Social problem solving in adolescents with suicidal behavior: a systematic review

There is an increasing focus on deficiencies in problem solving as a vulnerability factor for suicidal behavior in general and hence a target for treatment in suicide attempters. In view of the uncertainty of evidence for this in adolescents we conducted a systematic review of the international research literature examining the possible relationship between deficiencies in social problem-solving skills and suicidal behavior in this population. This was based on searching two electronic databases: Medline 1966 to September 2003 and PsychInfo 1887 to September 2003. Twenty-two studies of social problem-solving skills in adolescents with suicidal behavior were found. Most of these studies, which compared adolescent patients with suicide attempts versus either nonsuicidal psychiatric or normal controls, found evidence for problem-solving deficits in the attempters; however, few of the differences remain after controlling for depression and/or hopelessness. Because most of the studies are cross-sectional, it is difficult to differentiate between the possibilities that deficiencies in problem-solving skills lead to depression when adolescents are faced by adversity and hence to suicidal behavior, or whether depression is the main factor which undermines problem-solving skills. Future research, preferably with longitudinal research designs, is required to determine the nature of the association between problem-solving skills and suicidal behavior in adolescents. This has important implications for therapeutic interventions.     

Cognitive-Behavior Therapy for Reduction of Persistent Anger

Although persistent anger is not represented in DSM-IV as a psychiatric disorder, it is nevertheless a significant clinical problem. Based on our experience with both research and clinic patients from a diverse urban population, and drawing on methods utilized by others, we have refined and elaborated several treatment strategies that appear useful for anger reduction. The strategies derive from a counterconditioning treatment model: patients are exposed (either naturally or by design) to situations that may evoke anger, while they apply physiological, cognitive, and/or behavioral methods that can dampen the habitually angry response. The specific anger-reduction methods include: applied muscle relaxation, cognitive reappraisal, inhibition of overresponding, and reversal of underresponding (through acquisition of effective communication and problem-solving skills). Preliminary evidence is presented indicating that anger patients experience significant reduction in the intensity, duration, and frequency of anger reactions after completing 12 sessions of therapy utilizing these anger-reduction methods.     

Clinical,Studies in Psychiatry by H. S. Sullivan

A structured group therapy approach for psychiatric inpatients is presented. After reviewing the literature indicating that insight-oriented approaches are not effective with severely disturbed patients, the data supporting an interpersonal, cognitive, problem-solving approach with such patients is reviewed. A rationale for combining this cognitive problem-solving approach and Yalom's interpersonal approach with psychiatric inpatients is then presented. This structured group therapy approach, called the problem-solving support group (PSSG) is discussed, defining the nature and composition, screening procedures, methods, and techniques of the PSSG. Its use with psychiatric patients is illustrated by therapy protocols depicting the nature of the therapeutic interactions during the group, while also demonstrating what the group appears to be accomplishing for its members.     

青少年孤独感与抑郁症状:反应风格的中介作用以及性别的调节作用

基于反应风格理论,本研究探索反应风格在青少年孤独感与抑郁症状之间的中介效应。使用孤独感量表、儿童反应风格量表以及儿童抑郁量表对 795 名 青少年进行调查。结果发现：（1）青少年孤独感能显著预测抑郁症状。（2）青少年孤独感能通过反刍、问题解决间接预测抑郁症状。（3）反应风格整体（比率分数）中介青少年孤独感与抑郁症状之间的关系。本研究结果显示,反应风格能够解释青少年孤独感与抑郁症状之间的内在机制。     

青少年孤独感与抑郁症状:反应风格的中介作用以及性别的调节作用

基于反应风格理论,本研究探索反应风格在青少年孤独感与抑郁症状之间的中介效应。使用孤独感量表、儿童反应风格量表以及儿童抑郁量表对 795 名 青少年进行调查。结果发现：（1）青少年孤独感能显著预测抑郁症状。（2）青少年孤独感能通过反刍、问题解决间接预测抑郁症状。（3）反应风格整体（比率分数）中介青少年孤独感与抑郁症状之间的关系。本研究结果显示,反应风格能够解释青少年孤独感与抑郁症状之间的内在机制。     

Interpersonal problem-solving deficits in self-poisoning patients

Self-poisoning patients (n = 40) were compared with psychiatric patients (n = 40) and nonpatient controls (n = 20) on measures of interpersonal problem-solving skills and locus of control in an effort to determine the importance of these cognitive and personality variables in self-poisoning behavior. The psychiatric and self-poisoning groups showed deficits on measures assessing interpersonal problem solving when compared with nonpatient controls. The self-poisoning group performed below the level of the psychiatric patients on all except one test, on which they performed at the level of the psychiatric group. Locus of control did not differentiate self-poisoning patients from nonpatient controls, and it was concluded that this variable is not an important factor in self-poisoning behavior.     

