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WeHeartCBT: cognitive behavioural therapy resources

WeHeartCBT is a collection of resources aimed at helping children and young people who are struggling with symptoms of anxiety and/or low mood. Resources are based on a Cognitive Behavioural Therapy (CBT) approach and are for mental health professionals, schools and parents/families.

What is Cognitive Behavioural Therapy (CBT)?

Cognitive Behavioural Therapy (CBT) is an evidence based therapeutic intervention aimed at helping people who are struggling with anxiety and/or low mood. 

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Teaching materials for schools based on the UK National Curriculum and a Whole School Approach to mental health. 

Free resources for practitioners delivering CBT  based interventions with children, young people and families.

Useful resources for children, young people and families struggling with feelings of low mood and//or anxiety.

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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?
• Find a therapist 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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Cognitive Behavioral Therapy (CBT)

Resource type

Therapy tool.

"Should" Statements

Information handouts

Activity Diary (Hourly Time Intervals)

Activity Diary (No Time Intervals)

Activity Menu

Activity Planning

Activity Selection

All-Or-Nothing Thinking

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An Introduction To CBT (Psychology Tools For Living Well)

Books & Chapters

Anger - Self-Monitoring Record

Anger Decision Sheet

Anger Diary (Archived)

Anger Self-Monitoring Record (Archived)

Anger Thought Challenging Record

Anxiety - Self-Monitoring Record

Anxiety Self-Monitoring Record (Archived)

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Audio Collection: Psychology Tools For Mindfulness

Audio Collection: Psychology Tools For Overcoming PTSD

Autonomic Nervous System

Avoidance Hierarchy (Archived)

Before I Blame Myself And Feel Guilty

Behavioral Activation Activity Diary

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Behavioral Experiment

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Belief-O-Meter (CYP)

Boundaries - Self-Monitoring Record

Catastrophizing

Catching Your Thoughts (CYP)

CBT Appraisal Model

CBT Daily Activity Diary With Enjoyment And Mastery Ratings

CBT Thought Record Portrait

Challenging Your Negative Thinking (Archived)

Changing Avoidance (Behavioral Activation)

Checking Certainty And Doubt

Classical Conditioning

Cognitive Behavioral Model Of Anorexia Nervosa (Fairburn, Cooper, Shafran, 2003)

Cognitive Behavioral Model Of Body Dysmorphic Disorder (BDD: Veale, 2004)

Cognitive Behavioral Model Of Bulimia Nervosa (Fairburn, Cooper, Shafran, 2003)

Cognitive Behavioral Model Of Clinical Perfectionism (Shafran, Cooper, Fairburn, 2002)

Cognitive Behavioral Model Of Depersonalization (Hunter, Phillips, Chalder, Sierra, David, 2003)

Cognitive Behavioral Model Of Fear Of Body Sensations

Cognitive Behavioral Model Of Generalized Anxiety Disorder (GAD: Dugas, Gagnon, Ladouceur, Freeston, 1998)

Cognitive Behavioral Model Of Health Anxiety (Salkovskis, Warwick, Deale, 2003)

Cognitive Behavioral Model Of Insomnia (Harvey, 2002)

Cognitive Behavioral Model Of Intolerance Of Uncertainty And Generalized Anxiety Disorder Symptoms (Hebert, Dugas, 2019)

Cognitive Behavioral Model Of Panic (Clark, 1986)

Cognitive Behavioral Model Of Persistent Postural-Perceptual Dizziness (PPPD: Whalley, Cane, 2017)

Cognitive Behavioral Model Of Post Traumatic Stress Disorder (PTSD: Ehlers & Clark, 2000)

Cognitive Behavioral Model Of Social Phobia (Clark, Wells, 1995)

Cognitive Behavioral Model Of The Relapse Process (Marlatt & Gordon, 1985)

Cognitive Behavioral Model Of Tinnitus (McKenna, Handscombe, Hoare, Hall, 2014)

Cognitive Behavioral Treatment Of Childhood OCD: It's Only A False Alarm: Therapist Guide

Treatments That Work™

Cognitive Behavioral Treatment of Childhood OCD: It's Only a False Alarm: Workbook

