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
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.|
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.
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
This section includes links to recommended manuals about PST.Return to Resource Options
This section includes links to recommended manuals about PST.
- Problem Solving Therapy for Suicide Prevention in VA Presented by Dr. Shannon Sisco
- Emotion-Focused Problem Solving Therapy and Suicidality Presented by Dr. Art Nezu
This section includes links to recommended articles about CBT-SP.
- 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 (
- 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 (
- 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 (
- 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 (
- 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/ (
- 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 (
- 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 (