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Noradrenergic modulation of cognitive flexibility in problem solving.

Stress causes impaired performance on tests of creativity. Drugs that block beta-adrenergic receptors improve test performance in patients with test anxiety. Furthermore, catecholamine precursors (L-DOPA) reduce the flexibility of semantic networks. Our study investigated the effect of noradrenergic system modulation on cognitive flexibility in problem solving. Eighteen normal subjects undertook three problem solving tasks (number series, shape manipulation and anagrams) 45 min after propranolol, placebo and ephedrine. On the task that appeared to rely most heavily on cognitive flexibility (anagrams), subjects who were most able to solve these problems demonstrated significantly shorter solution times (logarithmic scores) after propranolol than after ephedrine. This suggested that the noradrenergic system exerts a modulatory effect on cognitive flexibility in problem solving.

Adolescent↗

A problem-solving version of the Allen Cognitive Level Test.

The purpose of this study was to construct and validate a problem-solving version of the existing Allen Cognitive Level Test (ACL) (Allen, 1985). The new problem-solving version of the ACL (ACL-PS) follows the theoretical developments of the cognitive disability theory and the information processing approach. It was constructed to provide a more accurate assessment of the problem-solving process as well as task performance, especially at the higher cognitive levels. Both tests were administered to a psychiatric adolescent group (n = 49) who were subdivided according to diagnosis and to a matched nondysfunctional control group (n = 29). The results showed that both the ACL and the ACL-PS differentiated significantly between the patients and the control subjects and among the patient groups. At Level 6 of the ACL, none of the subjects needed any demonstration, with all scores distributed between independent performance or performance following verbal instructions only, that is, problem-solving phases that were added with the ACL-PS. The scoring of the ACL-PS is provided in addition to detailed scoring of the cognitive levels. It is suggested that the ACL-PS be implemented as a clinical evaluative tool with adolescents.

Adolescent↗

Social problem solving: a moderator of the relation between negative life stress and depression symptoms in children.

The social problem-solving skill of generating effective alternative solutions was tested as a moderator of the relation between negative life stress and depressed mood in children. Boys (n = 25) and girls (n = 25), ages 8 to 12 years, from inner-city, lower socioeconomic group families, completed measures of depression symptoms, negative impact of life events, and quantity and effectiveness of alternative solutions to social problems. Results indicated that the effectiveness of alternative solutions children generate in response to peer social problems moderates the relation between stress and depression. Children who experienced a high impact of negative life events, with less effective social problem-solving skills, reported higher levels of depression compared to children who experienced a high impact of negative life events but exhibited more effective social problem-solving skills. Results are discussed in terms of alternative theoretical models for the mechanisms whereby effective social problem-solving skills moderate stress-related depression.

Child↗

Integrated learning: explicit strategies and their role in problem-solving instruction for students with learning disabilities.

This study investigated the effectiveness of an explicit strategy as a means of linking facts, concepts, and problem solving in an unfamiliar domain of learning. Participants were 37 secondary students with learning disabilities. All students were taught health facts and concepts, which they then applied to problem-solving exercises presented through computer-simulation games. Students in the experimental group were taught an explicit strategy for solving the problems; the comparison group was given supportive feedback and encouraged to induce their own strategies. The explicit strategy group performed significantly better on two transfer measures, including videotaped problem-solving exercises.

Adolescent↗

Problem-solving ability and repetition of deliberate self-harm: a multicentre study.

BACKGROUND: While recent studies have found problem-solving impairments in individuals who engage in deliberate self-harm (DSH), few studies have examined repeaters and non-repeaters separately. The aim of the present study was to investigate whether specific types of problem-solving are associated with repeated DSH. METHOD: As part of the WHO/EURO Multicentre Study on Suicidal Behaviour, 836 medically treated DSH patients (59% repeaters) from 12 European regions were interviewed using the European Parasuicide Study Interview Schedule (EPSIS II) approximately 1 year after their index episode. The Utrecht Coping List (UCL) assessed habitual responses to problems. RESULTS: Factor analysis identified five dimensions--Active Handling, Passive-Avoidance, Problem Sharing, Palliative Reactions and Negative Expression. Passive-Avoidance--characterized by a pre-occupation with problems, feeling unable to do anything, worrying about the past and taking a gloomy view of the situation, a greater likelihood of giving in so as to avoid difficult situations, the tendency to resign oneself to the situation, and to try to avoid problems--was the problem-solving dimension most strongly associated with repetition, although this association was attenuated by self-esteem. CONCLUSIONS: The outcomes of the study indicate that treatments for DSH patients with repeated episodes should include problem-solving interventions. The observed passivity and avoidance of problems (coupled with low self-esteem) associated with repetition suggests that intensive therapeutic input and follow-up are required for those with repeated DSH.

