Evidence-Based Behavioral Treatments for Diabetes: Problem-Solving Therapy

Problem solving is a basic human thinking process. Many general counseling and psychotherapy approaches, such as cognitive behavioral therapy, include problem solving as a component of treatment for managing life problems and emotional disorders.1 Similarly, educational and lifestyle interventions in diabetes often include elements of problem solving as part of broader intervention approaches.2 Among diabetes educators, problem solving is identified as necessary for patient mastery of diabetes self-management and as the skill most difficult to teach patients.3 This article describes the origins of problem-solving therapy (PST) as a formal, stand-alone intervention approach for behavior change; application of this technique to diabetes care; and evidence of its effectiveness in improving diabetes outcomes. Problem solving, which has its origins in the behavioral and cognitive basic sciences,4–8 is an identified intervention approach for behavior change.9,10 Cognitive psychology defines problem solving as involving the following components: the individual is goal-directed; reaching the goal requires a series of mental processes; and those processes are cognitive rather than automatic.6,7 Problem solving can perhaps be described more simply as a series of cognitive operations used to figure out what to do when the way to reach a goal is not apparent. Although problem solving is a counseling approach that may be incorporated within other intervention models, PST is a stand-alone intervention with a longstanding history. PST took root in clinical and counseling psychology in the 1960s and 1970s to address a variety of mental health disorders, including schizophrenia and psychotic disorders, depression and suicidality, social phobia, generalized anxiety disorder, and posttraumatic stress disorder.11,12 PST has also been used to address marital/family distress, lifestyle management in people with mental retardation, stress management, ineffective coping, and substance abuse.11 There is a substantial evidence …