Cognitive Case Formulation

Cognitive Distortions – Unhelpful Thinking Styles (Common)

Cognitive Distortions – Unhelpful Thinking Styles (Extended)

Compassionate Thought Challenging Record

Core Belief Magnet Metaphor

Court Trial Thought Challenging Record (Archived)

Critical Care And PTSD

Critical Illness Intensive Care And Post-Traumatic Stress Disorder (PTSD)

Cross Sectional Formulation

Daily Monitoring Form

Decatastrophizing

Demanding Standards – Living Well With Your Personal Rules

Depression - Self-Monitoring Record

Discounting In Perfectionism – The Ratchet Effect

Disqualifying Others

Disqualifying The Positive

Dissociation - Self-Monitoring Record

Embracing Uncertainty

Emotional Reasoning

Evaluating Unhelpful Automatic Thoughts

Evaluating Your Demanding Standards

Examining Your Negative Thoughts

Exploring Problems Using A Cross Sectional Model

Exposure And Response (Ritual) Prevention For Obsessive Compulsive Disorder (Second Edition): Therapist Guide

Exposure And Response Prevention

Exposure Practice Form

Exposure Session Record

Exposures For Fear Of Appearing Anxious

Exposures For Fear Of Body Sensations

Exposures For Fear Of Breathlessness

Exposures For Fear Of Death

Exposures For Fear Of Flying

Exposures For Fear Of Heights

Exposures For Fear Of Illness

Exposures For Fear Of Losing Control Of Your Mind

Exposures For Fear Of Uncertainty

Exposures For Fear Of Vomiting

Externalizing

Facing Your Fears (CYP)

Facing Your Fears And Phobias

Links to external resources.

Psychology Tools makes every effort to check external links and review their content. However, we are not responsible for the quality or content of external links and cannot guarantee that these links will work all of the time.

• Scale Download Primary Link Archived Link
• Bern Inventory of Treatment Goals | Grosse, Grawe | 2002 Download Primary Link Archived Link

Cognitive therapy competence / adherence measures

• Manual Download Primary Link Archived Link
• Manual Download Archived Link
• Manual accs-scale.co.uk Download Primary Link
• 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

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 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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Dr. Julie Osborn, a therapist specializing in cognitive behavioral therapy (CBT), shares her experiences in the field and helps her listeners; addressing the issues they face and the situations they find themselves in. CBT is a short-term, goal-orientated psychotherapy treatment that takes a hands-on, practical approach to problem solving. Dr. Osborn teaches how cognitive behavioral therapy can be used everyday in our lifelong pursuit of happiness.

.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;} Vacations, Holidays & CBT

Vacations (or holidays!) are amazing! But sometimes we can put so much pressure on ourselves to ‘relax, relax, relax’ that we end up needing a vacation from our vacation!

So how can you get the most out of your precious vacation time?

How can you have reasonable expectations?

How can you really relax?

Join me, Dr Julie Osborn, as I share with you some amazing CBT tools that will really help you relax and enjoy your vacation. 

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.css-r6mb8g{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:1;overflow:hidden;} Behavior & CBT

Cognitive-Behavioral Therapy (CBT) is equal parts thoughts and behaviors.

How can you identify behaviors that you might want to adjust?

How can you use CBT tools to adjust your behavior? Join me, Dr Julie Osborn, as I share with you how  behaviors fit with CBT. 

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Attachment Styles & CBT

Our ability to relate to each other as human beings forms the basis of healthy relationships.

What is your attachment style?

How can your attachment style affect you as an adult?

And how can you use CBT with your attachment style to former deeper, more meaningful attachments?

Join me, Dr Julie Osborn, as we articulate this fascinating topic together. 

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Are CBT Tools Worth The Effort?

The stigma of mental health has improved over time, but we all know it still exists. This reality, combined with the effort involved with therapy, may make you feel discouraged from learning CBT tools.

Is it worth the effort to learn CBT tools? Why?

How can these tools help you prepare for and deal with unexpected events in the future?

Join me, Dr Julie Osborn, as we talk about the state of mental health today and how CBT tools can ma...

