Problem-Solving Training

Problem solving is a skill that has been implemented for a wide array of difficulties, including anxiety, depression, couples conflict, and stress management. In general, clients are taught a set of skills for approaching problems of everyday living. Steps involved in problem solving include problem definition and formulation, generation of alternatives, decision making, and verification.

D’Zurilla and Nezu (1999) identified two main targets of treatment: the orientation toward problem solving and the style of problem solving. The goals of problem-solving training are to increase positive and decrease negative problem-solving orientation and to foster a rational problem-solving style that minimizes maladaptive styles of being impulsive or careless or avoiding problems. Thus, training begins with steps of problem-solving orientation to develop positive self-efficacy beliefs, such as by reverse-advocacy role play that encourages clients to recognize their overly negative beliefs through contrast and by visualization of successfully resolving a problem and being reinforced as a result. The orientation phase also includes recognition that problems are a normal part of human existence and ways of identifying problems as they occur, such as by using negative emotions as a cue for recognizing that a problem exists and to observe what is occurring in the environment that is causing the emotions.

For the style of problem solving phase, clients are first trained in problem definition. This involves gathering information about the problem, objectively and concisely defining the problem, separating facts from assumptions, identifying the features that make the situation problematic, and setting realistic goals (Nezu, Nezu, & Lombardo, 2003). Next, alternatives are developed by generating as many solutions as possible, deferring judgment until a full list is generated, and then developing a list of action plans for the enactment of each solution. In the decision-making phase, a cost benefit analysis is conducted of each solution to identify the ones that are most likely to be successful and to be implemented. Effective solutions, or solutions that are likely to be successful and lead to the most positive and least negative consequences, are then selected. The final step is implementing the action plan associated with the most effective solution, and evaluating the success of its implementation along with troubleshooting and modification where necessary.

Problem solving is essentially a skill-building intervention. The mechanisms underlying problem solving include reinforcement from skills acquisition and from the success with which the problem solving resolves pending problems. In addition, by facing problematic situations rather than avoiding them, a type of exposure is being conducted that may lead to extinction of CRs. Furthermore, changes in cognitive appraisals and assumptions are involved in the problem orientation phase of the procedure. Also, successful implementation of problem solving may raise self-efficacy and provide evidence that disconfirms negative beliefs about the self and the world.

As an example, John, a writer, was suffering from depression. One of the problem behaviors connected with his depression, both as a cause and consequence, was incompletion of writing projects. He had almost a dozen half-written short stories and scripts and had not completed a writing project for several years. This in turn was causing financial problems, as writing was his primary source of income. Treatment began by specifying the problem as incompletion of writing projects, with a clear description of the factors that appeared to contribute to incompletion, such as poor time management. A realistic goal was set of completing the project that was the closest to being finished within 4 weeks. Next, John began brainstorming solutions, including finding a writing buddy; scheduling his time more effectively; providing reinforcements for each interval in which writing was accomplished; removing all other writing projects from his desk to increase focus upon the selected project; paying someone to help him write; taking a 4-week retreat to a place where he would be less distracted; and asking his family to leave for 4 weeks so he would be less distracted. The steps involved in each potential solution were also generated. For example, to schedule his time more effectively, John needed to prioritize his writing within the context of his other daily responsibilities as a father and husband, schedule several blocks of time per day for writing only, and learn how to communicate the importance of this schedule to his family. He then considered which solutions were most feasible and most likely to succeed. He selected scheduling his time more effectively and providing reinforcement (a phone call to a friend, or reading, among other reinforcers), for each time he wrote for the scheduled period of time. This plan was put into practice. After the first week, John realized that he had scheduled too many short blocks of time during the day and revised his plan to two 2-hour blocks of time. With that revision, John was able to complete his project in a timely manner.

Problem-solving training has been used widely across psychological disorders as well as for individuals with medical disorders, marital and family problems, and general stress management. Problem-solving training also has been found to be effective in primary care settings for the management of depression and is often incorporated with other cognitive and behavioral strategies such as when treating substance use disorders. There appear to be few contraindications to this approach, although it would not be the preferred approach when the evidence indicates that other approaches are more effective for specific disorders, as in the case of some anxiety disorders where repeated exposure to phobic stimuli is especially effective.