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How to Deal With Anxiety: 13 Ways to Cope

• Calm Anxiety Immediately
• Long-Term Strategies
• Next in Anxiety Disorder Guide What Is an Anxiety Disorder?

People often use the word “ anxiety ” to describe general feelings of nervousness, unease, or worry. However, there’s a difference between feeling anxious and having an anxiety disorder.

It’s normal to feel anxious during stressful times in life, but if you’re experiencing persistent anxiety that interferes with your daily life, you may have an anxiety disorder.

Though it can be debilitating for some, anxiety is typically manageable or treatable through a variety of short- and long-term interventions. This article will provide several ways to cope with and treat anxiety.

Illustration by Julie Bang for Verywell Health

How to Calm Anxiety Immediately: 5 Skills to Adopt

Anxiety symptoms can be distressing and can adversely impact your life. Though treatment needs will differ from person to person, there are many techniques for coping with anxiety that you can try on your own.

Question Your Thought Pattern

Anxiety often causes worrying thoughts and distressing images that feel intrusive and uncontrollable. One way to stop negative thought patterns is to catch them as they are happening and replace them with positive thoughts or ideas. These positive images don't need to be related to the worrying situation; any positive image can reduce anxiety.

You can also try questioning the validity of your thoughts. Try not to focus on things that are not factual or helpful. As you notice yourself thinking something unkind or untrue, stop and reframe your thoughts toward something more useful.

For example, if you have the thought, "I'm so bad at public speaking," a kinder and more helpful thought replacement could be, "I'm not as skilled at public speaking as I am at other things, but I will set a goal for myself to practice and learn new techniques to improve."

Deep Breathing

Intentional breathing is an effective way to reduce anxiety symptoms in the moment. Deep breathing exercises can be twice as effective: They help minimize stress in the body by encouraging relaxation and serve as a distraction when used as a focal point to interrupt intrusive thoughts.

There are many different kinds of deep breathing exercises . Here is one to try called 4-7-8 breathing:

• Find a comfortable position and intentionally relax your muscles.
• Close your eyes or soften your gaze.
• Take a deep breath in as you expand your belly, counting to four as you inhale.
• Hold your breath while counting to seven.
• Exhale while contracting your belly and counting to eight.
• Continue for as long as desired.

Grounding Techniques

Grounding (or earthing) exercises connect the body to the natural environment. Grounding is a stabilizing factor that can improve sleep, slow heart rates, and reduce stress and anxiety. The easiest way to practice grounding is to spend time outside in the dirt, grass, and other natural environments.

Grounding is most effective when you allow your skin to come into direct contact with Earth's surface, so try taking off your shoes and walking barefoot.

Special equipment can also be used for grounding when it's unsafe or impossible to spend time outdoors.

Physical exercise and movement are linked to better mental health and reduced anxiety symptoms. Exercise includes all movements that are routine, structured, and intended to improve health. Though exercise may impact types of anxiety differently, most exercises have a positive effect on symptoms, especially when added to a treatment plan that also includes things like therapy and medication.

Here are some examples of exercises to try:

• Aerobic exercises, such as biking, walking, hiking, or swimming
• Weight-bearing exercises, such as squats, weight lifting, and push-ups
• Stretching exercises, such as yoga, Pilates, or tai chi

Always check with a healthcare provider before starting a new exercise routine.

Aromatherapy

Aromatherapy is a method of using essential oils to encourage relaxation and promote health. Depending on the oil, different oils can be inhaled, used in massage, added to compresses, used in baths, or even consumed. Essential oils have been used for a long time as an alternative medicine, and certain oils have been shown to reduce anxiety. These include:

Aromatherapy oils can be purchased over the counter for use at home. Before using aromatherapy, be sure you understand its recommended method of use and never consume an oil without knowing if it's safe. For expert guidance on using aromatherapy, consult an aromatherapist who can help you determine the best oils for your symptoms and offer advice on how to use them.

Long-Term Strategies for Coping With Anxiety

In addition to in-the-moment coping strategies, there are also techniques you can use for managing anxiety symptoms over the long term.

Identify and Learn to Manage Your Triggers

Keeping track of your triggers, or things that bring on or worsen anxiety symptoms will allow you to recognize when they are happening and what causes them. Try keeping a log to track your symptoms. Include what you did before your symptoms started and how long they lasted.