Truth, Lies & CBT

Figuring out who you truly are and who you want to be can be challenging.

But the faster we can get to the truth, the faster we can make the changes we want to.

Are you lying to yourself to feel accepted or liked?

How can you know?

Join me, Dr Julie Osborn, as I take a deep dive into Mitch Albom’s inspiring new book, The Little Liar , and share the CBT tools that can help you find your truth.

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Conflicting Values & CBT

What if your child chooses different values to yours or the values you raised them with?

How can you love and support your child even when you’re struggling with their choice of values?

Join me, Dr Julie Osborn, as we talk about this challenging situation and share CBT tools that can help.

Narcissistic Personality Disorder (NPD) & CBT

Narcissistic Personality Disorder (NPD) is one more and more people are encountering in their daily lives, whether it’s someone you work with, a friend or family member, or someone you’re in or were in a relationship with.

How can you identify a narcissistic personality?

How can you protect yourself?

How can you heal?

Join me, Dr Julie Osborn, as I share with you CBT tools to help you handle a narcissistic personality.

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Seasonal Affective Disorder (SAD) & CBT

Seasonal Affective Disorder (SAD) impacts many people, particularly during the shorter, darker days of winter.

How can you use CBT tools to cope with the symptoms of SAD?

Join me, Dr Julie Osborn, as I share with you some suggestions & CBT tools to help you cope with Seasonal Affective Disorder.

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Labeling Yourself & CBT

Many people identify themselves as being their mental health disorder or challenge.

This can create problems because it can make you feel painted into a corner with no way to change things.

Since our brains believe what we tell them, how can you use CBT tools to make changes?

Join me, Dr Julie Osborn, as I share with you how to use your CBT tools for labeling and self-identifying.

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The Holidays & CBT

The holiday season can be challenging for many reasons. Past traumas and memories can make it hard to be around certain people.

How can you successfully navigate this time of the year?

How should you deal with relationships or people you find challenging?

Join me, Dr Julie Osborn, as I share with you how to use your CBT tools to handle the holidays. 

Betrayal & CBT

Personal or professional betrayal usually catches us off-guard, and can be extremely shocking.

How should you react to a perceived betrayal?

How can you process betrayal, whether it affects you, someone else, or both?

Join me, Dr Julie Osborn, as I share with you how to use your CBT tools to process betrayal. 

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The Inner Child & CBT

Pioneered by Dr John Bradshaw, the concept of the inner child is a therapy modality that has helped many.

When is this therapy modality helpful?

How can you use it?

How does the inner child work alongside CBT?

Join me, Dr Julie Osborn, as I discuss this fascinating therapy modality. 

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Intrusive Thoughts & CBT

Intrusive thoughts are unwanted, unpleasant thoughts, often associated with OCD.

Why do intrusive thoughts happen?

How can you cope with intrusive thoughts?

What can you do to improve things?

Join me, Dr Julie Osborn, as I discuss the many types of intrusive thoughts and how you can help yourself. 

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Childhood Abandonment & CBT

Childhood abandonment by a parent, caregiver or loved one can have lifelong repercussions.

How can you cope with your fear of abandonment?

What can you do to move forward in a healthy way?

Join me, Dr Julie Osborn, as I discuss childhood abandonment and how you can move forward.

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Family Enmeshment, Boundaries & CBT

Are you involved in your own life, or are you involved in other peoples' lives?

Your answer to this question could say a lot about the boundaries you have with your family.

Family enmeshment can be a challenge to identify and unravel yourself from. 

Join me, Dr Julie Osborn, as I discuss family enmeshment and how you can set healthy boundaries.

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Triggering & CBT

The word ‘trigger’ has become synonymous with moments of fear, anxiety, or trauma being relived.

What is ‘triggering’?

How can you use CBT tools to cope with triggers?

Join me, Dr Julie Osborn, as I share with you the CBT tools that can help you move forward.

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Blame & CBT

Blame gets you nowhere. It keeps you stuck in a negative place.

What are the benefits of blame?

How can using a cost-benefit analysis help?

What tools can help you adjust negative thought patterns?

