescales.

“Depression is one of the most common mental health disorders with a high burden of disease and the leading cause of years of life lost due to disability” (Hu et al., 2020, p. 1).

Exercise interventions Research has shown that even low-to-moderate levels of exercise can help manage and treat depression (Hu et al., 2020).
Gratitude Practicing gratitude can profoundly affect how we see our lives and those around us. Completing gratitude journals and reviewing three positive things that have happened at the end of the day have been shown to decrease depression and promote wellbeing (Shapiro, 2020).
Behavioral activation Scheduling activities that result in positive emotions can help manage and overcome depression (Behavioral Activation for Depression, n.d.).

Anxiety can stop clients from living their lives fully and experiencing positive emotions. Many interventions can help, including:

Understanding your anxiety triggers Interoceptive exposure techniques focus on reproducing sensations associated with anxiety and other difficult emotions. Clients benefit from learning to identify anxiety triggers, behavioral changes, and associated bodily sensations (Boettcher et al., 2016).
Using a building image Clients are asked to form a mental image of themselves as a building. Their description of its state of repair and quality of foundation provides helpful insight into the client’s wellbeing and degree of anxiety (Thomas, 2016).

Grief therapy

Grief therapy helps clients accept reality, process the pain, and adjust to a new world following the loss of a loved one. Several techniques can help, including (modified from (Worden, 2018):

Creating memory books Compiling a memory book containing photographs, memorabilia, stories, and poems can help families come together, share their grief, and reminisce.
Directed imagery Like the ‘empty chair’ technique, through imagining the missing loved one in front of them, the grieving person is given the opportunity to talk to them.

Substance abuse

“There has been significant progress and expansion in the development of evidence-based psychosocial treatments for substance abuse and dependence” (Jhanjee, 2014, p. 1). Psychological interventions play a growing role in disorder treatment programs; they include:

Brief optimistic interventions Brief advice is delivered following screening and assessment to at-risk individuals to reduce drinking and other harmful activities.
Motivational interviewing This technique involves using targeted questioning while expressing empathy through reflective listening to resolve client ambivalence about their substance abuse.

Marriage therapy

Interventions are a vital aspect of marriage therapy, often targeting communication skills, problem-solving, and taking responsibility (Williams, 2012).

They can include the following interventions:

Taking responsibility It is vital that clients take responsibility for their actions within a relationship. The counselor will work with the couple, asking the following questions, as required (modified from Williams, 2012):

How have you contributed to the relationship’s problems? What changes are needed to improve the relationship? Are you willing to make the changes needed?

Create an action plan Once the couple agrees, the changes will be combined into a plan, with specific actions to help them achieve their goal.

Helping cancer patients

“There is no evidence to suggest that having counseling will help treat or cure your cancer”; however, it may help with coping, relationship issues, and dealing with practical problems (Cancer Research UK, 2019, para. 16).

Several counseling interventions that have proven helpful with the psychological burden include (Guo et al., 2013):

Psychoeducation Sharing the importance of mental wellbeing and coping with the client and involving them in their cancer treatment can reduce anxiety and improve confidence.
Cognitive-Behavioral Therapy Replacing incorrect or unhelpful beliefs can help the client achieve a more positive outlook regarding the treatment.

World’s Largest Positive Psychology Resource

The Positive Psychology Toolkit© is a groundbreaking practitioner resource containing over 500 science-based exercises , activities, interventions, questionnaires, and assessments created by experts using the latest positive psychology research.

Updated monthly. 100% Science-based.

“The best positive psychology resource out there!” — Emiliya Zhivotovskaya , Flourishing Center CEO

Career counselors help individuals or groups cope more effectively with career concerns, including (Niles & Harris-Bowlsbey, 2017):

Career choice
Managing career changes and transitions
Job-related stress
Looking for a job

While there are many interventions and strategies, the following are insightful and effective:

Creating narratives Working with clients to build personal career narratives can help them see their movement through life with more meaning and coherence and better understand their decisions. Such an intervention can be valuable in looking forward and choosing the next steps.
Group counseling Multiple group sessions can be arranged to cover different aspects of career-related issues and related emotional issues. They may include role-play or open discussion around specific topics.

The ultimate goals are usually to “help group members respond to each other with a combination of therapeutic attending, and sharing their own reactions and related experiences” (Cochran & Cochran, 2015, p. 329).

Examples of group interventions include:

Circle of friends This group intervention involves gathering a child’s peers into a circle of friendly support to encourage and help them with problem-solving. The intervention has led to increased social acceptance of children with special needs (Magyar-Moe et al., 2015).
Group mindfulness Mindfulness in group settings has been shown to be physically and mentally beneficial (Shapiro, 2020). New members may start by performing a body-scan meditation where they bring awareness to each part of their body before turning their attention to their breathing.

17 Tools To Increase Motivation and Goal Achievement

These 17 Motivation & Goal Achievement Exercises [PDF] contain all you need to help others set meaningful goals, increase self-drive, and experience greater accomplishment and life satisfaction.

Created by Experts. 100% Science-based.

We have many free interventions, using various approaches and mediums, that support the counseling process and client goal achievement.

Nudge Interventions in Groups The group provides a valuable setting for exploring the potential of ‘nudges’ to alter behavior in a predictable way.
Developing Interoceptive Exposure Therapy Interventions This worksheet explores the sensations behind panic attacks and phobias.
Therapist Interoceptive Exposure Record Use this helpful log to track interoceptive exposure interventions.
Motivational Interviewing This template uses the five stages of change to consider the client’s readiness for change and the appropriate interventions to use.
Breaking Out of the Comfort Zone Making changes typically requires clients to step out of their comfort zone. This worksheet identifies opportunities to embrace new challenges.

More extensive versions of the following tools are available with a subscription to the Positive Psychology Toolkit© , but they are described briefly below:

Benefit finding

Psychological research has identified long-term benefits to using benefit finding, with individuals reporting new appreciation for their strengths and building resilience (e.g., Affleck & Tennen, 1996; Davis et al., 1998; McMillen et al., 1997).

Begin by talking about a traumatic event.
Focus on the positive aspects of the experience.
Consider what the experience has taught you.
Identify how the experience has helped you grow
Self-compassion box

Self-compassion is a crucial aspect of our psychological wellbeing, made up of showing ourselves kindness, accepting imperfection, and paying attention to personal suffering with clarity and objectivity.

Step one – Begin by recognizing the uncompassionate self.
Step two – Select self-compassion reminders.
Step three – Redirect attention to self-compassion.
Step four – Reflect on creating more self-compassion in life.

Over time, the client should see the gaps closing between where they are now and where they want to be.

If you’re looking for more science-based ways to help others reach their goals, check out this collection of 17 validated motivation & goal achievement tools for practitioners. Use them to help others turn their dreams into reality by applying the latest science-based behavioral change techniques.

Counseling uses interventions to create positive change in clients’ lives. They can be performed individually but typically form part of a treatment or intervention plan developed with the client.

Each intervention helps the client work toward their goals, strengthen their capabilities, identify opportunities, increase motivation, and modify behavior.

They aim to create sufficient momentum to support change and avoid the risk of the client reverting, transitioning the client (often one small step at a time) from where they are now to where they want to be.

While some interventions have value in multiple settings – individual, group, career, couples, family – others are specific and purposeful. Many interventions target unhelpful, repetitive thinking patterns and aim to replace harmful thoughts, unrealistic expectations, or biased thinking. Others create a possible future where the client can engage with what might be or could happen , coming to terms with change or their own negative emotions.

Use this article to explore the range of interventions available to counselors in sessions or as homework. Try them out in different settings, working with the client to identify their value or potential for modification.

