Problem solving

Question 1

In what circumstances might it be appropriate to use problem solving?

Answer 1

1. The symptoms appear to be either caused by, or partly attributable to, a problem.
2. The patient feels that if a specific problem or set of problems is addressed, their symptoms will improve.

Question 2

Which resource should we consider using if we want to establish whether symptoms are being maintained by a specific problem?

Answer 2

Use the five areas to try and establish whether symptoms are being maintained by a problem.

Question 3

Explain the rationale for problem solving.

Answer 3

• If symptoms are being maintained by everyday problems, then addressing the problems may alleviate the symptoms.
• This is especially relevant in cases of depression, as depression is associated with a diminished ability to problem-solve (Kennerley & Kirk, 2011).
• Therefore if we can assist a patient with problem solving we might be able to improve their depressive symptoms.

Question 4

Who argued that problem-solving ability is diminished in cases of depression?

Answer 4

Kennerley and Kirk (2011) argue that problem solving ability is diminished in cases of depression.

Question 5

List the 7 steps to problem-solving according to Richards and Whyte (2011).

Answer 5

1. Problem identification: Patient writes down the problem they wish to solve.
2. Solution identification: Identify all possible solutions, no matter how silly they may seem.
3. Strengths and weaknesses analysis: What are the strengths and weaknesses of each solution?
4. Solution selection: ‘which solution do you think would take you nearest to your goal?’
5. Planning of solution implementation (use COM-B): ‘When do you want to do this by?’ ‘What steps will you take to achieve this?’
6. Implementation
7. Review: ‘How did it go?’ ‘What have you learned?’
   (Richards & Whyte, 2011).

Question 6

What could we do if a patient is having difficulty thinking of potential solutions?

Answer 6

If the patient is having difficulty thinking of possible solutions, change the person perspective (e.g. ‘what would you say to a friend in this position?) or change the time perspective (e.g. ‘what would you have done in similar situations in the past?’)
(Papworth et al, 2013).

Question 7

CHALLENGE 1: Client says other people are the problem.

How could we address this?

Answer 7

SOLUTION: Explain that changing one’s own responses may change that of others.

Question 8

CHALLENGE 2: Client says they have no problems.

How could we address this?

Answer 8

SOLUTION: Express disbelief. Give examples of possible problems.

Question 9

CHALLENGE 3: Client is having difficulties generating solutions.
How could we address this?

Answer 9

SOLUTION: Consider changes in time perspective and person perspective (Papworth et al, 2013).

Question 10

CHALLENGE 4: Client can’t pick which solution they think is best.
How could we address this?

Answer 10

SOLUTION: Encourage them to pick any one. If they feel disappointed with what they have chosen they will realise they did have a preference.

Question 11

CHALLENGE 5: Difficulties with implementation.

How could we address this?

Answer 11

SOLUTION: Work on assertion. Practice using role play.

Question 12

CHALLENGE 6: Implementation does not solve the problem.

How could we address this?

Answer 12

SOLUTION: Review the process as a learning curve that has led us one step closer to the solution. Repeat the cycle.

Question 13

PS is effective at treating depression, ESPECIALLY when hopelessness is a maintenance factor (_____ et al, 2000).

Answer 13

PS is effective at treating depression, ESPECIALLY hwn hopelessness is a maintenance factor (Mynor et al, 2000).

Question 14

Who conducted an RCT which compared the relative efficacy of BA vs. problem-solving, as treatments for major depression?

Answer 14

Hopko et al (2011) conducted an RCT which compared the relative efficacy of BA vs. PS, as treatments for major depression.

Question 15

Describe the sample in the RCT study by Hopko et al (2011)

Answer 15

1. Diagnosed with major depression.
2. Diagnosed with breast cancer.
3. n= 80.

Question 16

Describe the method in the RCT study by Hopko et al (2011).

Answer 16

1. Randomly assigned to problem-solving group (n= 40) vs. BA group (n= 40).
2. Eight sessions of relevant treatment.

Question 17

What were the areas examined by the outcome measures in the RCT by Hopko et al (2011)?

Answer 17

Depression, anxiety, quality of life, social support and medical outcomes.

Question 18

What were the 3 key findings of Hopko et al (2011)?

Answer 18

1. Statistically significant improvements were found between pre and post treatment on all outcome measures, across both groups.
2. In both groups, approximately 75% of patients demonstrated clinical improvement in terms of depression severity.
3. Gains maintained at 12 month follow up, however evidence to suggest gains were maintained the longest in the BA group relative to the PS group.

Question 19

What is the overall conclusion of the RCT by Hopko et al (2011)?

Answer 19

BA and PS have equal propensity for clinical change however gains from BA may be maintained more long-term than gains from PS.

Question 20

Provide 2 criticisms of the RCT by Hopko et al (2011).

Answer 20

Critique 1: Only depression was measured at follow up, not anxiety. Given the comorbidity between depression and anxiety it is possible anxiety returned. Especially problematic given the is minimal evidence to suggest that BA is an effective treatment for anxiety (e.g. Jackupcak et al, 2006).
Critique 2: No control group.

Question 21

What did Hoek et al (2012) do?

Answer 21

Compared internet based PS with a waiting list condition.

Question 22

Describe the sample in the study by Hoek et al (2012).

Answer 22

Adolescents with depression and anxiety (n= 45).

Question 23

What were the main findings of the study by Hoek et al (2012)?

Answer 23

1. Symptoms improved in both PS group and waiting list group.
2. No significant differences were found between groups.

Question 24

What can we conclude from the study by Hoek et al (2012)?

Answer 24

Internet-based PS provides no added value to being on a waiting list .
Critique: Maybe the findings was due to small sample size (n= 45).

Question 25

Who argued that PS is particularly useful for older adults?

Answer 25

Arean et al (1993) argued that PS is particularly useful for older adults.

Question 26

Who argued that PS is a good treatment for dysthymia?

Answer 26

Barrett et al (2001) argued that PS is a good treatment for dysthymia.

Question 27

PS is a recommended treatment for mild-moderate depression (NICE ____).

Answer 27

PS is a recommended treatment for mild-moderate depression.