You can also keep track of what relief strategies you tried at the moment and which were most (and least) effective. Once you've logged a few experiences, review them to see if you notice any patterns.

Try Therapy

Working with a mental health provider can be a helpful way to understand your anxiety symptoms and develop a long-term treatment plan. The most commonly used approach to treating anxiety is cognitive behavioral therapy (CBT) .

CBT teaches coping mechanisms such as relaxation, problem-solving skills, methods for questioning or stopping unhealthy thoughts, and psychoeducation.

Daily or Routine Meditation

Mindfulness is being aware of the present moment rather than getting stuck in thoughts about the past or worries about the future. You can develop mindfulness through meditation and decrease rumination, worry, and other anxiety symptoms.

Try carving out time each day for meditation. There are many different approaches to try. Here is a simple option to get started:

• Sit comfortably with your eyes closed.
• Start to focus on your breathing.
• As you inhale, label the breath by saying "in breath" silently to yourself.
• As you exhale, label it "out breath."
• While you do this, you'll start to notice thoughts. Without judgment, notice them, label them "thoughts," and bring your attention back to your breathing.

Do this for as long as you can, building upon the length of time with practice. Remember that meditation is about noticing and intentionally slowing down the body and mind; it's not about clearing your thoughts.

The 3-3-3 Rule for Anxiety

The 3-3-3 rule can help you stop ruminating thoughts and bring you into the present moment. Whenever you feel anxious, look around the room and name three things you see, name three things you hear, and move three parts of your body.

Ask About Medications

For some people, medication serves as a way to help treat severe anxiety symptoms. The most common medications used to treat anxiety disorders are selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs).

These classes of medications are found to be equally effective, though some people may respond better to one over the other. Talk to a healthcare provider to learn more about medications for anxiety.

Change Your Diet and Supplements

Diet can have a significant impact on anxiety. Generally speaking, unhealthy diets that include a lot of processed foods can cause or worsen anxiety symptoms. Healthy diets that are associated with lower levels of anxiety include:

• The Mediterranean diet
• Anti-inflammatory diets
• Diets that feature large varieties of foods

The most important factors of these healthy diets are that they include vegetables, fruits, whole grains, and minimally processed foods, and they do not include a lot of sugar or refined grains.

Supplements can be a healthy way to add insufficient nutrients to diets. For example, taking an omega-3 fatty acid supplement can improve anxiety if your diet doesn't include enough of it. Always talk to a healthcare provider before taking a supplement, especially if you take medications.

Stay Active

Developing a regular exercise routine can help keep anxiety symptoms at bay over the long term. Try coming up with a plan you can stick to by finding enjoyable activities that fit your budget and are easily accessible. By implementing a plan, it will be easier to follow when anxiety symptoms worsen.

Journaling is a great way to get anxious thoughts out and keep track of them over time. There are many ways to journal, and no way is right or wrong. Here are some ideas to get started:

• Keep a log.
• Write about your thoughts, behaviors, and feelings each day.
• Write about your activities.
• Do a brain dump.
• Follow a prompt.

Anxiety can make it tempting to isolate, especially when symptoms are at their worst. Staying in touch with friends and loved ones serves as a protective factor against anxiety. Try planning at least one social event per week and following through even as your anxiety increases. To cope with anxiety in the moment, try one of the previously mentioned exercises, such as breathing or grounding techniques.

Attending an anxiety support group online or in person can also be helpful. Support groups can be found online or by asking a mental health provider for recommendations.

Understanding Anxiety Symptoms

Anxiety and panic disorders are both common and can be disruptive and challenging to cope with. Though similar, an anxiety attack is different from a panic attack.

Anxiety Symptoms

There are different kinds of anxiety disorders , each of which has its own set of symptoms. The most common anxiety disorders include generalized anxiety disorder (GAD) , social anxiety disorder , and phobias . Panic disorder is another type of anxiety disorder and is characterized by panic attacks. Anxiety symptoms can differ from person to person and vary depending on the specific disorder. Here are some common symptoms associated with anxiety:

• Restlessness
• Increased heart rate
• Nervousness or shaking
• Difficulty concentrating
• Feeling tired
• Difficulty sleeping
• Uncontrollable worry

Panic Attack vs. Anxiety Attack

In contrast to the often ever-present feelings of anxiety, a panic attack usually comes on suddenly and unexpectedly. Panic attacks are characterized by a racing heart, quick and shallow breaths, chest pain, dizziness, and feelings of dread or doom. Someone having a panic attack may think they are dying or have a sensation that they are outside of their own body.

