what is problem solving in cbt

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In brief: cognitive behavioral therapy (cbt).

Last Update: June 2, 2022 ; Next update: 2025.

Cognitive behavioral therapy (CBT) is one of the most common and best studied forms of psychotherapy. It is a combination of two therapeutic approaches, known as cognitive therapy and behavioral therapy.

The exact treatment approaches used will depend on the illness or problem to be treated. But the basic idea behind the therapy is always the same: What we think, how we behave, and how other people make us feel are all closely related – and they all affect our wellbeing.

• What is cognitive therapy?

The term cognitive comes from the Latin "cognoscere," meaning "to recognize." Cognitive therapy is about forming a clear idea of your own thoughts, attitudes and expectations. The goal is to recognize and change false and distressing beliefs. It is often not only the things and situations themselves that cause problems, but the sometimes exaggerated importance that we attach to them, too.

One example of a distressing thought pattern is when somebody immediately draws negative conclusions from a certain situation, generalizes them and applies them to other similar situations. In psychology, this generalized way of thinking is called “over-generalizing.” Another distressing way of thinking is known as “catastrophizing”: Something unsettling happens, and people immediately start worrying that it will turn into a disaster.

Such thought patterns can sometimes develop into self-fulfilling prophecies and make life difficult for those affected. If you think that other people don't like you, for instance, then you're likely to put your guard up when you're around them. As a result, they will be less friendly towards you too.

Cognitive therapy helps people learn to replace these thought patterns with more realistic and less harmful thoughts. It also helps people think more clearly and control their own thoughts better.

• How does behavioral therapy work?

Behavioral therapy has its origins in “behaviorism.” This theory assumes that human behavior is learned and can therefore be changed or learned differently. Behavioral therapy aims to find out whether certain behavioral patterns make your life more difficult or make problems worse. In the second step, you work on changing those behavioral patterns.

For example, people who have developed depressive thoughts often tend to become withdrawn and give up their hobbies. As a result, they feel even more unhappy and isolated. Behavioral therapy helps to identify this pattern and find ways to become more active again.

In anxiety disorders , behavioral therapy often includes learning about things that can help you feel calmer. For example, you can learn to reduce anxiety by consciously breathing in and out deeply so that your breathing is calmer and your body can relax. When doing this, you concentrate on your breathing instead of the thing that is causing your anxiety. These kinds of techniques can help you to calm down instead of letting your anxiety overwhelm you.

• Which thoughts and behavioral patterns are harmful, and which are not?

Harmful thoughts or behavioral habits can make people feel bad about themselves. Picture the following situation: You see somebody you know on the street and say hello, but they don't say hello back. Your own reaction to that very much depends on how you assess the situation:

Table: Example of harmful and neutral thoughts and behavioral patterns

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• How is CBT different from other psychological treatments?

Cognitive behavioral therapy (CBT) is problem-oriented. It focuses on working through specific current problems and finding solutions for them. Unlike psychoanalysis, for example, it doesn't mainly deal with the past. CBT is much more concerned with dealing with problems in the here-and-now. The most important thing is helping people to help themselves: They should be able to cope with their lives again without therapy as soon as possible. This doesn't mean that cognitive behavioral therapy completely ignores the influence of past events. But it mainly deals with identifying and changing current distressing thoughts and behavioral patterns.

Analytic psychotherapy, which has its origin in classic Freudian psychoanalysis, uses a different approach. Here the therapist tries to help the patient discover and understand problems and their deeper causes.

• When is CBT considered?

Cognitive behavioral therapy is used to treat mental health conditions such as depression , anxiety , obsessive-compulsive disorder and addictions. But it can also be used to treat physical conditions such as chronic pain, tinnitus and rheumatism . Here it can help people to cope better with the symptoms.

To really benefit from cognitive behavioral therapy, you have to be committed and willing to put in enough effort. The therapy can only help if you actively take part in it, you are open and honest with the therapist, and also work on your problems between the sessions. This can be quite exhausting, especially with severe psychological conditions such as severe depression or anxiety disorders. For this reason, medication is sometimes used at first to relieve the worst symptoms so that psychological treatment can be started.

When trying to find the right kind of psychotherapy, the specific goals play an important role. If you would like to look deeper into the cause of your problems, CBT is probably not the right choice. It is particularly useful if you are mainly interested in tackling specific problems, and are less interested in the causes.

• How does CBT work and how long does it take?

It is important that you and your therapist have a close and trusting working relationship. It can sometimes take a while to find the right therapist .

In the first session, you briefly describe your current problems and outline your expectations of the therapy. Then you define the goals of your therapy and make a therapy plan together with the therapist. The plan can be adjusted if your personal goals change over the course of therapy.

Therapy often includes writing down your own thoughts in a journal over a certain period of time. The therapist will then check the following things with you: Do you see things realistically? What happens if you behave differently than you normally do in a certain situation? In the therapy sessions, you will regularly discuss any problems you may have and progress that you have made.

Relaxation exercises, stress-reducing and pain-relieving techniques are often used in cognitive behavioral therapy, too. You also learn problem-solving strategies.

Compared to analytical psychotherapy approaches, cognitive behavioral therapy is a short-term treatment. But there is no "standard" length of treatment here. Some people already feel much better after a few sessions, while others need treatment for several months. This depends on various factors, such as the kind and severity of the problems. An individual session typically lasts about one hour. Sessions usually take place once a week. Cognitive behavioral therapy is offered in psychotherapy practices, hospitals and rehabilitation clinics. It is sometimes also offered as group therapy, or online.

• Can CBT also have side effects?

Psychological treatments can have side effects, too: Facing your problems or anxieties head on may be distressing or make you feel quite "wobbly" at first, and can negatively affect relationships with other people. It is important to speak openly with your therapist about any difficulties that come up during therapy.

There is hardly any scientific research on the possible side effects of psychotherapy.

• Who covers the costs?

In Germany, statutory health insurers pay for cognitive behavioral therapy to treat mental illnesses such as depression, anxiety, obsessive-compulsive disorder and addictions. The costs of cognitive behavioral therapy can also be covered for the treatment of severe psychological distress that is caused by a chronic physical illness. But it can sometimes take several weeks or months until you can see a therapist or until the insurance company approves the therapy.

In Germany, a psychotherapy practice can bill the statutory health insurer directly for two to four trial sessions at first – and up to six trial sessions for children, teenagers and people with learning difficulties. This allows the psychotherapist and client to get to know each other, find out what the problems are and whether therapy would be worthwhile. After the trial sessions, you and the therapist have to prepare an application explaining why therapy is needed. You have to submit this application to your health insurance company before therapy can begin. Besides this application, you also have to give your health insurer a medical report from your doctor stating that the symptoms aren't caused by a physical problem, and that there are no medical reasons not to have psychotherapy. The statutory health insurance company then decides whether to approve therapy based on an evaluation.

• Gemeinsamer Bundesausschuss (G-BA). Richtlinie des Gemeinsamen Bundesausschusses über die Durchführung der Psychotherapie (Psychotherapie-Richtlinie) . 2021.
• Pschyrembel Online . 2022.
• Robert Koch Institute (RKI), Statistisches Bundesamt (Destatis). Psychotherapeutische Versorgung . (Gesundheitsberichterstattung des Bundes; Heft 41). 2008.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

• Cite this Page InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. In brief: Cognitive behavioral therapy (CBT) [Updated 2022 Jun 2].

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• December 19, 2023

20 Cognitive Behavioral Therapy (CBT) Techniques with Examples

Muhammad Sohail

Table of contents.

Cognitive Behavioral Therapy (CBT) stands as a powerful, evidence-based therapeutic approach for various mental health challenges. At its core lies a repertoire of techniques designed to reframe thoughts, alter behaviors, and alleviate emotional distress. This article explores 20 most commonly used cbt techniques. These therapy techniques are scientifcally valid, diverse in their application and effectiveness, serve as pivotal tools in helping individuals navigate and conquer their mental health obstacles.

Cognitive Restructuring or Reframing:

This is the most talked about of all cbt techniques. CBT employs cognitive restructuring to challenge and alter negative thought patterns. By examining beliefs and questioning their validity, individuals learn to perceive situations from different angles, fostering more adaptive thinking patterns.

John, feeling worthless after a rejected job application, questions his belief that he’s incompetent. He reflects on past achievements and reframes the situation, realizing the rejection doesn’t define his abilities.

Guided Discovery:

In guided discovery, therapists engage individuals in an exploration of their viewpoints. Through strategic questioning, individuals are prompted to examine evidence supporting their beliefs and consider alternate perspectives, fostering a more nuanced understanding and empowering them to choose healthier cognitive pathways.

During therapy, Sarah explores her fear of failure. Her therapist asks, “What evidence supports your belief that you’ll fail? Can we consider alternate outcomes?” Guided by these questions, Sarah acknowledges her exaggerated fears and explores more balanced perspectives.

Journaling and Thought Records:

Writing exercises like journaling and thought records aid in identifying and challenging negative thoughts. Tracking thoughts between sessions and noting positive alternatives enables individuals to monitor progress and recognize cognitive shifts.

James maintains a thought journal. Between sessions, he records negative thoughts about social situations. He then challenges these thoughts, jotting down positive alternatives and notices a shift in his mindset.

Activity Scheduling and Behavior Activation:

By scheduling avoided activities and implementing learned strategies, individuals establish healthier habits and confront avoidance tendencies, fostering behavioral change.

Emily, struggling with social anxiety, schedules coffee outings with friends. By implementing gradual exposure, she confronts her fear and eventually feels more comfortable in social settings.

Relaxation and Stress Reduction Techniques:

CBT incorporates relaxation techniques like deep breathing, muscle relaxation, and imagery to mitigate stress. These methods equip individuals with practical skills to manage phobias, social anxieties, and stressors effectively.

David practices deep breathing exercises when faced with work stress. By incorporating this technique into his routine, he manages work-related anxiety more effectively.

Successive Approximation:

Breaking overwhelming tasks into manageable steps cultivates confidence through incremental progress, enabling individuals to tackle challenges more effectively.

Maria, overwhelmed by academic tasks, breaks down her study sessions into smaller, manageable sections. As she masters each segment, her confidence grows, making the workload seem more manageable.

Interoceptive Exposure:

This technique targets panic and anxiety by exposing individuals to feared bodily sensations, allowing for a recalibration of beliefs around these sensations and reducing avoidance behaviors.

Tom, experiencing panic attacks, deliberately induces shortness of breath in a controlled setting. As he tolerates this discomfort without avoidance, he realizes that the sensation, though distressing, is not harmful.

Play the Script Until the End:

Encouraging individuals to envision worst-case scenarios helps alleviate fear by demonstrating the manageability of potential outcomes, reducing anxiety.

Facing fear of public speaking, Rachel imagines herself stumbling during a presentation. By playing out this scenario mentally, she realizes that even if it happens, it wouldn’t be catastrophic.

Shaping (Successive Approximation):

Shaping involves mastering simpler tasks akin to the challenging ones, aiding individuals in overcoming difficulties through gradual skill development.

Chris, struggling with public speaking, begins by speaking to small groups before gradually addressing larger audiences. Each step builds his confidence for the next challenge.

Contingency Management:

This method utilizes reinforcement and punishment to promote desirable behaviors, leveraging the consequences of actions to shape behavior positively.

To encourage healthier eating habits, Sarah rewards herself with a favorite activity after a week of sticking to a balanced diet.

Acting Out (Role-Playing):

Role-playing scenarios allow individuals to practice new behaviors in a safe environment, facilitating skill development and desensitization to challenging situations.

Alex, preparing for a job interview, engages in role-playing with a friend. They simulate the interview scenario, allowing Alex to practice responses and manage anxiety.

Sleep Hygiene Training:

Addressing the link between depression and sleep problems, this technique provides strategies for improving sleep quality, a critical aspect of mental well-being.

Lisa, struggling with sleep, follows sleep hygiene recommendations. She creates a calming bedtime routine and eliminates screen time before sleep, noticing improvements in her sleep quality.

