Problem Solving Treatment for Depression

Overseen By Helen Haile

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Washington

Disqualifiers: Bipolar, Psychotic disorders, Suicidal, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

410 Participants Needed

Trial Summary

What is the purpose of this trial?

Although evidence-based clinical interventions (CI) are a preferred treatment option for patients with depression, CIs are rarely available in community primary care settings. When available, CIs are often delivered with poor fidelity and abandoned by practitioners during the initial months post-training. Identifying effective implementation strategies to support the adoption, reach, and sustained use with fidelity of these CIs could enhance the effectiveness of primary care-based treatment of depression, as primary care is where most treatment for this disorder is delivered. Current models of primacy care practitioner training and supervision follow standard formal didactic procedures that might not be sufficient for successful adoption, high-fidelity delivery, and sustainment of CIs. Automated decision support tools and feedback systems embedded in health informatics technology have been found to be effective in supporting the use of best practices and hence might be useful for the transition from training to sustained CI use. In practice, however, these tools are ignored by practitioners, have mixed success on outcomes, and can hinder clinical care owing to poor design. Problem Solving Treatment Aid (PST-Aid), an educate and reorganize implementation strategy, is a web-based app that promotes practitioner-client collaboration in the use of PST for goal setting and action planning. A pilot randomized trial comparing Problem Solving Treatment (PST) training-as-usual to training plus PST-Aid found PST-Aid was deemed to be appropriate and usable to both practitioner and client users with preliminary support for benefits in depression outcomes.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your healthcare provider.

What data supports the effectiveness of the treatment Problem Solving Treatment Aid (PST-Aid) for depression?

Research shows that Problem-Solving Therapy (PST) is as effective as other therapies and medications for reducing depression symptoms. It works best when it includes training in positive problem orientation and all major problem-solving skills. ^{1 2 3 4 5}

How is Problem Solving Treatment for Depression different from other treatments?

Problem Solving Treatment (PST) for depression is unique because it focuses on teaching adaptive problem-solving skills and attitudes, which helps individuals manage their depression by addressing the root causes of their stress and emotional challenges. Unlike some other treatments, PST emphasizes a structured approach that includes defining problems, generating solutions, making decisions, and implementing solutions, making it a comprehensive cognitive-behavioral therapy. ^{4 5 6 7 8}

Research Team

Patrick Raue, PhD

Principal Investigator

University of Washington

Eligibility Criteria

This trial is for practitioners in the OCHIN network without specialized depression intervention training and English-speaking clients over 18 with a diagnosis of unipolar depression (PHQ-9 score ≥ 10). Practitioners should have a master's degree in social work, psychology, counseling, or related field and no prior formal PST training.

Inclusion Criteria

I work at a clinic that is part of the OCHIN network.

I am not in training for depression-specific interventions beyond regular clinic support.

I provide psychotherapeutic care within the OCHIN network.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Training

Participants receive training in Problem Solving Treatment (PST) with or without the PST-Aid tool

6 months

Implementation

Participants implement PST with or without PST-Aid, focusing on adoption, fidelity, and reach

24 months

Follow-up

Participants are monitored for changes in depression and anxiety symptoms, as well as implementation outcomes

9 weeks

Treatment Details

Interventions

• Problem Solving Treatment Aid (PST-Aid)
• Problem Solving Treatment as usual (PST as usual)

Trial Overview The study tests Problem Solving Treatment Aid (PST-Aid), a web-based app designed to help practitioners collaborate with clients on setting goals and planning actions. It compares standard Problem Solving Treatment training to this enhanced method using technology aids.

Participant Groups

Group I: Problem Solving Treatment Aid (PST-Aid) Experimental Treatment 1 Intervention

Participants in this arm will receiving training in PST with PST-Aid.

Group II: Problem Solving Treatment as usual (PST as usual) Active Control 1 Intervention

Participants in this arm will receiving training in PST as usual.

Who Is Running the Clinical Trial?

University of Washington

Lead Sponsor

Trials

1,858

Recruited

2,023,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Findings from Research

The electronic Problem-Solving Treatment (ePST) program significantly improved the knowledge of 13 social workers and trainees about PST, with a notable increase in their understanding after using the program (P = .001).

Participants demonstrated sufficient competence to begin practicing PST under supervision after using ePST, suggesting that this self-instructional method could help widely disseminate effective depression treatment, although ongoing supervision is necessary.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using Self-Guided Treatment Software (ePST) to Teach Clinicians How to Deliver Problem-Solving Treatment for Depression. Cartreine, JA., Chang, TE., Seville, JL., et al.[2021]

In a study involving 171 depressed, disabled, low-income patients aged 60 and older, both clinical case management (CM) and integrated problem-solving therapy (CM-PST) showed similar effectiveness in reducing depressive symptoms over 12 weeks, indicating that CM alone is sufficient for this population.