Though anxiety attacks are not diagnosable mental disorders, some people may have an increase in anxiety symptoms in connection with a stressful or triggering event or experience. This acute onset of anxiety symptoms is often described as an anxiety attack.

There are many techniques you can try for managing and treating anxiety. To cope with anxiety in the moment, try interrupting negative thought patterns with positive ones, deep breathing exercises, grounding techniques, getting exercise, or using aromatherapy. To treat anxiety and manage long-term symptoms, it may be helpful to track your triggers, seek therapy, or talk to a medical provider about medication. Eating a healthy diet, staying active, journaling, and keeping an active social life are also shown to positively affect anxiety.

NIH National Institute of Mental Health. Anxiety disorders .

Eagleson C, Hayes S, Mathews A, Perman G, Hirsch CR. The power of positive thinking: pathological worry is reduced by thought replacement in generalized anxiety disorder .  Behav Res Ther . 2016;78:13-18. doi:10.1016/j.brat.2015.12.017

Menigoz W, Latz TT, Ely RA, Kamei C, Melvin G, Sinatra D. Integrative and lifestyle medicine strategies should include Earthing (grounding): review of research evidence and clinical observations .  Explore (NY) . 2020;16(3):152-160. doi:10.1016/j.explore.2019.10.005

Stonerock GL, Hoffman BM, Smith PJ, Blumenthal JA. Exercise as treatment for anxiety: systematic review and analysis .  Ann Behav Med . 2015;49(4):542-556. doi:10.1007/s12160-014-9685-9

Barati F, Nasiri A, Akbari N, Sharifzadeh G. The effect of aromatherapy on anxiety in patients .  Nephrourol Mon . 2016;8(5):e38347. doi:10.5812/numonthly.38347

Curtiss JE, Levine DS, Ander I, Baker AW. Cognitive-behavioral treatments for anxiety and stress-related disorders .  Focus (Am Psychiatr Publ) . 2021;19(2):184-189. doi:10.1176/appi.focus.20200045

Mayo-Wilson E, Dias S, Mavranezouli I, et al. Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis .  Lancet Psychiatry . 2014;1(5):368-376. doi:10.1016/S2215-0366(14)70329-3

Aucoin M, LaChance L, Naidoo U, et al. Diet and anxiety: a scoping review .  Nutrients . 2021;13(12):4418. doi:10.3390/nu13124418

Locke AB, Kirst N, Shultz CG. Diagnosis and management of generalized anxiety disorder and panic disorder in adults .  Am Fam Physician . 2015;91(9):617-624.

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Stress and Anxiety Relief: 10 Strategies That Can Help

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Rachel Goldman, PhD FTOS, is a licensed psychologist, clinical assistant professor, speaker, wellness expert specializing in eating behaviors, stress management, and health behavior change.

Verywell / Mayur Kakade

Deep Breathing

Mindfulness, write in a journal, watch your caffeine intake, get enough sleep, talk to a loved one, label your emotions, talk to a therapist.

Stress and anxiety are a normal part of life. Sometimes they can even be a good thing. They can inspire you to take action and do your best when it really matters. 

The problem is when feelings of stress and anxiety get out of control. Then these feelings cannot only impair your performance—they can also make you sick. Chronic stress can have a number of serious health consequences including decreased immunity, decreased longevity, and a higher risk for anxiety disorders.

Stress is a response to a potential threat, while anxiety is the reaction to that stress. Unfortunately, both are incredibly common among U.S. adults and evidence suggests that recent world events have made the problem worse for many people. Nearly 8 in 10 adults report increased stress levels as a result of the COVID-19 pandemic.

While you can’t avoid all of the stress in your life, there are stress and anxiety relief strategies that can help you cope more effectively. This article discusses some self-help techniques that can help you get a handle on stress and anxiety. It also covers when to consider talking to a professional.