Adaptation, Psychological↗

Self-appraised problem solving and pain-relevant social support as predictors of the experience of chronic pain.

The purpose of this study was to examine the contributions of self-appraised problem-solving competence and pain-relevant social support to the prediction of pain, depression, and disability. The 234 chronic pain patients referred for participation in a comprehensive pain management program were administered self-report measures of pain, depression, disability, pain-relevant social support, and problem solving. Hierarchical multiple-regression analyses revealed that lower self-appraised problem-solving competence was related to increased pain, depression, and disability. Pain-relevant social support was directly related to pain and disability but indirectly related to depression. High levels of pain-relevant social support were found to buffer the relation between poorer self-appraised problem-solving competence and depressive symptoms. The results support the assessment of problem-solving skills in chronic pain patients and the investigation and utility of interventions aimed at increasing adaptive pain-relevant social support.

Adaptation, Psychological↗

Problem solving and suicidal behavior.

Research on suicidal behavior falls into two main areas: studies that aim to identify demographic and social risk factors, and studies that aim to investigate the psychological processes mediating suicidal behavior. Within the latter approach, impaired problem-solving ability has been found to be an important variable. This paper reviews recent research focusing on problem-solving deficits and their relation to suicidal behavior and considers some of the methodological problems that arise. These findings are discussed in terms of active versus passive problem solving, state or trait factors, and the psychological processes underlying problem solving. Suggestions for further research are made, focusing on the links between suicidal behavior, problem solving, and autobiographical memory.

Humans↗

Problem solving in nursing practice: application, process, skill acquisition and measurement.

This paper analyses the role of problem solving in nursing practice including the process, acquisition and measurement of problem-solving skills. It is argued that while problem-solving ability is acknowledged as critical if today's nurse practitioner is to maintain effective clinical practice, to date it retains a marginal place in nurse education curricula. Further, it has attracted limited empirical study. Such an omission, it is argued, requires urgent redress if the nursing profession is to meet effectively the challenges of the next decade and beyond.

Education, Nursing↗

Personal problem-solving scoring of TAT responses: known-groups validation.

Two studies employed a known-groups validation strategy to evaluate a Thematic Apperception Test (TAT) scoring system purported to measure personal problem-solving skills, the Personal Problem-Solving System (PPSS). In Study 1 clinicians rated the records of 46 mental health outpatients for the presence of personal problem-solving skills deficits. Verbatim TAT transcripts from these patients were blindly scored using the PPSS. Participants predicted to demonstrate problem-solving deficits obtained lower PPSS scores. In Study 2 a psychiatric sample (n = 47) and a community-based comparison group (n = 47) completed a life history questionnaire, a checklist of problems currently experienced, a measure of psychiatric symptoms, and responded to 3 TAT cards. TAT responses were again blindly scored using the PPSS. In contrast to the comparison group, psychiatric patients checked a greater number of current problems, endorsed more psychiatric symptoms, and obtained lower scores on the PPSS. A discriminant function analysis using PPSS scores correctly classified 72% of these participants. PPSS scores predicted group membership even after controlling for differences in age, education, the number of problems experienced, and psychiatric symptoms. This combination of variables correctly classified 92% of the participants. Results of both studies are interpreted as supporting the discriminant validity of the PPSS.

Journal Article↗

Problem-solving deficits in alcoholics: evidence from the California Card Sorting Test.

In an attempt to clarify the nature of the problem-solving deficits exhibited by chronic alcoholics, the California Card Sorting Test (CCST) and other measures of abstraction and problem solving were administered to 23 alcoholics and 16 nonalcoholic controls, equated for age, education and vocabulary. On the CCST, the alcoholics exhibited three types of deficits which appeared to be relatively independent. First, the alcoholics generated and identified fewer correct concepts than controls, although they executed concepts normally when cued by the examiner. Second, the alcoholics made more perseverative sorting responses and perseverative verbal explanations for their sorting behavior than did controls. Third, alcoholics provided less complete verbal explanations of the concepts that they correctly generated or identified. The differential importance of these factors on various measures of problem solving may help to explain the varied patterns of inefficient problem solving exhibited by alcoholics.

Adult↗

A developmental study of adults' performance on traditional and practical problem-solving tasks.