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

Affleck, G., & Tennen, H. (1996). Construing benefits from adversity: Adaptational significance and dispositional underpinnings. Journal of Personality , 64 , 899–922.
American Psychological Association. (n.d.). Intervention. In APA dictionary of psychology . Retrieved February 27, 2022, from https://dictionary.apa.org/intervention
Behavioral Activation for Depression. (n.d.). Retrieved February 16, 2022, from https://medicine.umich.edu/sites/default/files/content/downloads/Behavioral-Activation-for-Depression.pdf
Boettcher, H., Brake, C. A., & Barlow, D. H. (2016). Origins and outlook of interoceptive exposure. Journal of Behavior Therapy and Experimental Psychiatry , 53 , 41–51.
Cancer Research UK. (2019). How counselling can help . Retrieved February 28, 2022, from https://www.cancerresearchuk.org/about-cancer/coping/emotionally/talking-about-cancer/counselling/how-counselling-can-help
Cochran, J. L., & Cochran, N. H. (2015). The heart of counseling: Counseling skills through therapeutic relationships . Routledge, Taylor & Francis Group.
Corey, G. (2013). Theory and practice of counseling and psychotherapy . Cengage.
Davis, C. G., Nolen-Hoeksema, S., & Larson, J. (1998). Making sense of loss and benefiting from the experience: Two construals of meaning. Journal of Personality and Social Psychology , 75 , 561–574.
Dobson, K. S. (Ed.) (2010). Handbook of cognitive-behavioral therapies (3rd ed.). Guilford Press.
Guo, Z., Tang, H. Y., Li, H., Tan, S. K., Feng, K. H., Huang, Y. C., Bu, Q., & Jiang, W. (2013). The benefits of psychosocial interventions for cancer patients undergoing radiotherapy. Health and Quality of Life Outcomes , 11 (1), 1–12.
GoodTherapy. (2019, September 25). Treatment plan . Retrieved February 27, 2022, from https://www.goodtherapy.org/blog/psychpedia/treatment-plan
Hu, M. X., Turner, D., Generaal, E., Bos, D., Ikram, M. K., Ikram, M. A., Cuijpers, P., & Penninx, B. W. J. H. (2020). Exercise interventions for the prevention of depression: a systematic review of meta-analyses. BMC Public Health , 20 (1), 1255.
Jhanjee, S. (2014). Evidence-based psychosocial interventions in substance use. Indian Journal of Psychological Medicine , 36 (2), 112–118.
Magyar-Moe, J. L., Owens, R. L., & Conoley, C. W. (2015). Positive psychological interventions in counseling. The Counseling Psychologist , 43 (4), 508–557.
McMillen, J. C., Smith, E. M., & Fisher, R. H. (1997). Perceived benefit and mental health after three types of disaster. Journal of Consulting and Clinical Psychology , 65 , 733–739.
Michie, S., Atkins, L., & West, R. (2014). The behaviour change wheel: A guide to designing interventions . Silverback.
Nelson-Jones, R. (2014). Practical counselling and helping skills . Sage.
Niles, S. G., & Harris-Bowlsbey, J. (2017). Career development interventions . Pearson.
Shapiro, S. L. (2020). Rewire your mind: Discover the science + practice of mindfulness . Aster.
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2015). Study guide for counseling and psychotherapy theories in context and practice: Skills, strategies, and techniques (2nd ed.). Wiley.
Thomas, V. (2016). Using mental imagery in counselling and psychotherapy: A guide to more inclusive theory and practice . Routledge.
Williams, M. (2012). Couples counseling: A step by step guide for therapists . Viale.
Worden, J. W. (2018). Grief counseling and grief therapy: A handbook for the mental health practitioner . Springer.

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Problem-Solving Strategies and Obstacles

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Application
Improvement

From deciding what to eat for dinner to considering whether it's the right time to buy a house, problem-solving is a large part of our daily lives. Learn some of the problem-solving strategies that exist and how to use them in real life, along with ways to overcome obstacles that are making it harder to resolve the issues you face.

What Is Problem-Solving?

In cognitive psychology , the term 'problem-solving' refers to the mental process that people go through to discover, analyze, and solve problems.

A problem exists when there is a goal that we want to achieve but the process by which we will achieve it is not obvious to us. Put another way, there is something that we want to occur in our life, yet we are not immediately certain how to make it happen.

Maybe you want a better relationship with your spouse or another family member but you're not sure how to improve it. Or you want to start a business but are unsure what steps to take. Problem-solving helps you figure out how to achieve these desires.

The problem-solving process involves:

Discovery of the problem
Deciding to tackle the issue
Seeking to understand the problem more fully
Researching available options or solutions
Taking action to resolve the issue

Before problem-solving can occur, it is important to first understand the exact nature of the problem itself. If your understanding of the issue is faulty, your attempts to resolve it will also be incorrect or flawed.

Problem-Solving Mental Processes

Several mental processes are at work during problem-solving. Among them are:

Perceptually recognizing the problem
Representing the problem in memory
Considering relevant information that applies to the problem
Identifying different aspects of the problem
Labeling and describing the problem

Problem-Solving Strategies

There are many ways to go about solving a problem. Some of these strategies might be used on their own, or you may decide to employ multiple approaches when working to figure out and fix a problem.

An algorithm is a step-by-step procedure that, by following certain "rules" produces a solution. Algorithms are commonly used in mathematics to solve division or multiplication problems. But they can be used in other fields as well.

In psychology, algorithms can be used to help identify individuals with a greater risk of mental health issues. For instance, research suggests that certain algorithms might help us recognize children with an elevated risk of suicide or self-harm.

One benefit of algorithms is that they guarantee an accurate answer. However, they aren't always the best approach to problem-solving, in part because detecting patterns can be incredibly time-consuming.

There are also concerns when machine learning is involved—also known as artificial intelligence (AI)—such as whether they can accurately predict human behaviors.

Heuristics are shortcut strategies that people can use to solve a problem at hand. These "rule of thumb" approaches allow you to simplify complex problems, reducing the total number of possible solutions to a more manageable set.

If you find yourself sitting in a traffic jam, for example, you may quickly consider other routes, taking one to get moving once again. When shopping for a new car, you might think back to a prior experience when negotiating got you a lower price, then employ the same tactics.

While heuristics may be helpful when facing smaller issues, major decisions shouldn't necessarily be made using a shortcut approach. Heuristics also don't guarantee an effective solution, such as when trying to drive around a traffic jam only to find yourself on an equally crowded route.

Trial and Error

A trial-and-error approach to problem-solving involves trying a number of potential solutions to a particular issue, then ruling out those that do not work. If you're not sure whether to buy a shirt in blue or green, for instance, you may try on each before deciding which one to purchase.

This can be a good strategy to use if you have a limited number of solutions available. But if there are many different choices available, narrowing down the possible options using another problem-solving technique can be helpful before attempting trial and error.

In some cases, the solution to a problem can appear as a sudden insight. You are facing an issue in a relationship or your career when, out of nowhere, the solution appears in your mind and you know exactly what to do.

Insight can occur when the problem in front of you is similar to an issue that you've dealt with in the past. Although, you may not recognize what is occurring since the underlying mental processes that lead to insight often happen outside of conscious awareness .

Research indicates that insight is most likely to occur during times when you are alone—such as when going on a walk by yourself, when you're in the shower, or when lying in bed after waking up.

How to Apply Problem-Solving Strategies in Real Life

If you're facing a problem, you can implement one or more of these strategies to find a potential solution. Here's how to use them in real life:

Create a flow chart . If you have time, you can take advantage of the algorithm approach to problem-solving by sitting down and making a flow chart of each potential solution, its consequences, and what happens next.
Recall your past experiences . When a problem needs to be solved fairly quickly, heuristics may be a better approach. Think back to when you faced a similar issue, then use your knowledge and experience to choose the best option possible.
Start trying potential solutions . If your options are limited, start trying them one by one to see which solution is best for achieving your desired goal. If a particular solution doesn't work, move on to the next.
Take some time alone . Since insight is often achieved when you're alone, carve out time to be by yourself for a while. The answer to your problem may come to you, seemingly out of the blue, if you spend some time away from others.

Obstacles to Problem-Solving

Problem-solving is not a flawless process as there are a number of obstacles that can interfere with our ability to solve a problem quickly and efficiently. These obstacles include:

Assumptions: When dealing with a problem, people can make assumptions about the constraints and obstacles that prevent certain solutions. Thus, they may not even try some potential options.
Functional fixedness : This term refers to the tendency to view problems only in their customary manner. Functional fixedness prevents people from fully seeing all of the different options that might be available to find a solution.
Irrelevant or misleading information: When trying to solve a problem, it's important to distinguish between information that is relevant to the issue and irrelevant data that can lead to faulty solutions. The more complex the problem, the easier it is to focus on misleading or irrelevant information.
Mental set: A mental set is a tendency to only use solutions that have worked in the past rather than looking for alternative ideas. A mental set can work as a heuristic, making it a useful problem-solving tool. However, mental sets can also lead to inflexibility, making it more difficult to find effective solutions.

How to Improve Your Problem-Solving Skills

In the end, if your goal is to become a better problem-solver, it's helpful to remember that this is a process. Thus, if you want to improve your problem-solving skills, following these steps can help lead you to your solution:

Recognize that a problem exists . If you are facing a problem, there are generally signs. For instance, if you have a mental illness , you may experience excessive fear or sadness, mood changes, and changes in sleeping or eating habits. Recognizing these signs can help you realize that an issue exists.
Decide to solve the problem . Make a conscious decision to solve the issue at hand. Commit to yourself that you will go through the steps necessary to find a solution.
Seek to fully understand the issue . Analyze the problem you face, looking at it from all sides. If your problem is relationship-related, for instance, ask yourself how the other person may be interpreting the issue. You might also consider how your actions might be contributing to the situation.
Research potential options . Using the problem-solving strategies mentioned, research potential solutions. Make a list of options, then consider each one individually. What are some pros and cons of taking the available routes? What would you need to do to make them happen?
Take action . Select the best solution possible and take action. Action is one of the steps required for change . So, go through the motions needed to resolve the issue.
Try another option, if needed . If the solution you chose didn't work, don't give up. Either go through the problem-solving process again or simply try another option.

You can find a way to solve your problems as long as you keep working toward this goal—even if the best solution is simply to let go because no other good solution exists.

