Problem-Solving Skills Training 227

Problem-Solving Skills Training

A M Nezu and C M Nezu Social Problem Solving
Drexel University, Philadelphia, PA, USA
T J D’Zurilla Throughout history, psychologists and philosophers
State University of New York, Stony Brook, have argued that an essential part of being human is
NY, USA the capacity to solve problems. Perhaps the most im-
ã 2007 Elsevier Inc. All rights reserved. portant idea emanating from this belief is the notion
that problem-solving ability contributes significantly
This article is a revision of the previous edition article by to social competence and overall psychological well-
A M Nezu, C M Nezu and T J D’Zurilla, volume 3, pp 252–256, being, as the ability to cope with and resolve everyday
ã 2000, Elsevier Inc.
stressful problems has been found to be strongly
related to overall personal and social functioning.
Training individuals to become better problem
solvers in order to facilitate their ability to cope with
Social Problem Solving stressful situations has been referred to in the psycho-
The Problem-Solving Process therapy and counseling literature as social problem-
Problem-Solving Deficits solving therapy in order to highlight the social and
Problem Solving as a Moderator of Stress interpersonal context in which real-life problem solv-
Efficacy of PST ing occurs. Social problem solving is defined as the
PST Training Guidelines cognitive-behavioral process by which individuals
view the nature of problems in living and direct
their attempts at coping with such stressors. Relevant
Glossary problem-solving therapy (PST) goals broadly include
Effective Coping responses that achieve one’s altering the stressful nature of the situation itself (e.g.,
solutions problem-solving goals, but that also overcoming obstacles to a personal goal), changing
simultaneously maximize positive con- one’s reactions of distress to such problems (e.g., ac-
sequences (i.e., benefits) and minimize ceptance that a goal cannot be reached), or both.
negative consequences (i.e., costs). Problems can be single events (e.g., obtaining a loan
Problems Specific existing or anticipated situations from a bank), a series of related problems (e.g., contin-
that demand responses for adaptive
uous arguments with a spouse), or chronic situations
functioning, but that are not met by ef-
(e.g., a major chronic illness, such as cancer). Situations
fective coping responses from the person
confronted by them due to the presence become problems when effective responses are re-
of certain obstacles (e.g., ambiguity, quired in order for the person to cope adaptively, but
uncertainty, conflicting demands, lack when such responses are not immediately available
of resources, or uniqueness). or identifiable due to the presence of various obsta-
Problem The set of relatively stable cognitive- cles, including ambiguity, unpredictability, conflicting
orientation affective schemas that represent a per- demands, deficient skills, or lack of resources.
son’s generalized beliefs, attitudes, and Solutions are coping responses designed to alter the
emotional reactions about problems in nature of the problematic situation, one’s negative
living and one’s ability to successfully emotional reactions to it, or both, whereas effective
cope with such problems.
solutions are those coping responses that not only
Problem- The core cognitive-behavioral activities
achieve such goals, but also simultaneously maximize
solving style that people engage in when attempting
to cope with problems in living. positive consequences (i.e., benefits) and minimize
Social problem The cognitive-behavioral process by negative effects (i.e., costs).
solving which individuals view the nature of
problems in living and direct their The Problem-Solving Process
attempts at coping with such stressors.
Solution A coping response designed to alter the Problem-solving outcomes are largely determined by
nature of the problematic situation, two general but partially independent dimensions –
one’s negative emotional reactions to it, problem orientation and problem-solving style.
or both. Problem orientation is the set of relatively stable
228 Problem-Solving Skills Training

