9: Problem Solving Therapy - MIRECC / CoE
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9: Problem Solving Therapy

Risk Management and Treatment » Non-pharmacologic Treatments
9: Problem Solving Therapy

We suggest offering problem-solving based psychotherapies to: a) Patients with a history of more than one incident of self-directed violence to reduce repeat incidents of such behaviors; b) Patients with a history of recent self-directed violence to reduce suicidal ideation; and/or c) Patients with hopelessness and a history of moderate to severe traumatic brain injury

Strength:

Weak for

Category:

ReviewedNew-replaced

Grades and Definitions

Strong for
or "We recommend offering this option …"
Weak for
or "We suggest offering this option …"
No recommendation
or "There is insufficient evidence …"
Weak against
or "We suggest not offering this option …"
Strong against
or "We recommend against offering this option …"

Categories and Definitions

Evidence Reviewed* Recommendation Category* Definition*
Reviewed New-added New recommendation following review of the evidence
New-replaced Recommendation from previous CPG that has been carried over to the updated CPG that has been changed following review of the evidence
Not changed Recommendation from previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed but the recommendation is not changed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed based on review of the evidence
Not reviewed Not changed Recommendation from previous CPG that has been carried forward to the updated CPG, but for which the evidence has not been reviewed
Amended Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has not been reviewed and a minor amendment has been made
Deleted Recommendation from the previous CPG that has been removed because it was deemed out of scope for the updated CPG
*Adapted from the NICE guideline manual (2012): The guidelines manual. London: National Institute for Health and Care Excellence;2012. and Martinez Garcia L, McFarlane E, Barnes S, Sanabria AJ, Alonso-Coello P, Alderson P. Updated recommendations: An assessment of NICE clinical guidelines. Implement Sci. 2014;9:72.

Recommendation Resources

Problem-Solving Therapy (PST) for Suicide Prevention is a brief form of evidence-based treatment that teaches and empowers patients to solve the here-and-now problems contributing to suicidal ideation, self-directed violence and hopelessness. It has been shown to help increase self-efficacy and reduce risk of self-harm and suicide.

Training Resources

This section includes links to recommended trainings about PST.

VA-provided PST resources
Updated Moving Forward: Overcoming Life's Challenges Web Course
PST resources from professional organizations
Problem-Solving Therapy (PST) from the Suicide Prevention Resource Center
Problem-Solving Therapy for Depression | Society of Clinical Psychology
Problem Solving Therapy Canada
PST Canada Workshop recommended pre-reading
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Manuals

This section includes links to recommended manuals about PST.

Problem-Solving Therapy: A Treatment Manual Supplement
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Webinars

This section includes links to recommended manuals about PST.

CPG Webinar Problem Solving Therapy for Suicide Prevention in VA Presented by Dr. Shannon Sisco
CPG Webinar Emotion-Focused Problem Solving Therapy and Suicidality Presented by Dr. Art Nezu
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Articles

This section includes links to recommended articles about CBT-SP.

Barnes, S. M., Monteith, L. L., Gerard, G. R., Hoffberg, A. S., Homaifar, B. Y., & Brenner, L. A. (2017). Problem-solving therapy for suicide prevention in veterans with moderate-to-severe traumatic brain injury. Rehabilitation psychology, 62(4). 600-608. https://doi.org/10.1017/S104161022000397X
Beaudreau, S. A., Karel, M. J., Funderburk, J. S., Nezu, A. M., Nezu, C. M., Aspnes, A., & Wetherell, J. L. (2021). Problem-solving training for Veterans in home based primary care: an evaluation of intervention effectiveness. International psychogeriatrics, 1-12. Advance online publication. https://doi.org/10.1037/rep0000154
Brenner, L. A., Forster, J. E., Hoffberg, A. S., Matarazzo, B. B., Hostetter, T. A., Signoracci, G., & Simpson, G. K. (2018). Window to Hope: A Randomized Controlled Trial of a Psychological Intervention for the Treatment of Hopelessness Among Veterans With Moderate to Severe Traumatic Brain Injury. The Journal of head trauma rehabilitation, 33(2). E64-E73. https://doi.org/10.1097/HTR.0000000000000351
Hatcher, S., Sharon, C., Parag, V., & Collins, N. (2011). Problem-solving therapy for people who present to hospital with self-harm: Zelen randomised controlled trial. The British journal of psychiatry : the journal of mental science, 199(4). 310-316. https://doi.org/10.1192/bjp.bp.110.090126
McLeavey, B. C., Daly, R. J., Ludgate, J. W., & Murray, C. M. (1994). Interpersonal problem-solving skills training in the treatment of self-poisoning patients. Suicide & life-threatening behavior, 24(4). 382-394. https://pubmed.ncbi.nlm.nih.gov/7740595/
Nezu, A. M., Nezu, C. M., Stern, J. B., Greenfield, A. P., Diaz, C., & Hays, A. M. (2017). Social problem solving moderates emotional reactivity in predicting suicide ideation among U.S. Veterans. Military Behavioral Health, 5. 417-426. https://www.tandfonline.com/doi/abs/10.1080/21635781.2017.1337595
Salkovskis, P. M., Atha, C., & Storer, D. (1990). Cognitive-behavioural problem solving in the treatment of patients who repeatedly attempt suicide. A controlled trial. The British journal of psychiatry: the journal of mental science, 157. 871-876. https://doi.org/10.1192/bjp.157.6.871
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