Family interaction styles of children with depressive disorders, schizophrenia-spectrum disorders, and normal controls

Family interaction processes during a problem-solving task were examined in children with depressive disorders, children with schizophrenia-spectrum disorders, and a normal control group of community children screened for the absence of psychiatric disorder. Major findings were: a) children with depressive disorders were more likely than children with schizophrenia-spectrum disorders and children with no psychiatric disorder to direct guilt-inducing comments toward their parents; and b) parents of children with schizophrenia-spectrum disorders were more likely to direct harsh critical comments toward the child than were parents of depressed children or parents of normal controls. In addition, children's and mothers' use of benign criticism was linked, while children's harsh criticism was associated with intrusion from the father, and children's self-denigrating comments were related to specific paternal criticism. Implications of these results for understanding transactional processes associated with childhood-onset depressive and schizophrenia-spectrum disorders are discussed.     

Differentiating Cognitive Content between Depressed and Anxious Outpatients

Quantitative research suggests that depressed and anxious patients can be differentiated based on their cognitive content. This study used qualitative research methods to separate the specific components of open‐ended depressive and anxious thought content in 79 psychiatric outpatients. Patients with major depressive disorder (MDD; n = 36), generalized anxiety disorder (GAD; n = 10), and other psychiatric disorders (PC; n = 33) were instructed to (a) describe their most bothersome problem; (b) imagine the worst possible negative outcome followed by the best possible positive outcome; and (c) describe associated thoughts and emotions for each scenario. The content of patients' responses were coded to examine (a) the types and severity of problems; (b) the presence or absence of hopelessness, catastrophizing, hopefulness, and unrealistic positive expectations; and (c) the presence or absence of particular emotions associated with imagined worst and best outcomes. More GAD patients than MDD and PC patients indicated anticipated anxious emotions associated with imagined worst outcomes, and fewer MDD patients than GAD and PC patients indicated anticipated happiness associated with imagined best outcomes. No group differences emerged for the other variables considered. These findings suggest that depressed and anxious patients differ in their cognitive expectancies about future life events in terms of their own anticipated emotional reactions.     

Problem-solving skills training: Social validation and generalization

This study developed and evaluated a program for teaching a verbal problem-solving strategy to mildly mentally handicapped adults. Six general areas were targeted for training: Community Awareness, Authority Figures, Peer Issues, Stating One's Rights, Emergencies and Injuries, and Safety. The program features response-specific feedback, modeling, self-monitoring, positive reinforcement, response practice, self-correction, and individualized performance criterion levels. The experimental group (N = 3) received baseline, training, probes, and pre/posttraining generalization assessments, whereas the control group (N = 3) received only the pre/posttraining assessments. The generalization and probe assessments contained situations that were both similar and dissimilar to the training situations. The three month posttraining results revealed that the experimental subjects' problem-solving skills had generalized to both types of situations, whereas the control group showed little overall change. Furthermore, the experimental group's three month scores were comparable to those of a group of nonhandicapped individuals. Issues related to these results and suggestions for future research are discussed.     

发明创造问题解决中的原型位置效应

以科学发明创造问题为实验材料,采用“学习-测试”两阶段实验范式,对发明创造问题解决中的原型位置效应进行探讨,结果发现：（1）原型位置主效应显著,后呈现原型成绩显著优于先呈现原型;（2）原型位置效应受创造性倾向影响,随创造性倾向的提高而显著降低;（3）原型位置效应不受启发量影响,但不同创造性个体受高低启发量影响;（4）发明创造问题解决得分与创造性倾向总分相关显著,二者在原型位置效应上表现相同的效应。     

Assessing complex problem-solving skills with multiple complex systems

In this paper we propose the multiple complex systems (MCS) approach for assessing domain-general complex problem-solving (CPS) skills and its processes knowledge acquisition and knowledge application. After defining the construct and the formal frameworks for describing complex problems, we emphasise some of the measurement issues inherent in assessing CPS skills with single tasks (i.e., fixed item difficulty, low or unknown reliability, and a large impact of random errors). With examples of the MicroDYN test and the MicroFIN test (two instances of the MCS approach), we show how to adequately score problem-solving skills by using multiple tasks. We discuss implications for problem-solving research and the assessment of CPS skills in general.     

Toward an integrative model of suicide attempt: a cognitive psychological approach.

Applying a cognitive approach, the purpose of the present study was to expand previous research on stress-vulnerability models of depression and problem-solving deficits, as it relates to suicide attempt. Structural equation modelling, involving latent variables, was used to evaluate (a) whether low self-esteem, a low sense of self-efficacy, loneliness, and divorce constituted vulnerability factors for the development of depression; (b) whether hopelessness and suicidal ideation mediated the relationship between depression and suicide attempt; and (c) whether problem-solving deficits mediated the relationship between the vulnerability factors and suicide attempt, separate from depression/hopelessness. A total of 123 individuals, aged 18-75 years, participated in the study (72 suicide attempters and 51 psychiatric outpatients with no history of suicidal behavior). The results indicated a two path model of suicide attempt. The first path began with low self-esteem, loneliness, and separation or divorce, which advanced to depression, and was further mediated by hopelessness and suicidal ideation which led to suicide attempt. The second path developed from low self-esteem and a low sense of self-efficacy and advanced to suicide attempt, mediated by a negative appraisal of one's own problem-solving capacity, and poor interpersonal problem-solving skills. The importance of addressing both depression/hopelessness, and problem-solving deficits when working with suicide attempters is noted.     