Sarathy V. Real world problem-solving . Front Hum Neurosci . 2018;12:261. doi:10.3389/fnhum.2018.00261

Dunbar K. Problem solving . A Companion to Cognitive Science . 2017. doi:10.1002/9781405164535.ch20

Stewart SL, Celebre A, Hirdes JP, Poss JW. Risk of suicide and self-harm in kids: The development of an algorithm to identify high-risk individuals within the children's mental health system . Child Psychiat Human Develop . 2020;51:913-924. doi:10.1007/s10578-020-00968-9

Rosenbusch H, Soldner F, Evans AM, Zeelenberg M. Supervised machine learning methods in psychology: A practical introduction with annotated R code . Soc Personal Psychol Compass . 2021;15(2):e12579. doi:10.1111/spc3.12579

Mishra S. Decision-making under risk: Integrating perspectives from biology, economics, and psychology . Personal Soc Psychol Rev . 2014;18(3):280-307. doi:10.1177/1088868314530517

Csikszentmihalyi M, Sawyer K. Creative insight: The social dimension of a solitary moment . In: The Systems Model of Creativity . 2015:73-98. doi:10.1007/978-94-017-9085-7_7

Chrysikou EG, Motyka K, Nigro C, Yang SI, Thompson-Schill SL. Functional fixedness in creative thinking tasks depends on stimulus modality . Psychol Aesthet Creat Arts . 2016;10(4):425‐435. doi:10.1037/aca0000050

Huang F, Tang S, Hu Z. Unconditional perseveration of the short-term mental set in chunk decomposition . Front Psychol . 2018;9:2568. doi:10.3389/fpsyg.2018.02568

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

Math Interventions

Introduction
Subitizing Interventions
Counting Interventions: Whole Numbers Less Than 30
Counting Interventions: Whole Numbers Greater Than 30 (Place Value)
Counting Interventions: Fractions
Counting Interventions: Decimals
Composing and Decomposing Numbers Interventions
Rounding Interventions
Number Sense Lesson Plans
Addition and Subtraction Facts
Multiplication and Division Facts
Computational Fluency Lesson Plans
Understanding the Problem Interventions
Planning and Executing a Solution Interventions
Monitoring Progress & Reflecting on a Solution Interventions
Problem-Solving Process Interventions

Problem-Solving Process

Response to error: using the problem-solving process, feedback during the lesson, strategies to try after the lesson.

Problem-Solving Lesson Plans
Identifying Essential Variables Interventions
Direct Models Interventions
Counting On/Back Interventions
Deriving Interventions
Interpreting the Results Interventions
Mathematical Modeling Lesson Plans
Math Rules and Concepts Interventions
Math Rules and Concepts Lesson Plans

A student who has difficulty understanding the problem, planning and executing a solution , self-monitoring progress toward a goal, and evaluating a solution will benefit from intervention around the problem-solving process. The following interventions support students in internalizing this process from start to finish. This page includes intervention strategies that you can use to support your students in this area. Remember, if you're teaching a full process from start to finish, you probably want to use the Self-Regulated Strategy Development approach, which spreads explicit instruction of a full process across a series of intervention lessons. As you read, consider which of these interventions best aligns with your student's strengths and needs in the whole-learner domains.

Self-Regulated Strategy Development

Self-Regulated Strategy Development (or SRSD) is one way to teach the problem-solving process. The SRSD model "requires teachers to explicitly teach students the use of the strategy, to model the strategy, to cue students to use the strategy, and to scaffold instruction to gradually allow the student to become an independent strategy user." (Reid, Leinemann, & Hagaman, 2013). The steps of teaching SRSD are slightly different from the steps of explicit instruction because, in SRSD, each step must be mastered before the next one is started. For example, you might spend an entire lesson on Developing Background Knowledge before moving on to Discuss It (see below). The longterm goal of SRSD is for students to be able carry out the strategy independently, and so time is dedicated to teaching each step of the strategy in such a manner as enables students to internalize the material.

Teaching SRSD model requires six steps:

Develop Background Knowledge. Define the key ideas that students need to know in order to apply the strategy.
Discuss It. Tell the student what the strategy is called, and describe each step.
Model It. Use a think-aloud to demonstrate the strategy.
Memorize It . Internalize strategy.
Support It. Gradually release responsibility to students.
Independent performance. Give students opportunities to practice strategy without support.

SRSD Explicit Instruction Six-Step Model:

To support your students' ability to apply SRSD, you should start by explicitly teaching the six-step model. Keep in mind that this type of explicit instruction may take place over a number of days.

Step 1: Set the Context for Student Learning and Develop Background Knowledge.

Introduce Word Problem Mnemonics, and discuss the use of the mnemonic: "Today you will be learning a new trick to help you solve problems. This strategy is called CUBES." (Teacher gets out chart paper and markers and writes down C, U , B, E, and S vertically.) "CUBES is a self-regulated strategy, which means that you will learn to memorize the strategy and use it without my support. Let's go through each step of CUBES and see how it will help you go through the problem-solving process. First, C-Circle the Numbers" (Teacher write this next to C.) "U - Underline important words." (Teacher writes next to U.) B- Box the question " (Teache r writes next to B). E- Eliminate unnecessary information. S - Solve and Check. (Teacher writes these terms next to E and S). "Now, what do we need to know when we are doing CUBES? We need to know which words are important. We also need to eliminate unnecessary information" (Teacher goes on to define these terms.)

Step 2: Discuss It.

Discuss the significance and benefits of using CUBES. Discuss and determine goals for using the strategy. At this point, students can examine their past work to set an individual goal: "So, how is a self-regulated strategy going to help us? Well, it gives us an easy way to remember the five steps to solving the problem. How else does it help us?" (Teacher elicits student responses.) "When we are using a SRSD, we ask ourselves questions to make sure we are following the steps. We call these self-statements. My self-statements are 'What's my first step?' and 'What am I supposed to do now?' I ask myself self-statements so I can make sure that I am using each step of the strategy, and that I don't miss any steps." (Teacher and students discuss benefits of self-statements.) "Now let's take some time to set goals for using this strategy...." (Teacher and students set goals, such as "students will each have two self-statements they use when employing the CUBE strategy.")

Step 3: Model It.

The teacher models the strategy using think alouds and self-statements: "Watch as I show you what CUBES looks like when I use it. See if you can notice my self-statements. What am I supposed to do? I'm supposed to to follow the five steps to solve a problem. What is my first step? C. That's right, C. I need to circle the numbers. I'll do that now, and then check that off my CUBE S list. (Teacher circles numbers). Okay, I'm going to check my CUBES list again. I've already completed C. Now, on to U. I have to Underline important words. (Teacher continues to model the entire CUBES process with 1- 3 problems. The session ends. Teacher starts Model It with new problems on Day 2.)

Step 4: Memorize It .

Students memorize the mnemonic and each of the steps of CUBES. The idea is that the students will not be able to implement the strategy if they cannot recall the steps. "Next, we are are going to take some time to memorize each step. What is C?" "Circle the numbers!"What is U?" (Teacher completes this process for all the letters. At this time, students also write the mnemonic down so they can use it as a reference. If they need to, they can come up with a beat or a chant to remember the mnemonic.)

Step 5: Support It.

In step 5, the teacher gradually releases responsibility to the students. This is the most important stage, especially for struggling readers. In order for students to be able to implement this strategy on their own, they must be supported as needed. Graham, Harris, Mason, and Friedlander (2008), SRSD experts and authors, often tell their teachers, "Please Don't P.E.E. in the Classroom - P ost, E xplain, E xpect. Success with SRSD depends on using all the stages for students who have difficulty with [reading]." SRSD instruction and implementation are only successful when students are given multiple opportunities to practice using their strategy with teacher support before trying it on their own. "Let's read the next problem and do CUBES together this time..." Teacher follows the steps of gradual release to transfer responsibility to students. The teacher first engages students with guided support. She might read the problem and allow students to complete different parts of the strategy. Then, students might do CUBES in groups. This part of the strategy might take multiple days, until students are effectively completing the strategy by using self-statements.

Step 6: Independent Practice

In the final step, students practice using the strategy independently. "Now, you are ready to use CUBES on your own! Remember to use your self-statements, like What do I do next? and What am I supposed to do now? and I'll look at my CUBES sheet to see what I do next. as you employ this strategy!" Teacher circulates and provides support for students who are not yet ready to work independently.

Activity A: Word Problem Mnemonics

One way to support your student's problem-solving ability is to teach her a mnemonic for a series of steps to take whenever she encounters a story problem. The following brief, developed by the Evidence Based Intervention Network at the University of Missouri, describes this strategy. As you read, consider how each mnemonic breaks down the problem-solving process.

Click here to read the brief.

Word Problem Mnemonics in Action

In the video below, Emily Art explicitly models how to use the word mnemonic, CUBES, to teach the problem solving process.

As you watch, consider: How do mnemonics support a student's ability to independently carry out the problem solving process?

Another strategy to use to teach your student the problem-solving process is called Self-Organizing Questions. Gifford (2005) advocates for teaching students a series of questions to ask themselves that will guide them through the problem-solving process. Read through each prompt below and consider its purpose.

Getting to Grips: What are we trying to do?
Connecting to Prior Knowledge: Have we done anything like this before?
Planning: What do we need?
Considering Alternative Methods: Is there another way?
Monitoring Progress: How does it look so far?
Evaluating Solutions: Does it work? How can we check? Can we make it better?

Self-Organizing Questions in Action

Give the student a problem. Then, go through the six self-organizing questions to guide the student through the problem-solving process. This example refers to the problem below.

Lamont had 14 pumpkin seeds. He also had 32 apple seeds. He planted 41 of the seeds. How many seeds did Lamont have left?

Teacher: We are going to use the self-organizing questions to solve this problem. Frank, what are we trying to do?

Frank: We are trying to figure out how many seeds Lamont has left, after he plants the pumpkin and apple seeds.

Teacher: Let's think about similar problems we've had in the past. Have we done anything like this before?

Frank: Yes, yesterday, we solved a problem about how many baseball and soccer balls Jamie had.

Teacher: So, what do we need to do to plan to solve this problem?

