Christine Maguth Nezu

Project genesis: Assessing the efficacy of problem-solving therapy for distressed adult cancer patients

The efficacy of problem-solving therapy (PST) to reduce psychological distress was assessed among a sample of 132 adult cancer patients. A second condition provided PST for both the patient and a significant other. At posttreatment, all participants receiving PST fared significantly better than waiting list control patients. Further, improvements in problem solving were found to correlate significantly with improvements in psychological distress and overall quality of life. No differences in symptom reduction were identified between the 2 treatment protocols. At a 6-month follow-up, however, patients who received PST along with their significant other reported lower levels of psychological distress as compared with members of the PST-alone condition on approximately half of the outcome measures. These effects were further maintained 1-year posttreatment.

Helping cancer patients cope: A problem-solving approach

Cancer and its Consequences A Problem-Solving Conceptualization of Coping - Theory, Research and Relevance to Cancer Problem-Solving Therapy for Cancer Patients - Overview, Process and Related Clinical Issues Critical Elements of Training Problem Orientation Problem Definition and Formulation Generation of Alternatives Decision Making Solution Implementation and Verification Practice, Practice, Practice Problem-Solving Education for Family Caregivers of Cancer Patients.

A problem-solving approach to stress reduction among younger women with breast carcinoma: a randomized controlled trial.

Previous research indicates that younger women (i.e., ≤ 50) with breast carcinoma experience greater emotional distress than older women (i.e., > 50) and that coping style is significantly related to the psychosocial adjustment of women with this disease. The purpose of this study was to evaluate through a randomized controlled trial the effectiveness of a problem‐solving training intervention designed to empower women with breast carcinoma to cope with a range of difficulties when diagnosed in mid‐life.

Outpatient Psychotherapy for Adults with Mental Retardation and Concomitant Psychopathology: Research and Clinical Imperatives.

As the number of adults with mental retardation and concomitant psychological difficulties living in the community increases, so does the need for effective outpatient psychotherapy services. Despite this need, the relevant literature base is sorely lacking. This article is a brief review of this literature with regard to psychodynamic, behavioral, and group psychotherapy approaches. On the basis of this review, a research agenda is offered concerning future directions. Last, because of the lack of a rich database regarding effective treatment approaches for such individuals, this article includes a description of a model of clinical decision making that is geared to aid the practicing clinician in designing clinical interventions for adults with mental retardation.

Cognitive-behavior therapy for medically unexplained symptoms : A critical review of the treatment literature

Research has indicated that substantial numbers of physical or medical symptoms presented by patients remain unexplained medically. For example, studies have indicated that less than 25% of physical complaints presented to physicians have known or demonstrable organic or biological causes. Cognitive-behavior therapy (CBT) provides for a potentially effective means of impacting on this significant public health problem, both medically and psychologically. This paper reviews the extant literature regarding CBT for medically unexplained symptoms, as well as three related disorders—chronic fatigue syndrome, fibromyalgia, and noncardiac chest pain. Whereas this review provides support for the efficacy of CBT for such problems (e.g., effect sizes for CBT compared to control conditions centered around .40), it also identified a variety of methodological limitations regarding the studies themselves. Based on this analysis, recommendations for future research endeavors are provided and the implications of this area for prevention and treatment are offered.

Depression in adults with mild mental retardation: Are cognitive variables involved?

The applicability of models emphasizing the role of cognitive variables in depression originally based on persons with average intellectual abilities was assessed in this study with 107 adults with mild mental retardation. Results indicated that level of depressive symptomatology, as measured by two different self-report measures, was significantly correlated with frequency of automatic negative thoughts, feelings of hopelessness, rates of self-reinforcement, and amount of negative social support. Sixteen members of this original sample, diagnosed as clinically depressed, were then compared to 16 nondepressed controls. A statistical comparison between these two samples supported the previous correlational analyses suggesting the relevance of these findings to clinical depression. These results are discussed in terms of their implications for psychopathology model building specific to adults with mental retardation, as well as the potential utility of cognitive-based therapies for a population previously considered as inappropriate.

Aggression-related hostility bias and social problem-solving deficits in adult males with mental retardation.

Attributional bias and social problem-solving deficits in two groups of adult males (aggressive vs. nonaggressive) with mild mental retardation were investigated. When presented with vignettes depicting various problem situations, aggressive participants were less accurate in correctly identifying interpersonal intent, characterized by more problem-solving deficits, and generated higher numbers of aggressive solutions to resolve problems as compared to their nonaggressive counterparts. The present results support the applicability of contemporary models of social information processing and adjustment with regard to reactive aggression to men with mental retardation.

Identifying and selecting target problems for clinical interventions: A problem-solving model.

Target problem identification and selection are crucial components of all therapeutic endeavors. In this article, we describe some of the factors that negatively impinge on the validity of this process, as well as delineate a conceptual model geared toward facilitating the therapists effectiveness when engaged in these clinical tasks. Our model is based on a problem-solving framework, whereby the clinician is conceived of as the problem solver, and the discrepancy between the clients goal state and current state (i.e., presence of distress) represents the problem to be solved

Clinical decision making in everyday practice: The science in the art

Despite a growing literature base documenting the efficacy of behavioral interventions, the everyday practitioner is faced with the demands of processing and translating a complex set of clinical information in order to make effective and ethical decisions. In this article, we present a model of decision making geared to increase the contribution of the scientific process to the art of clinical practice. This model is based upon a problem-solving framework that provides a practical heuristic guide for the generation and evaluation of solutions to everyday clinical problems.

Social Problem Solving as a Mediator of the Stress-Pain Relationship Among Individuals With Noncardiac Chest Pain

OBJECTIVE The present study tested the hypothesis that social problem solving (SPS) served to mediate the relationship between preceived stress and noncardiac chest pain (NCCP). DESIGN Adults undergoing stress myocardial perfusion imaging (MPI) to determine the presence of underlying cardiovascular disease related to the experience of chest pain were recruited prior to stress testing to complete a series of self-report inventories. MAIN OUTCOME MEASURES MPI results were used to identify individuals with NCCP (N = 166; 91 men, 75 women; mean age = 53.92 years, SD = 11.98). Measures included perceived stress, SPS, and chest pain frequency and intensity. RESULTS In direct tests of the mediational effects of SPS, it was found that two problem-solving dimensions, negative problem orientation and rational problem solving, each served as significant mediators of the effects of stress on both NCCP intensity and frequency. CONCLUSION These results support a mediational analysis of NCCP that includes stress and SPS. As such, it identifies SPS as a potentially important clinical target to consider when developing future psychosocial-based therapy protocols for treating individuals with NCCP.