problem solving skills training manual

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Problem-Solving Skills Training (PSST)

About this program.

Target Population: 7 to 14 year olds with behavioral problems, particularly children who struggle to handle disappointments, frustrations, or problems calmly

For children/adolescents ages: 7 – 14

Program Overview

PSST is aimed at decreasing inappropriate or disruptive behavior in children. The program teaches that problem behaviors arise because children lack constructive ways to deal with thoughts and feelings and instead resort to dysfunctional ones. It is designed to help children learn to slow down, stop and think, and generate multiple solutions to any given problem. The program uses a cognitive-behavioral approach to teach techniques in managing thoughts and feelings, and interacting appropriately with others. Specific techniques include modeling, role-playing, positive reinforcement of appropriate behavior, and teaching alternative behaviors. Children are typically given homework to help them practice implementing these skills. Most sessions are individual, but parents may be brought in to observe and to learn how to assist in reinforcing new skills.

Program Goals

The goals of Problem-Solving Skills Training (PSST) are:

• Train the child to think differently about situations and behave differently in diverse situations
• Help the child internalize the problem solving steps so that they are able to use them to evaluate potential solutions to problems occurring outside of therapy
• Learn and generalize problem solving skills and how to apply problem solving skills using self-instruction
• Learn how to generate positive solutions that would enable the child to avoid physical aggression, resolve the conflict, and keep themselves out of trouble

Logic Model

The program representative did not provide information about a Logic Model for Problem-Solving Skills Training (PSST) .

Essential Components

The essential components of Problem-Solving Skills Training (PSST) include:

• Sessions that are fun for children as they play various games and have the opportunity to earn prizes as they learn the following:
• The 5 Problem Solving Steps used to handle any problem situation
• How to use these problem solving steps for hypothetical problems
• How to use these problem solving steps for simple problems outside of session
• How to use these steps to solve challenging hypothetical situations
• How to ultimately use these steps to solve problems that come up in their own life
• Individual treatment with one of the staff of certified clinicians who will keep the child's goals in mind throughout the therapy
• A number of sessions with the parent before beginning with the child so that the parents will know how to encourage and maintain the child's growth

Program Delivery

Child/adolescent services.

Problem-Solving Skills Training (PSST) directly provides services to children/adolescents and addresses the following:

• Oppositional behavior, aggressive behavior, antisocial behavior

Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Parents are involved sporadically during treatment to help support their child in implementing Problem-Solving Skills Training .

Recommended Intensity:

Weekly 50-minute sessions

Recommended Duration:

Approximately 8 to 14 weeks

Delivery Settings

This program is typically conducted in a(n):

• Outpatient Clinic

Problem-Solving Skills Training (PSST) includes a homework component:

The child is given homework to help them learn to apply problem solving skills to everyday situations. Homework is a natural extension of treatment where learned problem solving skills are applied to real life situations.

Resources Needed to Run Program

The typical resources for implementing the program are:

PSST requires a standard clinical treatment room.

Manuals and Training

Prerequisite/minimum provider qualifications.

PSST providers must be Master's level mental health professionals.

Manual Information

There is not a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:

• Bernadette Lecza, MS, CKPMT [email protected]

Training Type/Location:

Training is occasionally available either online or onsite.

Number of days/hours:

Total training time is about 8 hours.

Implementation Information

Pre-implementation materials.

There are no pre-implementation materials to measure organizational or provider readiness for Problem-Solving Skills Training (PSST) .

Formal Support for Implementation

There is no formal support available for implementation of Problem-Solving Skills Training (PSST) .

Fidelity Measures

There are no fidelity measures for Problem-Solving Skills Training (PSST) .

Implementation Guides or Manuals

There are implementation guides or manuals for Problem-Solving Skills Training (PSST) as listed below:

A comprehensive overview of Problem Solving Skills Training is available. For more information, please contact the program representative who is listed at the bottom of the page.

Research on How to Implement the Program

Research has not been conducted on how to implement Problem-Solving Skills Training (PSST) .

