Problem Solving Treatment for Depression

Overseen By Patrick Raue, PhD

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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to enhance the use of Problem Solving Treatment for individuals with depression in primary care settings. It compares standard training with a new web-based app called PST-Aid, which facilitates collaboration between practitioners and clients in setting goals and planning actions. The trial seeks practitioners in the OCHIN network with a master's degree in a relevant field, as well as clients diagnosed with depression who experience significant symptoms. Participants should speak English and not have other psychiatric disorders, substance abuse issues, or dementia. As an unphased trial, this study provides a unique opportunity to contribute to innovative treatment methods for depression.

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 prior data suggests that the Problem Solving Treatment Aid (PST-Aid) is safe for use in depression treatment?

Research shows that Problem Solving Treatment (PST) is generally well-received by people with depression. Studies have found that PST reduces symptoms of depression and improves daily life. Many prefer it, with fewer discontinuing treatment compared to options like cognitive behavioral therapy (CBT).

The Problem Solving Treatment Aid (PST-Aid) is an online tool that enhances collaboration between practitioners and clients. A small study found that both practitioners and clients considered PST-Aid suitable and easy to use. Early evidence suggests it may improve depression outcomes.

In summary, previous studies have shown that both PST and PST-Aid are safe and effective, with users generally finding them acceptable. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Problem Solving Treatment Aid (PST-Aid) for depression because it enhances traditional Problem Solving Treatment (PST) by incorporating additional support tools. Unlike standard treatments like medication or cognitive behavioral therapy, PST-Aid aims to empower individuals by providing structured guidance, making the therapeutic process more engaging and potentially more effective. This approach is unique in its focus on active problem-solving, which can help patients develop practical skills to manage their depression in real-life situations. By potentially improving accessibility and user engagement, PST-Aid offers a promising alternative to conventional treatment methods.

What evidence suggests that this trial's treatments could be effective for depression?

Research shows that Problem Solving Treatment (PST) can help reduce symptoms of depression. Studies have found that PST is more effective than receiving no treatment for depression. In this trial, participants will receive either Problem Solving Treatment as usual (PST as usual) or Problem Solving Treatment Aid (PST-Aid). A small initial trial found that PST-Aid was easy for both therapists and clients to use and showed early signs of helping with depression. Another study confirmed that PST significantly improves depression scores over time. This suggests that using PST, especially with tools like PST-Aid, could be beneficial for people dealing with depression. ^{1 3 4 6 7}

Who Is on the Research Team?

Patrick Raue, PhD

Principal Investigator

University of Washington

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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 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]

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]

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]

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 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]

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]

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]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT06494384

Study Details | NCT06494384 | Implementation of Problem- ... PST Aid is more effective in reducing client depressive symptoms and improving functioning.

2. ncbi.nlm.nih.gov ncbi.nlm.nih.gov/books/NBK74902/

Problem solving therapies for depression: a meta-analysis This review evaluated the effects of problem-solving therapy (PST) for depression. The authors concluded that PST is more effective than inactive controls ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S1054139X22004530

Problem Solving as an Active Ingredient in Indicated ... Intervention protocols that included problem solving and no more than one other specific component appeared to be effective for depression but not anxiety.

4. bmcpsychiatry.biomedcentral.com bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-11-156

The effectiveness of problem solving therapy in deprived ... This pilot study evaluates the feasibility, acceptability and effectiveness of this PST program for CMD's in deprived communities around Cape Town.

5. psychiatryonline.org psychiatryonline.org/doi/10.1176/appi.ps.20230027

Versus Peer-Supported Problem-Solving Therapy for Rural ... Both interventions resulted in clinically significant improvement in depression by week 12. Depression scores in the CM-PST group dropped by 4.1 ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC2943727/

Problem Solving Therapy for Subthreshold Depression in ... PST-HC provides information and education on depression and helps patients develop new problem solving strategies for dealing with daily living stressors. An ...

7. researchgate.net researchgate.net/publication/242658685_Problem-Solving_Treatment_for_Primary_Care_PST-PC_A_Treatment_Manual_for_Depression

Problem-Solving Treatment for Primary Care (PST-PC) Problem Solving therapy (PST) is a low intensity cognitive-behavioral intervention that focuses on training in adaptive problem-solving attitudes and skills.