Frank: We need to add up the total number of seeds, and then subtract how many he planted.

Teacher: Is there another way to solve this problem?

Frank: We could probably draw it, or use manipulatives to help us.

Teacher: Okay, go ahead and execute it! How does it look so far?

Frank: It's working for me. I added the types of seeds together, which gave me 46. Then, I subtracted the 41 seeds he planted. That gave me 5 seeds leftover, which seems about right.

Teacher: How can we check our answer?

Frank: I'll see if I can add it back up. My solution was 5, so I'll add that to 41, which gives me 46. Then, I'll add the number of seeds he had total, which gives me 46! So, it matches!

Activity C: Solve It

If your student has particular struggles with understanding the problem, use Solve It, which is an explicit approach to teaching the problem-solving process, with an emphasis on understanding what the problem is about. The following brief, developed by the Evidence Based Intervention Network at the University of Missouri, describes this strategy. As you read, consider how this approach supports student understanding of problems.

Click here to read the brief.

Solve It in Action Read the sample lesson plan (Montague, 2006) below to see what Solve It looks like in action. For your reference, click here to access a self-regulation script for students.

SolveItLesson.pdf

Gifford, S. (2005). Teaching mathematics 3-5: Developing learning in the foundation stage. Berkshire: McGraw-Hill Education. Graham, S., & Harris, K.R. (2005). Writing better: Effective strategies for teaching students with learning difficulties. Baltimore, Maryland: Paul H. Brookes Publishing Co. Hughes, E.M. (2011). Intervention Name: Solve It! Columbia, Mo: The Evidence Based Intervention Network, The University of Missouri. Retrieved from https://education.missouri.edu/ebi/math-acquisition/ Hughes, E.M. & Powell, S. (2011). Intervention Name: Word-Problem Mnemonics. Columbia, Mo: The Evidence Based Intervention Network, The University of Missouri. Retrieved from https://education.missouri.edu/ebi/math-acquisition/ Montague, Marjorie. (2006). Self-regulation strategies for better math performance in middle school. In M. Montague and A. Jistendra (Eds.), Teaching mathematics to middle school students with learning disabilities. New York: The Guilford Press. Reid, R., Lienemann, T. O., & Hagaman, J. L. (2013). Strategy instruction for students with learning disabilities. New York: The Guilford Press.

Think about the following scenario, which takes place after a teacher has explicitly taught a student to use the problem-solving process. The following example refers to the problem below.

Lamont had 14 pumpkin seeds. He also had 32 apple seeds. He planted 41 of the seeds. How many seeds did Lamont have left? Teacher: "Now that you understand the problem, what are you doing to do next?" Student: "Solve it! 41-32 = 9. He had nine seeds left."

In such a case, what might you do?

When you are planning your lessons, you should anticipate that your student will make errors throughout. Here are a series of prompts that you can use to respond to errors. Keep in mind that all students are different, and that students might respond better to some types of feedback than to others.


Smallest Scaffold	As you continue to use these interventions, your student should have the steps to the problem-solving process listed in his notebook.
Medium Scaffold	If a student is struggling, back up your process. Ask the student to identify the next step he should take.
Highest Scaffold	If the student continues to struggle, model your own thinking. This will help a student understand how to use the problem solving process effectively.

If your student struggles to meet your objective, there are various techniques that you might try in order to adjust the activity so as best to meet your student's needs.

Activity	Description of Strategy	Script
All Activities	If your student rushes through a strategy by skipping the planning phase, encourage him to go back and select an attack strategy that matches the problem.	. Let's read the problem again and consider whether an equation is the best strategy for solving this problem."

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Last Updated: Jul 30, 2024 10:23 AM
URL: https://relay.libguides.com/math-interventions

Center for Teaching

Teaching problem solving.

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Tips and Techniques

Expert vs. novice problem solvers, communicate.

Have students identify specific problems, difficulties, or confusions . Don’t waste time working through problems that students already understand.
If students are unable to articulate their concerns, determine where they are having trouble by asking them to identify the specific concepts or principles associated with the problem.
In a one-on-one tutoring session, ask the student to work his/her problem out loud . This slows down the thinking process, making it more accurate and allowing you to access understanding.
When working with larger groups you can ask students to provide a written “two-column solution.” Have students write up their solution to a problem by putting all their calculations in one column and all of their reasoning (in complete sentences) in the other column. This helps them to think critically about their own problem solving and helps you to more easily identify where they may be having problems. Two-Column Solution (Math) Two-Column Solution (Physics)

Encourage Independence

Model the problem solving process rather than just giving students the answer. As you work through the problem, consider how a novice might struggle with the concepts and make your thinking clear
Have students work through problems on their own. Ask directing questions or give helpful suggestions, but provide only minimal assistance and only when needed to overcome obstacles.
Don’t fear group work ! Students can frequently help each other, and talking about a problem helps them think more critically about the steps needed to solve the problem. Additionally, group work helps students realize that problems often have multiple solution strategies, some that might be more effective than others

Be sensitive

Frequently, when working problems, students are unsure of themselves. This lack of confidence may hamper their learning. It is important to recognize this when students come to us for help, and to give each student some feeling of mastery. Do this by providing positive reinforcement to let students know when they have mastered a new concept or skill.

Encourage Thoroughness and Patience

Try to communicate that the process is more important than the answer so that the student learns that it is OK to not have an instant solution. This is learned through your acceptance of his/her pace of doing things, through your refusal to let anxiety pressure you into giving the right answer, and through your example of problem solving through a step-by step process.

Experts (teachers) in a particular field are often so fluent in solving problems from that field that they can find it difficult to articulate the problem solving principles and strategies they use to novices (students) in their field because these principles and strategies are second nature to the expert. To teach students problem solving skills, a teacher should be aware of principles and strategies of good problem solving in his or her discipline .

The mathematician George Polya captured the problem solving principles and strategies he used in his discipline in the book How to Solve It: A New Aspect of Mathematical Method (Princeton University Press, 1957). The book includes a summary of Polya’s problem solving heuristic as well as advice on the teaching of problem solving.

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Problem solving strategies

What skills do i need to be an effective problem solver, how can i improve my problem solving skills.

Problem solving strategies are methods of approaching and facilitating the process of problem-solving with a set of techniques , actions, and processes. Different strategies are more effective if you are trying to solve broad problems such as achieving higher growth versus more focused problems like, how do we improve our customer onboarding process?

Broadly, the problem solving steps outlined above should be included in any problem solving strategy though choosing where to focus your time and what approaches should be taken is where they begin to differ. You might find that some strategies ask for the problem identification to be done prior to the session or that everything happens in the course of a one day workshop.

The key similarity is that all good problem solving strategies are structured and designed. Four hours of open discussion is never going to be as productive as a four-hour workshop designed to lead a group through a problem solving process.

Good problem solving strategies are tailored to the team, organization and problem you will be attempting to solve. Here are some example problem solving strategies you can learn from or use to get started.

Use a workshop to lead a team through a group process

Often, the first step to solving problems or organizational challenges is bringing a group together effectively. Most teams have the tools, knowledge, and expertise necessary to solve their challenges – they just need some guidance in how to use leverage those skills and a structure and format that allows people to focus their energies.

Facilitated workshops are one of the most effective ways of solving problems of any scale. By designing and planning your workshop carefully, you can tailor the approach and scope to best fit the needs of your team and organization.

Problem solving workshop

Creating a bespoke, tailored process
Tackling problems of any size
Building in-house workshop ability and encouraging their use

Workshops are an effective strategy for solving problems. By using tried and test facilitation techniques and methods, you can design and deliver a workshop that is perfectly suited to the unique variables of your organization. You may only have the capacity for a half-day workshop and so need a problem solving process to match.

By using our session planner tool and importing methods from our library of 700+ facilitation techniques, you can create the right problem solving workshop for your team. It might be that you want to encourage creative thinking or look at things from a new angle to unblock your groups approach to problem solving. By tailoring your workshop design to the purpose, you can help ensure great results.

One of the main benefits of a workshop is the structured approach to problem solving. Not only does this mean that the workshop itself will be successful, but many of the methods and techniques will help your team improve their working processes outside of the workshop.

We believe that workshops are one of the best tools you can use to improve the way your team works together. Start with a problem solving workshop and then see what team building, culture or design workshops can do for your organization!

Run a design sprint

Great for:

aligning large, multi-discipline teams
quickly designing and testing solutions
tackling large, complex organizational challenges and breaking them down into smaller tasks

By using design thinking principles and methods, a design sprint is a great way of identifying, prioritizing and prototyping solutions to long term challenges that can help solve major organizational problems with quick action and measurable results.

Some familiarity with design thinking is useful, though not integral, and this strategy can really help a team align if there is some discussion around which problems should be approached first.

The stage-based structure of the design sprint is also very useful for teams new to design thinking. The inspiration phase, where you look to competitors that have solved your problem, and the rapid prototyping and testing phases are great for introducing new concepts that will benefit a team in all their future work.

It can be common for teams to look inward for solutions and so looking to the market for solutions you can iterate on can be very productive. Instilling an agile prototyping and testing mindset can also be great when helping teams move forwards – generating and testing solutions quickly can help save time in the long run and is also pretty exciting!

