Problem Solving Flashcards
Problem solving in depression:
Depression: The symptoms hinder an active approach in dealing with difficulties
- > problems accumulate
- > they feel overwhelmed and less able to manage
A deficit in problem solving skills is not needed!
Problem solving Generalized Anxiety disorder:
Avoidance of problems, but worry to anticipate all possible negative outcomes associated with uncertainty
- > chain of worries unrelated to the problem but catastrophic in nature
- > higher anxiety and less ability to tackle problems
A deficit in problem solving skills is not needed!
What is problem solving therapy?
- Brief structured psychological intervention to teach clients problem solving skills
- Based on principles of cognitive behavioural therapy (3rd generation) with a clear focus on the here and now
. • Requires an active role of the client in planning of the treatment and implementation of activities.
Theoretical framework for Problem Solving Therapy:
Stress-vulnerability:
Stress-vulnerability:
Theoretical models assume that biological, psychological, and/or social factors make people vulnerable for the development of psychological disorders like generalised anxiety and depression
In addition there are protective factors that make you less likely to develop psychological disorders such as good interpersonal relations, social support, self-esteem, locus of control, self-efficacy, and a good health. (Problem solving is about the locus of control)
Theoretical framework for Problem Solving Therapy:
Problem solving and feelings of control:
Problem solving and feelings of control
Psychological disorders, like generalised anxiety and depression, are caused by problems that people experience in their daily life.
When people learn in a structured way and step-by-step (1) to deal with their problems and (2) relate to them to what they find important in their life the internal locus of control will increase.
This protects against the development of generalised anxiety and depression and decreases symptoms in people with generalized anxiety and depression.
Aims of problem-solving treatment (a-d)
(a) The client gains insight in the relation between symptoms and problems
(b) The client defines current problems that they experience
(c) The client learns problem-solving skills to solve problems in a structured way.
(d) The client will have a positive experience re problem solving
What makes the intervention attractive?
- Generic and applicable to a lot of disorders (transdiagnostic)
- The intervention has a clear structure
- Clients often recognise the relation between problems and the development of symptoms
- De therapy is not psychologizing
These characteristics make the treatment applicable to a broad population including people with low socio-economic status
Different approaches (1) SPST
Social problem solving therapy (SPST; D’Zurilla & Nezu, 1982)
- 10-12 sessions
- Format: group
Next to learning problem solving skills attention to attitudes and beliefs that may interfere with problem solving tasks.
Different approaches (2) PST-PC
Problem solving therapy for primary care (PST-PC; Mynors-Wallis, 1995)
- 6-9 sessions
- Format: individual (nurses)
Aimed at the key elements of problem-solving
Different approaches (3) SET
Self-examination therapie (SET; Bowman, 1995)
- 4-6 sessions
- Format: Guided self-help (can be individually or in groups)
Next to problem solving skills also focused on the goals in life
PST: Six steps (Mynors-Wallis) long
(1) Orientation about the approach: rationale of PST
(2) Identify problem (Identify immediate and real problems and start with easier problems
- Losing my job
- Gettng into debts
- Health of parents and children
- Boiler broken down
- People at work don’t like me)
(3) Generate as many solutions as possible (Boiler broken down
- Get in contact with plumber
- Ignore the problem
- Try to fix it myself
- Move house)
(4) Choose a solution
(5) Make a plan to implement the solution (Set manageable goals: when will you do what
Contact a plumber:
- Get recommendations from friends
- Ring recommended plumbers
- Get quotations (a new problem may arise when quotations are extremely high and a new boiler is needed, how to pay for the boiler)
(6) Review the outcome, if unsuccessful go back to step 3
PST: Six steps (Mynors-Wallis) short
Challenges in treatment
- Convince clients that talking about the past is not necessary
- Motivate clients to make an action plan
- Clients deny that they have a problem
- Clients do not take responsibility for problem-solving (but want others to solve the problem)
Good explanation about the treatment and its rationale is very important!
Effectiveness of PST
- Firm evidence for depression
- PST is included in the guidelines for the treatment of mild to moderate depression (i.e. NICE: NHG)
- Evidence for anxiety, emotional disorders, physical health problems and self-mutilation
- Effects are relatively small (but comparable to other treatments)
Results for depression Meta-analysis
(Cuijpers et al., 2018 European Psychiatry, 22, 9-15)
- Average effect size g=0.79: but g=0.34 in studies of high quality (moderate effect)
- A lot of heterogeneity between studies
- Larger effects in studies from :
- the general population,
- group sessions,
- North America,
- waiting list control groups, \
- studies with a large risk of bias
- Target group or type of PST was no predictor (although SPST did slightly better)
- PST was slightly more effective than IPT and CBT
Lesson 2: 6-Steps plan (‘Alles onder controle’ (SET))
Step 1: Define the problem
Step 2: Think of as many solutions as possible
Step 3: Choose a solution
Step 4: Make a plan
Step 5: Implement the plan
Step 6: Review the outcome
main treatment options
PST: Six steps (Mynors-Wallis)
step four:
Smart Oncology: Collaborative care