Mastery and Pleasure Technique:

Encouraging engagement in enjoyable or accomplishment-driven activities serves as a mood enhancer and distraction from depressive thoughts.

After feeling low, Mark engages in gardening (a mastery activity) and then spends time painting (a pleasure activity). He finds joy in these activities, which uplifts his mood.

Behavioral Experiments:

This technique involves creating real-life experiments to test the validity of certain beliefs or assumptions. By actively exploring alternative thoughts or behaviors, individuals gather concrete evidence to challenge and modify their existing perspectives.

Laura believes people judge her negatively. She experiments by initiating conversations at social gatherings and observes that most interactions are positive, challenging her belief.

Externalizing:

Externalizing helps individuals separate themselves from their problems by giving those issues an identity or persona. This technique encourages individuals to view their problems as separate entities, facilitating a more objective approach to problem-solving.

Adam, dealing with anger issues, visualizes his anger as a separate entity named “Fury.” This helps him view his emotions objectively and manage them more effectively.

Acceptance and Commitment Therapy (ACT):

ACT combines mindfulness strategies with commitment and behavior-change techniques. It focuses on accepting difficult thoughts and emotions while committing to actions aligned with personal values, promoting psychological flexibility.

Sarah practices mindfulness exercises to accept her anxiety while committing to attend social events aligned with her values of connection and growth.

Imagery-Based Exposure:

This technique involves mentally visualizing feared or distressing situations, allowing individuals to confront and manage their anxieties in a controlled, imaginative setting.

Jack, afraid of flying, visualizes being on a plane, progressively picturing the experience in detail until he feels more comfortable with the idea of flying.

Mindfulness-Based Stress Reduction (MBSR):

MBSR incorporates mindfulness meditation and awareness techniques to help individuals manage stress, improve focus, and enhance overall well-being by staying present in the moment.

Rachel practices mindfulness meditation daily. By focusing on the present moment, she reduces work-related stress and enhances her overall well-being.

Systematic Desensitization:

Similar to exposure therapy, systematic desensitization involves pairing relaxation techniques with gradual exposure to anxiety-inducing stimuli. This process helps individuals associate relaxation with the feared stimuli, reducing anxiety responses over time.

Michael, with a fear of heights, gradually exposes himself to elevators first, then low floors in tall buildings, gradually working up to higher levels, reducing his fear response.

Narrative Therapy:

Narrative therapy focuses on separating individuals from their problems by helping them reconstruct and retell their life stories in a more empowering and positive light, emphasizing strengths and resilience.

Emily reevaluates her life story by focusing on instances where she overcame challenges, emphasizing her resilience and strength rather than her setbacks.

Each of these CBT techniques plays a unique role in helping individuals transform their thoughts, behaviors, and emotions. While some focus on cognitive restructuring, others emphasize behavioral modification or stress reduction. Together, they form a comprehensive toolkit empowering individuals to navigate their mental health challenges and foster positive change in their lives.

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10 Best Problem-Solving Therapy Worksheets & Activities

Cognitive science tells us that we regularly face not only well-defined problems but, importantly, many that are ill defined (Eysenck & Keane, 2015).

Sometimes, we find ourselves unable to overcome our daily problems or the inevitable (though hopefully infrequent) life traumas we face.

Problem-Solving Therapy aims to reduce the incidence and impact of mental health disorders and improve wellbeing by helping clients face life’s difficulties (Dobson, 2011).

This article introduces Problem-Solving Therapy and offers techniques, activities, and worksheets that mental health professionals can use with clients.

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This Article Contains:

What is problem-solving therapy, 14 steps for problem-solving therapy, 3 best interventions and techniques, 7 activities and worksheets for your session, fascinating books on the topic, resources from positivepsychology.com, a take-home message.

Problem-Solving Therapy assumes that mental disorders arise in response to ineffective or maladaptive coping. By adopting a more realistic and optimistic view of coping, individuals can understand the role of emotions and develop actions to reduce distress and maintain mental wellbeing (Nezu & Nezu, 2009).

“Problem-solving therapy (PST) is a psychosocial intervention, generally considered to be under a cognitive-behavioral umbrella” (Nezu, Nezu, & D’Zurilla, 2013, p. ix). It aims to encourage the client to cope better with day-to-day problems and traumatic events and reduce their impact on mental and physical wellbeing.

Clinical research, counseling, and health psychology have shown PST to be highly effective in clients of all ages, ranging from children to the elderly, across multiple clinical settings, including schizophrenia, stress, and anxiety disorders (Dobson, 2011).

Can it help with depression?

PST appears particularly helpful in treating clients with depression. A recent analysis of 30 studies found that PST was an effective treatment with a similar degree of success as other successful therapies targeting depression (Cuijpers, Wit, Kleiboer, Karyotaki, & Ebert, 2020).

Other studies confirm the value of PST and its effectiveness at treating depression in multiple age groups and its capacity to combine with other therapies, including drug treatments (Dobson, 2011).

The major concepts

Effective coping varies depending on the situation, and treatment typically focuses on improving the environment and reducing emotional distress (Dobson, 2011).

PST is based on two overlapping models:

Social problem-solving model

This model focuses on solving the problem “as it occurs in the natural social environment,” combined with a general coping strategy and a method of self-control (Dobson, 2011, p. 198).

The model includes three central concepts:

• Social problem-solving
• The problem
• The solution

The model is a “self-directed cognitive-behavioral process by which an individual, couple, or group attempts to identify or discover effective solutions for specific problems encountered in everyday living” (Dobson, 2011, p. 199).

Relational problem-solving model

The theory of PST is underpinned by a relational problem-solving model, whereby stress is viewed in terms of the relationships between three factors:

• Stressful life events
• Emotional distress and wellbeing
• Problem-solving coping

Therefore, when a significant adverse life event occurs, it may require “sweeping readjustments in a person’s life” (Dobson, 2011, p. 202).

• Enhance positive problem orientation
• Decrease negative orientation
• Foster ability to apply rational problem-solving skills
• Reduce the tendency to avoid problem-solving
• Minimize the tendency to be careless and impulsive

D’Zurilla’s and Nezu’s model includes (modified from Dobson, 2011):

• Initial structuring Establish a positive therapeutic relationship that encourages optimism and explains the PST approach.
• Assessment Formally and informally assess areas of stress in the client’s life and their problem-solving strengths and weaknesses.
• Obstacles to effective problem-solving Explore typically human challenges to problem-solving, such as multitasking and the negative impact of stress. Introduce tools that can help, such as making lists, visualization, and breaking complex problems down.
• Problem orientation – fostering self-efficacy Introduce the importance of a positive problem orientation, adopting tools, such as visualization, to promote self-efficacy.
• Problem orientation – recognizing problems Help clients recognize issues as they occur and use problem checklists to ‘normalize’ the experience.
• Problem orientation – seeing problems as challenges Encourage clients to break free of harmful and restricted ways of thinking while learning how to argue from another point of view.
• Problem orientation – use and control emotions Help clients understand the role of emotions in problem-solving, including using feelings to inform the process and managing disruptive emotions (such as cognitive reframing and relaxation exercises).
• Problem orientation – stop and think Teach clients how to reduce impulsive and avoidance tendencies (visualizing a stop sign or traffic light).
• Problem definition and formulation Encourage an understanding of the nature of problems and set realistic goals and objectives.
• Generation of alternatives Work with clients to help them recognize the wide range of potential solutions to each problem (for example, brainstorming).
• Decision-making Encourage better decision-making through an improved understanding of the consequences of decisions and the value and likelihood of different outcomes.
• Solution implementation and verification Foster the client’s ability to carry out a solution plan, monitor its outcome, evaluate its effectiveness, and use self-reinforcement to increase the chance of success.
• Guided practice Encourage the application of problem-solving skills across multiple domains and future stressful problems.
• Rapid problem-solving Teach clients how to apply problem-solving questions and guidelines quickly in any given situation.

Success in PST depends on the effectiveness of its implementation; using the right approach is crucial (Dobson, 2011).

Problem-solving therapy – Baycrest

The following interventions and techniques are helpful when implementing more effective problem-solving approaches in client’s lives.

First, it is essential to consider if PST is the best approach for the client, based on the problems they present.

Is PPT appropriate?

It is vital to consider whether PST is appropriate for the client’s situation. Therapists new to the approach may require additional guidance (Nezu et al., 2013).

Therapists should consider the following questions before beginning PST with a client (modified from Nezu et al., 2013):

• Has PST proven effective in the past for the problem? For example, research has shown success with depression, generalized anxiety, back pain, Alzheimer’s disease, cancer, and supporting caregivers (Nezu et al., 2013).
• Is PST acceptable to the client?
• Is the individual experiencing a significant mental or physical health problem?

All affirmative answers suggest that PST would be a helpful technique to apply in this instance.

Five problem-solving steps

The following five steps are valuable when working with clients to help them cope with and manage their environment (modified from Dobson, 2011).

Ask the client to consider the following points (forming the acronym ADAPT) when confronted by a problem:

• Attitude Aim to adopt a positive, optimistic attitude to the problem and problem-solving process.
• Define Obtain all required facts and details of potential obstacles to define the problem.
• Alternatives Identify various alternative solutions and actions to overcome the obstacle and achieve the problem-solving goal.
• Predict Predict each alternative’s positive and negative outcomes and choose the one most likely to achieve the goal and maximize the benefits.
• Try out Once selected, try out the solution and monitor its effectiveness while engaging in self-reinforcement.

If the client is not satisfied with their solution, they can return to step ‘A’ and find a more appropriate solution.

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Positive self-statements

When dealing with clients facing negative self-beliefs, it can be helpful for them to use positive self-statements.

Use the following (or add new) self-statements to replace harmful, negative thinking (modified from Dobson, 2011):

• I can solve this problem; I’ve tackled similar ones before.
• I can cope with this.
• I just need to take a breath and relax.
• Once I start, it will be easier.
• It’s okay to look out for myself.
• I can get help if needed.
• Other people feel the same way I do.
• I’ll take one piece of the problem at a time.
• I can keep my fears in check.
• I don’t need to please everyone.

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PST practitioners have many different techniques available to support clients as they learn to tackle day-to-day or one-off trauma.

5 Worksheets and workbooks

Problem-solving self-monitoring form.

Ask the client to complete the following:

• Describe the problem you are facing.
• What is your goal?
• What have you tried so far to solve the problem?
• What was the outcome?

Reactions to Stress

It can be helpful for the client to recognize their own experiences of stress. Do they react angrily, withdraw, or give up (Dobson, 2011)?

The Reactions to Stress worksheet can be given to the client as homework to capture stressful events and their reactions. By recording how they felt, behaved, and thought, they can recognize repeating patterns.

What Are Your Unique Triggers?

Helping clients capture triggers for their stressful reactions can encourage emotional regulation.

When clients can identify triggers that may lead to a negative response, they can stop the experience or slow down their emotional reaction (Dobson, 2011).

The What Are Your Unique Triggers ? worksheet helps the client identify their triggers (e.g., conflict, relationships, physical environment, etc.).

Problem-Solving worksheet

Imagining an existing or potential problem and working through how to resolve it can be a powerful exercise for the client.

Use the Problem-Solving worksheet to state a problem and goal and consider the obstacles in the way. Then explore options for achieving the goal, along with their pros and cons, to assess the best action plan.

Getting the Facts

Clients can become better equipped to tackle problems and choose the right course of action by recognizing facts versus assumptions and gathering all the necessary information (Dobson, 2011).

Use the Getting the Facts worksheet to answer the following questions clearly and unambiguously:

• Who is involved?
• What did or did not happen, and how did it bother you?
• Where did it happen?
• When did it happen?
• Why did it happen?
• How did you respond?

2 Helpful Group Activities

While therapists can use the worksheets above in group situations, the following two interventions work particularly well with more than one person.

Generating Alternative Solutions and Better Decision-Making

A group setting can provide an ideal opportunity to share a problem and identify potential solutions arising from multiple perspectives.

Use the Generating Alternative Solutions and Better Decision-Making worksheet and ask the client to explain the situation or problem to the group and the obstacles in the way.

