Problem-solving therapy (PST) has emerged as a promising treatment for major depressive disorder (MDD). The treatment, which is brief and easily accessible to a variety of health practitioners, has often been implemented within primary care settings. Building on this research, this case study highlights utilization of problem-solving therapy with a breast cancer patient diagnosed with recurrent major depression, applied within the context of a medical center oncology clinic. Following an 8-session PST protocol, the patient demonstrated notable decreases in self-reported depression and anxiety symptoms and an overall increase in quality of life and medical functioning. Consistent with an accumulating literature, these data support PST as an effective and parsimonious intervention for individuals with depression and concurrent medical problems such as breast cancer.
Akechi, T., Okuyama, T., Onishi, J., Morita, T., & Furukawa, T.A. (2008). Psychotherapy for depression among incurable cancer patients. Cochrane Database of Systematic Reviews, 2, CD005537.
2.
Alexopoulos, G., Raue, P., & Arean, P. (2003). Problem-solving therapy versus supportive therapy in geriatric major depression with executive dysfunction. American Journal of Geriatric Psychiatry, 11, 46-52.
3.
American Cancer Society. (2008). Cancer facts & figures 2008. Atlanta: Author.
4.
Antoni, M.H., Lehman, J.M., Kilbourn, K.M., Boyers, A.E., Culver, J.L., Alferi, S.M., et al. (2001). Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychology, 20, 20-32.
5.
Arean, P., Perri, M., Nezu, A., Schein, R.L., Christopher, F., & Joseph, T. (1993). Comparative effectiveness of social problem-solving therapy and reminiscence therapy as treatments for depression in older adults . Journal of Consulting and Clinical Psychology, 61, 1003-1010.
6.
Armento, M.E.A., & Hopko, D.R. (2007). The development and validation of the Environmental Reward Observation Scale (EROS). Behavior Therapy, 38, 107-119.
7.
Barlow, D.H., Allen, L.B., & Choate, M.L. (2004). Toward a unified treatment for emotional disorders . Behavior Therapy, 35, 205-230.
8.
Barrett, J.E., Williams, J.W., Oxman, T.E., Katon, W., Frank, E., Hegel, M.T., et al. (1999). The treatment effectiveness project. A comparison of the effectiveness of paroxetine, problem-solving therapy, and placebo in the treatment of minor depression and dysthymia in primary care patients: Background and research plan. General Hospital Psychiatry , 21, 260-273.
Beck, A.T., Steer, R.A., & Brown, G.K. (1996). Manual for Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.
12.
Brown, T.A., Di Nardo, P., & Barlow, D.H. (1994). Anxiety disorders interview schedule for DSM-IV . San Antonio, TX: Psychological Corporation.
13.
Clarke, D.M. (1998). Psychological factors in illness and recovery . New Zealand Medical Journal, 111, 410-412.
14.
Colman, L., & Hopko, D.R. (2006). Problem-solving treatment for depression (PST): Therapist manual for treating cancer patients with depression. Unpublished manuscript.
15.
Cuijpers, P., van Straten, A., & Warmerdam, L. (2007). Problem-solving therapies for depression: A meta-analysis . European Psychiatry, 22, 9-15.
16.
D'Zurilla, T.J., & Nezu, A.M. (2001). Problem-solving therapies. In K. Dobson (Ed.), Handbook of cognitive-behavioral therapies (2nd ed., pp. 211-245). New York: Guilford.
17.
Dexter, P.R., Stump, T.E., Tierney, W.M., & Wolinsky, F.D. (1996). The psychometric properties of the SF-36 health survey among older adults in a clinical setting. Journal of Clinical Geropsychology, 2, 225-237.
18.
Fawzy, F.I., Cousins, N., Fawzy, N.W., Kemeny, M.E., Elashoff, R., & Morton, D. (1990). A structured psychiatric intervention for patients with cancer. Archives of General Psychiatry, 47, 720-725.