cognitive-affective schemas that represent a person’s or incomplete. For example, a person with this style
generalized beliefs, attitudes, and emotional reactions is likely to consider only a few solution alternatives,
about problems in living and one’s ability to success- often impulsively implementing the first idea that
fully cope with such problems. Problem orientation comes to mind. In addition, the narrow range of options
can be either positive or negative. A positive orienta- and their consequences are scanned quickly, carelessly,
tion is one that involves a tendency to appraise pro- and unsystematically.
blems as challenges, be optimistic in believing that Avoidance style is a second maladaptive problem-
problems are solvable, perceive one’s own ability to solving pattern, this one characterized by procrasti-
solve problems as strong, and believe that successful nation, passivity, and overdependence on others to
problem solving involves time and effort. Conversely, provide solutions. This type of individual generally
a negative problem orientation is one that involves avoids problems rather than confronting them head
the tendency to view problems as threats, expect pro- on, puts off addressing problems for as long as possi-
blems to be unsolvable, doubt one’s own ability to ble, waits for problems to resolve themselves, and
solve problems successfully, and become frustrated attempts to shift the responsibility for solving his or
and upset when actually faced with problems. her problems to other people. In general, both styles
Problem-solving style refers to those core cognitive- lead to ineffective or unsuccessful problem resolution.
behavioral activities that people engage in when
attempting to cope with problems in living. Three
Problem-Solving Deficits
differing styles have been identified, one that is adap-
tive, while the other two reflect maladaptive ways of Important differences have been identified in indivi-
coping. Rational problem solving is the constructive duals characterized as effective versus ineffective
problem-solving style that involves the systematic and problem solvers. In general, when compared to their
planful application of certain specific skills, each of effective counterparts, ineffective problem solvers re-
which makes a distinct contribution toward the dis- port a greater number of life problems, more health
covery of an adaptive solution or coping response in a and physical symptoms, more anxiety, more depres-
problem-solving situation. Rational problem solving sion, and more psychological maladjustment. In ad-
involves the following four skills: problem definition dition, a negative problem orientation has been found
and formulation, generation of alternatives, decision to be associated with negative moods under routine
making, and solution implementation and verifica- and stressful conditions in general, as well as pessi-
tion. The goal of problem definition and formulation mism, negative emotional experiences, and clinical
is to delineate the reasons why a given situation is a depression. Persons with a negative orientation also
problem (e.g., the presence of obstacles), as well as to tend to worry and complain more about their health.
specify a set of realistic goals and objectives to help In addition, problem-solving deficits have been
guide further problem-solving efforts. The purpose of found to be significantly related to poor self-esteem,
the generation of alternatives task is to create, using hopelessness, suicidal risk, self-injury, anger prone-
various brainstorming principles, a large pool of pos- ness, increased alcohol intake and substance risk
sible solutions in order to increase the likelihood that taking, personalities difficulties, criminal behavior,
the most effective ideas will be ultimately identified. alcoholism, secondary physical complications among
The goal of decision making is to conduct a systematic persons with spinal cord injuries, premenstrual and
cost–benefit analysis of each alternative by identifying menstrual pain, physical health problems, dimin-
and then weighing their potential positive and nega- ished life satisfaction, physical problems among adult
tive consequences if carried out, and then, based on cancer patients, and pain severity among adult cardiac
this evaluation, to develop an overall solution plan. patients.
Finally, the purpose of solution implementation and
verification is to carry out the solution plan, monitor
Problem Solving as a Moderator of Stress
and evaluate its effectiveness, and troubleshoot if the
outcome is unsatisfactory. How people cope with stressful experiences, includ-
Two additional problem-solving styles have been ing major events (e.g., undergoing a divorce, dealing
identified, both of which are dysfunctional or maladap- with the death of a spouse) and daily problems (e.g.,
tive in nature. An impulsive/careless style involves a continued arguments with a co-worker, limited finan-
generalized response pattern characterized by impul- cial resources) can, in part, determine the degree
sive, hurried, and careless attempts at problem resolu- to which they will experience long-lasting psycholog-
tion. Although the individual characterized by this ical distress, particularly depression. Continued suc-
style actively attempts to apply various strategies to cessful attempts at problem resolution will lead to a
address problems, such attempts are narrow, hurried, reduction or minimization of immediate emotional
 Problem-Solving Skills Training 229