Once the approaches are captured and reviewed, the individual can share their decision-making process with the group if they want further feedback.

Visualization

Visualization can be performed with individuals or in a group setting to help clients solve problems in multiple ways, including (Dobson, 2011):

• Clarifying the problem by looking at it from multiple perspectives
• Rehearsing a solution in the mind to improve and get more practice
• Visualizing a ‘safe place’ for relaxation, slowing down, and stress management

Guided imagery is particularly valuable for encouraging the group to take a ‘mental vacation’ and let go of stress.

Ask the group to begin with slow, deep breathing that fills the entire diaphragm. Then ask them to visualize a favorite scene (real or imagined) that makes them feel relaxed, perhaps beside a gently flowing river, a summer meadow, or at the beach.

The more the senses are engaged, the more real the experience. Ask the group to think about what they can hear, see, touch, smell, and even taste.

Encourage them to experience the situation as fully as possible, immersing themselves and enjoying their place of safety.

Such feelings of relaxation may be able to help clients fall asleep, relieve stress, and become more ready to solve problems.

We have included three of our favorite books on the subject of Problem-Solving Therapy below.

1. Problem-Solving Therapy: A Treatment Manual – Arthur Nezu, Christine Maguth Nezu, and Thomas D’Zurilla

This is an incredibly valuable book for anyone wishing to understand the principles and practice behind PST.

Written by the co-developers of PST, the manual provides powerful toolkits to overcome cognitive overload, emotional dysregulation, and the barriers to practical problem-solving.

Find the book on Amazon .

2. Emotion-Centered Problem-Solving Therapy: Treatment Guidelines – Arthur Nezu and Christine Maguth Nezu

Another, more recent, book from the creators of PST, this text includes important advances in neuroscience underpinning the role of emotion in behavioral treatment.

Along with clinical examples, the book also includes crucial toolkits that form part of a stepped model for the application of PST.

3. Handbook of Cognitive-Behavioral Therapies – Keith Dobson and David Dozois

This is the fourth edition of a hugely popular guide to Cognitive-Behavioral Therapies and includes a valuable and insightful section on Problem-Solving Therapy.

This is an important book for students and more experienced therapists wishing to form a high-level and in-depth understanding of the tools and techniques available to Cognitive-Behavioral Therapists.

For even more tools to help strengthen your clients’ problem-solving skills, check out the following free worksheets from our blog.

• Case Formulation Worksheet This worksheet presents a four-step framework to help therapists and their clients come to a shared understanding of the client’s presenting problem.
• Understanding Your Default Problem-Solving Approach This worksheet poses a series of questions helping clients reflect on their typical cognitive, emotional, and behavioral responses to problems.
• Social Problem Solving: Step by Step This worksheet presents a streamlined template to help clients define a problem, generate possible courses of action, and evaluate the effectiveness of an implemented solution.

If you’re looking for more science-based ways to help others enhance their wellbeing, check out this signature collection of 17 validated positive psychology tools for practitioners. Use them to help others flourish and thrive.

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While we are born problem-solvers, facing an incredibly diverse set of challenges daily, we sometimes need support.

Problem-Solving Therapy aims to reduce stress and associated mental health disorders and improve wellbeing by improving our ability to cope. PST is valuable in diverse clinical settings, ranging from depression to schizophrenia, with research suggesting it as a highly effective treatment for teaching coping strategies and reducing emotional distress.

Many PST techniques are available to help improve clients’ positive outlook on obstacles while reducing avoidance of problem situations and the tendency to be careless and impulsive.

The PST model typically assesses the client’s strengths, weaknesses, and coping strategies when facing problems before encouraging a healthy experience of and relationship with problem-solving.

Why not use this article to explore the theory behind PST and try out some of our powerful tools and interventions with your clients to help them with their decision-making, coping, and problem-solving?

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .

• Cuijpers, P., Wit, L., Kleiboer, A., Karyotaki, E., & Ebert, D. (2020). Problem-solving therapy for adult depression: An updated meta-analysis. European P sychiatry ,  48 (1), 27–37.
• Dobson, K. S. (2011). Handbook of cognitive-behavioral therapies (3rd ed.). Guilford Press.
• Dobson, K. S., & Dozois, D. J. A. (2021). Handbook of cognitive-behavioral therapies  (4th ed.). Guilford Press.
• Eysenck, M. W., & Keane, M. T. (2015). Cognitive psychology: A student’s handbook . Psychology Press.
• Nezu, A. M., & Nezu, C. M. (2009). Problem-solving therapy DVD . Retrieved September 13, 2021, from https://www.apa.org/pubs/videos/4310852
• Nezu, A. M., & Nezu, C. M. (2018). Emotion-centered problem-solving therapy: Treatment guidelines. Springer.
• Nezu, A. M., Nezu, C. M., & D’Zurilla, T. J. (2013). Problem-solving therapy: A treatment manual . Springer.

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Problem solving

Worrying is a natural response to life's problems. But when it takes over and we can start to feel overwhelmed, it can really help to take a step back and break things down.

Learning new ways to work through your problems can make them feel more manageable, and improve your mental and physical wellbeing.

Video: Problem solving

The tips in this video can help you to find strategies and solutions for tackling the problems that can be solved, and learning how to manage and cope with those that cannot.

Steps and strategies to help you solve problems

1. focus on your values.

Feeling like you have lots of problems to solve in different areas of your life can make it difficult to know how and where to start.

A great way to focus is to write down a few areas of your life that are most important to you right now – for example, a relationship, finances or a long-term goal like studying or developing your career.

This can make it easier to prioritise which problems to tackle.

2. Tackle problems with possible solutions first

It's important to work out if your problem can be solved or is a "hypothetical worry" – things that are out of your control even though you might think about them often.

They might be based on something that happened in the past that cannot be changed or a worry about the future that starts with "what if…".

Ask yourself whether a problem can be dealt with by doing something practical. If the answer is no, it's a hypothetical worry.

Make a list of your problems, and work out which are solvable and which are hypothetical.

3. Set aside time to work through solvable problems

Set aside 5 or 10 minutes to think about possible solutions for one of your solvable problems.

Try to be as open-minded as you can, even if some ideas feel silly. Thinking broadly and creatively is often when the best solutions come to mind.

It may feel difficult at first but, over time, this approach can start to feel easier.

Once you have some ideas, think through or write down:

• the pros and cons of each solution
• whether it's likely to work
• if you have everything you need to try it

4. Make a plan

The next step is to choose a solution you want to try and make a plan for putting it into action. Try to be specific:

• What are you going to do?
• Do you need the support of anybody else?
• How much time do you need?
• When will you do it?

5. Try 'worry time'

Not all of our problems can be solved right away, but it can be difficult to switch off and stop ourselves from dwelling on them.

Using the "worry time" technique to stick to a short set time – say 10 to 15 minutes in the evening – for worrying can make this much easier to manage.

You can learn more about the worry time technique on tackling your worries .

6. Find time to relax

Worrying about our problems can make it harder to relax, but there are lots of things you can try to help you clear your mind and feel calmer.

The most important thing is to find what works for you. It might be getting active, spending time on an existing hobby or trying a new one, or techniques like mindfulness, meditation or our progressive muscle relaxation exercise.

Video: Progressive muscle relaxation

This video will guide you through an exercise to help you recognise when you're starting to get tense, and relax your body and mind.

7. Review and reflect

Once you start trying new approaches to solving and managing problems, consider setting aside time to review what went well with your solutions or anything else you noticed.

Make notes of the problems you face and any strategies you use to overcome them. This can come in handy later on and also be a good reminder of what works best for you.

Ticking off on a checklist any problems you manage to solve is a great way to recognise your achievements and boost your confidence.

8. Give journaling a go

Sometimes getting our thoughts out of our head – and down onto paper, our phones or anything else – is a great way to stop our worries and "what ifs" from spiralling out of control.

Expressing ourselves in this way can also make it easier to spot when our thoughts are unhelpful and we may benefit from a more balanced outlook. Give it a go to see if this works for you.

More self-help CBT techniques you can try

Bouncing back from life's challenges.

Taking steps to stay on top of your mental wellbeing and build resilience can really help you deal with problems when times are tougher. Learn more, and see tips and techniques you can use.

Tackling your worries

Facing your fears

Staying on top of things

Find more ideas to try in self-help CBT techniques

Problem solving self-help guide

Work through a self-help guide for problem solving based on Cognitive Behavioural Therapy (CBT).

Navigate self-help guide

1. introduction, 2. identifying problems, 3. types of problem - activity 1, 4. recognising there's a problem, 5. barriers to problem-solving, 6. activity 2 – writing your problem list, 7. activity 3 - focusing on one problem, 8. activity 4 - pros and cons, 9. choosing a solution, 10. plan your chosen solution - activity 5, 11. how did it go, 12. next steps.

Section 1 of 12

Urgent help

This self-help guide is intended for people with mild-to-moderate mental health issues.

If you're feeling distressed, in a state of despair, suicidal or in need of emotional support you can phone NHS 24 on 111.

For an emergency ambulance phone 999.

This self-help guide is intended for people with mild-to-moderate symptoms of depression.

It’s easy to feel overwhelmed by problems, particularly if you’re experiencing mental health difficulties. This guide:

• provides step-by-step advice on how to solve problems
• gives you a set of skills to help manage problems in the future

This guide is based on Cognitive Behavioural Therapy (CBT). CBT helps you to examine how you think about your life, and challenge negative automatic thoughts to free yourself from unhelpful thought and behaviour patterns.

How to use the problem solving self-help guide

Working through this guide can take around 30 to 40 minutes, but you should feel free to work at your own pace.

Work through the guide on your device, using the “Next” button to move forward and use the “Previous” button instead of the Back button in your browser. To type in a graphic or diary, click or tap the part you’d like to fill in and use your keyboard as usual.

If you’d like to save the guide and return to it later, you’ll need to save it as a PDF on your device before you leave the page. You can then continue filling it out on the PDF. We don’t use a login feature on our mental health self-help guides for privacy reasons.

If you’d like to print the guide at any time, you’ll find an option to save and print the whole guide, including the parts you have added, in each section.

Section 2 of 12

When you solve a problem, it increases your confidence and makes you feel more able to solve problems in future. When you feel overwhelmed, it’s easy to forget that you already have the ability to solve problems – it’s how you’ve coped with life so far. This guide is designed to help you tap into that ability and boost your confidence.

Finding the hidden problem

Sometimes you can’t tell what the problem that’s affecting you most actually is – you might feel stuck and unable to think of anything that would help.

Here are 2 examples of hidden problems:

Work was becoming stressful for Paul after a new computer system was put in place. He’d been confident at work before, but was now finding it hard to get out of bed to go into the office. All his colleagues seemed to be managing fine, but Paul was making lots of mistakes. When his boss asked how he was doing, Paul felt like he had to say he was fine, as he was worried about being sacked. At home, his girlfriend had noticed a change in his mood – he wasn’t keen to go out or do anything they used to enjoy.

Mandy was a single parent. She looked after her sister’s child as well as her own 12-year-old daughter, Lizzie. She also cared for her elderly mum, who was unwell. Mandy found it difficult to find time for herself, and always felt like her house was a mess and cleaning was never done. She found herself becoming irritable, especially when people asked her to do things or asked her what was wrong. Mandy was angry that no one seemed to understand how busy she was.

From these examples, you may be able to see how sometimes problems can become overwhelming and hard to identify, while at other times you can see them clearly. In this guide you’ll continue to work on identifying your own problems, and work out a series of steps to solve them.

Section 3 of 12

There are a large number of different types of problem. Have a look at this list and see which type – or types – your problem could be.

• relationships – for example, difficulties getting along with your partner/spouse, falling out of touch with friends, or feeling alone and isolated
• money – for example, struggling to manage bills or afford different expenses, increasing debts,  or feeling pressure to spend money you can’t afford
• lifestyle issues – for example, drinking too much alcohol, not eating healthily, not having time for your interests, or not having time to keep in touch with friends and loved ones
• work/education – for example, trouble doing well at work or meeting deadlines
• addiction issues – for example alcohol, drugs, or gambling
• managing health – for example, organising GP and dentist appointments, or getting enough exercise
• illness or disability – for example, dealing with a chronic illness or having a disability
• family responsibilities – for example, being there for family commitments, organising childcare, helping with lots of requests from family, or being a carer

Use the boxes below to type any problems you might experience that fall under these categories.

