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Problem-solving group therapy: two inpatient models based on level of functioning.

Hospitalized psychiatric patients frequently have deficits in their problem-solving abilities. An inpatient problem-solving group provides a therapeutic experience in which patients learn and apply the problem-solving process to practical and interpersonal difficulties they are presently experiencing. Two problem-solving group models, derived from cognitive-behavior theory, are suggested to accommodate diverse levels of inpatient functioning. Implications for nursing practice and recommendations are addressed.

Hospitalization↗

PubMed1977

View box exercises for teaching problem solving in radiology.

An organized radiologic problem-solving system is presented for developing improved view box exercises for students and residents. It is based on six components: (1) problem sensing, (2) problem hypothesizing, (3) problem searching and definition, (4) problem identification, (5) resolution, and (6) verification. Since all examinations by the practicing radiologist involve these components, worthwhile simulated clinical management games should also incorporate them. A simulated radiologic exercise should be a valid measurement of the resident's ability to manage a wide range of clinical situations and techniques and should improve problem-solving strategies. Use of simulated clinical cases eliminates risk to patients during the educational process.

Audiovisual Aids↗

PubMed1986

Using structured medical information to improve students' problem-solving performance.

In the study reported here, the authors assessed the use of efficient organization of knowledge and of problem-solving strategies to enhance medical students' clinical problem-solving skills. Thirty-five preclinical medical students were randomly assigned to a experimental or control group and given a knowledge base containing information on eight congenital heart diseases to learn. Information for the experimental group emphasized disease groupings (based on their similar clinical presentation), symptom-disease associations, and clinical problem-solving heuristics. The same information for the control group was presented in a textbook format that emphasized the pathophysiology of the diseases. The students then diagnosed three computerized diagnostic problems of varying difficulty while verbalizing their problem-solving strategies. The results showed that the experimental group acquired a higher ratio of diagnostic to nondiagnostic cues, mentioned the correct diagnosis sooner in their workups, and correctly diagnosed the most difficult case more often than the control group. These results provide support for revisions in the organization and presentation of information that are aimed at improving clinical problem-solving skills.

Clinical Competence↗

PubMed1988

Sources of maternal confidence and uncertainty and perceptions of problem-solving competence.

Although a mother's perception of her competence in problem-solving issues of infant care may affect her sensitivity to her infant's cues, little is known about factors that contribute to this perception. This study explored the type of information on which maternal confidence is based and examined its relationship to perceived competence in problem-solving issues of infant care. The 49 mothers of healthy newborns who participated in this study were interviewed 30 and 90 days after the infant's birth to learn about sources of confidence or uncertainty. The interview protocol also included scaled items to assess perceived problem-solving competence. The infant's mood was most frequently reported as either a source of confidence or uncertainty at both 30 and 90 days. The infant's response to care as a source of confidence or uncertainty was positively related to perceived competence, suggesting that strengthening mothers' attention to this source of information about their performance may be clinically useful. Direct study of the type of information used to evaluate competence in problem-solving is recommended, since it may differ from the type of information on which mothers base their confidence in caring for their infants.

Adult↗

PubMed1986

Problem-solving approach to clinical education.

A problem-solving method to provide appropriate clinical learning experiences was developed for physical therapy students enrolled in their first year of professional course work. Clinicians from selected facilities were asked to participate in a clinical rotation over a two-quarter period. Using a problem-solving format, each clinician was responsible for a two-hour presentation relating to a disease or disability. Each rotation was repeated weekly for seven different groups of 10 students. During the rotation, the clinician presented a patient with a particular disability or disease and worked with the students to identify patient problems, establish treatment goals, and discuss methods used to achieve the goals. The difficulties encountered with the clinical experiences and the positive aspects of the experiences are discussed.

Clinical Competence↗

PubMed1989

Social problem-solving therapy for unipolar depression: an initial dismantling investigation.

Tests the efficacy of social problem-solving therapy for unipolar depression and examines the relative contribution of training in the problem-orientation component of the overall model. This process involves various beliefs, assumptions, appraisals, and expectations concerning life's problems and one's problem-solving ability. It is conceptually distinct from the remaining four problem-solving components that are specific goal-directed tasks. A dismantling research design, involving 39 depressed Ss, provides findings that indicate problem-solving to be an effective cognitive-behavioral treatment approach for depression, thereby extending previous research. Moreover, the results underscore the importance of including problem-orientation training.

Adaptation, Psychological↗

PubMed1992

Problem solving to prevent work injuries in supported employment.

A problem-solving strategy was used to teach three groups of 3 individuals in supported employment how to prevent work-related injuries. The problem-solving strategy was taught in two training phases. The first training phase involved the use of cue cards, and the second involved the withdrawal of the cue cards. Interviews and staged generalization assessments in the participants' natural work environments were conducted before, during, and up to 12 weeks after training. In these assessments, situations were presented that were either similar or dissimilar to situations presented in training. Results of both the interviews and staged assessments indicated that the participants' newly acquired problem-solving skills generalized to similar and dissimilar situations.