19.
Ferster, C.B. (1973). A functional analysis of depression. American Psychologist, 28, 857-870.
20.
Frisch, M.B. (1994). Manual and treatment guide for the Quality of Life Inventory. Minneapolis, MN: National Computer Systems.
21.
Frisch, M.B. (1999). Quality of life assessment/intervention and the Quality of Life Inventory (QOLI). In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcome assessment (2nd ed.). Manwah, NJ: Lawrence Erlbaum.
22.
Gellis, Z.D., & Kenaley, B. (2008). Problem-solving therapy for depression in adults: A systematic review. Research on Social Work Practice, 18, 117-131.
23.
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology , Neurosurgery and Psychiatry, 23, 56-61.
24.
Hayes, S.C., Strosahl, K.D., & Wilson, K.G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford.
25.
Himelhoch, S.Weller, W.E., Wu, A.W., Anderson, G.F., & Cooper, L.A. (2004). Chronic medical illness, depression, and use of medical services among Medicare beneficiaries. Medical Care , 42, 512-521.
Hopko, D.R., Bell, J.L., Armento, M.E.A., Hunt, M.K., & Lejuez, C.W. (2005). Behavior therapy for depressed cancer patients in primary care. Psychotherapy: Theory, Research, Practice, Training, 42, 236-243.
28.
Hopko, D.R., Bell, J.L., Armento, M.E.A., Robertson, S.M.C., Mullane, C., Wolf, N., et al. (2008). Cognitive-behavior therapy for depressed cancer patients in a medical care setting. Behavior Therapy , 39, 126-136.
29.
Hopko, D.R., Colman, L., & Carvalho, J.P. (2008). Depression in cancer patients: Prevalence, impact, assessment, and intervention. Depression: Mind and Body, 4, 51-62.
30.
Hotopf, M., Chidgey, J., Addington-Hall, J., & Ly, K.L. (2002). Depression in advanced disease: A systematic review. Part 1. Prevalence and case finding. Palliative Medicine, 16, 81-97.
31.
Katon,W., Von Korff, M., Lin, E., Simon, G., Ludman, E., Russo, J., et al. (2004). A randomized trial of collaborative care in patients with diabetes and depression. Archives of General Psychiatry, 61, 1042-1049.
32.
Kobak, K.A., & Reynolds, W.M. (1999). Hamilton Depression Inventory . In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment (2nd ed., pp. 935-969). Mahwah, NJ : Lawrence Erlbaum.
33.
Larsen, D.L., Attkisson, C.C., Hargreaves, W.A., & Nguyen, T.D. (1979). Assessment of client/patient satisfaction: Development of a general scale. Evaluation and Program Planning, 2, 197-207.
34.
Lewinsohn, P.M. (1974). A behavioral approach to depression. In R. M. Friedman and M. M. Katz (Eds.), The psychology of depression: Contemporary theory and research (pp.157-185). New York: Wiley.
35.
Massie, M.J. (2004). Prevalence of depression in patients with cancer . Journal of the National Cancer Institute Monographs, 32, 57-71.
36.
Moorey, S., Greer, S., Bliss, J., & Law, M. (1998). A comparison of adjuvant psychological therapy and supportive counseling in patients with cancer. Psycho-Oncology , 7, 218-228.
37.
Morin, C.M., Landreville, P., Colecchi, C., McDonald, K., Stone, J., & Ling, W. (1999). The Beck Anxiety Inventory: Psychometric properties with older adults. Journal of Clinical Geropsychology, 5, 19-29.
38.
Myers, J.K., & Weissman, M.M. (1980). Use of a self-report symptom scale to detect major depression in a community sample. American Journal of Psychiatry, 137, 1081-1084.
39.
Mynors-Wallis, L. (2005). Problem-solving treatment for anxiety and depression: A Practical guide. Oxford, UK: Oxford University Press.
40.