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Kazdin, A., Esveldt-Dawson, K., French, N., & Unis, A. (1987). Problem-Solving Skills Training and relationship therapy in the treatment of antisocial child behavior. Journal of Consulting and Clinical Psychology, 55 (1), 76–85. https://doi.org/10.1037/0022-006X.55.1.76

Type of Study: Randomized controlled trial Number of Participants: 56

Population:

• Age — 7–13 years
• Race/Ethnicity — 77% White and 23% Black
• Gender — 45 Male and 11 Female
• Status — Participants were inpatients at a psychiatric facility.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations) The purpose of the study was to evaluate the effects of cognitive-behavioral Problem-Solving Skills Training (PSST) and nondirective relationship therapy (RT) for the treatment of antisocial child behavior. Participants were randomly assigned to PSST , relationship therapy (RT), or a control group that had therapist contact with no directed focus on the elements of the two treatment conditions. Measures utilized include the Child Behavior Checklist (CBCL), Therapist Evaluation Inventory, and the Child Evaluation Inventory . Results indicate that children in the PSST condition had greater decreases in aggression, externalizing behaviors, and overall behavior problems and greater increases in pro-social behavior at follow-up than did the RT and control groups. Limitations include the use of a hospitalized sample and reliance on a small number and type of evaluations.

Length of controlled postintervention follow-up: 1 year.

Kazdin, A. E., Bass, D., Siegel, T., & Thomas, C. (1989). Cognitive-behavioral therapy and relationship therapy in the treatment of children referred for antisocial behavior. Journal of Consulting and Clinical Psychology, 57 (4), 522–535. https://doi.org/10.1037/0022-006X.57.4.522

Type of Study: Randomized controlled trial Number of Participants: 112

• Race/Ethnicity — Not specified
• Gender — 87 Male and 25 Female
• Status — Participants were children receiving inpatient or outpatient treatment at a child conduct clinic.

Summary: (To include basic study design, measures, results, and notable limitations) The purpose of the study was to evaluate alternative treatments for children referred for severe antisocial behavior. Participants were randomized to receive one of two Problem-Solving Skills Training (PSST) treatment conditions: standard PSST or PSST-P which included a set of planned activities and "homework" to be performed outside of therapeutic sessions, or to a relationship therapy (RT) control condition. Measures utilized include the Child Behavior Checklist (CBCL), the School Behavior Checklist, the Parent Daily Report, Interview for Antisocial Behavior, the Children's Action Tendency Scale,  and the Self-Esteem Inventory . Results indicate that both PSST groups showed significantly higher improvement in behavior than the RT group. Improvement in PSST-P children's school-related behaviors were shown to be stronger in comparison with standard PSST . Limitations include no direct assessment of the cognitive processes that problem-solving skills training were designed to change and relationship therapy may not have been well or fairly tested.

Kazdin, A. E., Siegel, T. C., & Bass, D. (1992). Cognitive problem-solving skills training and parent management training in the treatment of antisocial behavior in children. Journal of Consulting and Clinical Psychology, 60 (5), 733–747. https://doi.org/10.1037/0022-006X.60.5.733

Type of Study: Randomized controlled trial Number of Participants: 97

• Race/Ethnicity — 69% White and 31% Black
• Gender — 76 Male and 21 Female
• Status — Participants were children referred for treatment to a psychiatric facility.

Summary: (To include basic study design, measures, results, and notable limitations) The purpose of the study was to evaluate the effects of Problem-Solving Skills Training (PSST) and parent management training (PMT) on children referred for severe antisocial behavior. Participants were randomly assigned to receive PSST , PMT, or a combination of PSST + PMT. Measures utilized include the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), the Health Resources Inventory, the Interview for Antisocial Behavior, the Children's Action Tendency Scale, the Self-Report Delinquency Checklist, the Parent Daily Report, the Parenting Stress Index (PSI), the Beck Depression Inventory (BDI) (mothers), and the Family Environment Scale . Results indicate that children in all conditions showed significant improvement at home and school, which was maintained at follow-up. PSST + PMT had the greatest effects on children's aggressive, delinquent, and antisocial behavior; and was also associated with greater improvements in parental stress and depression. Limitations include lack of an untreated comparison group, large attrition rate, and the small sample size.

Bushman, B. B., & Gimpel Peacock, G. (2010). Does teaching problem-solving skills matter? An evaluation of Problem-Solving Skills Training for the treatment of social and behavioral problems in children. Child & Family Behavior Therapy, 32 (2), 103–124. https://doi.org/10.1080/07317101003776449

Type of Study: Randomized controlled trial Number of Participants: 26

• Age — Mean=8.27 years
• Race/Ethnicity — 23 Caucasian, 1 Asian, and 2 Biracial
• Gender — 17 Male and 9 Female
• Status — Participants were families with children with social and behavioral problems.

