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Problem-solving therapy: how to turn a stuck problem into a plan you can test

The late notices sit in a pile on the counter, and every time you walk past, your stomach drops and you walk a little faster. Problem-solving therapy, a brief approach from the cognitive behavioral therapy (CBT) family, is built for moments like that. You state one problem clearly, list options before judging any of them, then pick one to try and set a date to see how it went.

Reviewed by our editors~11 min read

What problem-solving therapy is

Problem-solving therapy, or PST, teaches two things: a set of steps for working through everyday problems, and a steadier attitude toward having them. Thomas D'Zurilla and Marvin Goldfried first laid it out in 1971. By the late 1980s, Arthur Nezu and colleagues were testing it as a treatment for depression. As Patricia Areán's team describes the premise, helping people manage their lives better lowers stress, and lower stress eases depression.

A Cochrane review of therapy for depression in older adults even filed PST under CBT. Researchers planning a 2012 trial comparing the two still drew a line. In their account, CBT challenges the beliefs behind low mood and gets people active again. PST works on the problems of daily life and turns negative thinking into goal-directed action.

In the version written up for that trial, you choose one moderately hard problem from your list and define it clearly. You set a goal, brainstorm as many solutions as you can, and weigh the pros and cons of each. Then you choose one and turn it into an action plan. Later you review how it went, and if it didn't work, you come up with a new solution. The worksheet below follows that order.

Problem orientation: how you see problems

D'Zurilla's model also has a piece that comes before any step: problem orientation, the attitude you bring to problems in general. A questionnaire from D'Zurilla's group measures five dimensions, spelled out in a 2018 paper by Akira Hasegawa and colleagues. A positive orientation sees a problem as a challenge you can solve with time and persistence. A negative one sees problems as threats or as unsolvable, and it meets them with frustration. The other three are styles of solving. A rational style is deliberate and systematic, an impulsive style is hurried and careless, and an avoidant style puts problems off and waits for someone else to handle them.

In daily life, avoidance looks like bills that stay unopened, and impulsivity looks like paying whichever one sounds angriest. With a roommate, it can be months of silence followed by a furious text at midnight. In Hasegawa's study, which followed Japanese university students for eight weeks, negative orientation and rumination fed each other, and an impulsive, careless style predicted more depressive symptoms later.

PST works on orientation directly. According to Hasegawa's team, PST therapists help people see problems as normal and within their control, and a bad feeling becomes a cue that some problem needs attention. Nezu and Perri's 1989 study of 39 people with depression tested what the orientation training adds, and its results underscored keeping it. Bell and D'Zurilla's 2009 meta-analysis agreed: PST worked better with orientation training than with skills alone.

Solving a problem versus worrying about it

Worry feels like problem solving, since it's about problems. The difference shows at the end: problem solving ends with something you can do and check, while worry ends where it started, or one what-if further along.

Worriers don't seem to lack the skill. In a 1994 study by Davey, worry went with low confidence and a weak sense of control over solving problems, not with lower ability. In a 2023 lab study of 134 people, high worriers rated their problem-solving attitudes worse than low worriers did, yet they solved the test problems just as well. In that study, the more concrete a solution, the better it worked. The authors suggest that problem-solving help for worriers should target those attitudes. If you're a chronic worrier, trusting yourself to use the steps may be the harder part.

Some worries have no solvable part. A self-help web course built on PST was tested in a 2008 Dutch trial. It had people sort their problems into three groups: unimportant ones, ones that can be solved, and ones that can't, like the loss of someone you love. Only the solvable group went through the six-step procedure. For the rest, other tools fit better: worry time for repeat what-ifs, radical acceptance for what can't change, and decatastrophizing for a feared outcome.

Plenty of problems are mixed. You can't control whether your company cuts jobs, but you can update your resume this week. Work the solvable slice with the steps, and hand the rest to one of those tools.

Problem-solving worksheet: the seven steps

Work on paper or in a notes app, not in your head. For a first run, pick a problem that's real but not your heaviest, so you learn the steps before the stakes are high.

  1. Define the problem concretely. Write what's happening as facts: what, when, how often, who's involved. "My money's a mess" is a mood; "three bills are past due and payday is nine days away" is a problem. If it's huge, carve off a piece you could act on within a week or two.
  2. Set a goal you could reach. Say what better looks like, by a date, in terms of things you control. "Keep the power on this month" works. "Never stress about money again" doesn't, since nothing you do this week can deliver it. If the outcome depends on someone else, aim at your part, like asking clearly.
  3. Brainstorm without judging. List every option you can think of, obvious and silly ones included. Don't cross anything out yet, since grading each idea as it shows up tends to stop the list at two. If you stall, ask what you'd suggest to a friend in your spot.
  4. Weigh the pros and cons. For each option still standing, ask: Will it move me toward the goal? What does it cost in time or money, and in stress? How likely am I to actually do it? How does it play out in the short and long run, for me and for others? Cross out the clear losers.
  5. Pick one and plan it. Choose the option with the best mix of payoff and odds that you'll follow through. It won't be perfect, and it doesn't need to be. Write the first action with a day and time, plus what you need, like a phone number or a few lines to say. Name one thing that could block it and what you'll do then.
  6. Try it. Do the first action when you said you would, nerves and all; nerves don't mean the plan is wrong. Note what happened. If low mood keeps stopping you before any plan starts, behavioral activation works on that first.
  7. Review and adjust. Set the review date when you make the plan. Did the action move you toward the goal? If yes, keep going or take on the next piece. If it helped a little, change one thing and try again. If it flopped, pick the next option on your list. If nothing about the problem turns out to be changeable, move it to the can't-solve pile.

Keep the sheet, since your notes show which kinds of options you actually follow through on. If problems are landing faster than you can work them, our guide to feeling overwhelmed has a plan for digging out.

Three worked examples (made up)

These three people are invented to show how the worksheet plays out. Their details and results aren't data.

Bills piling up: Tess has stopped opening her mail. Written down, the problem is three past-due bills and $260 to last until payday. Her goal is to keep the power on and stop new late fees this month, not to fix her finances. Her nine ideas run from "call the utility" to "move to the woods." She picks two free calls, to the utility and the hospital's billing office, for her Monday lunch break. The utility splits the balance over three months. The hospital wants a form first, so at review she adds "mail the form Friday." For the dread underneath, see money anxiety.

A roommate conflict: Omar's roommate leaves dishes in the sink for days, and Omar washes them in silence, then explodes. Defined, the problem is that dishes sit three or four days and he ends up doing them. His goal is an empty sink most nights, without a blowup. His list runs from a chore chart to splitting the cost of a cleaner to moving out when the lease ends. He picks a calm talk on Sunday, with the cleaner as a fallback, and plans what to say with a DEAR MAN script. Two weeks later, weekdays are better and weekends aren't, so they add a Sunday-night check of the sink.

A stalled job search: Lena's search feels like it's going nowhere. Written down, it's 40 applications through job boards in six weeks and one phone screen. She hasn't messaged anyone she knows. "Get hired this month" isn't in her control, so her goal is two conversations with people in her field within two weeks. From her list she picks messages to three former coworkers, the option she's been avoiding, plus a resume swap with a friend. At her review, one coworker has offered a referral and the job boards are still silent, so she shifts more of her week toward people. If the search is wearing you down, see job search burnout.

Where it usually goes wrong

The problem is too big: "Fix my life" is a category, and you can't brainstorm a category. Shrink the problem until the first action fits inside a week. When Areán's team adapted PST for older adults whose depression came with trouble planning and organizing, they let people focus on less complex problems while they learned.

Waiting for the perfect option: Every option has a downside, and holding out for one that doesn't is a way of not choosing. Pick the best of what's on the list and let the review catch mistakes. If choosing is hard for you in general, see decision paralysis.

Brainstorming that turns into grading: If each idea gets a verdict the moment it lands ("too expensive," "he'll never agree"), the list dries up fast. Write first and judge in step four, or set a target, like ten ideas, before anything gets crossed out.

No review: Without a set date to look back, a plan that didn't work just fades, and the problem returns to the pile. The review tells you whether the option failed or never got tried, and those need different fixes.

What the research says, and where it's thin

Most of the evidence we found is for depression. Bell and D'Zurilla's meta-analysis of 21 samples found PST as effective as other talk therapies and medication. It also beat no treatment and controls that offered only support or attention. A 2007 meta-analysis by Pim Cuijpers and colleagues found results so scattered across 13 trials that it wasn't clear what made PST work better or worse. Their 2018 update of 30 trials found an effect size of 0.79 against control groups, but only 0.34 in the nine trials at low risk of bias. The authors call that small, and comparable to other therapies for depression.

A 2021 network meta-analysis of 331 trials found that the main therapies for depression, PST among them, all beat care as usual and mostly didn't differ from each other. PST looked somewhat stronger than some others over the long term. In primary care, a 2018 meta-analysis of 11 studies found an effect of 0.67 on depression or anxiety or both.

A 1995 UK trial with 91 primary care patients compared six PST sessions, about three and a half hours in total, with the antidepressant amitriptyline and with placebo. At 12 weeks, 60 percent had recovered with PST, 52 percent with the drug, and 27 percent with placebo. In a 2010 trial with 221 older adults whose depression came with executive dysfunction, 56.7 percent responded to PST by week 12, against 34.0 percent with supportive therapy.

The self-help evidence is thinner. The 2008 Dutch web course ran four weeks, with brief email feedback. Compared with a waiting list, it eased depression and anxiety symptoms by small to moderate amounts, but only 55 percent finished it. In people aged 14 to 24, a 2021 review of four trials found no clear effect of stand-alone problem-solving training on depressive symptoms. Malouff and colleagues found that results depended partly on whether a PST developer helped run the study, and the 2018 update flagged researcher allegiance too. We found no trial of a worksheet like this one used alone. This page and the chat below are self-help, not PST with a clinician, so judge the worksheet by whether your problems actually move.

Work through one problem with Helpy

The chat below runs with Helpy, the site's AI assistant. Describe what's going on in a few lines. It can help you narrow it to one concrete problem, list options without judging them, then pick a first step to try.

Evidence and sources

When to get more help

If problems keep piling up while your mood stays low most days, or you've stopped handling things you used to manage, talk to a therapist or your doctor. PST with a trained clinician goes further than a worksheet can, and it's fair to ask whether they offer it. If you're having thoughts of hurting yourself, reach out to a person right away; the numbers are below.

Important

This is educational self-help content, not a substitute for professional care. If anxiety is intense, sticks around for weeks, or makes daily life hard, reach out to a mental-health professional or doctor. If you’re in crisis or thinking about suicide, get help now: call or text 988 (988 Suicide & Crisis Lifeline), text HOME to 741741 (Crisis Text Line), or call 911 for emergencies. Available 24/7.

Read next

Decatastrophizing: give the worst case a size, then a planWhen the problem is a feared outcomeWorry time: how to schedule repetitive worryWhen worry has no solvable partBehavioral activation: how small actions pull you out of apathyWhen low mood stalls every plan

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