The development of problem-solving skills did not mediate the improvement in depression, suggesting that the benefits of CM do not rely on this specific therapeutic approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical Case Management versus Case Management with Problem-Solving Therapy in Low-Income, Disabled Elders with Major Depression: A Randomized Clinical Trial. Alexopoulos, GS., Raue, PJ., McCulloch, C., et al.[2022]

Problem Solving Therapy (PST) is an evidence-based psychological treatment that can be effectively utilized by general practitioners in Australia to help patients with mild to moderate depression who prefer non-drug approaches.

The article outlines the structured stages of PST and offers guidance for GPs on how to enhance their problem-solving skills and address challenges in implementing PST, promoting better patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using problem solving therapy in general practice. Pierce, D., Gunn, J.[2007]

Problem-Solving Therapy (PST) is as effective as other psychosocial therapies and medications for reducing depressive symptoms, based on a meta-analysis of 21 independent studies.

PST shows greater effectiveness when it includes training in a positive problem orientation and all four major problem-solving skills, suggesting that a comprehensive approach enhances its therapeutic impact.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Problem-solving therapy for depression: a meta-analysis. Bell, AC., D'Zurilla, TJ.[2022]

Problem solving therapy (PST) is an effective psychological strategy for treating common mental health conditions, showing similar efficacy to antidepressants in managing depression.

PST empowers patients by teaching them problem-solving skills that can be applied to their specific life challenges, making it a suitable intervention in general practice settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Problem solving therapy - use and effectiveness in general practice. Pierce, D.[2012]

Problem-solving therapy (PST) was administered to four breast cancer survivors, with three patients receiving six sessions and one receiving three sessions, leading to a decrease in depression and anxiety scores.

The preliminary results indicate that PST is an effective treatment for alleviating psychological distress in Japanese cancer patients, warranting further investigation in clinical trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Problem-solving therapy for psychological distress in Japanese cancer patients: preliminary clinical experience from psychiatric consultations. Akechi, T., Hirai, K., Motooka, H., et al.[2022]

Problem-solving therapy (PST) is likely an effective treatment for adult depression, showing a moderate effect size of g=0.79 compared to control groups across 30 randomized controlled trials involving 3530 patients.

When compared to other psychotherapies, PST's effectiveness is similar, with a small effect size of g=0.34 in studies with low risk of bias, indicating that while PST may be slightly more effective, the differences are not significant when accounting for researcher bias.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Problem-solving therapy for adult depression: An updated meta-analysis. Cuijpers, P., de Wit, L., Kleiboer, A., et al.[2020]

The pilot program training for Department of Defense providers in problem-solving training (PST) significantly increased their self-efficacy in delivering the intervention, indicating that they felt more confident in their ability to help service members manage distress (p < 0.001).

Service members who participated in the PST intervention (n = 435) reported significant reductions in distress and improvements in resilience and coping skills, as evidenced by declines in Outcome Questionnaire-30 and Patient Health Questionnaire-9 scores, and increases in Brief Resilience Scale and Social Problem Solving Inventory scores (all p < 0.001).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Military Health Provider Training and Evaluation of a Problem-Solving Intervention to Reduce Distress and Enhance Readiness Among Service Members. Cooper, DC., Bates, MJ.[2020]

References

1. United States pubmed.ncbi.nlm.nih.gov

Using Self-Guided Treatment Software (ePST) to Teach Clinicians How to Deliver Problem-Solving Treatment for Depression. [2021]

2. England pubmed.ncbi.nlm.nih.gov

Clinical Case Management versus Case Management with Problem-Solving Therapy in Low-Income, Disabled Elders with Major Depression: A Randomized Clinical Trial. [2022]

3. Australia pubmed.ncbi.nlm.nih.gov

Using problem solving therapy in general practice. [2007]

4. United States pubmed.ncbi.nlm.nih.gov

Problem-solving therapy for depression: a meta-analysis. [2022]

5. Australia pubmed.ncbi.nlm.nih.gov

Problem solving therapy - use and effectiveness in general practice. [2012]

6. England pubmed.ncbi.nlm.nih.gov

Problem-solving therapy for psychological distress in Japanese cancer patients: preliminary clinical experience from psychiatric consultations. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Problem-solving therapy for adult depression: An updated meta-analysis. [2020]

8. England pubmed.ncbi.nlm.nih.gov

Military Health Provider Training and Evaluation of a Problem-Solving Intervention to Reduce Distress and Enhance Readiness Among Service Members. [2020]