distress and a reduced likelihood of long-term nega- engage in dysfunctional problem-solving style activ-
tive affect (i.e., clinical depression). Alternatively, if ities (i.e., impulsive or careless attempts to cope with
one’s problem-solving coping skills are ineffective, or problems; avoidance of problems). PST interventions
if extreme emotional distress impacts negatively on include didactic explanations, training exercises,
one’s coping efforts, resulting in reduced motivation, practice opportunities, and homework assignments
inhibition of problem-solving performance, or both, geared to foster practice between training sessions.
then the likelihood of long-term emotional distress
will be increased. Further, such negative outcomes Problem Orientation
can lead to the exacerbation of existing problems
Training in this problem-solving component is geared
and the creation of new ones, which in turn can lead
to facilitate the following: positive self-efficacy beliefs
to another major stressful life event, and so forth. As
(the perception that people can improve their quality
such, how one copes with problems can lead to either
of life through effective coping and problem solving),
an escalation or attenuation of the stress process.
beliefs that problems are inevitable (accepting the
For example, research has demonstrated that under
notion that it is common and normal to experience a
similar levels of high stress, individuals with poor
wide range of problems), the ability to identify pro-
problem-solving skills experience significantly higher
blems accurately when they occur, and the ability to
levels of depression and anxiety than persons char-
inhibit emotional reactions that can lead to impulsive
acterized by more effective problem-solving skills,
reactions or avoidance.
supporting the notion that problem solving serves to
A variety of training approaches can be used to
attenuate the negative effects of stress.
foster a positive problem orientation. One technique
is the reverse advocacy role-play strategy. According
Efficacy of PST to this strategy, the therapist pretends to adopt a
particular belief about problems and asks the patient
If effective problem-solving skills serve as an impor-
to provide reasons why that belief is irrational, illogi-
tant buffering factor regarding the stress process,
cal, incorrect, or maladaptive. Such beliefs might
training individuals in such skills should lead to a
include the following statements: ‘‘Problems are
decrease in emotional distress and improvement in
not common to everyone; if I have a problem, that
overall psychological functioning. In fact, PST has
means I’m crazy,’’ ‘‘There must be a perfect solution
been shown to be effective in a wide range of clinical
to this problem,’’ ‘‘I’ll never be the same again.’’ At
populations, psychological problems, and the distress
times when the patient has difficulty generating argu-
associated with chronic medical disorders. These
ments against the therapist’s position, the counselor
include unipolar depression, geriatric depression, dis-
then adopts a more extreme form of the belief, such
tressed primary care patients, social phobia, agora-
as ‘‘No matter how long it takes, I will continue to try
phobia, obesity, coronary heart disease, adult cancer
and find the perfect solution to my problem.’’ This
patients, schizophrenia, mentally retarded adults
procedure is intended to help patients identify alter-
with concomitant psychiatric problems, HIV risk
native ways of thinking and then to dispute or con-
behaviors, drug abuse, suicide, childhood aggression,
tradict previously held negative beliefs with more
and conduct disorder.
adaptive perspectives.
In addition to its applicability to a variety of patient
Patients are also taught to use feelings or emotions
populations, PST also appears to be flexible with
as cues that a problem exists by using visual images of
regard to treatment goals and methods of implemen-
a red traffic stop sign as a signal to stop and think. In
tation. For example, it can be conducted in a group
essence, patients are taught to recognize various
format, on an individual and couples basis, and as
situations as problems and to label them as such.
part of a larger psychosocial intervention package,
Accurately labeling a problem as a problem serves
and can be delivered by telephone. It can also be
to inhibit the tendency to act impulsively or auto-
applied as a means of helping patients to overcome
matically in reaction to such situations. It also facil-
barriers associated with successful adherence to other
itates the tendency to approach or confront problems,
medical or psychosocial treatment protocols.
rather than to avoid them.

PST Training Guidelines Problem Definition and Formulation

Specific PST therapy objectives include (1) enhancing Problem definition can be likened to mapping a guide
individuals’ positive orientation and application of for the remainder of the problem-solving process. The
the four rational problem-solving tasks, and (2) mini- major focus of this task is to better understand the
mizing their negative orientation and tendency to nature of the problem and to set clearly defined and
230 Problem-Solving Skills Training