Section 4 of 12

Paul’s girlfriend helped him talk about his job more. He explained that he hated his job because he couldn’t get used to the new computer system and was always worried about making a mistake. Paul told her he felt like he had to stay late at work to avoid falling behind, and that meant he was too tired to go out when he got home.

Paul recognised he was so unhappy at work because he was terrified he’d make a mistake with the new computer system. He also recognised that trying to cope by staying late at work was causing another problem – he was too tired to do the things he enjoyed when he got home. This was making him more unhappy.

Mandy didn’t want to let anyone know how she was feeling, but one Saturday her sister asked if Mandy could drop her child off at a birthday party for her. Mandy lost her temper, and was shocked by how angry and upset she felt. Once she calmed down, she decided it was time to sit down and think about what was really going on.

Mandy recognised that all the different tasks she had to do for other people, and all the demands on her time, were making her feel frustrated and irritable. They were also making it hard to fit everything in. Mandy recognised that she found it hard to say no to other people. This left her feeling angry when she ended up with very little time to do her own tasks, or take time for herself to do things she enjoyed.

Think about your own situation. You’ve reached a point where you need to take action, which is why you’re completing this guide. Where do you think would be a good place to start?

Section 5 of 12

Sometimes it feels like it’s impossible to even start solving your problems, but that’s not the case. Here are some common challenges.

Avoiding the problem

Paul had been avoiding bringing up the difficulties he was having with his girlfriend or his boss, because he didn’t want anyone to criticise him or think he wasn’t good enough at his job. This meant his boss didn’t know what the problem was when he noticed Paul taking longer with his tasks, and he didn’t know how to help. It also meant Paul’s girlfriend didn’t know why he wasn’t interested in activities in the evening anymore.

Mandy had been avoiding thinking about her problems, as she didn’t feel she had enough time. Instead, she was concentrating on everything she had to do every day, so she felt like she was coping. This meant she had little time for herself and other people didn’t realise she was finding it hard to cope.

Take a few minutes to think about whether you’ve been avoiding thinking about what your problem is. The next part of this guide will give you the chance to write out a list of your problems.

Feeling like you have too many problems

Writing a list of your problems helps to break your difficulties down so you can deal with one at a time. It also helps you to feel less overwhelmed.

You know what the problems are, but not the solutions

It’s okay if you don’t know the solutions just now. This approach gives you a structure you can use to find possible solutions that are realistic for you. It’s important to be patient with yourself – you don’t have to have all the answers straight away.

"Everything's fine in my life – I don't know why I feel like this."

Sometimes you can’t always identify what the problem is – to a stranger, it might seem like your life is perfect. But problems can include how you feel about yourself and your life too.

Do you ever do any of these things?

• put yourself down – think negative thoughts about yourself
• think negatively – always worry about what might go wrong rather than think about what might go right
• feel like everything has to be perfect – set yourself unrealistically high standards, so nothing you do ever feels “good enough”

These thinking problems can also be tackled by the methods in this guide.

If you can’t think of any problems that could explain while you feel this way, even after working through this guide, you should consider looking at  the other mental health self-help guides on NHS inform  if you haven’t already. You could also make an appointment with your GP to discuss things further. You can find a local GP using  Scotland’s Service Directory .

Section 6 of 12

The next step is writing out a list of your problems. You can either:

• use the boxes below, and save and download the list to your device at the end of this guide
• download a sh eet to your device

Please note:  If you decide to download a sheet to fill in, the text you add to that sheet will only be saved to your device. If you use an iPhone, the only way to edit the problem list is by using a PDF app on your device.

Here are some tips to make writing your problem list easier:

• Remember there are no wrong answers   – even the small things, over time, can grow into big issues. Nothing you write in this list is too small.
• Think about what’s really important to you – often when we’re struggling with things that seem small, it’s because we’re having trouble with areas of life that really matter to us.
• Talking   – try to talk to someone you know well and trust. If there isn’t anyone you feel comfortable discussing your issues with, you could call a service like  Breathing Space .
• If you need to, take a little time   – get away from the situation to allow yourself time to put things into perspective. Why not make yourself a cup of tea, or go for a walk? It’s often easier to see what the problem is when you’re not in the middle of it.

Section 7 of 12

The goal of writing a problem list is to pick one problem to work on at a time. After writing your problem list, the next step is to select the one you want to work on first.

Which one you choose is up to you but we suggest starting with the one that looks the easiest, or least distressing, to solve. You could also choose the one that you feel is the most important.

The next step is coming up with ideas for solving that problem.

Mandy chose the problem “not having enough time to relax”. While getting her ideas down, she came up with the following list, to help her find the time to do this.

• Book Lizzie into an after-school club, like drama or dancing
• Ask a friend or neighbour to watch Lizzie one evening a week
• Forget about housework for the next 3 years
• Ask Lizzie to help with some of the household chores
• Find a gym with a class Lizzie could do and go together
• Ask my sister for help with some of the things I have to do
• Get more confident about saying “no” to doing things when I’m busy

Getting all your ideas out

Use the solution sheet below to start writing out possible solutions to the problem you’ve chosen. The idea is to think up as many ways as possible of solving it, not come up with the perfect answer right away.

It’s important to write down every suggestion you think of, even if it seems unrealistic or ridiculous. The idea is to free up your creative thinking – thinking freely can help you consider things you normally wouldn’t.

You can include things you’re already doing to try and solve the problem.

You don’t have to fill out every line – if you can only come up with 2 or 3 solutions, that’s fine.

Ignore the part about pros and cons for now – this will be covered in the next section.

Download a solution sheet you can print or fill out on your device

Please note:  the text you add to the solution sheet will only be saved to your device. If you use an iPhone, the only way to edit the solution sheet is by using a PDF app on your device.

Section 8 of 12

The next step is thinking about the pros (good things) and cons (bad things) of each solution you thought of. Writing these down can help.

As an example, here’s the list Mandy came up with for her chosen problem.

Problem:  not having enough time to relax.

Write the pros and cons of each solution in the boxes on your solution sheet.

Section 9 of 12

Listing the pros and cons should’ve made it easier for you to decide what to do next. If not, try reading over the list again and thinking of some more pros and cons for each solution.

Are you having difficulty choosing a solution?

There are a few things that can make it harder for you to decide on a solution.

No solution seems good enough

There’s no such thing as a perfect solution – if there was, it’s likely you’d have solved the problem already. Are you setting your standards too high?

Your solution might not be perfect, but it doesn’t have to be perfect to start making things better.

You're scared to make the wrong choice

There’s always a bit of guessing involved in choosing a solution, as we can’t look into the future and see what’s going to happen.

With a lot of problems, it’s better to do something different than leave things the way they are. Even if things don’t turn out the way you’d hoped, it’s still a good chance to learn something and practice these problem-solving skills. In the next steps you’ll also review whether your solution helped – if not, you can follow the steps to try a different solution.

Two suggestions seem equally good

If you can’t choose which looks best, it might not matter very much which one you choose – they could both work equally well. Try one and see how it goes.

"The more I think about choosing a solution, the more I worry."

Getting caught up in worry can end up becoming a problem on its own. If you find yourself getting stressed out by trying to think of a solution, there are a couple of things you can do.

• do a relaxation exercise – you can find some  here
• distract yourself – do something different for a little while, like watching TV or reading a book
• decide to forget about the problem for a few hours or even a day – after you’ve had a break, you will feel better when you start thinking about it again
• it could be a good idea to look at your problem list and start with one that feels less overwhelming, where it’s easier think of possible solutions
• maybe a problem needs to be broken down more into simple steps to make it easier to think about solutions – for example, change “the house is a mess” to “the kitchen needs to be cleaned”

If you’re struggling to choose a solution and feel you’re getting caught up in worry, it might be worth visiting the  Depression  or  Anxiety  self-help guides on our site. If you’ve come to this guide from one of these, feel free to go back and work through it again if you think it’ll help.

We also have a lot of material on  coping with stress  that you might find helpful.

Section 10 of 12

It can be helpful to make a plan for the solution you’ve chosen. Once you lay out a step-by-step plan, taking action on your problem stops being a big task and becomes a number of smaller, more manageable tasks.

For example, Mandy decided to get more confident about saying no to things. You can see her action plan in the examples below.

Use the boxes below to write out your action plan step by step. You can save and download this at the end of the guide.

Or, if you prefer, you can download an action plan below to fill out on your device.

Download an action plan

Please note:  the text you add to the action plan PDF will only be saved to your device. If you use an iPhone, the only way to edit the action plan is by using a PDF app on your device.

Section 11 of 12

This is the time to reflect on how problem-solving went. Remember, even if your solution didn’t go the way you hoped, it’s important to keep using this approach until you feel confident.

1. The problem is solved

Well done! Your solution worked. Here are a couple of things to remember in future:

• You might not be aware that you’ve solved your problem until you realise you haven’t thought about it in a while – that’s fine, and shows that you don’t have to dwell on problems to solve them.
• It might be that things haven’t changed, or haven’t changed that much, but you’re now more able to deal with it.

2. The problem is slightly better

If the problem is slightly better, but not solved yet, there’s still a little more for you to do. There are a few things that could help:

• Keep doing what you’re doing – your problem could be solved if you continue with your current plan of action.
• Choose another solution from your list – have another look at your pros and cons list and see if another option could work better. Maybe a combination of two or more is the answer. You might even have another idea for a solution when you look at the list again.
• Choose another goal – have another look at your problem list and see if there is something else you could work on for a while.
• Choose a connected problem – if there’s another item on your problem list that could help solve the one you’re still working on, spend some time on that. You can return to the first problem later.

3. The problem isn’t better at all

If things aren’t any better, there are a few things you can do:

• Think about whether your plan has had time to work – things might get better if you keep going.
• Ask if anything at all is different – some things might be bad, but consider whether or not they were worse before you applied this problem-solving approach. The situation might have improved without you realising it.
• Try another option – go back over your solutions list, and the pros and cons, and see if a different solution works better.
• Check if you followed all the problem-solving steps correctly and, if needed, go back over some or all of the steps again.

If there still isn’t any improvement after you’ve done these things, don’t worry. If possible, discuss the problem with a person you trust, like a close friend or family member. You could also talk to someone anonymously using a service like  Breathing Space .

However it’s worked out, you should be proud of yourself for taking these steps. Keep using this problem-solving approach and it’ll get easier.

Section 12 of 12

Keep using the techniques from this guide – they’ll continue to help you. It’s important not to fall into old habits or forget how to use this problem-solving approach.

Remember that the problems you work on using these techniques don’t have to be big or life-changing – they can be day-to-day issues, or even decisions you need to make as part of work or study. The more you practice, the easier problem-solving will be.

Further help

If you’re feeling distressed, in a state of despair, suicidal or need emotional support you can phone NHS 24 on 111.

If you feel you need more help with your mental health, try speaking to your GP, or  search for mental health and wellbeing services in your area .

For information and advice when you’re feeling down, you can phone  Breathing Space  on 0800 83 85 87.

The Breathing Space phoneline is available:

• 24 hours at weekends (6pm Friday to 6am Monday)
• 6pm to 2am on weekdays (Monday to Thursday)

If you found this guide helpful and would like to do more work like this,  Living Life  offers a range of structured psychological interventions and therapies to improve mental health and wellbeing. This service is appointment-based and specifically for low mood, or mild/moderate depression or anxiety. Living Life are open Monday to Friday, from 1pm to 9pm, and you can phone them on 0800 328 9655 for an assessment appointment.

To learn more about coping with mental health issues,  visit our other mental health self-help guides on NHS inform .

For information that could help solve problems related to your health,  visit our Care, Support and Rights section .

To find services in your area that could help with a range of health and wellbeing issues, visit  Scotland’s Service Directory .