Break problems down into smaller issues

Organizational challenges and problems are often complicated and large scale in nature. Sometimes, trying to resolve such an issue in one swoop is simply unachievable or overwhelming. Try breaking down such problems into smaller issues that you can work on step by step. You may not be able to solve the problem of churning customers off the bat, but you can work with your team to identify smaller effort but high impact elements and work on those first.

This problem solving strategy can help a team generate momentum, prioritize and get some easy wins. It’s also a great strategy to employ with teams who are just beginning to learn how to approach the problem solving process. If you want some insight into a way to employ this strategy, we recommend looking at our design sprint template below!

Use guiding frameworks or try new methodologies

Some problems are best solved by introducing a major shift in perspective or by using new methodologies that encourage your team to think differently.

Props and tools such as Methodkit , which uses a card-based toolkit for facilitation, or Lego Serious Play can be great ways to engage your team and find an inclusive, democratic problem solving strategy. Remember that play and creativity are great tools for achieving change and whatever the challenge, engaging your participants can be very effective where other strategies may have failed.

LEGO Serious Play

Improving core problem solving skills
Thinking outside of the box
Encouraging creative solutions

LEGO Serious Play is a problem solving methodology designed to get participants thinking differently by using 3D models and kinesthetic learning styles. By physically building LEGO models based on questions and exercises, participants are encouraged to think outside of the box and create their own responses.

Collaborate LEGO Serious Play exercises are also used to encourage communication and build problem solving skills in a group. By using this problem solving process, you can often help different kinds of learners and personality types contribute and unblock organizational problems with creative thinking.

Problem solving strategies like LEGO Serious Play are super effective at helping a team solve more skills-based problems such as communication between teams or a lack of creative thinking. Some problems are not suited to LEGO Serious Play and require a different problem solving strategy.

Card Decks and Method Kits

New facilitators or non-facilitators
Approaching difficult subjects with a simple, creative framework
Engaging those with varied learning styles

Card decks and method kids are great tools for those new to facilitation or for whom facilitation is not the primary role. Card decks such as the emotional culture deck can be used for complete workshops and in many cases, can be used right out of the box. Methodkit has a variety of kits designed for scenarios ranging from personal development through to personas and global challenges so you can find the right deck for your particular needs.

Having an easy to use framework that encourages creativity or a new approach can take some of the friction or planning difficulties out of the workshop process and energize a team in any setting. Simplicity is the key with these methods. By ensuring everyone on your team can get involved and engage with the process as quickly as possible can really contribute to the success of your problem solving strategy.

Source external advice

Looking to peers, experts and external facilitators can be a great way of approaching the problem solving process. Your team may not have the necessary expertise, insights of experience to tackle some issues, or you might simply benefit from a fresh perspective. Some problems may require bringing together an entire team, and coaching managers or team members individually might be the right approach. Remember that not all problems are best resolved in the same manner.

If you’re a solo entrepreneur, peer groups, coaches and mentors can also be invaluable at not only solving specific business problems, but in providing a support network for resolving future challenges. One great approach is to join a Mastermind Group and link up with like-minded individuals and all grow together. Remember that however you approach the sourcing of external advice, do so thoughtfully, respectfully and honestly. Reciprocate where you can and prepare to be surprised by just how kind and helpful your peers can be!

Mastermind Group

Solo entrepreneurs or small teams with low capacity
Peer learning and gaining outside expertise
Getting multiple external points of view quickly

Problem solving in large organizations with lots of skilled team members is one thing, but how about if you work for yourself or in a very small team without the capacity to get the most from a design sprint or LEGO Serious Play session?

A mastermind group – sometimes known as a peer advisory board – is where a group of people come together to support one another in their own goals, challenges, and businesses. Each participant comes to the group with their own purpose and the other members of the group will help them create solutions, brainstorm ideas, and support one another.

Mastermind groups are very effective in creating an energized, supportive atmosphere that can deliver meaningful results. Learning from peers from outside of your organization or industry can really help unlock new ways of thinking and drive growth. Access to the experience and skills of your peers can be invaluable in helping fill the gaps in your own ability, particularly in young companies.

A mastermind group is a great solution for solo entrepreneurs, small teams, or for organizations that feel that external expertise or fresh perspectives will be beneficial for them. It is worth noting that Mastermind groups are often only as good as the participants and what they can bring to the group. Participants need to be committed, engaged and understand how to work in this context.

Coaching and mentoring

Focused learning and development
Filling skills gaps
Working on a range of challenges over time

Receiving advice from a business coach or building a mentor/mentee relationship can be an effective way of resolving certain challenges. The one-to-one format of most coaching and mentor relationships can really help solve the challenges those individuals are having and benefit the organization as a result.

A great mentor can be invaluable when it comes to spotting potential problems before they arise and coming to understand a mentee very well has a host of other business benefits. You might run an internal mentorship program to help develop your team’s problem solving skills and strategies or as part of a large learning and development program. External coaches can also be an important part of your problem solving strategy, filling skills gaps for your management team or helping with specific business issues.

Now we’ve explored the problem solving process and the steps you will want to go through in order to have an effective session, let’s look at the skills you and your team need to be more effective problem solvers.

Problem solving skills are highly sought after, whatever industry or team you work in. Organizations are keen to employ people who are able to approach problems thoughtfully and find strong, realistic solutions. Whether you are a facilitator , a team leader or a developer, being an effective problem solver is a skill you’ll want to develop.

Problem solving skills form a whole suite of techniques and approaches that an individual uses to not only identify problems but to discuss them productively before then developing appropriate solutions.

Here are some of the most important problem solving skills everyone from executives to junior staff members should learn. We’ve also included an activity or exercise from the SessionLab library that can help you and your team develop that skill.

If you’re running a workshop or training session to try and improve problem solving skills in your team, try using these methods to supercharge your process!

Active listening

Active listening is one of the most important skills anyone who works with people can possess. In short, active listening is a technique used to not only better understand what is being said by an individual, but also to be more aware of the underlying message the speaker is trying to convey. When it comes to problem solving, active listening is integral for understanding the position of every participant and to clarify the challenges, ideas and solutions they bring to the table.

Some active listening skills include:

Paying complete attention to the speaker.
Removing distractions.
Avoid interruption.
Taking the time to fully understand before preparing a rebuttal.
Responding respectfully and appropriately.
Demonstrate attentiveness and positivity with an open posture, making eye contact with the speaker, smiling and nodding if appropriate. Show that you are listening and encourage them to continue.
Be aware of and respectful of feelings. Judge the situation and respond appropriately. You can disagree without being disrespectful.
Observe body language.
Paraphrase what was said in your own words, either mentally or verbally.
Remain neutral.
Reflect and take a moment before responding.
Ask deeper questions based on what is said and clarify points where necessary.

Active Listening #hyperisland #skills #active listening #remote-friendly This activity supports participants to reflect on a question and generate their own solutions using simple principles of active listening and peer coaching. It’s an excellent introduction to active listening but can also be used with groups that are already familiar with it. Participants work in groups of three and take turns being: “the subject”, the listener, and the observer.

Analytical skills

All problem solving models require strong analytical skills, particularly during the beginning of the process and when it comes to analyzing how solutions have performed.

Analytical skills are primarily focused on performing an effective analysis by collecting, studying and parsing data related to a problem or opportunity.

It often involves spotting patterns, being able to see things from different perspectives and using observable facts and data to make suggestions or produce insight.

Analytical skills are also important at every stage of the problem solving process and by having these skills, you can ensure that any ideas or solutions you create or backed up analytically and have been sufficiently thought out.

Nine Whys #innovation #issue analysis #liberating structures With breathtaking simplicity, you can rapidly clarify for individuals and a group what is essentially important in their work. You can quickly reveal when a compelling purpose is missing in a gathering and avoid moving forward without clarity. When a group discovers an unambiguous shared purpose, more freedom and more responsibility are unleashed. You have laid the foundation for spreading and scaling innovations with fidelity.

Collaboration

Trying to solve problems on your own is difficult. Being able to collaborate effectively, with a free exchange of ideas, to delegate and be a productive member of a team is hugely important to all problem solving strategies.

Remember that whatever your role, collaboration is integral, and in a problem solving process, you are all working together to find the best solution for everyone.

Marshmallow challenge with debriefing #teamwork #team #leadership #collaboration In eighteen minutes, teams must build the tallest free-standing structure out of 20 sticks of spaghetti, one yard of tape, one yard of string, and one marshmallow. The marshmallow needs to be on top. The Marshmallow Challenge was developed by Tom Wujec, who has done the activity with hundreds of groups around the world. Visit the Marshmallow Challenge website for more information. This version has an extra debriefing question added with sample questions focusing on roles within the team.

Communication

Being an effective communicator means being empathetic, clear and succinct, asking the right questions, and demonstrating active listening skills throughout any discussion or meeting.

In a problem solving setting, you need to communicate well in order to progress through each stage of the process effectively. As a team leader, it may also fall to you to facilitate communication between parties who may not see eye to eye. Effective communication also means helping others to express themselves and be heard in a group.

Bus Trip #feedback #communication #appreciation #closing #thiagi #team This is one of my favourite feedback games. I use Bus Trip at the end of a training session or a meeting, and I use it all the time. The game creates a massive amount of energy with lots of smiles, laughs, and sometimes even a teardrop or two.

Creative problem solving skills can be some of the best tools in your arsenal. Thinking creatively, being able to generate lots of ideas and come up with out of the box solutions is useful at every step of the process.

