PROBLEM-SOLVING TRAINING

In our opinion, one of the important innovations of this treatment is the use of specific strategies for each type of worry. For worries about current problems, we have found that the application of sound problem- solving principles is an extremely helpful treatment strategy. That is, rather than worrying about a problem, it is better to actually solve it! As such, once the reevaluation of beliefs about the usefulness of worry has been completed, the treatment turns to problem-solving training for worries about current problems. Obviously, worries about hypothetical situations (for example, worries about situations that have not happened, and in most cases, never will) are not addressed with problem solving. In fact, attempting to solve a problem that may well never exist is not only unproductive, but can actually lead to increased worry. A specific treatment strategy for this type of worry is presented in the next module (see Module 5: Imaginal Exposure). However, for worries about current

problems, taking an action-oriented stance such as problem solving is, in our opinion, the most appropriate treatment strategy.

There are two discrete elements involved in this treatment module, improving problem orientation and applying problem-solving skills. As mentioned previously, problem orientation refers to the way in which an individual views problems and problem solving, and is therefore consid- ered a cognitive set. Problem-solving skills, on the other hand, refer to the steps that an individual carries out in order to actually solve a problem. These include (1) defining the problem and formulating problem-solving goals; (2) generating alternative solutions; (3) choosing a solution; and (4) implementing the chosen solution and assessing its effectiveness (see D’Zurilla & Nezu, 1999, for a detailed description of these steps). In our treatment, we devote as much time to assisting clients in enhancing their orientation toward problems as we do to the application of skills. As such, both of these problem-solving dimensions are treated as separate, albeit complementary, elements.

Given that problem-solving training was not specifically designed for individuals with GAD, it should come as no surprise that it needs to be modified to meet the specific needs of this client population. As a result, we modified “standard” problem-solving training by placing a strong emphasis on the role of uncertainty in both the problematic situation and the problem-solving process, and by consistently distinguishing between the passive process of worry and the active process of problemsolving. Improving Problem Orientation

Uncertainty in the Problem-Solving Process

Social problems (that is, problematic situations that occur in the natu- ral social environment) have many uncertainty-inducing qualities. For example, the problem itself might be ambiguous or vague, the effects of the chosen solution are unpredictable, and the repercussions of an inef- fective solution are difficult to estimate. Not unexpectedly, for a client who is intolerant of uncertainty, the problem-solving process is likely to be construed as threatening and aversive. It should therefore come as no surprise that GAD clients have a negative orientation toward problems and problem solving.

As noted earlier, learning to tolerate uncertainty in daily life is cen- tral to our treatment and is addressed either directly or indirectly in every session. The introduction of problem orientation and problem- solving skills is no exception. The presence of uncertainty in the prob- lem-solving process is therefore discussed in session, as well as any fears

that clients might have about the process. The futility of searching for certainty, particularly as it pertains to daily life problems, is also dis- cussed. Rather than worrying about problems, clients are encouraged to “move forward” with problem solving despite the inherent uncertainty of the situation. Not only is this beneficial to clients because they learn how to deal with everyday problems, but they are also given yet another opportunity to increase their tolerance for uncertainty. Thus, in terms of initially addressing problem orientation, it is important to acknowledge the uncertainty of the problem situation, address the client’s negative thoughts/emotions in relation to problem solving, and encourage action

toward the problem.

pact of a Negative Problem Orientation

The impact of a negative problem orientation is best seen in the con-

sequences of this cognitive set. Specifically, if clients are threatened

by problems, doubt their ability to solve them, and anticipate a nega- tive outcome irrespective of effort, then it is likely that they will react negatively on an emotional, cognitive, and behavioral level. In terms of emotions, clients are likely to be frustrated, irritated, anxious, or depressed when confronted with problems, given their predisposi- tion to view them as threatening. In terms of cognitions, a negative evaluation of problems is likely to lead GAD clients to worry exces- sively about problems when they arise. In addition, if problems are left unsolved, they can generate new problems over time, which them- selves can become worry topics. In this manner, holding a negative problem orientation can be seen as maintaining, and at times exacer- bating, the worry cycle. Finally, in terms of behavioral consequences, clients might avoid or delay solving problems because they view the problems as threatening and have a negative outcome expectancy. This final consequence relates directly to the importance of discuss- ing problem orientation prior to addressing problem-solving skills. Specifically, so long as problems are seen as threatening and unlikely to be effectively dealt with irrespective of effort, clients are unlikely to use their problem-solving skills (no matter how good they are). As a consequence, a series of strategies designed to encourage clients to approach problematic situations, rather than avoid them, are used in this treatment (see Chapter 5 for strategies for improving negative

Applying Problem-Solving Skills

In terms of problem-solving skills, the emphasis is placed on two ideas. First, the problem-solving skills component is not presented as “learning about new skills.” This is because most people are intuitively aware of the general steps involved in solving problems. Rather, the emphasis is placed on learning how to use the skills effectively. Improperly defining a problem, setting unrealistic goals, or being unsure about how to select a potential solution are more likely to be the difficulties that people encounter with problem solving. Focusing on mastering the skills, rather than learning what they are, will be more reflective of the client’s experi- ence. Second, clients are encouraged to tolerate uncertainty throughout the problem-solving process. At each step of this process, the goal is to achieve the best result for that particular individual, not the perfect result. In other words, problem solving is expected to be a deliberate and rational process where clients do the best they can at each step. Once they have completed a problem-solving step, clients need to move forward to the next stage of problem solving, without the certainty that they made the “perfect” or the “right” choice. In essence, the implementation of one’s problem-solving skills is an exercise in tolerating uncertainty.

One noteworthy point related to the use of problem solving as a way to tolerate uncertainty is that in reality, things might not turn out as expected. Even when one is highly organized, it is impossible to have complete control (or certainty) over one’s social environment. Unex- pected events can arise, people might not react as planned, and solutions might not work out as well as expected. However, events such as these can promote one’s tolerance for uncertainty. When clients do not attain their desired goal and come to realize that they can handle unexpected adversity, they greatly benefit from their “mistake.” In this way, moving forward with problem solving, despite the uncertainty of the process, represents a “win-win” situation for individuals with GAD. Once they have had some experience in dealing with current problems via problem solving, the therapist can then begin assisting clients in addressing the second type of worry; that is, worry about hypothetical situations.