Exercise can be a highly effective way to deal with things in your life that are causing distress. Research has also found that regular physical activity can protect people against stress and anxiety while also promoting positive emotions.

Exercise can be beneficial for a variety of reasons. It helps to lower the body's stress hormones including adrenaline and cortisol, while also increasing endorphin levels. Endorphins are the body's "feel-good" chemicals. In addition to acting as natural painkillers, they also play a role in inducing feelings of relaxation and boosting mood.

The Centers for Disease Control and Prevention (CDC) recommends getting at least 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity activity, or an equivalent combination each week.

Even if you can't meet these benchmarks, any amount or type of exercise is better than nothing and can benefit your mental health and help to decrease anxiety and stress.

Deep breathing can be a highly effective way to deal with feelings of stress and combat symptoms of anxiety. According to the American Institute of Stress, deep breathing combats stress in a number of ways:

• Increased blood flow to the brain stimulates the parasympathetic symptoms and promotes feelings of calmness
• Redirects attention from negative thoughts to the body and physical sensations instead

Fortunately, deep breathing techniques are easy to learn, can be practiced anywhere, and don’t require any special tools.

Try This: Belly Breathing

• Sit in a comfortable position.
• Place one hand on your belly and the other hand on your chest.
• Inhale slowly through your nose, allowing your belly to expand to move your hand outward without expanding your chest.
• Slowly exhale through pursed lips and let your hand on your belly gently help push all of the air out.
• Repeat this move for 3 to 10 breaths.

Experts also suggest that meditation , the ancient practice that involves focused concentration, can be a highly effective tool for stress and anxiety relief. A brief meditation can be helpful as a quick way to induce feelings of calm when you are feeling stressed. Practicing it regularly may help lower your overall stress levels and combat feelings of anxiety. 

While the body's stress response can trigger the fight or flight response and put the body into an alert state so you can take action, meditation acts in much the opposite way. It soothes the body's stress response, bringing your heightened physiological and psychological reactions back to a more relaxed state.

Because meditation involves focusing your awareness, it can also help take you out of the distracted, worried thoughts that make you feel stressed or anxious. 

Fortunately, there are many different forms of meditation that you can try. Two main types you might consider include concentrative meditation and mindfulness meditation . It pays to experiment and figure out which one you find the most helpful.

Mindfulness is a state of being fully aware and focused on the present moment. It can have a number of positive health effects, including helping to lower stress and anxiety. 

Research has found that an approach known as mindfulness-based stress reduction (MBSR), can be helpful for reducing normal everyday stress as well as for coping with other sources of stress such as chronic illness.  

This eight-week program utilizes mindfulness along with yoga to address the behaviors, feelings, and thoughts that worsen stress.

While this program is a great option for intensive mindfulness-based training, there are also many quick and easy mindfulness practices you can try to incorporate daily.

When you are feeling stressed out or anxious, you might find it helpful to spend a few moments writing down your feelings. Journaling for stress relief allows you to express your emotions, notice patterns you might have missed, and reflect on the things for which you are grateful.

One 2018 study found that journaling, particularly when it focused on positive emotions, was an effective way to combat the effects of stress and improve overall well-being.

If you decide to try this strategy for stress and anxiety relief, make sure that it doesn’t become an exercise in rumination . This doesn’t mean you should avoid writing about all negative feelings, but consider using it as an opportunity to write about solutions you might try or ways to turn the situation around and make a negative into a positive.

Caffeine might be the most commonly consumed drug in the world, but its psychological effects are often underestimated. While low to moderate doses can make you feel more alert and energetic, too much can leave you feeling jittery and anxious.

It is important to remember, however, that everyone's tolerance for caffeine is different. Some people may be able to drink a moderate amount of coffee each day, around four or five cups a day, without noticing any ill effects. 

For other people, just a small amount of caffeine can cause feelings of shakiness or nervousness. If you feel like caffeine might be contributing to feelings of anxiety, consider gradually reducing your intake. Slowly lowering your intake over time can help minimize the unpleasant symptoms of caffeine withdrawal .

Sleep is essential for mental well-being , and research has shown that a lack of sleep may contribute to both the onset and maintenance of a number of mental health conditions, including anxiety.

