Problem Solving Therapy for Parents and Families of Youth with Chronic Medical Conditions

Editors: Emily F. Law, Ph.D.; Emma Fisher, Ph.D.

Date: July, 2019

Empirical review statusVery strong recommendation.

Summary of sample characteristics across studies:

Variable

Example

Child Age

Across trials, there was variability in the age range of children:

  1. Toddler to Adolescence (0-14 years) (Seid et al., 2010)

 

  1. Elementary to Adolescence (5-16 years) (Nansel et al., 2012; Wade et al., 2005; Wade et al., 2006)

 

  1. Adolescence (11-18 years) (Sahler et al., 2013; Wade et al., 2011)

 

 

Child Sex

All trials enrolled both male and female children

Parent Sex

Three studies enrolled only mothers (Sahler et al., 2002; Sahler et al., 2005; Sahler et al., 2013). The remaining studies enrolled >90% mothers (e.g., Seid et al., 2010; Wade et al., 2005).

 

Family Ethnicity/Race

The majority of trials enrolled primarily Caucasian/Non-Hispanic families. In two trials, participants were primarily Hispanic (Sahler et al., 2013; Seid et al., 2010).

Therapist type

In the majority of trials, treatment was delivered by master’s level therapists or Ph.D. students.

Presenting problem

  1. Asthma: Seid et al., 2010
  2. Cancer: Sahler et al., 2002; Sahler et al., 2005; Sahler et al., 2013
  3. Diabetes: Nansel et al., 2012
  4. Heart Disease: McCusker et al., 2010
  5. Traumatic Brain Injury: Wade et al., 2005; Wade et al., 2006; Wade et al., 2011

Socioeconomic status

In the majority of trials, average socioeconomic status of families was middle to upper class. In a few trials, families were from predominantly lower socioeconomic backgrounds (e.g., Nansel et al., 2012; Sahler et al., 2013; Seid et al., 2010)

Language

In two trials, the intervention was delivered in English and Spanish (Sahler et al., 2005; Sahler et al., 2013; Seid et al., 2010). In all other trials the intervention was delivered in English.

 

Brief summary of treatment:

  • Basic premise: Psychological distress in response to a child’s chronic medical condition is influenced by the ability to use constructive social problem solving attitudes and skills to cope with stressful events.
  • Essence of therapy: Problem solving therapy teaches a structured approach to responding to real-life problems. Skills are typically taught in a sequence including identifying the problem, brainstorming solutions, decision making, solution implementation and evaluation/revision. Modeling, behavioral rehearsal, in-vivo practice, and performance feedback are used to support acquisition and generalization of skills.
  • Length: Treatment duration for children: 0-11 hours. Treatment duration for parents:  4-11 hours.

 

Treatment resources:

Treatment Manual Available For Purchase
Problem Solving Therapy: A Treatment Manual (Nezu, Nezu & D’Zurilla, 2012)

Self-Help Books
Solving Life’s Problems: A 5-Step Guide to Enhanced Well-Being (Nezu, Nezu & D’Zurilla, 2006)

Training Resources
APA Psychotherapy Training Video: Problem Solving Therapy, with Drs. Arthur Nezu & Christine Maguth Nezu (2009)

Worksheets/Handouts
Social Problem-Solving Inventory Revised (SPSI-R; D’Zurilla, Nezu & Maydeu-Olivares, 2007)

Worksheets/Handouts
See Worksheets/Handouts in Problem Solving Therapy: A Treatment Manual (Nezu, Nezu & D’Zurilla, 2012) and Solving Life’s Problems: A 5-Step Guide to Enhanced Well-Being (Nezu, Nezu & D’Zurilla, 2006)

 

Clinical Trials, Systematic Reviews, and Meta-Analyses:

Clinical Trials:

  1. McCusker, C. G., Doherty, N. N., Molloy, B., Rooney, N., Mulholland, C., Sands, A., . . . Casey, F. (2012). A randomized controlled trial of interventions to promote adjustment in children with congenital heart disease entering school and their families. J Pediatr Psychol, 37(10), 1089-1103. doi: 10.1093/jpepsy/jss092jss092 [pii]
  2. Nansel, T. R., Iannotti, R. J., & Liu, A. (2012). Clinic-integrated behavioral intervention for families of youth with type 1 diabetes: randomized clinical trial. Pediatrics, 129(4), e866-873. doi: 10.1542/peds.2011-2858peds.2011-2858 [pii]
  3. Sahler, O. J., Dolgin, M. J., Phipps, S., Fairclough, D. L., Askins, M. A., Katz, E. R., . . . Butler, R. W. (2013). Specificity of problem-solving skills training in mothers of children newly diagnosed with cancer: results of a multisite randomized clinical trial. J Clin Oncol, 31(10), 1329-1335. doi: 10.1200/JCO.2011.39.1870JCO.2011.39.1870 [pii]
  4. Sahler, O. J., Fairclough, D. L., Phipps, S., Mulhern, R. K., Dolgin, M. J., Noll, R. B., . . . Butler, R. W. (2005). Using problem-solving skills training to reduce negative affectivity in mothers of children with newly diagnosed cancer: report of a multisite randomized trial. J Consult Clin Psychol, 73(2), 272-283.
  5. Sahler, O. J., Varni, J. W., Fairclough, D. L., Butler, R. W., Noll, R. B., Dolgin, M. J., . . . Mulhern, R. K. (2002). Problem-solving skills training for mothers of children with newly diagnosed cancer: a randomized trial. Journal of Developmental & Behavioral Pediatrics, 23(2), 77-86.
  6. Seid, M., Varni, J. W., Gidwani, P., Gelhard, L. R., & Slymen, D. J. (2010). Problem-solving skills training for vulnerable families of children with persistent asthma: report of a randomized trial on health-related quality of life outcomes. Journal of Pediatric Psychology, 35(10), 1133-1143. doi: jsp133 [pii]10.1093/jpepsy/jsp133
  7. Wade, S. L., Carey, J., & Wolfe, C. R. (2006a). An online family intervention to reduce parental distress following pediatric brain injury. J Consult Clin Psychol, 74(3), 445-454. doi: 2006-08433-005 [pii]10.1037/0022-006X.74.3.445
  8. Wade, S. L., Carey, J., & Wolfe, C. R. (2006b). The efficacy of an online cognitive-behavioral family intervention in improving child behavior and social competence following pediatric brain injury. Rehabilitation Psychology, 51, 179-189. doi:10.1037/0090-5550.51.3.179
  9. Wade, S. L., Walz, N. C., Carey, J., McMullen, K. M., Cass, J., Mark, E., . . . Yeates, K. O. (2011). Effect on behavior problems of teen online problem-solving for adolescent traumatic brain injury. Pediatrics, 128, e1-e7. doi: 10.1542/peds.2010-3721
  10. Wade, S. L., Walz, N. C., Carey, J., McMullen, K. M., Cass, J., Mark, E., . . . Yeates, K. O. (2012). A randomized trial of teen online problem solving: Efficacy in improving caregiver outcomes after brain injury. Health Psychology, 31, 767-776. doi: 10.1037/a0028440
  11. Wade, S. L., Wolfe, C., Brown, T. M., & Pestian, J. P. (2006). Putting the pieces together: preliminary efficacy of a web-based family intervention for children with traumatic brain injury. J Pediatr Psychol, 30(5), 437-442.

Systematic Reviews and Meta-Analyses:

  1. Eccleston, C., Fisher, E., Law, E. F., Bartlett, J., & Palermo, T. M. (2015). Psychological therapies for parents of children and adolescents with chronic illness. Cochrane Database of Systematic Reviews 2015, Issue 4.
  2. Eccleston, C., Palermo, T.M., Fisher, E., & Law, E. F. (2012). Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database of Systematic Reviews. Issue 8.
  3. Law, E.F., Fisher, E., Fales, J., Noel, M., & Eccleston, C. (2014). Systematic review and meta-analysis of parent and family-based interventions for children and adolescents with chronic medical conditions. Journal of Pediatric Psychology 39(8), 866-886.

Related Resources

Progress Notes