Randomized controlled trial of a brief problem-orientation intervention for suicidal ideation

Empirical evaluations suggest that problem orientation, the initial reaction to problems, differentiates suicidal youth from nonchnical controls and nonideating psychiatric controls. One promising area for intervention with suicidal youth relates to enhancing this specific coping skill. Nonclinical participants (N = 110) with active suicidal ideation were randomly assigned to receive a brief problem-orientation intervention or a control procedure. The current study evaluated the benefits of a brief prevention intervention based on the Problem-Solving Therapy model. Exposure to a brief video intervention regarding problem solving and coping skills was sufficient to elicit significant decreases in suicidal ideation and depression, but the intervention did not elicit improvements in problem orientation or other problem-solving abilities. These findings provide preliminary support for a brief, video-based problem-solving and coping skills module. However, considerable work in developing secondary prevention interventions remains.     

Can false memories prime alternative solutions to ambiguous problems?

Research has demonstrated that false memories are capable of priming and facilitating insight-based problem-solving tasks by increasing solution rates and decreasing solution times. The present research extended this finding by investigating whether false memories could be used to bias ambiguous insight-based problem-solving tasks in a similar manner. Compound remote associate task (CRAT) problems with two possible correct answers, a dominant and a non-dominant solution, were created and normed (Experiment 1). In Experiment 2, participants were asked to solve these CRAT problems after they were given Deese/Roediger-McDermott lists whose critical lures were also the non-dominant solution to half of the corresponding CRATs. As predicted, when false memories served as primes, solution rates were higher and solution times were faster for non-dominant than dominant CRAT solutions. This biasing effect was only found when participants falsely recalled the critical lure, and was not found when participants did not falsely recall the critical lure, or when they were not primed. Results are discussed with regard to spreading activation models of solution competition in problem-solving tasks and current theories of false memory priming effects.     

Problem-solving skills training for psychiatric inpatients: An analysis of generalization

A program for teaching problem-solving skills was evaluated with six psychiatric inpatients in a multiple baseline across groups design. Subjects received training on 12 problem situations and the generalization of verbal problem-solving to six novel situations was assessed via probes presented by a novel person in an untrained setting. The generalization of overt behavior was assessed via pre/post contrived in vivo assessments that contained six situations used in training. The in vivo situations were integrated within a sequence of ongoing events in an effort to enhance the ‘naturalness’ of the assessment. The probes revealed some improvement in verbal problem-solving skills, whereas minimal improvement occurred in the post in vivo test. Following the study, an attempt was made to enhance performance by having the trainer conduct a probe and adding verbal prompts to evoke problem-solving during an additional in vivo assessment. Both efforts produced improvements in subjects' performance to a level near that achieved by a normative sample of 20 individuals. The results suggest that in vivo problem-solving may be dependent on the methods used in presenting problem situations as well as situational factors. Issues related to these results and suggestions for future research are discussed.     

Group-based problem-solving therapy in self-poisoning females: A pilot study

Aims: The treatment of suicidal behaviour remains limited in efficacy. This pilot study assessed the effectiveness of a time-limited, group-based problem-solving therapy intervention compared with a treatment as usual control group, in females who self-poison. Method: A total of 18 clients were equally randomised to treatment or control groups. All clients were assessed using standardised questionnaires for depression, hopelessness, suicidal ideation and social problem-solving skills, at pre-treatment, post-treatment and two months follow-up. Results: The treatment group experienced significant reductions in levels of depression, hopelessness, suicidal ideation and improvements in self-assessed social problem-solving skills. Improvements in mental health and aspects of self-assessed problem-solving skills for the treatment group continued to be evident at two months follow-up. The control group did not change significantly over time on mental health measures or social problem solving abilities. Conclusion: Although limited by small sample size, the results suggest that group-based problem-solving therapy is effective in the management of deliberate self-poisoning. This paper is a unique contribution in that it examines the implementation of problem solving therapy with a homogenous population and in a group format. Methodological concerns and directions for future research are discussed.     

Adolescent Suicidal Risk: Psychological,Problem Solving,and Environmental Factors

This study examined the life stress and problem-solving interactional model of suicide proposed by Clum, Patsiokas, and Luscomb (1979) . Thirty-three hospitalized suicidal adolescents were compared with 21 adolescents hospitalized for other psychiatric problems and with 89 controls. The assessment battery was composed of psychological measures, problem-solving measures, and environmental and family measures. The discriminant analyses revealed that the suicide group could be discriminated from the psychiatric control group but not from the high school control group. Unexpectedly, life stresses did not contribute to the identification of current suicide risk. The results suggest the importance of assessing suicide risk at the time of admission to minimize any subsequent changes in the risk group.