Section 1 of 17

This guide aims to help you:

• find out if you could have symptoms of depression
• understand more about depression
• find ways to manage or overcome depression

How to use the depression self-help guide

Work through the guide on your device, using the "Next" button to move forward and use the "Previous" button instead of the Back button in your browser. To type in a graphic or diary, click or tap the part you’d like to fill in and use your keyboard as usual.

Last updated: 27 May 2021

Section 2 of 17

2. Symptoms of depression

Section 3 of 17

3. Symptoms of depression

Last updated: 3 July 2024

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• Feedback form accs-scale.co.uk Download Primary Link
• Website accs-scale.co.uk Download Primary Link

Case Conceptualization / Case Formulation

• Cognitive conceptualisation (excerpt from Basics and Beyond) | J. Beck Download Archived Link
• Dysfunctional assumptions ideas Download Primary Link Archived Link
• Developing a cognitive formulation | Michael Free Download Primary Link Archived Link
• Case formulation in CBT | Caleb Lack Download Primary Link Archived Link
• A case formulation approach to cognitive-behavior therapy | Jacqueline Persons | 2015 Download Primary Link Archived Link
• The case formulation approach to cognitive behavior therapy | Jacqueline Persons | 2014 Download Primary Link Archived Link

Information (Professional)

• Cognitive- behavioural therapy An information guide | Neil Rector | 2010 Download Primary Link Archived Link
• A therapist’s guide to brief cognitive behavioral therapy | Cully, Teten | 2008 Download Primary Link Archived Link
• Problem solving (OCT Practical Guides | Helen Kennerley | 2016 Download Primary Link Archived Link
• Working with Schemas, Core Beliefs, and Assumptions | Frank Wills | 2008 Download Primary Link Archived Link

Presentations

• The role of a case conceptualization model and core tasks of intervention | Donald Miechenbaum | 2014 Download Primary Link Archived Link
• Transdiagnostic treatments for anxiety disorders | Martin Anthony | 2013 Download Primary Link Archived Link
• The unified protocol for the transdiagnostic treatment of emotional disorders | Ellen Frank, Fiona Ritchey | 2015 Download Primary Link Archived Link
• Making CBT Work (Working with your CBT therapist / Making your CBT therapist work with you) | Paul Salkovskis Download Archived Link

Treatment Guide

• A manual of cognitive behavior therapy for people with learning disabilities and common mental disorders | Hassiotis, Serfaty, Azam, Martin, Strydom, King | 2012 Download Primary Link Archived Link
• CBT case formulation | Jacqueline Persons Download Primary Link
• Cognitive Interpersonal Cycle Worksheet | Stirling Moorey | 2007 Download Primary Link Archived Link

Recommended Reading

• Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognitive therapy and research, 36(5), 427-440 Download Primary Link
• Schema change processes in cognitive therapy | Padesky | 1994 Download Primary Link Archived Link
• Wright, B., Williams, C., & Garland, A. (2002). Using the Five Areas cognitive–behavioural therapy model with psychiatric patients. Advances in Psychiatric Treatment, 8(4), 307-315. Download Primary Link
• Williams, C., & Garland, A. (2002). Identifying and challenging unhelpful thinking. Advances in Psychiatric Treatment, 8(5), 377-386. Download Primary Link
• Garland, A., Fox, R., & Williams, C. (2002). Overcoming reduced activity and avoidance: a Five Areas approach. Advances in Psychiatric Treatment, 8(6), 453-462. Download Primary Link
• Williams, C., & Garland, A. (2002). A cognitive–behavioural therapy assessment model for use in everyday clinical practice. Advances in Psychiatric Treatment, 8(3), 172-179. Download Primary Link
• A provider’s guide to brief cognitive behavioral therapy | Cully, Dawson, Hamer, Tharp | 2021 Download Primary Link Archived Link
• Padesky, C. A., Mooney, K. A. (1990). Clinical tip: presenting the cognitive model to clients. International Cognitive Therapy Newsletter, 6, 13-14 Download Primary Link Archived Link
• Arch, J. J., & Craske, M. G. (2009). First-line treatment: a critical appraisal of cognitive behavioral therapy developments and alternatives. Psychiatric Clinics of North America, 32(3), 525-547 Download Primary Link Archived Link

What Is Cognitive Behavioral Therapy?

Assumptions of cbt.

• people actively process information;
• our appraisals (the way that we think and interpret events) determine how we feel;
• dysfunctional thinking and biases in information processing (cognition/​thinking) are responsible for the problems that people experience;
• different problems are associated with different cognitive themes (cognitive specificity theory): depression is associated with loss and defeat; anxiety is associated with danger and threat; obsessive-compulsive disorder is associated with inflated responsibility; substance abuse is associated with permissive beliefs; eating disorders are associated with self-criticism; social anxiety is associated with fear of evaluation; and PTSD is associated with appraisals of immediate threat;
• the thoughts that we have can be ‘distorted’ or biased . Common biases include over-generalization, arbitrary inference, selective abstraction, and catastrophizing;
• changing how we think and act will impact how we feel: cognition, emotion, and behavior interact in a reciprocal manner;
• psychopathology is a result of an interaction between stress and vulnerability;
• cognition happens at multiple levels (Alford & Beck, 1997) and all can influence the way that we feel and behave: preconscious, unintentional, automatic (e.g., negative automatic thoughts); the conscious level (e.g., if a patient is asked to explain the meaning of an automatic thought); and the metacognitive level (beliefs about beliefs);
• experiences, memories, thoughts, attitudes, and beliefs are encapsulated as ‘schemas’ and which may become activated and influence our perceptions and behaviors.

Principles of CBT

Judith Beck (1995) identified 11 principles of the practice of cognitive behavioral therapy, and these were expanded by Wills (2009):

• cognitive behavioral therapists use formulation to focus their therapeutic work
• cognitive behavioral therapists use formulation to tackle interpersonal and alliance issues
• cognitive behavioral therapy requires a sound therapeutic relationship
• cognitive behavioral therapists stress the importance of collaboration in the therapeutic relationship
• cognitive behavioral therapy is brief and time-limited
• cognitive behavioral therapy is structured and directional
• cognitive behavioral therapy is problem- and goal-oriented
• cognitive behavioral therapy initially emphasizes a focus on the present
• cognitive behavioral therapy uses an educational model
• homework and self-practice is a central feature of cognitive behavioral therapy (incorporating the use of CBT worksheets)
• cognitive behavioral therapists teach clients to evaluate and modify their thoughts
• cognitive behavioral therapy uses various methods to change cognitive content including thought records, behavioral experiments, surveys
• cognitive behavior therapy uses a variety of methods to promote behavioral change including exposure, behavioral experiments, role-play.

Procedures and Techniques of CBT

• Data gathering and symptom monitoring   are used to understand problems and to measure change. CBT is an evidence-based approach that relies upon accurate data gathering regarding symptoms and experiences.
• Behavioral activation   is a set of techniques for encouraging engagement in meaningful activity and is an effective treatment for depression.
• Case formulation   is a method for understanding the origin and maintenance of a problem in cognitive and behavioral terms. CBT therapists may use a mixture of cross-sectional formulation to understand difficulties in the here-and-now, longitudinal formulation to understand the origins and precipitants of a problem, and cognitive behavioral models to understand the mechanisms underlying a problem.
• Cognitive restructuring   describes techniques for changing what we think. It often involves the use of thought records, behavioral experiments, data gathering, or psychoeducation.
• Exposure   is a technique from behavior therapy that is extensively used by CBT therapists, particularly for the treatment of anxiety. ‘Facing your fears’ is an essential behavioral component of CBT.
• Problem solving   describes a series of techniques that are often taught as part of a CBT intervention. Effective problem solving helps people to make adaptive choices.
• Socratic methods are used by CBT therapists to help their clients explore what they know, and to form their own opinions on a topic. Aaron Beck encouraged the use of Socratic-like technique in his original treatment manual “use questioning rather than disputation and indoctrination … it is important to try to elicit from the patient what he is thinking rather than telling the patient what the therapist believes he is thinking” (Beck et al, 1979).
• Alford, B. A., & Beck, A. T. (1997). The relation of psychotherapy integration to the established systems of psychotherapy.  Journal of psychotherapy integration ,  7 (4), 275-289.
• Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression . New York: Guilford.
• Beck, J. S. (1995). Cognitive therapy: Basics and beyond . New York: Guilford.
• Wills, F. (2009). Beck’s cognitive therapy . CBT Distinctive Features Series. New York: Routledge.
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What is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is a form of psychological treatment that has been demonstrated to be effective for a range of problems including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness. Numerous research studies suggest that CBT leads to significant improvement in functioning and quality of life. In many studies, CBT has been demonstrated to be as effective as, or more effective than, other forms of psychological therapy or psychiatric medications.

It is important to emphasize that advances in CBT have been made on the basis of both research and clinical practice. Indeed, CBT is an approach for which there is ample scientific evidence that the methods that have been developed actually produce change. In this manner, CBT differs from many other forms of psychological treatment.

CBT is based on several core principles, including:

• Psychological problems are based, in part, on faulty or unhelpful ways of thinking.
• Psychological problems are based, in part, on learned patterns of unhelpful behavior.
• People suffering from psychological problems can learn better ways of coping with them, thereby relieving their symptoms and becoming more effective in their lives.

CBT treatment usually involves efforts to change thinking patterns. These strategies might include:

• Learning to recognize one’s distortions in thinking that are creating problems, and then to reevaluate them in light of reality.
• Gaining a better understanding of the behavior and motivation of others.
• Using problem-solving skills to cope with difficult situations.
• Learning to develop a greater sense of confidence in one’s own abilities.

CBT treatment also usually involves efforts to change behavioral patterns. These strategies might include:

• Facing one’s fears instead of avoiding them.
• Using role playing to prepare for potentially problematic interactions with others.
• Learning to calm one’s mind and relax one’s body.

Not all CBT will use all of these strategies. Rather, the psychologist and patient/client work together, in a collaborative fashion, to develop an understanding of the problem and to develop a treatment strategy.

CBT places an emphasis on helping individuals learn to be their own therapists. Through exercises in the session as well as “homework” exercises outside of sessions, patients/clients are helped to develop coping skills, whereby they can learn to change their own thinking, problematic emotions, and behavior.

CBT therapists emphasize what is going on in the person’s current life, rather than what has led up to their difficulties. A certain amount of information about one’s history is needed, but the focus is primarily on moving forward in time to develop more effective ways of coping with life.

Source: APA Div. 12 (Society of Clinical Psychology)

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What Is Problem-Solving Therapy?

Verywell / Madelyn Goodnight

Problem-Solving Therapy Techniques

How effective is problem-solving therapy, things to consider, how to get started.

Problem-solving therapy is a brief intervention that provides people with the tools they need to identify and solve problems that arise from big and small life stressors. It aims to improve your overall quality of life and reduce the negative impact of psychological and physical illness.

Problem-solving therapy can be used to treat depression , among other conditions. It can be administered by a doctor or mental health professional and may be combined with other treatment approaches.

At a Glance

Problem-solving therapy is a short-term treatment used to help people who are experiencing depression, stress, PTSD, self-harm, suicidal ideation, and other mental health problems develop the tools they need to deal with challenges. This approach teaches people to identify problems, generate solutions, and implement those solutions. Let's take a closer look at how problem-solving therapy can help people be more resilient and adaptive in the face of stress.

Problem-solving therapy is based on a model that takes into account the importance of real-life problem-solving. In other words, the key to managing the impact of stressful life events is to know how to address issues as they arise. Problem-solving therapy is very practical in its approach and is only concerned with the present, rather than delving into your past.

This form of therapy can take place one-on-one or in a group format and may be offered in person or online via telehealth . Sessions can be anywhere from 30 minutes to two hours long. 