Location/Institution: Utah

Summary: (To include basic study design, measures, results, and notable limitations) The purpose of the study was to evaluate the effectiveness of Problem-Solving Skills Training (PSST) for the treatment of social and behavioral problems in children. Participants were randomly assigned to either a PSST treatment group or a nondirective comparison group. Measures utilized include the Skills Rating System (SSRS), the Parent Daily Report (PDR), Child Behavior Checklist for Ages 6-18 (CBCL/6-18), Parenting Stress Index-Short Form (PSI-SF) , and a parent questionnaire at baseline, post-treatment, and at a 6-week follow-up. Results indicate that children in both the treatment and comparison group showed similar improvement, with PSST showing a minor advantage on several PDR and SSRS scales. Limitations include the small sample size and short-term follow-up.

Length of controlled postintervention follow-up: 6 weeks.

Additional References

Kazdin, A. E. (2010). Problem-Solving Skills Training and Parent Management Training for Oppositional Defiant Disorder and Conduct Disorder. In J. R. Weisz & A. E. Kazdin (Eds.). Evidence-based psychotherapies for children and adolescents (2nd ed., pp. 211-226). Guilford Press.

Kazdin, A. E. (2011). Problem-Solving Skills Training for children and adolescents: Overview. Yale Parenting Center.

Kazdin, A. E. (2017). Parent Management Training and Problem-Solving Skills Training for child and adolescent conduct problems. In J. R. Weisz & A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents (pp.142–158). Guilford Press.

Contact Information

Date Research Evidence Last Reviewed by CEBC: December 2023

Date Program Content Last Reviewed by Program Staff: November 2021

Date Program Originally Loaded onto CEBC: April 2009

Glossary | Sitemap | Limitations & Disclosures

The CEBC is funded by the California Department of Social Services’ (CDSS’) Office of Child Abuse Prevention and is one of their targeted efforts to improve the lives of children and families served within child welfare system.

© copyright 2006-2024 The California Evidence-Based Clearinghouse for Child Welfare www.cebc4cw.org

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Bright IDEAS: Problem-Solving Skills Training

Program Synopsis

Designed to reduce the emotional distress in mothers of children recently diagnosed with cancer, this coping skills training teaches a five-step problem-solving approach applicable to situations commonly encountered during pediatric cancer treatment. The study showed improvements in various problem-solving skills and mood and stress symptoms.

Program Highlights

Program materials.

Preview, download, or order free materials on a CD

Program Developer

Contact Program Developer

Program Developer Contact

For inquiries related to staff training, please contact the Principal Investigator (P.I.), Olle Jane Sahler, at: [email protected] .

Featured Profile

Learn more about this program and the developer who created it

Program Scores

Mothers of children newly diagnosed with cancer are at increased risk for distress and symptoms of anxiety and depression associated with discovering their child has a potentially life-threatening illness. The stresses may stem from fear of their child's death, the daily demands of medical care, economic burdens associated with treatment, and family tensions. High levels of distress in mothers at the beginning of their child's cancer treatment may interfere with decisions about the administration of complex medical therapies. It is therefore crucial to help a mother reduce her emotional distress as soon as possible after her child is diagnosed with cancer.

The Program

Bright IDEAS: Problem-Solving Skills Training (PSST) is an eight session intervention that reduces emotional distress in mothers of children recently diagnosed with cancer. The letters in IDEAS represent the five essential steps of the PSST problem-solving approach.  The "I" stands for "identify the problem"; "D" stands for "determine the options"; "E" is for "evaluate options and choose the best"; "A" is for "act"; and "S" is for "see if it worked." PSST uses a generic, cognitive-behavioral coping skills training approach applicable to situations commonly encountered during pediatric cancer treatment. The intervention, which makes use of a manual, is delivered as weekly, 60 minute instructional sessions during regularly scheduled pediatric oncology clinic appointments or extended hospitalizations.

Optimum maternal engagement is gained by focusing on problems the mother identifies as especially relevant to her and her family. This approach also enables the mother and interventionist to review the appropriateness of selected solutions over time and changing circumstances.  The first session of PSST establishes a relationship between the mother and interventionist and introduces the problem-solving steps. The manual is presented and the mother is asked to identify relevant problems, choosing the most pressing one to work on first. The mother and interventionist work on the selected problem jointly, incorporating an analysis chart and a chart of possible solutions and potential barriers. As homework, the mother is asked to carry out the solution she ranked as most likely to succeed. Subsequent sessions continue to review homework assignments, work on the problem identified, and discuss the need for a supportive partner to assist in developing problem-solving skills after the intervention ends. 