Ninety-six individuals between the ages of 20 and 80 were presented with two types of problem-solving tasks. One was a traditional laboratory problem-solving task; the other was composed of a number of practical problems. Three types of practical problems were employed--problems that young adults might encounter in their daily lives, problems that middle-aged adults might encounter, and problems that elderly adults might encounter. On the traditional laboratory task, performance decreased with increasing age. On the practical problems, however, performance increased from the 20- to the 30-year-old group and decreased thereafter with the most drastic decreases occurring in the 60- and 70-year-old groups. When the three types of practical problems were analyzed separately, the performance of the younger adults was better than the performance of older adults on all of the problem-solving tasks, even on the practical problems that were designed specifically to be ones that older adults would be more likely to encounter in their daily lives.

Adult↗

Anxiety and problem-solving ability in mothers of premature infants.

A study was conducted to examine factors associated with anxiety in mothers of premature infants. Demographic information was obtained from 40 mothers of premature infants who were then tested for anxiety and problem-solving ability with the State-Trait Anxiety Inventory and the Means-Ends Problem-Solving Procedure. Neither the mother's past pregnancy outcomes nor her current infant's physical status had an effect on maternal anxiety levels. The difference in the level of anxiety experienced by mothers grouped according to problem-solving ability (t = 2.94; P = 0.0053) was significant. Mothers with good problem-solving ability acknowledged experiencing higher levels of anxiety than did mothers with lower problem-solving abilities.

Anxiety↗

Problem solving in Parkinson's disease: comparison of performance on the Wisconsin and California Card Sorting Tests.

Previous demonstrations that problem solving deficits may occur early in the course of Parkinson's disease (PD) have been taken to support the view that disturbances in the functioning of the frontal lobes are responsible for the initial cognitive deficits in this disease. However, no specific pattern of responding associated with poor problem solving by PD patients has been observed consistently. In an effort to clarify the nature of the problem solving deficits in PD we administered the Wisconsin Card Sorting Test (WCST) and the California Card Sorting Test (CCST), a new test which provides separate measures of concept generation, concept identification, and concept execution as well as several different measures of perseveration. On both tests PD patients of lower than normal mental status performed poorly and their patterns of performance resembled those previously described for patients with focal frontal lobe lesions, but PD patients of normal mental status performed normally. Because poor problem solving in association with increased perseverative responding was only observed for patients with global cognitive deficits these findings do not necessarily support the idea that frontal dysfunction is the principal cause of impaired cognition in PD. Although the overall pattern of results was similar for the WCST and the CCST, the CCST was more sensitive for detecting deficits than was the WCST.

Aged↗

Information processing and social cognitive problem solving in schizophrenia. Assessment of interrelationships and changes over time.

The relationship between basic information processing and social cognitive problem solving (SCPS) was studied in 31 schizophrenic, 16 depressive, and 31 control subjects. The clinical subjects were assessed twice, during symptom exacerbation and 3 months later, after partial remission. Control subjects were tested during the same time period. Subjects completed a means-ends problem-solving test, an alternative solution generation task, and an information-processing test battery. Results showed that schizophrenic subjects demonstrated significant improvement in a number of information-processing indices over time. No significant changes on the social cognitive problem-solving variables were found. Furthermore, all three groups demonstrated different patterns of relationships between information processing and social cognitive problem solving. Implications for treatment are discussed.

Adult↗

Perceived problem-solving ability, stress, and coping in mothers of children with physical disabilities: potential cognitive influences on adjustment.

Examined the contribution of perceived problem-solving ability to the adjustment of mothers of children with a physical disability, in conjunction with appraised disability-related stress and approach and avoidance coping, as a further evaluation of Wallander and Varni's Disability-Stress-Coping model emphasizing cognitive processes. One hundred sixteen mothers of children, ages 2 to 20, with spina bifida or cerebral palsy completed measures of relevant constructs. Results show that the mother's appraisal of disability-related stress is strongly associated with her reported maladjustment. However, perceptions of competence in problem solving are associated with better overall adjustment. A portion of this relation appears mediated by coping styLe, as confidence in one's problem-solving ability increases so does the likelihood of selecting more adaptive coping strategies when faced with disability-related stress. Overall, consideration of perceived problem-solving ability appears to make a valuable contribution to the Disability-Stress-Coping model and to current understanding of the experience of coping with raising a child with a disability. Perceived problem-solving ability can also be linked to clinical intervention, as discussed.

Journal Article↗

A trial of problem-solving by community mental health nurses for anxiety, depression and life difficulties among general practice patients. The CPN-GP study.