Cues↗

PubMed1989

Perceived problem-solving skills and drinking patterns among college students.

The cognitive social-learning-theory literature on alcohol abuse points to failure to generate appropriate alternative behaviors to drinking as a major predictor of relapse to drinking. Viewing drinking as a continuous variable, ranging from abstinence to abuse, it should be possible to demonstrate a relationship between problem-solving abilities and drinking patterns. The hypothesis that individuals' perceived problem-solving skills are related to their pattern of alcohol use was examined. It was expected that poorer perceived problem-solving skills would be related to maladaptive use of alcohol in response to problem situations. 192 students in Introductory Psychology at a midsized southern university participated. Each subject completed questionnaires assessing frequency and quantity of alcohol use, and stimuli associated with the onset of drinking. The Problem-solving Inventory was used to measure perceived problem-solving skills. Drinking pattern variables were formed by factor analysis. Canonical correlation analysis of the data supported the hypotheses. Students with lower confidence in problem-solving capabilities reported greater use of alcohol to cope with negative emotions and to escape from responsibilities than students with high confidence in their abilities. Amount of alcohol consumed was not related to problem-solving skills.

Adaptation, Psychological↗

PubMed1979

The effects of EMG feedback training during problem solving: a case study.

The present case study investigated the effects of competing task demands on biofeedback training to reduce frontalis muscle tension. Baseline levels of frontalis muscle tension were recorded for relaxation and problem solving. The subject was trained to decrease muscle tension with biofeedback for the problem-solving task alone. The results indicated that EMG training during problem-solving was successfully accomplished. Frontalis muscle tension during relaxation baseline did not change as a result of reductions in muscle tension during problem-solving feedback training. This suggests that the decrease of muscle tension cannot be attributed to reductions in overall muscle tension levels. Instead, training was specific to the problem-solving feedback phases. Additionally, it was found that accuracy in problem-solving did not decline as a result of simultaneous feedback training. Thus EMG biofeedback training can be accomplished and exercised without disruption of ongoing mental activity.

Adult↗

PubMed1989

The relation between stressful life events and adjustment in elementary school children: the role of social support and social problem-solving skills.

This study investigated the relation between stressful life events and adjustment in elementary school children, with particular emphasis on the potential main and stress-buffering effects of social support and social problem-solving skills. Third through fifth graders (N = 361) completed social support and social problem-solving measures. Their parents provided ratings of stress in the child's environment and ratings of the child's behavioral adjustment. Teachers provided ratings of the children's behavioral and academic adjustment. Hierarchical multiple regressions revealed significant stress-buffering effects for social support and problem-solving skills on teacher-rated behavior problems, that is, higher levels of social support and problem-solving skills moderated the relation between stressful life events and behavior problems. A similar stress-buffering effect was found for problem-solving skills on grade-point average and parent-rated behavior problems. In terms of children's competent behaviors, analyses supported a main effect model of social support and problem-solving. Possible processes accounting for the main and stress-buffering effects are discussed.

Achievement↗

PubMed1991

Parent-child problem-solving interactions in families of visually impaired youth.

Investigated problem-solving and conflict-resolution strategies, an important aspect of family functioning, in visually impaired adolescents and their parents. Visually impaired adolescents were compared to adolescents with spina bifida and a control group of adolescents without disabilities. Parent-adolescent dyads participated in a problem-solving discussion of topics reflecting family disagreement. Videotapes of these discussions were rated for patterns of interaction using the Marital Interaction Coding System (MICS-III). Examination of positive and negative reciprocal patterns of interaction using sequential analyses and contrasting frequencies of specific behavioral codes revealed no differences between groups for adolescents, mothers, and fathers on the problem-solving discussion. Results are discussed in terms of (a) the impact of visual impairment on family functioning and (b) the need to identify those subgroups of visually impaired and their families that may be at heightened risk for maladjustment.

Adaptation, Psychological↗

PubMed1991

Interpersonal problem-solving in depressed students.

This study investigated whether depressed students suffer from a deficit in interpersonal problem-solving and attempted to specify the hypothesized deficit using a qualitative analysis of problem-solving strategies. Twenty depressed students were compared with 20 nondepressed controls with respect to the strategies they developed on a Situation Specific Problem-Solving Inventory. Results supported the hypothesis of a problem-solving deficit in depressed students. Although depressed students seemed to have an adequate definition of the problem and the target, they showed a significant lack of action-oriented strategies.

Adult↗

PubMed1992

Social problem solving among popular and unpopular children.