Time Required

Training: Interventionists participate in a 1-2 day (8-16 hours) training workshop and are required to receive ongoing supervision of intervention delivery at a rate of 1 hour per 4 hours of client contact.

Program Implementation: Implementation occurs over an 8-week period and involves: --Weekly, 1 hour sessions --Variable at-home time to complete homework assignments following each session

Intended Audience

PSST targets mothers of children recently diagnosed with cancer.

Suitable Settings

The intervention is suitable for implementation in medical-center-based oncology centers and outpatient oncology clinics during regularly scheduled pediatric appointments for medical treatment or during extended pediatric hospitalizations.

Required Resources

Interventionists are mental health professionals with master's degrees or doctoral candidates in psychology. 

The following materials are required:  --Instructor/parent manual (English) --Parent manual (Spanish) --Parent pocket workbook (English) --Parent pocket workbook (Spanish) --Parent pocket worksheets (English) --Parent pocket worksheets (Spanish) --Parent individual handouts (Spanish) --Current Problems Inventory (English) --Current Problems Inventory (Spanish)

For information on cost and staff training, please contact the Principal Investigator (P.I.) for this program.  The P.I.'s contact information can be viewed on the Products page .

About the Study

A multisite randomized clinical study investigated the effects of the Bright IDEAS intervention on problem-solving skills and symptoms of mood disturbance, posttraumatic stress, and depression in mothers of children recently diagnosed with cancer. A total of 430 English-speaking and Spanish-speaking mothers were randomly assigned to either the PSST intervention or the usual triaged psychosocial care routinely provided at pediatric cancer care centers following a comprehensive assessment by a mental health professional within a few days of the diagnosis. The participating mothers were 51% White, 26% Hispanic, 6% African American, 2% American Indian, 2% Asian, and 13% other-mixed ethnicity. 

Four self-report interview scales were used to measure changes in problem-solving skills, mood, and posttraumatic stress symptoms:

--Social Problem-Solving Inventory-Revised (SPSI-R), a 52-item instrument that measures  5 dimensions of problem-solving skill - a positive or negative problem-solving orientation and 3 strategic styles of problem solving (i.e., rational, impulsivity-carelessness, or avoidance) - on a 5-point scale that ranges from 1 (not at all true) to 5 (extremely true). The total score (0-20) is the weighted average of the 5 subscores, with higher scores indicating better problem-solving skills.

--Profile of Mood States (POMS), a 65-item inventory of positive and negative adjectives  rated on a 5-point scale that ranges from 1 (not at all) to 5 (extremely) to describe mood-related feelings during the prior week. The POMS inventory generates seven subscales: tension/anxiety, depression/dejection, anger/hostility, fatigue, confusion, vigor, and friendliness. These subscales combine to produce a total POMS score, with higher scores reflecting greater mood disturbance (i.e., negative affectivity).

--Impact of Events Scale, Revised (IES-R), a 22-item measurement tool for posttraumatic stress symptoms that generates subscales on intrusive thoughts, avoidance, and hyperarousal symptom frequency in response to a specific event during the prior week. The total score is the sum of the three subscales, with higher scores indicating more posttraumatic stress symptoms.

--Beck Depression Inventory-II (BDI-II), a 21-item self-report instrument that measures depressive symptoms during the prior week. Total scores vary from 0 to 63 and indicate whether depression is minimal (0-13), mild (14-19), moderate (20-28), or severe (29-63).

The instruments were administered to participating mothers in both conditions at three time points: baseline, prior to randomization (T1); at the end of the PSST intervention or 10-12 weeks after baseline for the usual psychosocial care comparison (T2); and 6 months postbaseline (T3). Although mothers assigned to PSST and mothers receiving usual psychosocial care did not differ in any baseline demographic characteristics, PSST mothers had higher scores on the Positive Problem Orientation subscale of the SPSI-R than mothers receiving usual psychosocial care at baseline.

Key Findings

• Mothers assigned to the PSST intervention reported increased problem-solving skills (higher total score on the SPSI-R; p=.017), less use of a negative (e.g., angry, anxious, depressed) problem-solving orientation (p=.003), and less use of an avoidance problem-solving style (p=.013) than mothers assigned to the usual psychosocial comparison from baseline to the first follow-up assessment 10-12 weeks postbaseline.  PSST mothers who were single (single vs. married or living with a partner; p=.05) and younger (25 years old vs. 35 and 45 years old; p=.05) reported larger increases in problem-solving skills (SPSI-R).