Key Components

There are two major components that make up the problem-solving therapy framework:

• Applying a positive problem-solving orientation to your life
• Using problem-solving skills

A positive problem-solving orientation means viewing things in an optimistic light, embracing self-efficacy , and accepting the idea that problems are a normal part of life. Problem-solving skills are behaviors that you can rely on to help you navigate conflict, even during times of stress. This includes skills like:

• Knowing how to identify a problem
• Defining the problem in a helpful way
• Trying to understand the problem more deeply
• Setting goals related to the problem
• Generating alternative, creative solutions to the problem
• Choosing the best course of action
• Implementing the choice you have made
• Evaluating the outcome to determine next steps

Problem-solving therapy is all about training you to become adaptive in your life so that you will start to see problems as challenges to be solved instead of insurmountable obstacles. It also means that you will recognize the action that is required to engage in effective problem-solving techniques.

Planful Problem-Solving

One problem-solving technique, called planful problem-solving, involves following a series of steps to fix issues in a healthy, constructive way:

• Problem definition and formulation : This step involves identifying the real-life problem that needs to be solved and formulating it in a way that allows you to generate potential solutions.
• Generation of alternative solutions : This stage involves coming up with various potential solutions to the problem at hand. The goal in this step is to brainstorm options to creatively address the life stressor in ways that you may not have previously considered.
• Decision-making strategies : This stage involves discussing different strategies for making decisions as well as identifying obstacles that may get in the way of solving the problem at hand.
• Solution implementation and verification : This stage involves implementing a chosen solution and then verifying whether it was effective in addressing the problem.

Other Techniques

Other techniques your therapist may go over include:

• Problem-solving multitasking , which helps you learn to think clearly and solve problems effectively even during times of stress
• Stop, slow down, think, and act (SSTA) , which is meant to encourage you to become more emotionally mindful when faced with conflict
• Healthy thinking and imagery , which teaches you how to embrace more positive self-talk while problem-solving

What Problem-Solving Therapy Can Help With

Problem-solving therapy addresses life stress issues and focuses on helping you find solutions to concrete issues. This approach can be applied to problems associated with various psychological and physiological symptoms.

Mental Health Issues

Problem-solving therapy may help address mental health issues, like:

• Chronic stress due to accumulating minor issues
• Complications associated with traumatic brain injury (TBI)
• Emotional distress
• Post-traumatic stress disorder (PTSD)
• Problems associated with a chronic disease like cancer, heart disease, or diabetes
• Self-harm and feelings of hopelessness
• Substance use
• Suicidal ideation

Specific Life Challenges

This form of therapy is also helpful for dealing with specific life problems, such as:

• Death of a loved one
• Dissatisfaction at work
• Everyday life stressors
• Family problems
• Financial difficulties
• Relationship conflicts

Your doctor or mental healthcare professional will be able to advise whether problem-solving therapy could be helpful for your particular issue. In general, if you are struggling with specific, concrete problems that you are having trouble finding solutions for, problem-solving therapy could be helpful for you.

Benefits of Problem-Solving Therapy

The skills learned in problem-solving therapy can be helpful for managing all areas of your life. These can include:

• Being able to identify which stressors trigger your negative emotions (e.g., sadness, anger)
• Confidence that you can handle problems that you face
• Having a systematic approach on how to deal with life's problems
• Having a toolbox of strategies to solve the issues you face
• Increased confidence to find creative solutions
• Knowing how to identify which barriers will impede your progress
• Knowing how to manage emotions when they arise
• Reduced avoidance and increased action-taking
• The ability to accept life problems that can't be solved
• The ability to make effective decisions
• The development of patience (realizing that not all problems have a "quick fix")

Problem-solving therapy can help people feel more empowered to deal with the problems they face in their lives. Rather than feeling overwhelmed when stressors begin to take a toll, this therapy introduces new coping skills that can boost self-efficacy and resilience .

Other Types of Therapy

Other similar types of therapy include cognitive-behavioral therapy (CBT) and solution-focused brief therapy (SFBT) . While these therapies work to change thinking and behaviors, they work a bit differently. Both CBT and SFBT are less structured than problem-solving therapy and may focus on broader issues. CBT focuses on identifying and changing maladaptive thoughts, and SFBT works to help people look for solutions and build self-efficacy based on strengths.

This form of therapy was initially developed to help people combat stress through effective problem-solving, and it was later adapted to address clinical depression specifically. Today, much of the research on problem-solving therapy deals with its effectiveness in treating depression.

Problem-solving therapy has been shown to help depression in: 

• Older adults
• People coping with serious illnesses like cancer

Problem-solving therapy also appears to be effective as a brief treatment for depression, offering benefits in as little as six to eight sessions with a therapist or another healthcare professional. This may make it a good option for someone unable to commit to a lengthier treatment for depression.

Problem-solving therapy is not a good fit for everyone. It may not be effective at addressing issues that don't have clear solutions, like seeking meaning or purpose in life. Problem-solving therapy is also intended to treat specific problems, not general habits or thought patterns .

In general, it's also important to remember that problem-solving therapy is not a primary treatment for mental disorders. If you are living with the symptoms of a serious mental illness such as bipolar disorder or schizophrenia , you may need additional treatment with evidence-based approaches for your particular concern.

Problem-solving therapy is best aimed at someone who has a mental or physical issue that is being treated separately, but who also has life issues that go along with that problem that has yet to be addressed.

For example, it could help if you can't clean your house or pay your bills because of your depression, or if a cancer diagnosis is interfering with your quality of life.

Your doctor may be able to recommend therapists in your area who utilize this approach, or they may offer it themselves as part of their practice. You can also search for a problem-solving therapist with help from the American Psychological Association’s (APA) Society of Clinical Psychology .

If receiving problem-solving therapy from a doctor or mental healthcare professional is not an option for you, you could also consider implementing it as a self-help strategy using a workbook designed to help you learn problem-solving skills on your own.

During your first session, your therapist may spend some time explaining their process and approach. They may ask you to identify the problem you’re currently facing, and they’ll likely discuss your goals for therapy .

Keep In Mind

Problem-solving therapy may be a short-term intervention that's focused on solving a specific issue in your life. If you need further help with something more pervasive, it can also become a longer-term treatment option.

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Shang P, Cao X, You S, Feng X, Li N, Jia Y. Problem-solving therapy for major depressive disorders in older adults: an updated systematic review and meta-analysis of randomized controlled trials .  Aging Clin Exp Res . 2021;33(6):1465-1475. doi:10.1007/s40520-020-01672-3

Cuijpers P, Wit L de, Kleiboer A, Karyotaki E, Ebert DD. Problem-solving therapy for adult depression: An updated meta-analysis . Eur Psychiatry . 2018;48(1):27-37. doi:10.1016/j.eurpsy.2017.11.006

Nezu AM, Nezu CM, D'Zurilla TJ. Problem-Solving Therapy: A Treatment Manual . New York; 2013. doi:10.1891/9780826109415.0001

Owens D, Wright-Hughes A, Graham L, et al. Problem-solving therapy rather than treatment as usual for adults after self-harm: a pragmatic, feasibility, randomised controlled trial (the MIDSHIPS trial) .  Pilot Feasibility Stud . 2020;6:119. doi:10.1186/s40814-020-00668-0

Sorsdahl K, Stein DJ, Corrigall J, et al. The efficacy of a blended motivational interviewing and problem solving therapy intervention to reduce substance use among patients presenting for emergency services in South Africa: A randomized controlled trial . Subst Abuse Treat Prev Policy . 2015;10(1):46. doi:doi.org/10.1186/s13011-015-0042-1

Margolis SA, Osborne P, Gonzalez JS. Problem solving . In: Gellman MD, ed. Encyclopedia of Behavioral Medicine . Springer International Publishing; 2020:1745-1747. doi:10.1007/978-3-030-39903-0_208

Kirkham JG, Choi N, Seitz DP. Meta-analysis of problem solving therapy for the treatment of major depressive disorder in older adults . Int J Geriatr Psychiatry . 2016;31(5):526-535. doi:10.1002/gps.4358

Garand L, Rinaldo DE, Alberth MM, et al. Effects of problem solving therapy on mental health outcomes in family caregivers of persons with a new diagnosis of mild cognitive impairment or early dementia: A randomized controlled trial . Am J Geriatr Psychiatry . 2014;22(8):771-781. doi:10.1016/j.jagp.2013.07.007

Noyes K, Zapf AL, Depner RM, et al. Problem-solving skills training in adult cancer survivors: Bright IDEAS-AC pilot study .  Cancer Treat Res Commun . 2022;31:100552. doi:10.1016/j.ctarc.2022.100552

Albert SM, King J, Anderson S, et al. Depression agency-based collaborative: effect of problem-solving therapy on risk of common mental disorders in older adults with home care needs . The American Journal of Geriatric Psychiatry . 2019;27(6):619-624. doi:10.1016/j.jagp.2019.01.002

By Arlin Cuncic, MA Arlin Cuncic, MA, is the author of The Anxiety Workbook and founder of the website About Social Anxiety. She has a Master's degree in clinical psychology.

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Problem-Solving Therapy: How It Works & What to Expect

Author: Lydia Antonatos, LMHC

Lydia Angelica Antonatos LMHC

Lydia has over 16 years of experience and specializes in mood disorders, anxiety, and more. She offers personalized, solution-focused therapy to empower clients on their journey to well-being.

Problem-solving therapy (PST) is an intervention with cognitive and behavioral influences used to assist individuals in managing life problems. Therapists help clients learn effective skills to address their issues directly and make positive changes. PST is used in various settings to address mental health concerns such as depression, anxiety, and more.

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What Is Problem-Solving Therapy?

Problem-solving therapy (PST) is based on a model that the body, mind, and environment all interact with each other and that life stress can interact with a person’s predisposition for developing a mental condition. 2 Within this context, PST contends that mental, emotional, and behavioral struggles stem from an ongoing inability to solve problems or deal with everyday stressors. Therefore, the key to preventing health consequences and improving quality of life is to become a better problem-solver. 3 , 4

The problem-solving model has undergone several revisions but upholds the value of teaching people to become better problem-solvers. Overall, the goal of PST is to provide individuals with a set of rational problem-solving tools to reduce the impact of stress on their well-being.

The two main components of problem-solving therapy include: 3 , 4

• Problem-solving orientation: This focuses on helping individuals adopt an optimistic outlook and see problems as opportunities to learn from, allowing them to believe they can solve problems.
• Problem-solving style: This component aims to provide people with constructive problem-solving tools to deal with different life stressors by identifying the problem, generating/brainstorming solution ideas, choosing a specific option, and implementing and reviewing it.

Techniques Used in Problem-Solving Therapy

PST emphasizes the client, and the techniques used are merely conduits that facilitate the problem-solving learning process. Generally, the individual, in collaboration and support from the clinician, leads the problem-solving work. Thus, a strong therapeutic alliance sets the foundation for encouraging clients to apply these skills outside therapy sessions. 4

Here are some of the most relevant guidelines and techniques used in problem-solving therapy:

Creating Collaboration

As with other psychotherapies, creating a collaborative environment and a healthy therapist-client relationship is essential in PST. The role of a therapist is to cultivate this bond by conveying a genuine sense of commitment to the client while displaying kindness, using active listening skills, and providing support. The purpose is to build a meaningful balance between being an active and directive clinician while delivering a feeling of optimism to encourage the client’s participation.

This tool is used in all psychotherapies and is just as essential in PST. Assessment seeks to gather facts and information about current problems and contributing stressors and evaluates a client’s appropriateness for PST. The problem-solving therapy assessment also examines a person’s immediate issues, problem-solving attitudes, and abilities, including their strengths and limitations. This sets the groundwork for developing an individualized problem-solving plan.

Psychoeducation

Psychoeducation is an integral component of problem-solving therapy and is used throughout treatment. The purpose of psychoeducation is to provide a client with the rationale for problem-solving therapy, including an explanation for each step involved in the treatment plan. Moreover, the individual is educated about mental health symptoms and taught solution-oriented strategies and communication skills.

This technique involves verbal prompting, like asking leading questions, giving suggestions, and providing guidance. For example, the therapist may prompt a client to brainstorm or consider alternatives, or they may ask about times when a certain skill was used to solve a problem during a difficult situation. Coaching can be beneficial when clients struggle with eliciting solutions on their own.