reasonable goals. In other words, locating a specific three additional purposes: the patient can receive
destination on a map makes it easier to find the best professional feedback from the therapist, increased
route to get there. Training in problem definition and facility with the overall PST model can decrease the
formulation focuses on the following five specific amount of time and effort necessary to apply
tasks: gathering all available information about the the various problem-solving tasks with each new
problem, using clear and unambiguous language, problem, and practice fosters maintenance and
separating facts from assumptions, identifying the generalization of the skills.
factors that make the situation a problem, and setting The number of practice sessions required after for-
realistic problem-solving goals. mal PST training often is dependent upon the compe-
tency level a patient achieves, as well as on the actual
Generation of Alternatives improvement in his or her overall quality of life.
When generating alternative solutions to a problem, In the research protocols that have found PST to
PST encourages broad-based, creative, and flexible be an effective cognitive-behavior therapy interven-
thinking. In essence, patients are taught various brain- tion, the number of included sessions has ranged from
storming strategies (e.g., the more the better, defer 8 to 12.
judgment of ideas until a comprehensive list is creat-
ed). This helps to increase the likelihood that the best See Also the Following Articles
or most effective solution ideas will be discovered.
Anxiety; Cognitive Behavioral Therapy; Depression and
Decision Making Manic-Depressive Illness.

Once a list of alternative options has been genera-

ted, the problem solver begins to systematically and Further Reading
thoroughly evaluate the potential for each solution to Allen, S. M., Shah, A. C., Nezu, A. M., et al. (2002).
meet the defined goal(s). Training in this component A problem-solving approach to stress reduction among
helps the patient to use the following criteria to conduct younger women with breast carcinoma: a randomized
a cost–benefit analysis based on the utility of each controlled trial. Cancer 94, 3089–3100.
alternative solution: the likelihood that the solution Chang, E. C., D’Zurilla, T. J. and Sanna, L. J. (eds.) (2004).
will meet the defined goal, the likelihood that the per- Social problem solving: theory, research, and training.
son responsible for solving the problem can actually Washington, D.C.: American Psychological Association.
carry out the solution plan optimally, personal (i.e., D’Zurilla, T. J. and Nezu, A. M. (1999). Problem-solving
therapy: a social competence approach to clinical inter-
effects on oneself) and social (i.e., effects on others)
vention (2nd edn.). New York: Springer.
consequences, and short- and long-term effects.
D’Zurilla, T. J., Nezu, A. M. and Maydeu-Olivares (2002).
Social Problem-Solving Inventory-Revised (SPSI-R):
Solution Implementation and Verification
technical manual. North Tonawanda, NY: Multi-Health
This last rational problem-solving task involves first Systems.
carrying out the solution plan and then monitoring D’Zurilla, T. J., Nezu, A. M. and Maydeu-Olivares, A.
and evaluating the consequences of the actual out- (2004). Social problem solving: theory and assessment.
come. PST encourages the patient to practice the per- In: Chang, E. C., D’Zurilla, T. J. & Sanna, L. J. (eds.)
Social problem solving: theory, research, and training,
formance aspect of solution implementation as a
pp. 11–27. Washington, D.C.: American Psychological
means of enhancing the probability that it will be
Association.
carried out in its optimal form. Once the plan is Nezu, A. M. (1987). A problem-solving formulation of
under way, the patient is encouraged to monitor the depression: a literature review and proposal of a pluralis-
actual results. Using this information allows the indi- tic model. Clinical Psychology Review 7, 122–144.
vidual to evaluate the results by comparing the actual Nezu, A. M. (2004). Problem solving and behavior therapy
outcome with his or her expectations or predictions revisited. Behavior Therapy 35, 1–33.
about the outcome. Nezu, A. M. and D’Zurilla, T. J. (1989). Social problem
solving and negative affective states. In: Kendall, P. C. &
Supervised Practice Watson, D. (eds.) Anxiety and depression: distinctive and
overlapping features, pp. 285–315. New York: Academic
After the majority of training has occurred, the re- Press.
mainder of PST should be devoted to practicing the Nezu, A. M. and Perri, M. G. (1989). Problem-solving
newly acquired skills and applying them to a variety therapy for unipolar depression: an initial dismantling
of stressful problems. Beyond actually solving stress- investigation. Journal of Consulting and Clinical Psy-
ful problems, ongoing in-session practice serves chology 57, 408–413.
 Prolactin and Stress 231