• Mothers assigned to the PSST intervention continued to report less use of a negative (e.g., angry, anxious, depressed) problem-solving orientation (p=.016) and less use of an avoidance problem-solving style (p=.026) than mothers assigned to the usual psychosocial comparison at the second, 6-month postbaseline follow-up. However, maternal reports of total problem-solving skills no longer differed between conditions at the 6-month postbaseline follow-up.

• Mothers assigned to the PSST intervention reported less total mood disturbance (total POMS score; p<.001), fewer symptoms of depression (BDI-II; p<.001), and fewer posttraumatic stress symptoms (IES-R total; p<.001) than mothers assigned to the usual psychosocial care comparison from baseline to the first follow-up assessment 10-12 weeks postbaseline.

• Mothers assigned to the PSST intervention continued to report fewer symptoms of depression (BDI-II; p<.001) and fewer posttraumatic stress symptoms (IES-R total; p<.001) than mothers assigned to the usual psychosocial comparison at the second, 6-month postbaseline follow-up. However, maternal reports of total mood disturbance on the POMS no longer differed between conditions at the 6-month postbaseline follow-up.
• In general, Spanish-speaking mothers reported larger improvements in total problem-solving skills (SPSI-R), less mood disturbance (POMS), fewer depression symptoms (BDI-II), and fewer posttraumatic stress symptoms (IES-R total) than English-speaking mothers, at both follow-up assessments (10-12 weeks and 6 months postbaseline), regardless of condition assignment.

Publications

Sahler,O.J.; Fairclough,D.L.; Phipps,S.; Mulhern,R.K.; Dolgin,M.J.; Noll,R.B.; Katz,E.R.; Varni,J.W.; Copeland,D.R.; 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. Journal of Consulting and Clinical Psychology, 73 (2), 272-283.

Sahler, O. J. Z., Varni, J. W., Fairclough, D. L., Butler, R. W., Noll, R. B., Dolgin, M. J., Phipps, S., Copeland, D. R., Katz, E. R., & Mulhern, R. K. (2002). Problem-solving skills training for mothers of children with newly diagnosed cancer: A randomized trial. Journal of Developmental and Behavioral Pediatrics, 23 (2), 77-86.

Sahler OJZ, Dolgin MJ, Phipps S, Fairclough DL, Askins MA, Katz ER, Noll RB, Butler RW. (2013). Specificity of problem-solving skills training in mothers of children newly diagnosed with cancer: Results of a multisite randomized clinical trial. Journal of Clinical Oncology, 31 (10), 1329-1335.

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Cognitive Remediation Therapy: 13 Exercises & Worksheets

This can result in concentration, organizational, and planning difficulties that impact their quality of life and independent living.

Cognitive Remediation Therapy (CRT) helps by increasing awareness of intellectual difficulties and improving thinking skills. While originally designed for people with thinking problems associated with schizophrenia, it has also proven successful for those with other diagnoses (Bristol Mental Health, n.d.).

CRT works by encouraging a range of exercises and activities that challenge memory, flexible thinking, planning, and concentration problems.

This article explores CRT and its potential to help clients and includes techniques, activities, and worksheets to build effective therapy sessions.

Before you continue, we thought you might like to download our three Positive CBT Exercises for free . These science-based exercises will provide you with detailed insight into Positive CBT and give you the tools to apply it in your therapy or coaching.

This Article Contains:

What is cognitive remediation therapy (crt), how does cognitive remediation work, 8 techniques for your sessions, 7 exercises, activities, & games, 6 helpful worksheets and manuals, implementing online crt programs, 3 best software programs for helping your clients, a take-home message.

“Cognitive remediation is a behavioral treatment for people who are experiencing cognitive impairments that interfere with daily functioning” (Medalia, Revheim, & Herlands, 2009, p. 1).

Successful cognitive functions, including memory, attention, visual-spatial analysis, and abstract reasoning, are vital for engaging with tasks, the environment, and healthy relationships.

CRT improves cognitive processing and psychosocial functioning through behavioral training and increasing individual confidence in people with mental health disorders (Corbo & Abreu, 2018). Training interventions focus on the skills and supports required to “improve the success and satisfaction people experience in their chosen living, learning, working, and social environments” (Medalia et al., 2009, p. 2).