Join me, Dr Julie Osborn, as I share with you the lightbulb-moment reasoning and CBT tools that can help you move forward.

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Existential Dread & CBT

Many people feel anxiety over aging and death, searching for the meaning of life, and their own personal purpose. 

What is the difference between existential therapy and cognitive behavioral therapy?

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How can CBT help you with anxiety around existential dread?

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Barbie & CBT

The Barbie movie has shone a spotlight on vital issues that women everywhere face.

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How CBT Can Affect Physical Symptoms

The brain is a very powerful organ, and it can affect us in unexpected ways. This can include physical symptoms stemming from mental health challenges.

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What Is Problem-Solving Therapy?

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.

Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.

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.

Get Help Now

We've tried, tested, and written unbiased reviews of the best online therapy programs including Talkspace, BetterHelp, and ReGain. Find out which option is the best for you.

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.

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 .

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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

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Last updated: 27 May 2021

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2. Symptoms of depression

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3. Symptoms of depression

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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.

Before you continue, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises explore fundamental aspects of positive psychology, including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.

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.

5 Worksheets and workbooks

Problem-solving self-monitoring form.

Answering the questions in the Problem-Solving Self-Monitoring Form provides the therapist with necessary information regarding the client’s overall and specific problem-solving approaches and reactions (Dobson, 2011).

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.

17 Top-Rated Positive Psychology Exercises for Practitioners

Expand your arsenal and impact with these 17 Positive Psychology Exercises [PDF] , scientifically designed to promote human flourishing, meaning, and wellbeing.

Created by Experts. 100% Science-based.

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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How to Thrive as You Age

A cheap drug may slow down aging. a study will determine if it works.

Allison Aubrey

A drug taken by millions of people to control diabetes may do more than lower blood sugar.

Research suggests metformin has anti-inflammatory effects that could help protect against common age-related diseases including heart disease, cancer, and cognitive decline.

Scientists who study the biology of aging have designed a clinical study, known as The TAME Trial, to test whether metformin can help prevent these diseases and promote a longer healthspan in healthy, older adults.

Michael Cantor, an attorney, and his wife Shari Cantor , the mayor of West Hartford, Connecticut both take metformin. "I tell all my friends about it," Michael Cantor says. "We all want to live a little longer, high-quality life if we can," he says.

Michael Cantor started on metformin about a decade ago when his weight and blood sugar were creeping up. Shari Cantor began taking metformin during the pandemic after she read that it may help protect against serious infections.

Shari and Michael Cantor both take metformin. They are both in their mid-60s and say they feel healthy and full of energy. Theresa Oberst/Michael Cantor hide caption

Shari and Michael Cantor both take metformin. They are both in their mid-60s and say they feel healthy and full of energy.

The Cantors are in their mid-60s and both say they feel healthy and have lots of energy. Both noticed improvements in their digestive systems – feeling more "regular" after they started on the drug,

Metformin costs less than a dollar a day, and depending on insurance, many people pay no out-of-pocket costs for the drug.

"I don't know if metformin increases lifespan in people, but the evidence that exists suggests that it very well might," says Steven Austad , a senior scientific advisor at the American Federation for Aging Research who studies the biology of aging.

An old drug with surprising benefits

Metformin was first used to treat diabetes in the 1950s in France. The drug is a derivative of guanidine , a compound found in Goat's Rue, an herbal medicine long used in Europe.

The FDA approved metformin for the treatment of type 2 diabetes in the U.S. in the 1990s. Since then, researchers have documented several surprises, including a reduced risk of cancer. "That was a bit of a shock," Austad says. A meta-analysis that included data from dozens of studies, found people who took metformin had a lower risk of several types of cancers , including gastrointestinal, urologic and blood cancers.

Austad also points to a British study that found a lower risk of dementia and mild cognitive decline among people with type 2 diabetes taking metformin. In addition, there's research pointing to improved cardiovascular outcomes in people who take metformin including a reduced risk of cardiovascular death .

As promising as this sounds, Austad says most of the evidence is observational, pointing only to an association between metformin and the reduced risk. The evidence stops short of proving cause and effect. Also, it's unknown if the benefits documented in people with diabetes will also reduce the risk of age-related diseases in healthy, older adults.