The kinds of problems you will likely discuss in a problem solving workshop are often difficult to solve, and by approaching things in a fresh, creative manner, you can often create more innovative solutions.

Having practical creative skills is also a boon when it comes to problem solving. If you can help create quality design sketches and prototypes in record time, it can help bring a team to alignment more quickly or provide a base for further iteration.

The paper clip method #sharing #creativity #warm up #idea generation #brainstorming The power of brainstorming. A training for project leaders, creativity training, and to catalyse getting new solutions.

Critical thinking

Critical thinking is one of the fundamental problem solving skills you’ll want to develop when working on developing solutions. Critical thinking is the ability to analyze, rationalize and evaluate while being aware of personal bias, outlying factors and remaining open-minded.

Defining and analyzing problems without deploying critical thinking skills can mean you and your team go down the wrong path. Developing solutions to complex issues requires critical thinking too – ensuring your team considers all possibilities and rationally evaluating them.

Agreement-Certainty Matrix #issue analysis #liberating structures #problem solving You can help individuals or groups avoid the frequent mistake of trying to solve a problem with methods that are not adapted to the nature of their challenge. The combination of two questions makes it possible to easily sort challenges into four categories: simple, complicated, complex , and chaotic . A problem is simple when it can be solved reliably with practices that are easy to duplicate. It is complicated when experts are required to devise a sophisticated solution that will yield the desired results predictably. A problem is complex when there are several valid ways to proceed but outcomes are not predictable in detail. Chaotic is when the context is too turbulent to identify a path forward. A loose analogy may be used to describe these differences: simple is like following a recipe, complicated like sending a rocket to the moon, complex like raising a child, and chaotic is like the game “Pin the Tail on the Donkey.” The Liberating Structures Matching Matrix in Chapter 5 can be used as the first step to clarify the nature of a challenge and avoid the mismatches between problems and solutions that are frequently at the root of chronic, recurring problems.

Data analysis

Though it shares lots of space with general analytical skills, data analysis skills are something you want to cultivate in their own right in order to be an effective problem solver.

Being good at data analysis doesn’t just mean being able to find insights from data, but also selecting the appropriate data for a given issue, interpreting it effectively and knowing how to model and present that data. Depending on the problem at hand, it might also include a working knowledge of specific data analysis tools and procedures.

Having a solid grasp of data analysis techniques is useful if you’re leading a problem solving workshop but if you’re not an expert, don’t worry. Bring people into the group who has this skill set and help your team be more effective as a result.

Decision making

All problems need a solution and all solutions require that someone make the decision to implement them. Without strong decision making skills, teams can become bogged down in discussion and less effective as a result.

Making decisions is a key part of the problem solving process. It’s important to remember that decision making is not restricted to the leadership team. Every staff member makes decisions every day and developing these skills ensures that your team is able to solve problems at any scale. Remember that making decisions does not mean leaping to the first solution but weighing up the options and coming to an informed, well thought out solution to any given problem that works for the whole team.

Lightning Decision Jam (LDJ) #action #decision making #problem solving #issue analysis #innovation #design #remote-friendly The problem with anything that requires creative thinking is that it’s easy to get lost—lose focus and fall into the trap of having useless, open-ended, unstructured discussions. Here’s the most effective solution I’ve found: Replace all open, unstructured discussion with a clear process. What to use this exercise for: Anything which requires a group of people to make decisions, solve problems or discuss challenges. It’s always good to frame an LDJ session with a broad topic, here are some examples: The conversion flow of our checkout Our internal design process How we organise events Keeping up with our competition Improving sales flow

Dependability

Most complex organizational problems require multiple people to be involved in delivering the solution. Ensuring that the team and organization can depend on you to take the necessary actions and communicate where necessary is key to ensuring problems are solved effectively.

Being dependable also means working to deadlines and to brief. It is often a matter of creating trust in a team so that everyone can depend on one another to complete the agreed actions in the agreed time frame so that the team can move forward together. Being undependable can create problems of friction and can limit the effectiveness of your solutions so be sure to bear this in mind throughout a project.

Team Purpose & Culture #team #hyperisland #culture #remote-friendly This is an essential process designed to help teams define their purpose (why they exist) and their culture (how they work together to achieve that purpose). Defining these two things will help any team to be more focused and aligned. With support of tangible examples from other companies, the team members work as individuals and a group to codify the way they work together. The goal is a visual manifestation of both the purpose and culture that can be put up in the team’s work space.

Emotional intelligence

Emotional intelligence is an important skill for any successful team member, whether communicating internally or with clients or users. In the problem solving process, emotional intelligence means being attuned to how people are feeling and thinking, communicating effectively and being self-aware of what you bring to a room.

There are often differences of opinion when working through problem solving processes, and it can be easy to let things become impassioned or combative. Developing your emotional intelligence means being empathetic to your colleagues and managing your own emotions throughout the problem and solution process. Be kind, be thoughtful and put your points across care and attention.

Being emotionally intelligent is a skill for life and by deploying it at work, you can not only work efficiently but empathetically. Check out the emotional culture workshop template for more!

Facilitation

As we’ve clarified in our facilitation skills post, facilitation is the art of leading people through processes towards agreed-upon objectives in a manner that encourages participation, ownership, and creativity by all those involved. While facilitation is a set of interrelated skills in itself, the broad definition of facilitation can be invaluable when it comes to problem solving. Leading a team through a problem solving process is made more effective if you improve and utilize facilitation skills – whether you’re a manager, team leader or external stakeholder.

The Six Thinking Hats #creative thinking #meeting facilitation #problem solving #issue resolution #idea generation #conflict resolution The Six Thinking Hats are used by individuals and groups to separate out conflicting styles of thinking. They enable and encourage a group of people to think constructively together in exploring and implementing change, rather than using argument to fight over who is right and who is wrong.

Flexibility

Being flexible is a vital skill when it comes to problem solving. This does not mean immediately bowing to pressure or changing your opinion quickly: instead, being flexible is all about seeing things from new perspectives, receiving new information and factoring it into your thought process.

Flexibility is also important when it comes to rolling out solutions. It might be that other organizational projects have greater priority or require the same resources as your chosen solution. Being flexible means understanding needs and challenges across the team and being open to shifting or arranging your own schedule as necessary. Again, this does not mean immediately making way for other projects. It’s about articulating your own needs, understanding the needs of others and being able to come to a meaningful compromise.

The Creativity Dice #creativity #problem solving #thiagi #issue analysis Too much linear thinking is hazardous to creative problem solving. To be creative, you should approach the problem (or the opportunity) from different points of view. You should leave a thought hanging in mid-air and move to another. This skipping around prevents premature closure and lets your brain incubate one line of thought while you consciously pursue another.

Working in any group can lead to unconscious elements of groupthink or situations in which you may not wish to be entirely honest. Disagreeing with the opinions of the executive team or wishing to save the feelings of a coworker can be tricky to navigate, but being honest is absolutely vital when to comes to developing effective solutions and ensuring your voice is heard.

Remember that being honest does not mean being brutally candid. You can deliver your honest feedback and opinions thoughtfully and without creating friction by using other skills such as emotional intelligence.

Explore your Values #hyperisland #skills #values #remote-friendly Your Values is an exercise for participants to explore what their most important values are. It’s done in an intuitive and rapid way to encourage participants to follow their intuitive feeling rather than over-thinking and finding the “correct” values. It is a good exercise to use to initiate reflection and dialogue around personal values.

Initiative

The problem solving process is multi-faceted and requires different approaches at certain points of the process. Taking initiative to bring problems to the attention of the team, collect data or lead the solution creating process is always valuable. You might even roadtest your own small scale solutions or brainstorm before a session. Taking initiative is particularly effective if you have good deal of knowledge in that area or have ownership of a particular project and want to get things kickstarted.

That said, be sure to remember to honor the process and work in service of the team. If you are asked to own one part of the problem solving process and you don’t complete that task because your initiative leads you to work on something else, that’s not an effective method of solving business challenges.

15% Solutions #action #liberating structures #remote-friendly You can reveal the actions, however small, that everyone can do immediately. At a minimum, these will create momentum, and that may make a BIG difference. 15% Solutions show that there is no reason to wait around, feel powerless, or fearful. They help people pick it up a level. They get individuals and the group to focus on what is within their discretion instead of what they cannot change. With a very simple question, you can flip the conversation to what can be done and find solutions to big problems that are often distributed widely in places not known in advance. Shifting a few grains of sand may trigger a landslide and change the whole landscape.

Impartiality

A particularly useful problem solving skill for product owners or managers is the ability to remain impartial throughout much of the process. In practice, this means treating all points of view and ideas brought forward in a meeting equally and ensuring that your own areas of interest or ownership are not favored over others.

There may be a stage in the process where a decision maker has to weigh the cost and ROI of possible solutions against the company roadmap though even then, ensuring that the decision made is based on merit and not personal opinion.

Empathy map #frame insights #create #design #issue analysis An empathy map is a tool to help a design team to empathize with the people they are designing for. You can make an empathy map for a group of people or for a persona. To be used after doing personas when more insights are needed.

Being a good leader means getting a team aligned, energized and focused around a common goal. In the problem solving process, strong leadership helps ensure that the process is efficient, that any conflicts are resolved and that a team is managed in the direction of success.

