What is problem solving therapy and when is it used? - Chapter 7

What is social problem-solving?

Social problem solving (SPS) is a multidimensional process in which individuals try to find an effective way to deal with a wide variety of stressful problems encountered in daily life. There can be different coping responses for different situations and times. According to SPS theory, the outcomes of SPS are determined by: problem orientation, and problem-solving style.

Problem orientation is a set of stable cognitive-affective schemas that include a person's assumptions, attitudes, and emotional responses to problems, and an individual's ability to cope with these problems successfully. There are two types of problem orientation and it is important to investigate what problem orientation someone has in therapy because it can greatly influence the motivation and ability to focus on problem-solving.

• A positive problem orientation: seeing problems as challenges, being optimistic in the belief that problems can be solved, having a great sense of self, wanting to invest time and effort in problem-solving and seeing negative emotions as part of the process.
• Negative problem orientation: seeing problems such as threat and insoluble, doubts about coping skills and frustration when faced with negative emotions or problems

Problem-solving styles are the cognitive-behavioral activities that people perform when they solve problems. There are three types.

• Rational problem-solving: constructive approach in which people systematically apply the following skills:
  • Problem definition: clarify problem, set goal, identify obstacles
  • Generation of alternatives: coming up with solutions for possible obstacles
  • Decision making: predicting the consequences of the alternatives, making a cost-benefit analysis, drawing up a solution plan.
  • Solution implementation and verification: implement and evaluate plan
• Impulsive or careless style: non-adaptive style characterized by impulsive, hasty and careless attempts to solve problems.
• Avoidant problem-solving: non-adaptive style characterized by procrastination, passivity, dependence on others to come up with solutions.

What is Problem-Solving Therapy?

The goal of problem-solving therapy is to promote the adoption and proper implementation of adaptive coping strategies and behaviors. It has also been used as a relapse prevention agent, to improve adherence, and to prevent future psychopathology in vulnerable individuals by reducing their susceptibility to stress. Problems encountered in therapy are:

• Limited ability to use effective emotional regulation.
• Bias cognitive processing.
• Limited motivation due to feelings of hopelessness.

To overcome these obstacles, PST has the following objectives:

• Improve positive problem orientation.
• Reduce negative problem orientation.
• Improve effectiveness of rational problem-solving.
• Minimize avoidant problem-solving.
• Minimize impulsive problem-solving.

PST uses four problem-solving toolkits to achieve these goals and exercises guided practice skills on real-life problems, as well as in anticipation of problems in the future. The four toolkits are as follows:

Problem-Solving Multitasking Toolbox: this box consists of helping to overcome problems while dealing with stressful situations (cognitive overload). Our brain is unable to process large amounts of information in our working memory while solving problems or making decisions. Individuals are taught to use three multitasking skills: externalization (displaying information externally, such as writing down ideas), visualization (guided visual imagery of the problem and possible solutions), and simplification (breaking down a big problem into manageable small parts).

Stop, slow down, think and act toolkit (SSTA): especially important if the goal is to reduce clinically significant emotional distress or to prevent emotional worries from becoming extremely important. The ability to modulate negative emotional arousal and adopt a more thoughtful way of problem-solving is central.

• First, people learn to be more mindful by focusing on the how and what of mood, cognitive, behavioral and physical symptoms.
• Next comes "stop", behaviors to put the brakes on and to better handle emotional arousal (for example, yelling).
• Then slow down, slowing down the accelerated rate at which negative emotions come through techniques like meditation and counting to 10.
• The last two steps, "think" and "act" refer to the application of the four rational problem-solving steps (defining, alternatives, decision making and implementation).

Healthy thinking and imagery toolkit: This kit focuses primarily on negative thinking and feelings of hopelessness and contains strategies for cognitive change to increase optimism and a sense of self-efficacy. Use is made of the ABC model (A = activating event, B = beliefs / attitudes, C = emotional consequence based on the belief) to determine whether a negative thought should be changed. Reverse advocate of the devil role-playing is also used (therapist assumes client's attitude and client's role of therapist who has to tackle it). The second tool in this kit is visualization to increase motivation and reduce hopelessness. This is done to make the client feel what it is like to have resolved something well, to see the light at the end of the tunnel.

Planful problem-solving toolkit: This includes training in the four rational problem-solving steps. The first step (problem definition: distinguishing facts and assumptions, setting goals, identifying obstacles) uses problem-focused goals (changing the situation to the problem) and emotion-focused goals (changing cognitive-emotional reactions to situations). that cannot be changed). In the second step (generation alternatives) brainstorming is used.

It is believed that psychopathology can often be understood as a result of ineffective coping. This is supported by the finding that people with ineffective problem-solving strategies are more likely to experience problems in life, experience more health and physical problems, and report more alcohol abuse, psychological problems, and concerns. SPS appears to be a moderator in the stress-distress relationship, where in the same situation people with an ineffective style experience more distress. PST also appears to be an efficacious therapy, with training in problem orientation and homework assignments as moderators for therapy outcome.

Two trends have contributed to the development of PST, first, the interest in cognitive processes that facilitate self-control, second, the recognition that the effectiveness of interventions can be improved by adding strategies aimed at developing positive skills for social competence and improve problem solution. Following this, D’Zurilla and Goldfried came up with a training model for SPS, consisting of two components: General orientation (later: problem orientation), and Problem-solving ability. They gave guidelines on how to apply the training. Later a list was developed for measuring SPS, the "Social Problem Solving Inventory".

In addition to individual therapy, PST is also succesful in group therapy. The protocol consisted of discussions of current problems, but did not include systematic training in problem-solving skills. This proved to be more effective in improving problem-solving and moving the locus of control internally than other therapies. It appears that involving a significant other in individual therapy has beneficial effects. PST is often combined with other parts of CBT, PST with relaxation and education has been shown to have positive effects in lowering blood pressure through improved SPS skills in people with hypertension. PST has also been combined with Graded Activity (GA), which proved to be effective (fewer sick days at work). PST can also be added to therapy as a means of improving adherence or relapse prevention or used as a prevention strategy.

It has also been investigated whether PST can be given over the phone because many people cannot come to centers where PST is given. This turned out to be much less efficacious than face-to-face therapy. In breast cancer patients with low baseline levels of SPS, the intervention was not effective (may require more sessions or face-to-face contact). In people with an average or good SPS at the start, it appeared to bring improvements (better mental health). Internet therapy has also been tried. This was found to be just as effective as Internet CBT in reducing depression, but was faster than CBT. PST can also be included in a Collaborative Care Model, such as IMPACT, the whole model was found to be effective, but the separate effect of PST could not be investigated.

More research is needed on:

• •The role of PST in optimal functioning.
• Interventions in cardiovascular diseases because this has a major impact on a person's daily life.
• Preventing diseases with PST by overcoming the obstacles to a healthy lifestyle.
• The how and what of PST, moderators, mediators, the working mechanism and for whom it works.
• New methods of delivering PST, such as Internet and telephone therapy.

Social problem solving (SPS) is a multidimensional process in which individuals try to find an effective way to deal with a wide variety of stressful problems encountered in daily life. There can be different coping responses for different situations and times. According to SPS theory, the outcomes of SPS are determined by: 1. Problem orientation, and 2. Problem-solving style.