Wednesday, May 22, 2013

"Structured problem solving" a simple and useful CBT strategy in General Practice

Structured problem solving is a simple process that we can all do effectively when we are well.  When we are faced with a problem, we automatically assess the situation, we identify the cause of the problem, we work out our available options with its pros and cons, and then finally, we pick out the best option and follow through with that option.  We usually can do this quickly and with little effort.

However, when our patients are stressed, depressed and anxious, this process tends to "malfunction".   They become confused, overwhelmed, indecisive and then ultimately procrastinate.  They are forever searching for the perfect solution and unfortunately, there isn't any.

So how can we help our patients get out of this "bind"......
  1. Listen non judgementally and help them to identify what the core issue is and get them to write it down.
  2. Coach them to identify what their options are and get them to write it down
  3. Ask them to write down the pros and cons with each option
  4. Help them to pick out the "best option" ie the one with the most pros and the least cons.  Remind them that that the "best option" may still not be a good option but, it is still the "best option".
  5. Help them to create an action plan based on the best option.  Aim to be realistic and take baby steps first and gradually work towards the goal.
  6. Help them to reflect and review the process above and reimplement as needed.

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