What is Problem-Solving Therapy (PST)?

PST is a short-term psychological intervention that teaches patients to handle daily life problems using a six-step structured method. It improves self-efficacy and reduces depressive symptoms.

Who is PST recommended for?

PST is particularly recommended for individuals with mild to moderate depression caused by unresolved real-life issues, including financial stress, family conflict, or chronic illness.

How long does PST last?

PST typically includes 6 to 12 weekly sessions. It is a structured, action-oriented therapy suitable for individual or primary care settings.

Is PST as effective as CBT?

In mild to moderate depression, PST has shown comparable effectiveness to CBT, especially in primary care and low-resource settings.

PST can be delivered by trained psychologists, therapists, and also non-specialist health workers with proper training in structured intervention protocols.

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Problem-Solving Therapy (PST)

Problem-Solving Therapy (PST) is a structured, brief psychological approach originally developed by D’Zurilla and Goldfried in the 1970s to help patients effectively cope with everyday life problems. It is based on the premise that many forms of depressive distress are linked to a perceived inability or inefficacy in managing challenging situations, and that improving coping skills can significantly reduce affective symptoms.

Unlike classical psychodynamic or cognitive approaches, PST does not focus on deep emotions or thoughts but on the practical ability to face and resolve real-life problems through a series of guided, systematic, and replicable steps.

Theoretical Model and Clinical Rationale

According to the original model, depression may arise when an individual encounters stressful or difficult situations they are unable to manage effectively, either due to a lack of efficient strategies or because of a dysfunctional attitude toward problems.

This dysfunction typically manifests in two areas:

A negative problem orientation: viewing problems as insurmountable threats, holding beliefs of personal inefficacy, and catastrophizing;
An ineffective problem-solving process: impulsivity, avoidance, passivity, or use of maladaptive strategies such as rumination or escapism.

PST aims to modify the patient's problem approach and equip them with practical tools to manage problems effectively, thereby restoring a sense of mastery and reducing depressive thoughts and learned helplessness.

Treatment Structure and Techniques

Problem-solving therapy typically consists of 6–12 sessions with a clear and replicable protocol, involving the teaching and application of six fundamental steps:

1. Problem definition and clarification: clearly identifying the specific situation to be addressed;
2. Goal setting: defining realistic short- and medium-term objectives;
3. Generation of alternatives: guided brainstorming of possible solutions without judgment;
4. Evaluation of solutions: analyzing the pros and cons of each alternative;
5. Decision-making: selecting the most appropriate solution and planning the action;
6. Implementation and verification: carrying out the plan, monitoring outcomes, and revising as needed.

The therapist plays an active role, guiding the patient through examples, role-playing, and corrective feedback, while maintaining a concrete and action-oriented focus. The therapy may include homework, monitoring forms, and reinforcement of newly acquired skills.

Clinical Indications

PST has proven especially effective in treating mild to moderate depression, particularly when psychological distress is linked to unresolved practical problems such as family conflict, financial hardship, work-related stress, or chronic physical illness.

Main clinical indications include:

Depression in socially vulnerable contexts (unemployment, isolation, housing insecurity);
Depression associated with chronic medical illness (diabetes, cancer, chronic pain);
Prevention of postpartum depression or support for caregivers of frail individuals;
First-line outpatient treatment, including by non-specialist personnel (e.g., trained nurses, general psychologists);
Brief interventions in emergency settings (primary care, counseling services, telemedicine).

PST is also often used in combination with pharmacotherapy or as an introductory intervention before more complex approaches, thanks to its ease of implementation and highly pragmatic structure.

Efficacy and Guidelines

Numerous meta-analyses have confirmed PST’s efficacy in reducing depressive symptoms, especially in primary care settings and among patients with limited access to other psychological treatments. Its results are comparable to CBT in non-severe depression, with high acceptability and low cost.

NICE guidelines recommend PST as a first-line option for mild depression, especially within stepped-care programs. The APA recognizes it as a well-supported strategy in low-intensity clinical settings, while the CANMAT includes it among effective short-term therapies for patients with good engagement capacity.

The approach has shown particularly positive outcomes in reducing rumination, preventing relapse, and enhancing perceived self-efficacy, all of which are key elements in recovering from a depressive episode.

Final Considerations

Problem-Solving Therapy is a simple, direct, and evidence-based model suitable for both acute phases and prevention. Its practical focus and collaborative approach make it accessible to a wide range of patients, including those with low education levels or limited emotional literacy.

In an era where real-life challenges and environmental stressors play a growing role in mood disorders, PST emerges as an effective bridge between clinical psychology and social intervention, promoting concrete change and the restoration of a sense of agency.

Bibliography

D'Zurilla TJ, Nezu AM. Problem-solving therapy: a positive approach to clinical intervention. 3rd ed. New York: Springer; 2007.
Cuijpers P et al. The efficacy of problem-solving therapy in the treatment of depression: a meta-analysis. Psychol Med. 2007;37(3):351–361.
Bell AC, D'Zurilla TJ. Problem-solving therapy for depression: a meta-analysis. Clin Psychol Rev. 2009;29(4):348–353.
Gellis ZD, Kenaley B. Problem-solving therapy for depression in adults: a systematic review. Res Soc Work Pract. 2008;18(6):464–478.
Malouff JM et al. Efficacy of problem-solving therapy for depression: a meta-analytic review. Clin Psychol Rev. 2007;27(1):46–57.
National Institute for Health and Care Excellence (NICE). Depression in adults: treatment and management. NICE guideline [NG222]. 2022.
American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder. 3rd ed. 2010.
Canadian Network for Mood and Anxiety Treatments (CANMAT). Clinical guidelines for the management of major depressive disorder in adults. Can J Psychiatry. 2016;61(9):510–523.
Arean PA et al. Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction. Am J Psychiatry. 2010;167(11):1391–1398.
Wiles N et al. Effectiveness of problem-solving therapy in primary care for depression: a randomized controlled trial. Br J Gen Pract. 2013;63(612):e544–e551.