"That's what we need to figure out," says Steve Kritchevsky , a professor of gerontology at Wake Forest School of Medicine, who is a lead investigator for the Tame Trial.

The goal is to better understand the mechanisms and pathways by which metformin works in the body. For instance, researchers are looking at how the drug may help improve energy in the cells by stimulating autophagy, which is the process of clearing out or recycling damaged bits inside cells.

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Researchers also want to know more about how metformin can help reduce inflammation and oxidative stress, which may slow biological aging.

"When there's an excess of oxidative stress, it will damage the cell. And that accumulation of damage is essentially what aging is," Kritchevsky explains.

When the forces that are damaging cells are running faster than the forces that are repairing or replacing cells, that's aging, Kritchevsky says. And it's possible that drugs like metformin could slow this process down.

By targeting the biology of aging, the hope is to prevent or delay multiple diseases, says Dr. Nir Barzilai of Albert Einstein College of Medicine, who leads the effort to get the trial started.

The ultimate in preventative medicine

Back in 2015, Austad and a bunch of aging researchers began pushing for a clinical trial.

"A bunch of us went to the FDA to ask them to approve a trial for metformin,' Austad recalls, and the agency was receptive. "If you could help prevent multiple problems at the same time, like we think metformin may do, then that's almost the ultimate in preventative medicine," Austad says.

The aim is to enroll 3,000 people between the ages of 65 and 79 for a six-year trial. But Dr. Barzilai says it's been slow going to get it funded. "The main obstacle with funding this study is that metformin is a generic drug, so no pharmaceutical company is standing to make money," he says.

Barzilai has turned to philanthropists and foundations, and has some pledges. The National Institute on Aging, part of the National Institutes of Health, set aside about $5 million for the research, but that's not enough to pay for the study which is estimated to cost between $45 and $70 million.

The frustration over the lack of funding is that if the trial points to protective effects, millions of people could benefit. "It's something that everybody will be able to afford," Barzilai says.

Currently the FDA doesn't recognize aging as a disease to treat, but the researchers hope this would usher in a paradigm shift — from treating each age-related medical condition separately, to treating these conditions together, by targeting aging itself.

For now, metformin is only approved to treat type 2 diabetes in the U.S., but doctors can prescribe it off-label for conditions other than its approved use .

Michael and Shari Cantor's doctors were comfortable prescribing it to them, given the drug's long history of safety and the possible benefits in delaying age-related disease.

"I walk a lot, I hike, and at 65 I have a lot of energy," Michael Cantor says. I feel like the metformin helps," he says. He and Shari say they have not experienced any negative side effects.

Research shows a small percentage of people who take metformin experience GI distress that makes the drug intolerable. And, some people develop a b12 vitamin deficiency. One study found people over the age of 65 who take metformin may have a harder time building new muscle.

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"There's some evidence that people who exercise who are on metformin have less gain in muscle mass, says Dr. Eric Verdin , President of the Buck Institute for Research on Aging. That could be a concern for people who are under-muscled .

But Verdin says it may be possible to repurpose metformin in other ways "There are a number of companies that are exploring metformin in combination with other drugs," he says. He points to research underway to combine metformin with a drug called galantamine for the treatment of sarcopenia , which is the medical term for age-related muscle loss. Sarcopenia affects millions of older people, especially women .

The science of testing drugs to target aging is rapidly advancing, and metformin isn't the only medicine that may treat the underlying biology.

"Nobody thinks this is the be all and end all of drugs that target aging," Austad says. He says data from the clinical trial could stimulate investment by the big pharmaceutical companies in this area. "They may come up with much better drugs," he says.

Michael Cantor knows there's no guarantee with metformin. "Maybe it doesn't do what we think it does in terms of longevity, but it's certainly not going to do me any harm," he says.

Cantor's father had his first heart attack at 51. He says he wants to do all he can to prevent disease and live a healthy life, and he thinks Metformin is one tool that may help.

For now, Dr. Barzilai says the metformin clinical trial can get underway when the money comes in.