Nezu, A. M., Nezu, C. M. and Perri, M. G. (1989). Prob- Nezu, C. M., D’Zurilla, T. J. and Nezu, A. M. (2005).
lem-solving therapy for depression: theory, research, Problem-solving therapy: theory, practice, and appli-
and clinical guidelines. New York: Wiley. cation to sex offenders. In: McMurran, M. & McGuire, J.
Nezu, A. M., Nezu, C. M., Friedman, S. H., Faddis, S. and (eds.) Social problem solving and offenders: evidence,
Houts, P. S. (1998). Helping cancer patients cope: a evaluation and evolution, pp. 103–123. Chichester,
problem-solving approach. Washington, D.C.: American UK: Wiley.
Psychological Association. Perri, M. G., Nezu, A. M., McKelvey, W. F., et al. (2001).
Nezu, A. M., Nezu, C. M., Felgoise, S. H., McClure, K. S. Relapse prevention training and problem-solving therapy
and Houts, P. S. (2003). Project genesis: assessing the in the long-term management of obesity. Journal of Con-
efficacy of problem-solving therapy for distressed adult sulting and Clinical Psychology 69, 722–726.
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Prolactin and Stress

G Tolis gland, as do many of the antipsychotic drugs. The
Hippokrateion Hospital, Athens, Greece, and McGill latter act as dopamine receptor antagonists at the
University, Montreal, Canada
pituitary prolactotropes, thereby blocking the normal
G Rombopoulos, D Kaltsas, E Katounda,
inhibitory effect of endogenous dopamine on PRL
V Kaltzidou and N Angelopoulos
Hippokrateion Hospital, Athens, Greece secretion. Dopamine, a key PRL inhibitory factor, is
released from the hypothalamus and transmitted to
ã 2007 Elsevier Inc. All rights reserved. the anterior pituitary gland by way of the hypophysial
portal vessels. Opiates increase PRL levels by a cen-
Glossary tral action that may involve dopamine neurons. Hy-
Catabolism A wasting process. perprolactinemia linked to a microprolactinoma is
Dopamine A catecholamine neurotransmitter that clinically manifested by disturbed gonadal function,
mediates nerve signaling in the central decreased libido, and various psychological distur-
nervous system. bances (i.e., anxiety and depressive states) that
Opiergic Opiates or compounds that have an can be ameliorated in part by the administration
compounds opiate-like effect, for example, morphine, of dopamine agonists and/or serotonin antagonists.
methadone, and heroin. Such observations, as well as the phenomenon of
Prolactin Polypeptide produced in the pituitary with pseudopregnancy, raise the possibility of PRL being
(PRL) somatolactotropic actions, essential for involved in central nervous system (CNS) circuits
the preparation of the breast during preg- beyond those involved in pregnancy and lactation.
nancy and to assure postpartum lactation.
Animal studies have indicated that PRL receptor-
Somatomam- The growth of breast function regulatory
motropic effect effect. deficient mice have hyperprolactinemia, presumably
due to the lack of feedback stimulation of TIDA
neurons, and that the chronic elevation of PRL secre-
tion occurs in rodents lacking a functional D2 dopa-
Prolactin (PRL), a somatolactotropic pituitary hor- mine receptor. These findings suggest that PRL gains
mone of paramount importance in lactation, is under access to the CNS, presumably, via the arcuate–
tonic inhibition primarily by the tubero-infundibular median eminence region, which has an incomplete
dopaminergic neurons (TIDA). Psychotropic medica- blood–brain barrier. In experiments transplanting
tions (the class of butyrophenones, i.e., haloperidol) the pituitary to the kidney, there is excess PRL pro-
increase PRL levels, whereas dopamine agonists (e.g., duction because the pituitary grafts are remote from
apomorphine and bromocriptine) suppress PRL secre- the site of dopamine release (in the hypothalamus).
tion. Recent advances in neurochemistry have made The demonstration that there is PRL mRNA in the
drugs available that have antipsychotic actions with- hypothalamus and other brain areas suggests that
out altering PRL secretion (e.g., clozapine). Thyrotro- the behavioral effects assigned to PRL may relate to
pin-releasing hormone (TRH) increases serum PRL its presence in monoaminergic and peptidergic neu-
levels by a direct effect on the anterior pituitary rons. Immunohistochemical and in situ hybridization