SAN ANTONIO – Teaching older adults how to solve some of the challenging problems in their lives can help ease or lift the burden of late-life depression, Patricia A. Areán, Ph.D., reported at the annual meeting of the American Association for Geriatric Psychiatry.
People with poor problem-solving skills might be susceptible to depression, and life problems such as death of a spouse, financial worries, or health concerns such as disability can help trigger depression, said Dr. Areán, a licensed clinical psychologist and professor of psychiatry at the University of California, San Francisco.
But with problem-solving therapy (PST), patients can feel that they are in control of at least some aspect of their lives and work with the therapist to find practical solutions to challenging problems.
Although it is similar to cognitive-behavioral therapy, in PST the therapist focuses on "teaching a set of skills to walk patients through problems they encounter in a systematic way," Dr. Areán said.
PST helps patients better manage their lives. With fewer problems, their self-reliance is enhanced, often leading to increased optimism and improved mood. When patients have learned how to more effectively solve problems, the skills can help to prevent further bouts of depression, she said.
The technique has been shown to be effective among community-dwelling older adults, primary care patients, homebound and disabled elderly, and older adults with treatment-resistant late-life depression. It can be performed in the setting that’s most comfortable or convenient for the patient, whether that’s "on the phone, office, home, Skype, whatever," she said.
Seven steps are essential to PST. The therapist:
• Orients the patient to the therapy and helps clarify and define the problem;
• Helps the patient set realistic goals and expectations;
• Works with the patient to "brainstorm" multiple potential solutions;
• Helps the patient evaluate and compare the proposed solutions;
• Works with the patient to select a feasible solution;
• Helps to implement the solution; and
• Evaluates the outcome.
The program consists of 12 hour-long sessions dedicated to solving a particular problem, reviewing problem-solving skills, and discussing additional problems to solve between sessions. The goal is to enable the patient to eventually solve problems on his or her own.
The first session focuses on socializing the patient to the therapy, discussing depression, giving a broad outline of PST, and providing a therapy frame. The patient and therapist then compile a brief problem list, using a worksheet that allows them to list a problem with 5 to 10 potential solutions, and to weigh the pros and cons of each.
"Start with the easiest problem first," Dr. Areán said. If the patient wants to tell his or her story, the therapist should patiently but firmly direct the discussion back toward the problem at hand.
In the remaining sessions, the patient is asked to consider whether each proposed solution meets immediate and/or long-term goals, might create other problems, and is feasible. The patient can then choose the solution that has the right combination of most pros and fewest cons, is the most workable, and requires the least amount of effort.
The process includes a solution evaluation follow-up to discuss whether the solution worked, and if it did, why. If the solution did not work, then the follow-up discusses what the patient learned, and whether he or she has considered if the problem needs to be redefined.
It also is important that patients take some time during their problem-solving to include pleasant activities and reward for their hard work. The therapist, in turn, should reinforce the patient’s efforts at change, Dr. Areán said.
PST is versatile, with a brief but structured format that lends itself to multiple settings and cultural groups, and can be easily learned by clinicians at PST "hubs" throughout the United States, she concluded.
Dr. Areán reported no conflicts of interest.