Problem solving as an active ingredient in indicated prevention and treatment of youth depression and anxiety: an integrative review

Purpose: Problem solving is a common focus of psychological interventions for young people. However, existing evidence syntheses are relatively limited in their scope and conclusions. Taking a transdiagnostic approach and incorporating diverse sources of evidence, we examined the role of problem solving as an active ingredient for the indicated prevention and treatment of depression and anxiety in 14-24-year-olds. Method: Three information sources were integrated: (i) a systematic review of randomised controlled trials of problem solving; (ii) a meta-synthesis of qualitative evidence on the therapeutic experience of problem solving; and (iii) consultations with a Youth Advisory Group (YAG). Insights from the YAG were analysed thematically and integrated alongside other sources using a framework synthesis method. Results: Problem solving appeared to be effective as a sole intervention for depression but not anxiety. Multi-component interventions with a problem-solving element achieved moderate effect sizes for both conditions. There was no clear evidence that effectiveness varied by population characteristics, intervention formats or contextual factors. Qualitative evidence and youth consultations highlighted positive views about the practicality, simplicity and flexibility of problem solving. Converging sources also suggested changes in problem orientation as a key transdiagnostic process contributing to positive outcomes. Conclusions: Problem solving is a widely applicable therapeutic approach that can help young people with emotional problems to resolve specific stressors and lead to a more hopeful mindset about managing future challenges. Implications for practice are discussed.