OBJECTIVES: To compare the effectiveness of community mental health nurse (CMHN) problem-solving and generic CMHN care, against usual general practitioner (GP) care in reducing symptoms, alleviating problems, and improving social functioning and quality of life for people living in the community with common mental disorders; and to undertake a cost comparison of each CMHN treatment compared with usual GP care. DESIGN: A pragmatic, randomised controlled trial with three arms: CMHN problem-solving, generic CMHN care and usual GP care. SETTING: General practices in two southern English counties were included in the study. CMHNs were employed by local NHS trusts providing community mental health services. PARTICIPANTS: Participants were GP patients aged 18--65 years with a new episode of anxiety, depression or reaction to life difficulties and had to score at least 3 points on the General Health Questionnaire-12 screening tool. Symptoms had to be present for a minimum of 4 weeks but no longer than 6 months. INTERVENTIONS: Patients were randomised to one of three groups: (1) CMHN problem-solving treatment, (2) generic CMHN treatment, or (3) usual GP care. All three groups of patients remained free to consult their GPs throughout the course of the study, and could be prescribed psychotropic drug treatments. MAIN OUTCOME MEASURES: Patients were assessed at baseline, and 8 weeks and 26 weeks after randomisation. The primary outcome measure was psychological symptoms measured on the Clinical Interview Schedule -- Revised. Other measures included social functioning, health-related quality of life, problem severity and satisfaction. The economic outcomes were evaluated with a cost--utility analysis. RESULTS: Twenty-four CMHNs were trained to provide problem-solving under supervision, and another 29 were referred patients for generic support. In total, 247 patients were randomised to the three arms of the study, referred by 98 GPs in 62 practices. All three groups of patients were greatly improved by the 8-week follow-up. No significant differences were found between the groups at 8 weeks or 26 weeks in symptoms, social functioning or quality of life. Greater satisfaction with treatment was found in the CMHN groups. CMHN care represented a significant additional health service cost and there were no savings in sickness absence. CONCLUSIONS: The study found that specialist mental health nurse support is no better than support from GPs for patients with anxiety, depression and reactions to life difficulties. The results suggest that healthcare providers could consider adopting policies of restricting referrals of unselected patients with common mental disorders to specialist CMHNs, although there may be other roles in primary care that CMHNs could play effectively. Further research should address the predictors of chronicity in common mental disorders and target extra treatment. More research is also needed into the effectiveness and cost-effectiveness of problem-solving treatment for other disorders, of facilitated self-help treatments for common mental disorders and of CMHN care for people with severe and enduring mental illnesses, as well as the prevention of mental disorders.

Adolescent↗

Perceived ability and level of education as predictors of traditional and practical adult problem solving.

Sixty adults (ages 19 to 80) were divided into three age groups. Each individual completed the Problem Solving Inventory (PSI), which assesses an individual's self-perception of problem-solving ability, prior to completing two types of problems, including concept-identification tasks and six everyday, practical problems. When the level of education across the younger, middle-aged, and older adults was controlled, older individuals perceived themselves as better problem solvers, and they were more confident in their problem-solving abilities than the other age groups. Additionally, these older adults with relatively high levels of education took more time to complete the concept-identification tasks but did not make more errors or need more choices to solve these tasks. Similarly, the older participants performed as well as either of the other age groups on the everyday, practical problems.

Adult↗

A problem-solving approach to nutrition education with Filipino mothers.

The study examined Filipino mothers' problem solving on issues related to child feeding, using a dyadic, peer-help approach. The participants were mothers of children under 6 yr of age from a village in the southern Philippines, where malnutrition among children is prevalent. Mothers were paired with a mutual friend (each nominated the other as a best friend) or a unilateral friend (only one nominated the other as a best friend) to discuss a feeding problem to which they initially gave similar solutions (agreed) and one to which they gave different solutions (disagreed). In the final step, they were asked to give privately the solutions they considered best for the problem. The number and quality of these final-step solutions were analyzed as a function of the friend relation, the level of initial agreement with their friend partner, and the source of the solution. Results indicated that the quantity and quality of solutions increased from before to after the dyadic discussion, especially among mothers paired with a mutual friend with whom they agreed. Most of their final-step solutions came from ones they themselves had generated during the discussion, not ones their friend partner had proposed. There was also evidence that high quality solutions were generated by mothers paired with a disagreeing unilateral friend. Implications for nutrition education concern the benefits of a peer-help, dyadic problem-solving approach, taking into account the role of a friend in facilitating a mother's production of new solutions to child feeding problems. The procedure may be used by health promoters who want to build capacities and self-reliance through collective problem solving.

Adult↗