The present study investigated two issues related to children's social status and problem solving: the content of problem-solving measures and judgments of the quality of responses to social problems. Three types of social problem situations were studied: peer entry/initiation, maintaining social interaction, and management of conflict. The quality of children's strategies for solving these problems was rated on two dimensions: effectiveness and social competence. Liked-most children obtained significantly more effective and socially competent ratings than liked-least children for only one of the social problem situations--management of conflict. Significant differences between liked-most and liked-least children were also found between the quality of their best effective and best socially competent solution and their worst socially competent solutions. Results are discussed in terms of the psychometric adequacy of social problem-solving measures and the resultant problems in interpretation.

Child, Preschool↗

PubMed1985

[Development of a questionnaire for problem solving].

Presented is the development of a measuring instrument in order to assess the problem solving ability (PLF). The PLF consists of 5 scales: a) experiencing problems, b) problem denial, c) tendency to solve problems in an unconventional way, d) dealing with the problem and e) tendency to conservative problem solving. Test-theoretical analyses are reported as well as, in greater detail, studies for test validation on various populations. High covariations can be shown especially for personality factors.

Adaptation, Psychological↗

PubMed1991

Problem solving and diabetes self-care.

An important objective of diabetes care is to provide patients with self-regulation skills. For patients to assume responsibility for their own regimens, they need to have good problem-solving skills to cope with ongoing personal, social, and environmental barriers to adherence. Therefore, a Diabetes Problem Solving Interview for adults was developed and evaluated with 126 non-insulin-dependent outpatients. Interviewers elicited problem-solving strategies patients would use to cope with a variety of situations potentially interfering with dietary, exercise, and glucose testing adherence. Interviews were tape recorded and coded by trained raters to produce scores on both overall problem-solving skill ratings and frequency of use of different types of strategies. Results revealed only minor influences of patient characteristics on problem-solving measures. Prospective analyses revealed that problem-solving measures were significant and independent predictors of levels of dietary and exercise self-care at a 6-month follow-up.

Activities of Daily Living↗

PubMed1975

Academic achievement, situational stress, and problem-solving flexibility.

Academic overachieving (n equals 12) and underachieving (n equals 10) tenth grade boys were randomly assigned, with their parents, to either a success or a failure treatment in a problem solving task to determine the effects of induced stress on problem solving flexibility. For the underachievers, Ss in the success treatment were the most flexible, while for the overachievers, Ss in the failure treatment were the most flexible. A curvilinear proposition, consistent with Hebb's cue-arousal postulate was proposed to explain the results and also to explain the apparent discrepancies in the literature as to whether situational stress increases or decreases flexibility in problem solving. An implication of the proposition is that for persons with feelings of personal inadequacy, increases in situation stress result in decreased problem solving flexibility, but for persons with feelings of personal adequacy such increases enhance their problem solving flexibility.

Achievement↗

PubMed1985

Knowledge and clinical problem-solving.

A consistent finding in the literature on measures of clinical problem-solving scores is that there are very low correlations across different problems. This phenomenon is commonly labelled 'content-specificity', implying that the scores differ because the content knowledge necessary to solve the problems differs. The present study tests this hypothesis by presenting groups of residents and clinical clerks with a series of simulated patient problems in which content was systematically varied. Each subject also completed a multiple choice test with questions linked to each diagnosis presented in the clinical problems. Three of the four problem-solving scores showed low correlations, even to two presentations of the same problem, and no relationship to content differences. None of the scores were related to performance on the multiple choice test. The results suggest that variability in problem-solving scores is related to factors other than content knowledge, and several possibilities are discussed.

Canada↗

PubMed1992

Childhood depression and conduct disorder: I. Behavioral, affective, and cognitive aspects of family problem-solving interactions.

We assessed the family interactions of depressed, conduct-disordered, mixed depressed-conduct-disordered, and nonclinic children, ages 7-14 years, during a standardized family problem-solving discussion in the clinic. The child's and the mother's problem-solving proficiency, aversive behavior, and associated affective behavior (depressed and angry-hostile) were observed. The child and mother also rated each other's affect during the interaction for the dimensions sad, angry, critical, and happy on Likert-type scales. The child's and mother's cognitive constructions about the interaction were assessed using video-mediated recall. Although all clinic groups had lower levels of effective problem solving than did nonclinic children, their deficiencies were somewhat different. Mixed and depressed children displayed high levels of depressed affect and low levels of angry affect, whereas conduct-disordered children displayed both angry and depressed affect. In addition, conduct-disordered children had lower levels of positive problem solving and higher levels of aversive content than did non-conduct-disordered children. Depressed and conduct-disordered children had higher levels of self-referent negative cognitions than did mixed and comparison children, and depressed children also had higher other-referent negative cognitions than did all other groups. The study provides support for theories and treatment that stress the importance of family problem-solving and conflict resolution skills in child psychopathology.

Affect↗