It’s common for managers or executives to assume this role in a problem solving workshop, though it’s important that the leader maintains impartiality and does not bulldoze the group in a particular direction. Remember that good leadership means working in service of the purpose and team and ensuring the workshop is a safe space for employees of any level to contribute. Take a look at our leadership games and activities post for more exercises and methods to help improve leadership in your organization.

Leadership Pizza #leadership #team #remote-friendly This leadership development activity offers a self-assessment framework for people to first identify what skills, attributes and attitudes they find important for effective leadership, and then assess their own development and initiate goal setting.

In the context of problem solving, mediation is important in keeping a team engaged, happy and free of conflict. When leading or facilitating a problem solving workshop, you are likely to run into differences of opinion. Depending on the nature of the problem, certain issues may be brought up that are emotive in nature.

Being an effective mediator means helping those people on either side of such a divide are heard, listen to one another and encouraged to find common ground and a resolution. Mediating skills are useful for leaders and managers in many situations and the problem solving process is no different.

Conflict Responses #hyperisland #team #issue resolution A workshop for a team to reflect on past conflicts, and use them to generate guidelines for effective conflict handling. The workshop uses the Thomas-Killman model of conflict responses to frame a reflective discussion. Use it to open up a discussion around conflict with a team.

Planning

Solving organizational problems is much more effective when following a process or problem solving model. Planning skills are vital in order to structure, deliver and follow-through on a problem solving workshop and ensure your solutions are intelligently deployed.

Planning skills include the ability to organize tasks and a team, plan and design the process and take into account any potential challenges. Taking the time to plan carefully can save time and frustration later in the process and is valuable for ensuring a team is positioned for success.

3 Action Steps #hyperisland #action #remote-friendly This is a small-scale strategic planning session that helps groups and individuals to take action toward a desired change. It is often used at the end of a workshop or programme. The group discusses and agrees on a vision, then creates some action steps that will lead them towards that vision. The scope of the challenge is also defined, through discussion of the helpful and harmful factors influencing the group.

Prioritization

As organisations grow, the scale and variation of problems they face multiplies. Your team or is likely to face numerous challenges in different areas and so having the skills to analyze and prioritize becomes very important, particularly for those in leadership roles.

A thorough problem solving process is likely to deliver multiple solutions and you may have several different problems you wish to solve simultaneously. Prioritization is the ability to measure the importance, value, and effectiveness of those possible solutions and choose which to enact and in what order. The process of prioritization is integral in ensuring the biggest challenges are addressed with the most impactful solutions.

Impact and Effort Matrix #gamestorming #decision making #action #remote-friendly In this decision-making exercise, possible actions are mapped based on two factors: effort required to implement and potential impact. Categorizing ideas along these lines is a useful technique in decision making, as it obliges contributors to balance and evaluate suggested actions before committing to them.

Project management

Some problem solving skills are utilized in a workshop or ideation phases, while others come in useful when it comes to decision making. Overseeing an entire problem solving process and ensuring its success requires strong project management skills.

While project management incorporates many of the other skills listed here, it is important to note the distinction of considering all of the factors of a project and managing them successfully. Being able to negotiate with stakeholders, manage tasks, time and people, consider costs and ROI, and tie everything together is massively helpful when going through the problem solving process.

Record keeping

Working out meaningful solutions to organizational challenges is only one part of the process. Thoughtfully documenting and keeping records of each problem solving step for future consultation is important in ensuring efficiency and meaningful change.

For example, some problems may be lower priority than others but can be revisited in the future. If the team has ideated on solutions and found some are not up to the task, record those so you can rule them out and avoiding repeating work. Keeping records of the process also helps you improve and refine your problem solving model next time around!

Personal Kanban #gamestorming #action #agile #project planning Personal Kanban is a tool for organizing your work to be more efficient and productive. It is based on agile methods and principles.

Research skills

Conducting research to support both the identification of problems and the development of appropriate solutions is important for an effective process. Knowing where to go to collect research, how to conduct research efficiently, and identifying pieces of research are relevant are all things a good researcher can do well.

In larger groups, not everyone has to demonstrate this ability in order for a problem solving workshop to be effective. That said, having people with research skills involved in the process, particularly if they have existing area knowledge, can help ensure the solutions that are developed with data that supports their intention. Remember that being able to deliver the results of research efficiently and in a way the team can easily understand is also important. The best data in the world is only as effective as how it is delivered and interpreted.

Customer experience map #ideation #concepts #research #design #issue analysis #remote-friendly Customer experience mapping is a method of documenting and visualizing the experience a customer has as they use the product or service. It also maps out their responses to their experiences. To be used when there is a solution (even in a conceptual stage) that can be analyzed.

Risk management

Managing risk is an often overlooked part of the problem solving process. Solutions are often developed with the intention of reducing exposure to risk or solving issues that create risk but sometimes, great solutions are more experimental in nature and as such, deploying them needs to be carefully considered.

Managing risk means acknowledging that there may be risks associated with more out of the box solutions or trying new things, but that this must be measured against the possible benefits and other organizational factors.

Be informed, get the right data and stakeholders in the room and you can appropriately factor risk into your decision making process.

Decisions, Decisions… #communication #decision making #thiagi #action #issue analysis When it comes to decision-making, why are some of us more prone to take risks while others are risk-averse? One explanation might be the way the decision and options were presented. This exercise, based on Kahneman and Tversky’s classic study , illustrates how the framing effect influences our judgement and our ability to make decisions . The participants are divided into two groups. Both groups are presented with the same problem and two alternative programs for solving them. The two programs both have the same consequences but are presented differently. The debriefing discussion examines how the framing of the program impacted the participant’s decision.

Team-building

No single person is as good at problem solving as a team. Building an effective team and helping them come together around a common purpose is one of the most important problem solving skills, doubly so for leaders. By bringing a team together and helping them work efficiently, you pave the way for team ownership of a problem and the development of effective solutions.

In a problem solving workshop, it can be tempting to jump right into the deep end, though taking the time to break the ice, energize the team and align them with a game or exercise will pay off over the course of the day.

Remember that you will likely go through the problem solving process multiple times over an organization’s lifespan and building a strong team culture will make future problem solving more effective. It’s also great to work with people you know, trust and have fun with. Working on team building in and out of the problem solving process is a hallmark of successful teams that can work together to solve business problems.

9 Dimensions Team Building Activity #ice breaker #teambuilding #team #remote-friendly 9 Dimensions is a powerful activity designed to build relationships and trust among team members. There are 2 variations of this icebreaker. The first version is for teams who want to get to know each other better. The second version is for teams who want to explore how they are working together as a team.

Time management

The problem solving process is designed to lead a team from identifying a problem through to delivering a solution and evaluating its effectiveness. Without effective time management skills or timeboxing of tasks, it can be easy for a team to get bogged down or be inefficient.

By using a problem solving model and carefully designing your workshop, you can allocate time efficiently and trust that the process will deliver the results you need in a good timeframe.

Time management also comes into play when it comes to rolling out solutions, particularly those that are experimental in nature. Having a clear timeframe for implementing and evaluating solutions is vital for ensuring their success and being able to pivot if necessary.

Improving your skills at problem solving is often a career-long pursuit though there are methods you can use to make the learning process more efficient and to supercharge your problem solving skillset.

Remember that the skills you need to be a great problem solver have a large overlap with those skills you need to be effective in any role. Investing time and effort to develop your active listening or critical thinking skills is valuable in any context. Here are 7 ways to improve your problem solving skills.

Share best practices

Remember that your team is an excellent source of skills, wisdom, and techniques and that you should all take advantage of one another where possible. Best practices that one team has for solving problems, conducting research or making decisions should be shared across the organization. If you have in-house staff that have done active listening training or are data analysis pros, have them lead a training session.

Your team is one of your best resources. Create space and internal processes for the sharing of skills so that you can all grow together.

Ask for help and attend training

Once you’ve figured out you have a skills gap, the next step is to take action to fill that skills gap. That might be by asking your superior for training or coaching, or liaising with team members with that skill set. You might even attend specialized training for certain skills – active listening or critical thinking, for example, are business-critical skills that are regularly offered as part of a training scheme.

Whatever method you choose, remember that taking action of some description is necessary for growth. Whether that means practicing, getting help, attending training or doing some background reading, taking active steps to improve your skills is the way to go.

Learn a process

Problem solving can be complicated, particularly when attempting to solve large problems for the first time. Using a problem solving process helps give structure to your problem solving efforts and focus on creating outcomes, rather than worrying about the format.

Tools such as the seven-step problem solving process above are effective because not only do they feature steps that will help a team solve problems, they also develop skills along the way. Each step asks for people to engage with the process using different skills and in doing so, helps the team learn and grow together. Group processes of varying complexity and purpose can also be found in the SessionLab library of facilitation techniques . Using a tried and tested process and really help ease the learning curve for both those leading such a process, as well as those undergoing the purpose.

Effective teams make decisions about where they should and shouldn’t expend additional effort. By using a problem solving process, you can focus on the things that matter, rather than stumbling towards a solution haphazardly.

Create a feedback loop

Some skills gaps are more obvious than others. It’s possible that your perception of your active listening skills differs from those of your colleagues.

It’s valuable to create a system where team members can provide feedback in an ordered and friendly manner so they can all learn from one another. Only by identifying areas of improvement can you then work to improve them.

Remember that feedback systems require oversight and consideration so that they don’t turn into a place to complain about colleagues. Design the system intelligently so that you encourage the creation of learning opportunities, rather than encouraging people to list their pet peeves.