Exercises typically focus on specific cognitive functions, where tasks are repeated (often on a computer) at increasing degrees of difficulty. For example:

• Paying attention
• Remembering
• Being organized
• Planning skills
• Problem-solving
• Processing information

Based on the principles of errorless learning and targeted reinforcement exercises , interventions involve memory, motor dexterity, and visual reading tasks. Along with improving confidence in personal abilities, repetition encourages thinking about solving tasks in multiple ways (Corbo & Abreu, 2018).

While initially targeted for patients with schizophrenia, CRT is an effective treatment for other mental health conditions , including mood and eating disorders (Corbo & Abreu, 2018).

CRT is particularly effective when the cognitive skills and support interventions reflect the individual’s self-selected rehabilitation goals. As a result, cognitive remediation relies on collaboration, assessing client needs, and identifying appropriate opportunities for intervention (Medalia et al., 2009).

Cognitive remediation vs cognitive rehabilitation

CRT is one of several skill-training psychiatric rehabilitation interventions. And yet, cognitive remediation is not the same as cognitive rehabilitation (Tchanturia, 2015).

Cognitive rehabilitation typically targets neurocognitive processes damaged because of injury or illness and involves a series of interventions designed to retrain previously learned cognitive skills along with compensatory strategies (Tsaousides & Gordon, 2009).

While initially done in person, they can subsequently be performed remotely as required (Corbo & Abreu, 2018; Bristol Mental Health, n.d.).

Well-thought-out educational software provides multisensory feedback and positive reinforcement while supporting success, choice, and control of the learning process. Its design can target either specific cognitive functions or non-specific learning skills and mechanisms (Medalia et al., 2009).

CRT successfully uses the brain’s neuroplasticity and is often more effective in younger age groups who haven’t experienced the effects of long-term psychosis. It works by increasing activation and connectivity patterns within and across several brain regions involved in working memory and high-order executive functioning (Corbo & Abreu, 2018).

The Neuropsychological Educational Approach to Cognitive Remediation (NEAR) is one of several approaches that provide highly individualized learning opportunities. It allows each client to proceed at their own pace on tasks selected and designed to engage them and address their cognitive needs (Medalia et al., 2009).

NEAR and other CRT techniques are influenced by learning theory and make use of the following (Medalia et al., 2009):

• Errorless learning Encouraging the client to learn progressively, creating a positive experience without relying on trial and error.
• Shaping and positive feedback Reinforcing behaviors that approximate target behaviors (such as good timekeeping) and offering rewards (for example, monthly certificates for attendance).
• Prompting Using open-ended questions that guide the client toward the correct response.
• Modeling Demonstrating how to solve a problem.
• Generalizing Learning how to generalize learned skills to other situations.
• Bridging Understanding how to apply skills learned inside a session outside  in everyday life.

Encouraging intrinsic motivation (doing the tasks for the satisfaction of doing them rather than for external rewards) and task engagement are also essential aspects of successful CRT programs (Medalia et al., 2009).

Therapy is most effective when it successfully supports clients as they transfer learning skills into the real world.

Download 3 Free Positive CBT Exercises (PDF)

These detailed, science-based exercises will equip you or your clients with tools to find new pathways to reduce suffering and more effectively cope with life stressors.

Download 3 Free Positive CBT Tools Pack (PDF)

By filling out your name and email address below.

Cognitive remediation techniques must be selected according to the skills and needs of the client and typically fall into one of three major intervention categories (Medalia et al., 2009):

• Planning exercises, such as planning a trip to the beach to practice cognitive strategies
• Cueing and sequencing , such as adding signs or placing reminder notes at home to encourage completing everyday tasks (for example, brushing teeth)

Such techniques rely on several key principles, including “(1) teaching new, efficient, information processing strategies; (2) aiding the transfer of cognitive gains to the real world; and (3) modifying the local environment” (Medalia et al., 2009, p. 5).

• Restorative approaches Directly target cognitive deficits by repeating task practices and gradually increasing difficulty and complexity; along with regular feedback, they encourage accurate and high levels of performance.

Practice is often organized hierarchically, as follows:

• Elementary aspects of sensory processing (for example, improving auditory processing speed and accuracy)
• High-order memory and problem-solving skills (including executive functioning and verbal skills)

This technique assumes a degree of neuroplasticity that, with training, results in a greater degree of accuracy in sensory representations, improved cognitive strategies for grouping stimuli into more meaningful groups, and better recall.

• Repetition and reaching for increasing levels of task difficulty
• Modeling other people’s positive behavior
• Role-play  to re-enact experienced or imagined behavior from different perspectives
• Corrective feedback to improve and correct unwanted or unhelpful behavior

Complex social cognitive processes are typically broken down into elemental skills for repetitive practice, role-play, and corrective feedback.