Mystakidou, K., Tsilika, E., Parpa, E., Pathiaki, M., Patiraki, E., Galanos, A., et al. (2007). Exploring the relationships between depression, hopelessness, cognitive status, pain, and spirituality in patients with advanced cancer. Archives of Psychiatric Nursing, 21, 150-161.
41.
Nezu, A.M., Nezu, C.M., Felgoise, S.H., McClure, K.S., & Houts, P.S. (2003). Project Genesis: Assessing the efficacy of problem-solving therapy for distressed adult cancer patients. Journal of Consulting and Clinical Psychology, 71, 1036-1048.
42.
Nezu, A.M., Nezu, C.M., Houts, P.S., Friedman, S.H., & Faddis, S. (1999). Relevance of problem-solving therapy to psychosocial oncology. Journal of Psychosocial Oncology, 16, 5-26.
43.
Nezu, A.M., Ronan, G.F., Meadows, E.A., & McClure, K.S. (2000). Practitioner's guide to empirically based measures of depression. New York: Kluwer Academic/Plenum.
44.
Osman, A., Kopper, B.A., Barrios, F.X., Osman, J.R., & Wade, T. (1997). The Beck Anxiety Inventory: Reexamination of factor structure and psychometric properties. Journal of Clinical Psychology, 53, 7-14.
45.
Radloff, L. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401.
46.
Ronson, A., & Razavi, D. (2000). Affective and anxiety disorders in patients with cancer: Optimal management. In K. J. Palmer (Ed.), Depression associated with medical illness (pp. 113-128). Kwai Chung, Hong Kong: Adis International.
47.
Spiegel, D., & Bloom, J.R. (1983). Group therapy and hypnosis reduce metastatic breast carcinoma pain. Psychosomatic Medicine, 45, 333-339.
48.
Spiegel, D., & Giese-Davis, J. (2003). Depression and cancer: Mechanisms and disease progression. Biological Psychiatry , 54, 269-282.
49.
Stanley, M.A., Beck, J.G., & Zebb, B.J. (1998). Psychometric properties of the MSPSS in older adults. Aging and Mental Health, 2, 186-193.
50.
Stanley, M.A., Novy, D.M., Bourland, S.L., Beck, J.G., & Averill, P.M. (2001). Assessing older adults with generalized anxiety: A replication and extension. Behaviour Research and Therapy , 39, 221-235.
51.
Steer, R.A., Willman, M., Kay, P.A., & Beck, A.T. (1994). Differentiating elderly medical and psychiatric outpatients with the Beck Anxiety Inventory. Assessment, 1, 345-351.
52.
Stommel, M., Given, B.A., & Given, C.W. (2002). Depression and functional status as predictors of death among cancer patients. Cancer, 94, 2719-2727.
53.
Trisjsburg, R.W., van Knippenberg, F.C.E., & Rijpma, S.E. (1992). Effects of psychological treatment on cancer patients: A critical review. Psychosomatic Medicine, 54, 489-517.
54.
Ware, J.E., & Sherbourne, C.D. (1992). The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30, 473-483.
55.
Weber, B.A., Roberts, B.L., Resnick, M., Deimling, G., Zauszniewski, J.A., Musil. C., et al. (2004). The effect of dyadic intervention on self-efficacy, social support, and depression for men with prostate cancer. Psychooncology, 13, 47-60.
56.
Weitzner, M.A., Meyers, C.A., Stuebing, K.K., & Saleeba, A.K. (1997). Relationship between quality of life and mood in long-term survivors of breast cancer treated with mastectomy. Support Care Cancer, 5, 241-248.
57.
Wetherell, J.L., & Areán, P.A. (1997). Psychometric evaluation of the Beck Anxiety Inventory with older medical patients. Psychological Assessment, 9, 136-144.
58.
Zimet, G.D., Dahlem, N.W., Zimet, S.G., & Farley, G.K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 17, 37-49.