Shaping intervention refers to teaching new skills and building on them as the person gradually improves the quality of each skill. Shaping works by reinforcing the desired problem-solving behavior and adding perspective as the individual gets closer to their intended goal.

In problem-solving therapy, modeling is a method in which a person learns by observing. It can include written/verbal problem-solving illustrations or demonstrations performed by the clinician in hypothetical or real-life situations. A client can learn effective problem-solving skills via role-play exercises, live demonstrations, or short-film presentations. This allows individuals to imitate observed problem-solving skills in their own lives and apply them to specific problems.

Rehearsal & Practice

These techniques provide opportunities to practice problem-solving exercises and engage in homework assignments. This may involve role-playing during therapy sessions, practicing with real-life issues, or imaginary rehearsal where individuals visualize themselves carrying out a solution. Furthermore, homework exercises are an important aspect when learning a new skill. Ongoing practice is strongly encouraged throughout treatment so a client can effectively use these techniques when faced with a problem.

Positive Reinforcement & Feedback

The therapist’s task in this intervention is to provide support and encouragement for efforts to apply various problem-solving skills. The goal is for the client to continue using more adaptive behaviors, even if they do not get it right the first time. Then, the therapist provides feedback so the client can explore barriers encountered and generate alternate solutions by weighing the pros and cons to continue working toward a specific goal.

Use of Analogies & Metaphors

When appropriate, analogies and metaphors can be useful in providing the client with a clearer vision or a better understanding of specific concepts. For example, the therapist may use diverse skills or points of reference (e.g., cooking, driving, sports) to explain the problem-solving process and find solutions to convey that time and practice are required before mastering a particular skill.

What Can Problem-Solving Therapy Help With?

Although problem-solving therapy was initially developed to treat depression among primary care patients, PST has expanded to address or rehabilitate other psychological problems, including anxiety , post-traumatic stress disorder , personality disorders , and more.

PST theory asserts that vulnerable populations can benefit from receiving constructive problem-solving tools in a therapeutic relationship to increase resiliency and prevent emotional setbacks or behaviors with destructive results like suicide. It is worth noting that in severe psychiatric cases, PST can be effectively used when integrated with other mental health interventions. 3 , 4

PST can help individuals challenged with specific issues who have difficulty finding solutions or ways to cope. These issues can involve a wide range of incidents, such as the death of a loved one, divorce, stress related to a chronic medical diagnosis, financial stress , marital difficulties, or tension at work.

Through the problem-solving approach, mental and emotional distress can be reduced by helping individuals break down problems into smaller pieces that are easier to manage and cope with. However, this can only occur as long the person being treated is open to learning and able to value the therapeutic process. 3 , 4

Lastly, a large body of evidence has indicated that PST can positively impact mental health, quality of life, and problem-solving skills in older adults. PST is an approach that can be implemented by different types of practitioners and settings (in-home care services, telemedicine, etc.), making mental health treatment accessible to the elderly population who often face age-related barriers and comorbid health issues. 1 , 5, 6

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Problem-Solving Therapy Examples

Due to the versatility of problem-solving therapy, PST can be used in different forms, settings, and formats. Following are some examples where the problem-solving therapeutic approach can be used effectively. 4

People who suffer from depression often evade or even attempt to ignore their problems because of their state of mind and symptoms. PST incorporates techniques that encourage individuals to adopt a positive outlook on issues and motivate individuals to tap into their coping resources and apply healthy problem-solving skills. Through psychoeducation, individuals can learn to identify and understand their emotions influence problems. Employing rehearsal exercises, someone can practice adaptive responses to problematic situations. Once the depressed person begins to solve problems, symptoms are reduced, and mood is improved.

The Veterans Health Administration presently employs problem-solving therapy as a preventive approach in numerous medical centers across the United States. These programs aim to help veterans adjust to civilian life by teaching them how to apply different problem-solving strategies to difficult situations. The ultimate objective is that such individuals are at a lower risk of experiencing mental health issues and consequently need less medical and/or psychiatric care.

Psychiatric Patients

PST is considered highly effective and strongly recommended for individuals with psychiatric conditions. These individuals often struggle with problems of daily living and stressors they feel unable to overcome. These unsolved problems are both the triggering and sustaining reasons for their mental health-related troubles. Therefore, a problem-solving approach can be vital for the treatment of people with psychological issues.

Adherence to Other Treatments

Problem-solving therapy can also be applied to clients undergoing another mental or physical health treatment. In such cases, PST strategies can be used to motivate individuals to stay committed to their treatment plan by discussing the benefits of doing so. PST interventions can also be utilized to assist patients in overcoming emotional distress and other barriers that can interfere with successful compliance and treatment participation.

Benefits of Problem-Solving Therapy

PST is versatile, treating a wide range of problems and conditions, and can be effectively delivered to various populations in different forms and settings—self-help manuals, individual or group therapy, online materials, home-based or primary care settings, as well as inpatient or outpatient treatment.

Here are some of the benefits you can gain from problem-solving therapy:

• Gain a sense of control over your life
• Move toward action-oriented behaviors instead of avoiding your problems
• Gain self-confidence as you improve the ability to make better decisions
• Develop patience by learning that successful problem-solving is a process that requires time and effort
• Feel a sense of empowerment as you solve your problems independently
• Increase your ability to recognize and manage stressful emotions and situations
• Learn to focus on the problems that have a solution and let go of the ones that don’t
• Identify barriers that may hinder your progress

How to Find a Therapist Who Practices Problem-Solving Therapy

Finding a therapist skilled in problem-solving therapy is not any different from finding any qualified mental health professional. This is because many clinicians often have knowledge in cognitive-behavioral interventions that hold similar concepts as PST.

As a general recommendation, check your health insurance provider lists, use an online therapist directory , or ask trusted friends and family if they can recommend a provider. Contact any of these providers and ask questions to determine who is more compatible with your needs. 3 , 4

Are There Special Certifications to Provide PST?

Therapists do not need special certifications to practice problem-solving therapy, but some organizations can provide special training. Problem-solving therapy can be delivered by various healthcare professionals such as psychologists, psychiatrists, physicians, mental health counselors, social workers, and nurses.

Most of these clinicians have naturally acquired valuable problem-solving abilities throughout their career and continuing education. Thus, all that may be required is fine-tuning their skills and familiarity with the current and relevant PST literature. A reasonable amount of understanding and planning will transmit competence and help clients gain insight into the causes that led them to their current situation. 3 , 4

Questions to Ask a Therapist When Considering Problem-Solving Therapy

Psychotherapy is most successful when you feel comfortable and have a collaborative relationship with your therapist. Asking specific questions can simplify choosing a clinician who is right for you. Consider making a list of questions to help you with this task.

Here are some key questions to ask before starting PST:

• Is problem-solving therapy suitable for the struggles I am dealing with?
• Can you tell me about your professional experience with providing problem-solving therapy?
• Have you dealt with other clients who present with similar issues as mine?
• Have you worked with individuals of similar cultural backgrounds as me?
• How do you structure your PST sessions and treatment timeline?
• How long do PST sessions last?
• How many sessions will I need?
• What expectations should I have in working with you from a problem-solving therapeutic stance?
• What expectations are required from me throughout treatment?
• Does my insurance cover PST? If not, what are your fees?
• What is your cancellation policy?

How Much Does Problem-Solving Therapy Cost?

The cost of problem-solving therapy can range from $25 to $150 depending on the number of sessions required, severity of symptoms, type of practice, geographic location, and provider’s experience level. However, if your insurance provider covers behavioral health, the out-of-pocket costs per session may be much lower. Medicare supports PST through professionally trained general health practitioners. 1

What to Expect at Your First PST Session

During the first session, the therapist will strive to build a connection and become familiar with you. You will be assessed through a clinical interview and/or questionnaires. During this process, the therapist will gather your background information, inquire about how you approach life problems, how you typically resolve them, and if problem-solving therapy is a suitable treatment for you. 3 , 4

Additionally, you will be provided psychoeducation relating to your symptoms, the problem-solving method and its effectiveness, and your treatment goals. The clinician will likely guide you through generating a list of the current problems you are experiencing, selecting one to focus on, and identifying concrete steps necessary for effective problem-solving. Lastly, you will be informed about the content, duration, costs, and number of therapy sessions the therapist suggests. 3 , 4

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Is Problem-Solving Therapy Effective?

Extensive research and studies have shown the efficacy of problem-solving therapy. PST can yield significant improvements within a short amount of time. PST is also useful for addressing numerous problems and psychological issues. Lastly, PST has shown its efficacy with different populations and age groups.

One meta-analysis of PST for depression concluded that problem-solving therapy was as efficient for reducing symptoms of depression as other types of psychotherapies and antidepressant medication. Furthermore, PST was significantly more effective than not receiving any treatment. 7 However, more investigation may be necessary about PST’s long-term efficacy in comparison to other treatments. 5,6

How Is PST Different From CBT & SFT?

Problem-solving, cognitive-behavioral, and solution-focused therapy belong to the cognitive-behavioral framework, sharing a common goal to modify thoughts, aptitudes, and behaviors to improve mental health and quality of life.

Problem-Solving Therapy Vs. Cognitive-Behavioral Therapy

Cognitive behavioral therapy (CBT) is a short-term psychosocial treatment developed under the premise that how we think affects how we feel and behave. CBT addresses problems arising from maladaptive thought patterns and seeks to challenge and modify these to improve behavioral responses and overall well-being. CBT is the most researched approach and preferred treatment in psychotherapy due to its effectiveness in addressing various problems like anxiety, sleep disorders, substance abuse, and more.

Like CBT, PST addresses mental, emotional, and behavioral issues. However, PST may provide a better balance of cognitive and behavioral elements.

Another difference between these two approaches is that PST mostly focuses on faulty thoughts about problem-solving orientation and modifying maladaptive behaviors that specifically interfere with effective problem-solving. Usually, PST is used as an integrated approach and applied as one of several other interventions in CBT psychotherapy sessions.

Problem-Solving Therapy Vs. Solution-Focused Therapy

Solution-focused therapy (SFT) , like PST, is a goal-directed, evidence-based brief therapeutic approach that encourages optimism, options, and self-efficacy. Similarly, it is also grounded on cognitive behavioral principles. However, it differs from problem-solving therapy because SFT is a semi-structured approach that does not follow a step-by-step sequential format. 8

SFT mainly focuses on solution-building rather than problem-solving, specifically looking at a person’s strengths and previous successes. SFT helps people recognize how their lives would differ without problems by exploring their current coping skills. Community mental health, inpatient settings, and educational environments are increasing the use of SFT due to its demonstrated efficacy. 8

Final Thoughts

Problem-solving therapy can be an effective treatment for various mental health concerns. If you are considering treatment, ask your doctor for recommendations or conduct your own research to learn more about this approach and other options available.

Additional Resources

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For Further Reading

• 12 Strategies to Stop Using Unhealthy Coping Mechanisms
• Depression Therapy: 4 Effective Options to Consider
• CBT for Depression: How It Works, Examples, & Effectiveness

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Best Online Psychiatry Services

Online psychiatry, sometimes called telepsychiatry, platforms offer medication management by phone, video, or secure messaging for a variety of mental health conditions. In some cases, online psychiatry may be more affordable than seeing an in-person provider. Mental health treatment has expanded to include many online psychiatry and therapy services. With so many choices, it can feel overwhelming to find the one that is right for you.

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Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy .

Beaudreau, S. A., Gould, C. E., Sakai, E., & Terri Huh, J. W. (2017). Problem-Solving Therapy. In N. A. Pachana (Ed.), Encyclopedia of geropsychology : with 148 figures and 100 tables . Singapore: Springer.

Broerman, R. (2018). Diathesis-Stress Model. In T. Shackleford & V. Zeigler-Hill (Eds.), Encyclopedia of Personality and Individual Differences (Living Edition, pp. 1–3). Springer, Cham. https://doi.org/10.1007/978-3-319-28099-8_891-1

Mehmet Eskin. (2013). Problem solving therapy in the clinical practice . Elsevier.