Professor Dame Til Wykes: cognitive remediation therapy

It is vital that activities within CRT are interesting and engaging for clients. They must foster the motivation required to persevere to the end of the task or game.

The following three games and puzzles are particularly valuable for children and adolescents (modified from Tchanturia, 2015):

SET is a widely available card game that practices matching based on color, shape, shading, etc.

Clients must shift their thinking to identify multiple ways of categorizing and grouping cards, then physically sort them based on their understanding.

It may be helpful to begin with a limited set of cards to reduce the likelihood of the clients becoming overwhelmed by the game or finding it less enjoyable.

2. Rush Hour

Rush Hour is another fun game that balances problem-solving skills with speed.

Puzzles start simple and increase in complexity, with additional elements involved. Skills developed include problem-solving and abstract thinking, and the game requires a degree of perseverance.

Other activities require no specialist equipment and yet can be highly engaging and support clients in learning transferable skills (modified from Tchanturia, 2015).

• Bigger picture thinking This involves the client picturing a shape in their minds or looking at one out of sight of the therapist. They then describe the shape (without naming it), while the therapist attempts to draw it according to the instructions. This practice is helpful with clients who get overwhelmed by detail and cannot see the bigger picture.
• Word searches Word searches encourage the client to focus on relevant information and ignore everything else – an essential factor in central coherence. Such puzzles also challenge memory, concentration, and attention.
• Last word response Last word response is a challenging verbal game promoting cognitive flexibility. The first player makes up and says a sentence out loud. Each subsequent player makes up a new sentence, starting with the last word of the previous player’s sentence. For example, ‘ I like cheese’ may be followed by the next player saying, ‘ Cheese is my favorite sandwich ingredient ,’ etc.
• Dexterity Using your non-dominant hand once a week (for example, combing your hair or brushing your teeth) stimulates different parts of your brain, creating alternative patterns of neuron firing and strengthening cognitive functions.

The following therapy worksheets help structure Cognitive Remediation Therapy sessions and ensure that the needs of clients are met using appropriately targeted CRT interventions (modified from Medalia et al., 2009; Medalia & Bowie, 2016):

Client referral to CRT

The Cognitive Remediation Therapy Referral Form captures valuable information when a client is referred from another agency or therapist so that the new therapist can identify and introduce the most appropriate CRT interventions. The form includes information such as:

Primary reasons

Secondary reasons

• Self-confidence
• Working with others
• Time management
• Goal-directed activities

Cognitive Appraisal for CRT

The Cognitive Appraisal for CRT form is helpful for identifying and recording areas of cognitive processing that cause difficulty for the client and require focus during Cognitive Remediation Therapy sessions.

Clients are scored on their degree of difficulty with the following:

• Paying attention during conversation
• Maintaining concentration in meetings
• Completing tasks once started
• Starting tasks
• Planning and organizing tasks and projects
• Reasoning and solving problems

Software Appraisal for CRT

The Software Appraisal for CRT form helps assess which software would be most helpful in a specific Cognitive Remediation Therapy session. It provides valuable input for tailoring treatment to the needs of the client.

For example:

• Level of reading ability required
• Cognitive deficits addressed by the software
• What is the multimedia experience like?
• How much input is required by the therapist?

Appraisal records become increasingly important as more software is acquired for clients with various cognitive deficits from multiple backgrounds.

Software Usage for CRT

The Software Usage for CRT form helps keep track of the software clients have tried and how effectively it supports them as they learn, develop, and overcome cognitive deficits.

The client considers the software they use and whether they practiced the following areas of cognition:

• Concentration
• Processing speed
• Multitasking
• Logic and reasoning
• Organization
• Fast responses
• Working memory

Thought Tracking During Cognitive Remediation Therapy

Thought Tracking During Cognitive Remediation Therapy is valuable for identifying and recording the client’s goals for that day’s Cognitive Remediation Therapy session and understanding how it relates to their overall treatment goals.

Planning to Meet Goals in CRT

The Planning to Meet Goals in CRT worksheet is for clients requiring support and practice in planning, goal-setting, and goal achievement.

Working with the client, answer the following prompts:

• What goal or project are you working toward?
• What date should it be completed by?
• Are there any obstacles to overcome to complete the goal?
• Are there any additional resources required?
• Then consider the steps needed to achieve the goal.

Other free resources

Happy Neuron provides several other free resources that are available for download .