A poor night of sleep can also leave you feeling stressed and irritable the next day. In addition to feeling exhausted, you might find that even the smallest inconveniences seem unmanageable. 

Research has also found that people who experience problems with anxiety are also more likely to struggle with sleep problems. People with sleep difficulties are at a higher risk of developing generalized anxiety disorder , a condition marked by excessive, persistent, and intrusive feelings of worry and anxiety.

Even people who normally don't have problems with anxiety have higher levels of distress and anxiety levels after a night of poor sleep, so finding ways to protect your rest is important.

Tactics like going to bed and waking at the same time, avoiding digital devices before bedtime , and creating a comfortable sleep environment can help you get a better night's rest. 

Social support is essential for mental health, particularly when you are facing something that causes you to feel stressed or anxious. Spend some time talking to a good friend or other loved one about how you are feeling.

Social support can come in a variety of forms . Sometimes it can involve validating your feelings (emotional support), while in other cases it involves doing things to help people manage a problem (tangible support). In other instances, it might simply involve sharing information (informational support) or helping you feel supported (belongingness support).

No matter what type of support it is, however, research suggests that feeling supported by others can help lower your blood pressure and better cope with stress.

Also, remember that you are not alone and there are people who understand what it is like to struggle with anxiety and excessive stress. According to the National Institute of Mental Health, nearly 20% of adults in the U.S. have some type of anxiety disorder.

So don't be afraid to share what you are feeling with a friend, or consider reaching out to an anxiety support group , either in person or online. 

Research has also found that, in many cases, putting your feelings into words, known as affect labeling, can help reduce the intensity of those emotions. This means that talking to a friend about the things that are causing your stress can actually make those feel less overwhelming. 

Try This: Affect Labeling

Focus on labeling your emotions clearly and be as specific as you can be. You might start by saying something general such as “I feel bad,” but work on going further to really identify the source of the distress and how you feel about it.

After some thought, you might realize that you feel bad because you are worried, angry, or disappointed. Acknowledge and accept your emotions without judging them.

It's not always easy to know when it's time to see a professional about your stress and anxiety. It often builds over time, so it can be difficult to recognize when it's become too much because it has simply become your new normal. 

If your symptoms of stress and anxiety are causing distress and interfering with your ability to function normally, then it is important to talk to a doctor or therapist. But you also don't have to wait until things feel overwhelmingly out of control to reach out for help.

A therapist can help you identify the sources of stress and anxiety in your life and come up with strategies that will help you cope. They can also determine if you have an anxiety disorder and recommend effective treatments that can help you find relief, including psychotherapy and medications.

A Word From Verywell

Stress and anxiety can take a toll on both your physical and mental well-being. Fortunately, there are a number of things that you can do on your own to improve your ability to cope with stress. By becoming better at managing your stress, you may also be able to lower your risk for anxiety. 

If you are still struggling to find stress and anxiety relief, it may be time to talk to your healthcare provider or mental health professional .

American Psychological Association.  Stress effects on the body .

American Psychological Association. Stress in America™ 2020 .

Schultchen D, Reichenberger J, Mittl T, et al. Bidirectional relationship of stress and affect with physical activity and healthy eating . Br J Health Psychol . 2019;24(2):315-333. doi:10.1111/bjhp.12355

Harvard Health. How does exercise reduce stress? Surprising answers to this question .

Centers for Disease Control and Prevention (CDC). How much physical activity do adults need ?.

American Institute of Stress. Take a deep breath .

University of Michigan Health. Stress management: breathing exercises for relaxation .

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Hoge EA, Bui E, Marques L, et al. Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity . J Clin Psychiatry . 2013;74(08):786-792. doi:10.4088/JCP.12m08083

Smyth JM, Johnson JA, Auer BJ, Lehman E, Talamo G, Sciamanna CN. Online positive affect journaling in the improvement of mental distress and well-being in general medical patients with elevated anxiety symptoms: a preliminary randomized controlled trial . JMIR Ment Health . 2018;5(4):e11290. doi:10.2196/11290

Lara DR. Caffeine, mental health, and psychiatric disorders . J Alzheimers Dis . 2010;20 Suppl 1:S239-48. doi:10.3233/JAD-2010-1378

Scott AJ, Webb TL, