Journal of Consulting and Clinical Psychology 1989, Vol. 57, No. 3,408-413 Copyright 1989 by the American Psychological Association, Inc. 0022-006X/89/S00.75 Social Problem-Solving Therapy for Unipolar Depression: An Initial Dismantling Investigation Arthur M. Nezu Beth Israel Medical Center, New York and Mount Sinai School of Medicine, New York Michael G. Perri Fairleigh Dickinson University and Franklin D. Roosevelt Veterans Administration Hospital, Montrose, New York Tests the efficacy of social problem-solving therapy for unipolar depression and examines the relative contribution of training in the problem-orientation component of the overall model. This process involves various beliefs, assumptions, appraisals, and expectations concerning life's problems and one's problem-solving ability. It is conceptually distinct from the remaining four problem-solving components that are specific goal-directed tasks. A dismantling research design, involving 39 de- pressed Ss, provides findings that indicate problem-solving to be an effective cognitive-behavioral treatment approach for depression, thereby extending previous research. Moreover, the results un- derscore the importance of including problem-orientation training. Social problem solving refers to the process by which people discover, create, or identify effective means of coping with stressful events encountered in living (D'Zurilla & Nezu, 1982). A model of unipolar depression based on a problem-solving for- mulation has recently been articulated that suggests that deficits in problem-solving skills serve as one important vulnerability factor for depression (Nezu, 1987; Nezu, Nezu, & Perri, 1989). When such deficits lead to ineffective coping attempts under high levels of stress (emanating either from major negative life events or from continuous daily problems), depression is likely to occur. One corollary from this theory suggests that problem-solving training leads to decreases in depressive symptomatology. To date, only two outcome studies provide a direct test of this hy- pothesis. In one study, Russian and Lawrence (1981) found that problem-solving therapy was superior to a social reinforcement approach for symptom reduction among a group of institution- alized elderly depressives. In an investigation by Nezu (1986b), subjects who received problem-solving treatment reported sig- nificantly lower depression scores than participants in two con- trol conditions. Although the results of these two studies provide initial support, additional confirming evidence remains critical. Moreover, research is necessary to better understand how prob- lem-solving therapy affects symptom change. Thus, this study assesses the efficacy of problem-solving therapy for unipolar We extend our grateful appreciation to Christine M. Nezu for her helpful comments on earlier drafts of this article, as well as for her sug- gestions concerning clinical aspects of the treatments conducted in this study. Correspondence concerning this article should be addressed to Ar- thur M. Nezu, Department of Psychiatry, Beth Israel Medical Center, 1st Avenue at 16th Street, New York, New York 10003. depression and the relative contribution of the problem-orien- tation component. A dismantling strategy was used to address these goals by randomly assigning depressed subjects to one of three conditions: (a) problem-solving therapy (PST), (b) abbre- viated problem-solving therapy (APST), and (c) wait-list con- trol (WLC). The problem-orientation process within social problem solv- ing can be described as a set of orienting responses that consists of the immediate cognitive-behavioral-affective reactions of a person when first confronted with a problematic or stressful sit- uation. These responses include a set of beliefs, assumptions, appraisals, and expectations concerning life's problems and one's own general problem-solving ability. The remaining four components of the model (i.e., problem definition and formula- tion, generation of alternative solutions, decision making, and solution implementation and verification) can be described as a set of cognitive-behavioral skills or goal-directed tasks that enable a person to solve a particular stressful problem success- fully. Conceptually, training in the problem-orientation process is geared to facilitate an individual's motivation both to actually apply the four problem-solving skills and to feel self-efficacious in doing so. If not addressed, a negative problem-solving orien- tation can lead to negative affect and avoidance motivation that could inhibit or disrupt later problem-solving performance. As such, the orientation process can be considered as concep- tually distinct from the other four problem-solving components skills (cf. D'Zurilla, 1986). This difference provides one reason for singling out the orientation component for further scrutiny. A second reason involves the discrepant support for problem- solving training observed in the literature regarding other psy- chological disorders. Studies that find problem-solving training to be ineffective often exclude training in the orientation pro- cess, whereas successful training programs include the entire model (Nezu et al., 1989). Therefore, we hypothesized that (a) PST subjects would become less depressed than APST partici- 408