Consider the five Cs when selecting online CRT programs (modified from Medalia et al., 2009):

• Cognitive – What target deficits are being addressed?
• Client – What interests and level of functioning does the client have?
• Computer – What computing requirements and compatibility factors need to be considered?
• Context – Does the software use real-world or fantasy activities and environments? Are they age and cognitive ability appropriate?
• Choice – Is the learner given choice and options to adapt the activity to their preferences?

Once you’ve ordered the software, give it a thorough review to understand when it is most appropriate to use and with whom.

For online CRT programs to be effective as teaching tools and activities, they should include the following features (modified from Medalia et al., 2009, p. 53):

• Intrinsically motivating
• Active use of information
• Multisensory strategies
• Frequent feedback
• Control over the learning process
• Positive reinforcement
• Application of newly acquired skills in appropriate contexts
• Errorless learning – challenging yet not frustrating

Therapists must become familiar with each program’s content and processes so that targeted deficits are fully understood and clients are engaged without confusion or risk of failure.

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A great deal of software “targets different skills and offers a variety of opportunities for contextualization and personalization” (Medalia et al., 2009, p. 43).

We focus on three suppliers of extensive CRT software resources below (recommended by Medalia et al., 2009).

1. Happy Neuron

Happy Neuron provides a wide variety of online brain training exercises and activities to stimulate cognitive functioning in the following areas:

• Visual-spatial

When you’re performing well, the exercises become increasingly difficult.

The exercises are grouped into the following areas:

• Brain speed
• People skills
• Intelligence

3. Games for the Brain

Cognitive difficulties, such as challenges with paying attention, planning, remembering, and problem-solving, can further compound and exacerbate mental health issues

While initially created for schizophrenia, CRT is also valuable for other mental health problems, including eating and mood disorders. Treatments are effective in one-to-one and group sessions, and lessons can be transferred to the outside world, providing crucial gains for a client’s mental wellbeing and social interaction.

Through repeated and increasingly challenging skill-based interventions, CRT benefits cognitive functioning and provides confidence gains to its users. The treatment adheres to learning theory principles and targets specific brain processing areas such as motor dexterity, memory, and visual-spatial perception, along with higher-order functioning.

Involving clients in treatment choices increases the likelihood of ongoing perseverance, engagement, and motivation as activities repeat with increasing degrees of difficulty.

This article offers a valuable starting point for exploring CRT and its benefits, with several worksheets and forms to encourage effective treatment.

We hope you enjoyed reading this article. For more information, don’t forget to download our three Positive CBT Exercises for free .

• Bristol Mental Health. (n.d.). Cognitive remediation therapy: Improving thinking skills . Retrieved December 15, 2021, from http://www.awp.nhs.uk/media/424704/cognitive-remediation-therapy-022019.pdf
• Corbo, M., & Abreu, T. (2018). Cognitive remediation therapy: EFPT psychotherapy guidebook . Retrieved December 15, 2021, from https://epg.pubpub.org/pub/05-cognitive-remediation-therapy/release/3
• Medalia, A., & Bowie, C. R. (2016). Cognitive remediation to improve functional outcomes . Oxford University Press.
• Medalia, A., Revheim, N., & Herlands, T. (2009). Cognitive remediation for psychological disorders: Therapist guide . Oxford University Press.
• Tchanturia, K. (2015). Cognitive remediation therapy (CRT) for eating and weight disorders . Routledge.
• Tsaousides, T., & Gordon, W. A. (2009). Cognitive rehabilitation following traumatic brain injury: Assessment to treatment. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine , 76 (2), 173-181.

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What our readers think.

To my surprise this is a treatment that has not been discussed in the area I live and work. I just stumbled upon this when I was researching cognitive impairments with schizophrenia. I currently work on a team with multiple mental health professionals that go out into the community, to work with people diagnosed with Schizophrenia. It seems like most of what we do is manage and monitor symptoms. Are you aware of anyone or any agency in Buffalo, NY that uses this method of treatment? I am trying to figure out how to get trained and use it in practice, if that is possible. Any help will be greatly appreciated.

This looks like the treatment my daughter needs. She has struggled for years with the cognitive problems associated with depression. How do we find a therapist near us who can use these techniques?

I’m sorry to read that your daughter is struggling. You can find a directory of licensed therapists here (and note that you can change the country setting in the top-right corner). You’ll also find that there are a range of filters to help you drill down to the type of support you need: https://www.psychologytoday.com/us/therapists

I hope you find the help you need.

– Nicole | Community Manager

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