Problem Solving: A Proven and Simple Way to Treat Depression

If you are human, you will have problems. Having problems means that you are normal and solving them means you are a happy normal! You can use problem-solving skills to solve major life events such as losing a job or having a serious medical condition, or ongoing daily stressors such as financial issues, arguments with your spouse, or difficulties relating to co-workers. In essence, a problem represents the discrepancy between your current state (what is) and your desired state (what you want). Problem-solving therapy is an effective treatment for depression but has received little attention as most popular books on self-help of depression heavily rely on cognitive-behavioral techniques (Kirkham et al., 2015).

The problem-solving steps are described next (Martell et al., 2010; Nezu et al., 1989).

Problem-solving steps

1. Define the problem in clear and specific behavioral terms, i.e., what specific behavior needs to be addressed or changed. You will be able to generate better solutions for a specific problem such as, “I have been postponing paying my bills for last two weeks and feel overwhelmed whenever I try to do that” versus the vague problem, “I can’t get anything done.” To get the specifics of a problem, describe it in terms of: Who? What? When? Where? Why? and How? Seek all available facts and information concerning the problem. Describe these facts in clear and unambiguous terms. Differentiate relevant from irrelevant information and objective facts from unverified inferences, assumptions, and interpretations.

2. Define your goals in addressing the problem – what is your desired outcome? Goals are often stated beginning with the phrase, “How can I …?” Set realistic goals and also delineate concrete obstacles that prevent you from reaching these goals. In listing these obstacles, it may become apparent to you that solving the overall problem may require you to first address some sub-goals. For example, if your goal is to run three times a week as a part of your exercise regimen, a sub-goal would be to ensure that you have running shoes. Goals can be either problem-focused goals for situations that can be changed (e.g., fixing your car or losing weight) or emotion-focused goals for situations that cannot be changed or where your emotional reaction, if unchanged, would create more problems for you in the long run (e.g., terminal illness in a family member, holding on to negative emotions such as resentment, anger, or jealousy).

3. Brainstorm possible solutions to the problem. When brainstorming solutions, generate as many solutions as possible, don’t analyze or judge the possible solutions at this stage, and think in terms of both broad strategies and focused tactics. However, be aware that when you are feeling depressed, it is a challenge not to prematurely judge a solution negatively due to your underlying pessimistic thoughts (e.g., “This is never going to work,” or “Yes, but…” rejection of a solution). Also, a judgmental stance engendered by depression curbs creative thinking. If you are drawing a blank, then use the following strategies to stimulate your brain into thinking about more solutions:

Think about an individual you know personally who you admire and respect or someone from the world of movies, books, or current events. Next, ask yourself, “How would he or she approach this problem? What actions would this person take if faced with the same problem?”

Close your eyes and imagine yourself in the problematic situation. Imagine yourself successfully coping with the problem. Think of what you would say and do to deal effectively with the situation.

4. Weigh pros and cons for each solution. For each possible solution, ask yourself the following questions:

• “How likely is it that this solution would help me reach my goal?”
• “What bad things could happen if I pick this solution?”
• “What is the likelihood that I can implement this solution in its optimal form?”

When thinking about the consequences for each solution, it is helpful to have a 3-point scale:

0 = mostly negative consequences
1 = a relatively equal number of positive and negative consequences
2 = mostly positive consequences

To be more pragmatic, you can elucidate the consequences for each possible solution across two broad categories of personal consequences and social consequences. The former include time/effort, emotional cost or gain, consistency with moral/ethical values, effects on personal growth, and effects on physical well-being while the latter include effects on family, friends, and community. An effective solution, in addition to reaching your goals, maximizes the positive consequences and minimizes the negative consequences.

5. Pick one solution and implement it. Sometimes a combination of solutions may work better as they complement each other. You may also modify a solution either by making it stronger or simplifying it. If it turns out that most of your solutions have more negative than positive consequences, then consider whether you correctly defined the problem and/or generated sufficient number of solutions.

6. Evaluate the effectiveness of the solution and make changes to your approach, if needed. The three questions to ask yourself in this stage are:

• “How well did my solution meet my goals?”
• “What were the actual effects on me and how well did they match my original predictions?”
• “What were the actual effects on others and how well did they match my original predictions?”

7. If the problem is not resolved, then do one of the following troubleshooting strategies:

• Reset your goals as they may not be realistic
• Break the problem down into smaller chunks
• Think of more possible solutions

Tips to improve problem-solving skills

The following tips will enhance your problem-solving skills (Nezu et al., 1989):

• Recognize that problems are part-and-parcel of life.
• Many individuals have common types of problems and you are not alone.
• Approach problem-solving with a rational, realistic, and positive attitude.
• Don’t avoid facing a problem. Solving problems breaks the vicious cycle of problems leading to depression leading to more problems.
• Work on smaller problems and build yourself up for the bigger ones.
• There is no such thing as the perfect solution. Pick the best solution that works for you.
• Stop and think before picking a solution – the first idea may not always be the best!
• You have the ability to change your solution whenever you want.
• The pessimistic thought patterns in depression itself may lead you to believe that you are inadequate and incapable of changing your situation. You can challenge these assumptions by asking yourself, “What is the evidence that supports the assumption that I am inadequate and incapable of changing my situation?” “What is the evidence that contradicts this assumption?”
• Anxiety and depression tend to go hand in hand. Fear of failure may prevent you from approaching problem-solving as you tend to catastrophize the likely consequences of change. In this context, it is prudent to develop a more realistic assessment of the situation by asking yourself, “What have I got to lose by trying to change?” “What is the worst thing that can happen if I try, but I am unsuccessful in solving this problem?”
• Use self-affirmative statements to divert your attention from unhelpful negative thoughts that interfere with your problem-solving abilities. For example, “I can handle this situation,” “I have the skills to handle this, all I have to do is try,” or “I am going to feel good about myself when I solve this problem.”
• If you cannot solve a problem after trying the troubleshooting strategies, then seek help from someone who is more knowledgeable or trained to deal with your situation. For instance, consult a financial advisor if you are not able to solve your financial problems after repeated problem-solving attempts.
• If a problem initially thought as changeable become unchangeable (for example, a loved one initially diagnosed with a treatable medication condition now has a terminal illness), then switching to acceptance and trying to change your reaction (grief, depression, anxiety, anger), i.e., emotional coping is more helpful than trying to solve the problem.

Becoming a master problem-solver comes with practice. You may want to write down the problem-solving steps on an index card as a reference to deal with minor or major problems. In addition, it is essential to integrate your new behaviors into a routine in order to have an enduring impact of the problem-solving exercise.

HARPREET S. DUGGAL, MD, FAPA

REFERENCES

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, Oct 5. doi: 10.1002/gps.4358.

Martell, C. R., Dimidjian, S., & Herman-Dunn, R. (2010). Behavioral activation for depression: A clinician’s guide. New York, NY: The Guilford Press.

Nezu, A. M., Nezu, C., & Perri, M. G. (1989). Problem-solving in depression: Theory, research, and clinical guidelines. New York, NY: John Wiley & Sons, Inc.