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This story was edited by Jane Greenhalgh

A blood test for stroke risk? Biomarker for risk of future cerebrovascular disease

Quantitative assessments for potential stroke, cognitive decline.

A simple blood test could allow doctors to determine whether a person may be at higher risk for stroke or cognitive decline during their lifetime, according to a new UCLA Health study.

The study, published in the journal Stroke , found that measuring concentrations of a network of inflammatory molecules in the blood could allow doctors to calculate a risk score for susceptibility for cerebral small vessel disease -- a common cause of stroke and a contributor to cognitive decline found especially among the elderly.

Currently, the only way to determine a person's risk for cerebral vascular diseases has been to use a combination of imaging such as an MRI scan, family history, demographic variables and other risk factor evaluations, said study lead author Dr. Jason Hinman of the UCLA Comprehensive Stroke and Center and the Mary S. Easton Center for Alzheimer's Research and Care at UCLA. In clinical practice, neurologists may only find a patient is at risk after they have had a stroke or a cerebral event that warns of one, Hinman said.

The new study found that by measuring the concentrations of this network of inflammatory molecules in the blood of patients who have not had a cerebrovascular event, medical providers may be able to quantitatively assess a person's risk for cerebral small vessel disease and future stroke.

"The same way one uses cholesterol tests to evaluate one's future risk for heart attack, we don't have such a thing to estimate future risk for stroke," Hinman said. "I believe we can do that by something as simple as a blood test which in theory can enable broader access to the best level of care and not lock it behind advanced imaging studies and specialist evaluations."

The study focused on a biologically-connected network of inflammatory molecules known as the interleukin-18, or IL-18, network, which includes proteins and signaling molecules used to fight various infections.

Past studies have linked individual molecules in the IL-18 network to cerebral small vessel disease and stroke risk. However, the concentration of these individual molecules can fluctuate in response to other ailments such as the flu or autoimmune disorders, making them unreliable predictors of stroke risk at an individual level, Hinman said.

In 2020, University of California researchers including Hinman found that six molecules in the IL-18 network were associated with the presence of vascular brain injuries during MRI scans.

Building off these findings, Hinman sought to determine in this latest publication whether IL-18 network could be used to assess a person's susceptibility to stroke risk or cognitive decline.

To test this, the researchers used health data from a generations-long study known as the Framingham Heart Study. This study has tracked the medical history of thousands of residents in the city of Framingham, Massachusetts, throughout their lives since launching in 1948. Blood samples taken from participants had been tested for five of the six molecules later identified as being in the IL-18 network.

By using the blood samples and medical histories of the Framingham participants, Hinman and his coauthor were able to create a mathematical model that generates a risk score based on the concentrations of the IL-18 network molecules. Of the more than 2,200 Framingham residents included in Hinman's study, those whose risk scores were in the top 25% had an 84% chance of having a stroke during their lifetime. Overall, elevated risk scores were associated with a 51% increased risk of stroke and resulted in diagnostic prediction compared to existing risk assessment tools.

What remains unclear and requires further study is how or if a person's risk score can be modified or reduced, Hinman said.

"The real challenge is in the primary care space. Are you at risk before you have an event?" Hinman said. "That's what we're all interested in doing is preventing a stroke before it even happens."

• Heart Disease
• Stroke Prevention
• Brain Injury
• Disorders and Syndromes
• Cognitive neuroscience
• Blood transfusion
• COX-2 inhibitor
• Intelligence quotient

Story Source:

Materials provided by University of California - Los Angeles Health Sciences . Original written by Will Houston. Note: Content may be edited for style and length.

Journal Reference :

• Richard A. Martirosian, Crystal D. Wiedner, Jasmin Sanchez, Katherine T. Mun, Kiran Marla, Cristina Teran, Marissa Thirion, David S. Liebeskind, Emer R. McGrath, Jared M. Zucker, Rebecca Bernal, Alexa S. Beiser, Charles DeCarli, Jayandra J. Himali, Sudha Seshadri, Jason D. Hinman. Association of Incident Stroke Risk With an IL-18-Centered Inflammatory Network Biomarker Composite . Stroke , 2024; DOI: 10.1161/STROKEAHA.123.044719

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