While practice might not make perfect, it does make the problem solving process easier. If you are having trouble with critical thinking, don’t shy away from doing it. Get involved where you can and stretch those muscles as regularly as possible.

Problem solving skills come more naturally to some than to others and that’s okay. Take opportunities to get involved and see where you can practice your skills in situations outside of a workshop context. Try collaborating in other circumstances at work or conduct data analysis on your own projects. You can often develop those skills you need for problem solving simply by doing them. Get involved!

Use expert exercises and methods

Learn from the best. Our library of 700+ facilitation techniques is full of activities and methods that help develop the skills you need to be an effective problem solver. Check out our templates to see how to approach problem solving and other organizational challenges in a structured and intelligent manner.

There is no single approach to improving problem solving skills, but by using the techniques employed by others you can learn from their example and develop processes that have seen proven results.

Try new ways of thinking and change your mindset

Using tried and tested exercises that you know well can help deliver results, but you do run the risk of missing out on the learning opportunities offered by new approaches. As with the problem solving process, changing your mindset can remove blockages and be used to develop your problem solving skills.

Most teams have members with mixed skill sets and specialties. Mix people from different teams and share skills and different points of view. Teach your customer support team how to use design thinking methods or help your developers with conflict resolution techniques. Try switching perspectives with facilitation techniques like Flip It! or by using new problem solving methodologies or models. Give design thinking, liberating structures or lego serious play a try if you want to try a new approach. You will find that framing problems in new ways and using existing skills in new contexts can be hugely useful for personal development and improving your skillset. It’s also a lot of fun to try new things. Give it a go!

Encountering business challenges and needing to find appropriate solutions is not unique to your organization. Lots of very smart people have developed methods, theories and approaches to help develop problem solving skills and create effective solutions. Learn from them!

Books like The Art of Thinking Clearly , Think Smarter, or Thinking Fast, Thinking Slow are great places to start, though it’s also worth looking at blogs related to organizations facing similar problems to yours, or browsing for success stories. Seeing how Dropbox massively increased growth and working backward can help you see the skills or approach you might be lacking to solve that same problem. Learning from others by reading their stories or approaches can be time-consuming but ultimately rewarding.

A tired, distracted mind is not in the best position to learn new skills. It can be tempted to burn the candle at both ends and develop problem solving skills outside of work. Absolutely use your time effectively and take opportunities for self-improvement, though remember that rest is hugely important and that without letting your brain rest, you cannot be at your most effective.

Creating distance between yourself and the problem you might be facing can also be useful. By letting an idea sit, you can find that a better one presents itself or you can develop it further. Take regular breaks when working and create a space for downtime. Remember that working smarter is preferable to working harder and that self-care is important for any effective learning or improvement process.

Want to design better group processes?

Over to you

Now we’ve explored some of the key problem solving skills and the problem solving steps necessary for an effective process, you’re ready to begin developing more effective solutions and leading problem solving workshops.

Need more inspiration? Check out our post on problem solving activities you can use when guiding a group towards a great solution in your next workshop or meeting. Have questions? Did you have a great problem solving technique you use with your team? Get in touch in the comments below. We’d love to chat!

James Smart is Head of Content at SessionLab. He’s also a creative facilitator who has run workshops and designed courses for establishments like the National Centre for Writing, UK. He especially enjoys working with young people and empowering others in their creative practice.

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IMAGES

Overview of the problem solving intervention
Problem-Solving Steps
Problem-Solving Therapy: Definition, Techniques, and Efficacy
Problem Solving Intervention by Sarah's Special Scaffolds
Theory: Practical Problem-Solving Approach
Problem Solving Practice Adhd

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Shocking Incident: Routine Stop Turns Deadly! #trading #financialmarket #tradingtrends
Why was the math teacher always late? #comedy #shorts
Méthodologie d'intervention collective de problem solving
Family Game Night: Overcoming Conspiracy Theories

COMMENTS

10 Best Problem-Solving Therapy Worksheets & Activities
"Problem-solving therapy (PST) is a psychosocial intervention, generally considered to be under a cognitive-behavioral umbrella" (Nezu, Nezu, & D'Zurilla, 2013, p. ix). It aims to encourage the client to cope better with day-to-day problems and traumatic events and reduce their impact on mental and physical wellbeing.
Problem-Solving Therapy: Definition, Techniques, and Efficacy
Problem-solving therapy is a brief intervention that provides people with the tools they need to identify and solve problems that arise from big and small life stressors. It aims to improve your overall quality of life and reduce the negative impact of psychological and physical illness. Problem-solving therapy can be used to treat depression ...
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.
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 ...
Problem-solving interventions and depression among adolescents and
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 ...
Problem-solving interventions and depression among adolescents and
Of these 10 interventions: three were adaptations of models proposed by D'Zurilla and Nezu [20, 34] and D'Zurilla and Goldfried , two were based on Mynors-Wallis's Problem-Solving Therapy (PST) guide, one was a problem-orientation video intervention adapted from D'Zurilla and Nezu , one was an online intervention adapted from Method of ...
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).
Problem-Solving Therapy
Problem-solving therapy is a cognitive-behavioral intervention geared to improve an individual's ability to cope with stressful life experiences. The underlying assumption of this approach is that symptoms of psychopathology can often be understood as the negative consequences of ineffective or maladaptive coping.
PDF Session 2 Problem-Solving Therapy
Problem-Solving Therapy (PST) is an evidenced-based intervention to facilitate behavioral changes through a variety of skill training. PST identifies strategies to support people to cope with difficulties in life and take the initiative to solve everyday problems. Using cognitive behavioral theories, effective and successful problem solving
Problem-solving training as an active ingredient of treatment for youth
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 ...
Problem-Solving Strategies: Definition and 5 Techniques to Try
In general, effective problem-solving strategies include the following steps: Define the problem. Come up with alternative solutions. Decide on a solution. Implement the solution. Problem-solving ...
Cognitive Behavioral Therapy Exercises: CBT Interventions
CBT interventions provide a simple way of understanding challenging situations and problematic reactions to them. Cognitive behavioral therapy emphasizes three main components implicated in psychological problems: thoughts, emotions, and behaviors. ... Problem Solving: Problem Solving is a cognitive behavioral therapy exercise to help people ...
Problem Solving
Problem Solving is a helpful intervention whenever clients present with difficulties, dilemmas, and conundrums, or when they experience repetitive thought such as rumination or worry. Effective problem solving is an essential life skill and this Problem Solving worksheet is designed to guide adults through steps which will help them to generate ...
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 process.
The Effectiveness of Problem-Solving Therapy for Primary Care Patients
PST. Holding that difficulties with problem solving make people more susceptible to depression, PST is a nonpharmacological, competence-based intervention that involves a step-by-step approach to constructive problem solving. 19,20 Developed from cognitive-behavioral-therapy, PST is a short-term psychotherapy approach delivered individually or in group settings.
Problem-Solving and Coping Skills Training for Youth with Deliberate
In other to understand better this intervention under review, a brief dive into some theories is worth noting. One of such is social problem-solving theory as espoused by D'Zurilla and Nezu. 26 This theory is pivotal to the framework of problem-solving interventions. It posits that that individuals' ability to effectively solve problems is ...
22 Best Counseling Interventions & Strategies for Therapists
Interventions are a vital aspect of marriage therapy, often targeting communication skills, problem-solving, and taking responsibility (Williams, 2012). They can include the following interventions: Taking responsibility It is vital that clients take responsibility for their actions within a relationship.
Problem-Solving Strategies and Obstacles
Several mental processes are at work during problem-solving. Among them are: Perceptually recognizing the problem. Representing the problem in memory. Considering relevant information that applies to the problem. Identifying different aspects of the problem. Labeling and describing the problem.
Problem-Solving Process Interventions
A student who has difficulty understanding the problem, planning and executing a solution, self-monitoring progress toward a goal, and evaluating a solution will benefit from intervention around the problem-solving process.The following interventions support students in internalizing this process from start to finish. This page includes intervention strategies that you can use to support your ...
Teaching Problem Solving
Make students articulate their problem solving process. In a one-on-one tutoring session, ask the student to work his/her problem out loud. This slows down the thinking process, making it more accurate and allowing you to access understanding. When working with larger groups you can ask students to provide a written "two-column solution.".
How to improve your problem solving skills and strategies
Planning skills are vital in order to structure, deliver and follow-through on a problem solving workshop and ensure your solutions are intelligently deployed. Planning skills include the ability to organize tasks and a team, plan and design the process and take into account any potential challenges.
Empowering single mothers in Iran: Applying a problem-solving model in
Since 2000, a problem-solving model has been taught to the Society for Protecting the Rights of the Child, and teachers and students of social work in two universities in Iran. Since 2006, with the initiation of UNICEF, social workers, psychologists and even some psychiatrists in Iran have been learning this model. In 2008, a group of researchers created an empowerment-oriented psycho-social ...
6 Creative Problem-Solving Examples for Students
Below are some practical activities to implement that can foster creative problem-solving skills in students. Why Early Development of Creative Problem-Solving Skills Matters. Instilling creative problem-solving skills from a young age can have lasting benefits that extend well beyond the classroom. Here are some of the key advantages: 1.
Coping without Rodri will be the ultimate test of Pep Guardiola's
Keep throwing problems at Guardiola and he keeps solving them, which might explain why those above him felt comfortable going into another season without a like-for-like Rodri replacement.