Nezu, A. M., Nezu, C. M., & D’Zurilla, T. J. (2013). Problem-Solving Therapy A Treatment Manual . Springer Publishing Company.

Cuijpers, P., et al. (2018). Problem-solving therapy for adult depression: An updated meta-analysis. European Psychiatry   48 , 27–37. https://doi.org/10.1016/j.eurpsy.2017.11.006

Kirkham, J. G., Choi, N., & Seitz, D. P. (2015). Meta-analysis of problem-solving therapy for the treatment of major depressive disorder in older adults. International Journal of Geriatric Psychiatry , 31 (5), 526–535. https://doi.org/10.1002/gps.4358

Bell, A. C., & D’Zurilla, T. J. (2009). Problem-solving therapy for depression: A meta-analysis. Clinical Psychology Review , 29 (4), 348–353. https://doi.org/10.1016/j.cpr.2009.02.003

Proudlock, S. (2017). The Solution Focused Way Incorporating Solution Focused Therapy Tools and Techniques into Your Everyday Work . Routledge.

Nezu, A. M., Nezu, C. M., & Gerber, H. R. (2019). (Emotion‐centered) problem‐solving therapy: An update. Australian Psychologist , 54 (5), 361–371. https://doi.org/10.1111/ap.12418

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What Is Cognitive Behavioral Therapy?

Cristina Mutchler is a Peabody award-winning journalist, specializing in health and wellness content for over a decade.

Cognitive behavioral therapy (CBT)—often known as the "gold standard" psychotherapy—is one of the most common types of therapy that mental health professionals use to treat people with a variety of health conditions.

The concept of CBT is grounded in the theory that your thoughts and behaviors can affect your emotional well-being and physical health. As a result, the goal of CBT is to identify negative or disruptive thinking patterns and replace them with healthier thoughts and emotions.

How Does CBT Work?

Cognitive behavioral therapy is based on the premise that your thoughts or perceptions about a situation—rather than just the situation itself—determine the way you feel and behave. These thought or belief patterns are often learned from your past experiences.

Some of the core beliefs and principles of CBT include:

• Negative or harmful thought patterns can cause changes in your mental health
• Unhelpful behaviors can contribute to psychological issues
• Changing disruptive patterns can improve your emotional well-being and relieve symptoms

The purpose of CBT is to help identify thoughts and behaviors that may be negatively affecting your life. However, just recognizing these patterns is not enough. Instead, CBT works to restructure unhelpful thoughts and behaviors into positive and healthier patterns.

For example, this might involve recognizing a thought pattern such as "I can't handle the pain anymore" and changing it to "I've handled pain before and I can handle it again." The purpose of CBT is not to rid or remove problems or worries from your life. Instead, it's to reframe the outlook on how you manage your life's situations and circumstances, which may then help change your behaviors and overall health and well-being.

Cognitive Behavioral Therapy Techniques

Your CBT sessions with a mental health professional (e.g., psychologist, social worker, licensed counselor) can vary based on your condition, symptoms, and needs. While everyone's experience with CBT can differ, it's important to note that therapy sessions are typically very structured. You can usually expect to complete an average of 10 to 20 sessions with your therapist.

CBT is considered to be short-term therapy. However, the process is very interactive. During your sessions, your therapist may utilize a variety of CBT techniques that help them learn more about your needs, support you in understanding your current thoughts and behaviors, and try skills or activities that can help you change harmful patterns into healthy ones.

Some CBT strategies that your therapist may use include:

• Using introspection techniques to help you reflect on your internal thoughts and identify negative patterns
• Implementing problem-solving skills to cope with difficult situations
• Practicing facing your fears rather than avoiding them
• Trying role-playing scenarios to walk through real-life situations and creating options that can help you manage triggers or problems
• Showing you mind-body relaxation techniques that can help you become more in tune with your thinking
• Teaching you goal-setting techniques that actively help improve your thinking, behavior, and health outcomes
• Encouraging you to self-monitor yourself by making note of your thoughts throughout the day and tracking your daily behaviors
• Assigning you minimal homework (e.g., journaling, breathing exercises, etc). to complete outside of your therapy sessions to help you put into practice what you're learning

Who Does CBT Help?

CBT is often the first line of therapy for several health conditions. Research has shown CBT to be effective for children and adults who live with the following conditions:

• Anxiety or panic attacks
• Eating disorders
• Obsessive-compulsive disorder
• Substance use disorders
• Bipolar disorder
• Personality disorders
• Schizophrenia
• Post-traumatic stress disorder
• Fibromyalgia
• Irritable bowel syndrome

However, CBT is not just a good treatment for diagnosed health conditions. In fact, CBT can help you with daily stressors, such as:

• Chronic pain
• Relationship problems or divorce
• Grief and loss
• Stress or anger management
• Abandonment or trust issues
• Life changes (e.g., going to college, moving out, starting a new job, getting married)
• Time management and procrastination
• Low self-esteem

Cognitive Behavioral Therapy Benefits

It's worth noting that CBT is one of the most researched forms of psychotherapy, with plenty of scientific evidence backing its effectiveness. That said, the benefits of CBT include:

• Developing a positive outlook and healthier thought patterns
• Reminding you that you don't have to control everything around you, just how you react to life's situations
• Helping you notice improvements in your thinking in a short amount of time
• Being an effective and affordable treatment option in-person and virtually
• Improving your relationship with yourself and others
• Boosting your quality of life

A Quick Review

Cognitive behavioral therapy (CBT) is a form of therapy that mental health professionals can use to treat a wide range of health conditions including anxiety, depression, and insomnia. CBT is based on the concept that your thoughts can affect emotions and behaviors , which can then alter your mental and physical health outcomes.

CBT is one of the most researched therapies and effective treatments for mental health and physical health conditions. Using techniques such as identifying negative thought patterns, challenging behaviors, and practicing problem-solving skills, CBT can help you reframe unhelpful thoughts and cope with life's stressors.

If you're looking to try CBT, talk to your primary care provider about a referral, contact your health insurance to see if therapy is covered under your plan, or sign up for an online service to get paired with a therapist.

González-Prendes A. Cognitive-behavioral therapy and social work values: a critical analysis . J Soc Work Values Ethics. 2012;9(2).

David D, Cristea I, Hofmann SG. Why cognitive behavioral therapy is the current gold standard of psychotherapy . Front Psychiatry . 2018 Jan 29;9:4. doi:10.3389/fpsyt.2018.00004

Chand SP, Kuckel DP, Huecker MR. Cognitive behavior therapy. In: StatPearls . StatPearls Publishing; 2022.

American Psychological Association. What is cognitive behavioral therapy? .

MedlinePlus. Cognitive behavioral therapy for back pain .

National Alliance on Mental Illness. Psychotherapy .

Tang W, Kreindler D. Supporting homework compliance in cognitive behavioural therapy: Essential features of mobile apps . JMIR Ment Health . 2017 Jun 8;4(2):e20. doi:10.2196/mental.5283

Hofmann S, Asmundson GJG, eds. The science of cognitive behavioral therapy . 1st ed. Academic Press; 2017.

Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A.  The efficacy of cognitive behavioral therapy: A review of meta-analyses .  Cognit Ther Res . 2012;36(5):427-440. doi:10.1007/s10608-012-9476-1

Related Articles

Cognitive Behavioral Therapy

Solving problems the cognitive-behavioral way, problem solving is another part of behavioral therapy..

Posted February 2, 2022 | Reviewed by Ekua Hagan

• What Is Cognitive Behavioral Therapy?
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• Find a counsellor who practices CBT
• Problem-solving is one technique used on the behavioral side of cognitive-behavioral therapy.
• The problem-solving technique is an iterative, five-step process that requires one to identify the problem and test different solutions.
• The technique differs from ad-hoc problem-solving in its suspension of judgment and evaluation of each solution.

As I have mentioned in previous posts, cognitive behavioral therapy is more than challenging negative, automatic thoughts. There is a whole behavioral piece of this therapy that focuses on what people do and how to change their actions to support their mental health. In this post, I’ll talk about the problem-solving technique from cognitive behavioral therapy and what makes it unique.

The problem-solving technique

While there are many different variations of this technique, I am going to describe the version I typically use, and which includes the main components of the technique:

The first step is to clearly define the problem. Sometimes, this includes answering a series of questions to make sure the problem is described in detail. Sometimes, the client is able to define the problem pretty clearly on their own. Sometimes, a discussion is needed to clearly outline the problem.

The next step is generating solutions without judgment. The "without judgment" part is crucial: Often when people are solving problems on their own, they will reject each potential solution as soon as they or someone else suggests it. This can lead to feeling helpless and also discarding solutions that would work.

The third step is evaluating the advantages and disadvantages of each solution. This is the step where judgment comes back.

Fourth, the client picks the most feasible solution that is most likely to work and they try it out.

The fifth step is evaluating whether the chosen solution worked, and if not, going back to step two or three to find another option. For step five, enough time has to pass for the solution to have made a difference.

This process is iterative, meaning the client and therapist always go back to the beginning to make sure the problem is resolved and if not, identify what needs to change.

Advantages of the problem-solving technique

The problem-solving technique might differ from ad hoc problem-solving in several ways. The most obvious is the suspension of judgment when coming up with solutions. We sometimes need to withhold judgment and see the solution (or problem) from a different perspective. Deliberately deciding not to judge solutions until later can help trigger that mindset change.

Another difference is the explicit evaluation of whether the solution worked. When people usually try to solve problems, they don’t go back and check whether the solution worked. It’s only if something goes very wrong that they try again. The problem-solving technique specifically includes evaluating the solution.

Lastly, the problem-solving technique starts with a specific definition of the problem instead of just jumping to solutions. To figure out where you are going, you have to know where you are.

One benefit of the cognitive behavioral therapy approach is the behavioral side. The behavioral part of therapy is a wide umbrella that includes problem-solving techniques among other techniques. Accessing multiple techniques means one is more likely to address the client’s main concern.

Salene M. W. Jones, Ph.D., is a clinical psychologist in Washington State.

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Student-centered active learning improves performance in solving higher-level cognitive questions in health sciences education.

Simple Summary

1. introduction, 2. materials and methods, 2.1. study design, 2.2. theoretical lectures, 2.3. informative sessions, 2.4. student surveys, 2.5. learning outcomes assessment, 3.1. learning outcomes assessment, 3.2. survey conducted during the information session on active learning, 3.2.1. academic year 2022/2023.

• 27% of the students had experience with problem-based learning.
• 72% had experienced collaborative learning.
• 27% were familiar with flipped learning.

3.2.2. Academic Year 2023/2024

• Almost all students indicated they had no prior experience with any form of active learning.
• 79% had experience with collaborative learning.
• 56% knew what flipped learning was.
• 10% of the students chose option (a): “Expository teaching, where the teacher tells me everything I need to know”.
• 89% of students chose option (b): “Active teaching, where I learn to think about and use the content I am learning under the guidance of the teacher”.
• 1% of students chose option (c): “I don’t care, I can always be a GoogleVet”.

3.3. Anonymous Survey Conducted at the End of the Thematic Block

3.4. anonymous survey conducted at the end of the experience, 3.5. students attending to discussion session, 4. discussion, 5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, acknowledgments, conflicts of interest.

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Share and Cite

Martín-Alguacil, N.; Avedillo, L. Student-Centered Active Learning Improves Performance in Solving Higher-Level Cognitive Questions in Health Sciences Education. Int. Med. Educ. 2024 , 3 , 346-362. https://doi.org/10.3390/ime3030026

Martín-Alguacil N, Avedillo L. Student-Centered Active Learning Improves Performance in Solving Higher-Level Cognitive Questions in Health Sciences Education. International Medical Education . 2024; 3(3):346-362. https://doi.org/10.3390/ime3030026

Martín-Alguacil, Nieves, and Luis Avedillo. 2024. "Student-Centered Active Learning Improves Performance in Solving Higher-Level Cognitive Questions in Health Sciences Education" International Medical Education 3, no. 3: 346-362. https://doi.org/10.3390/ime3030026

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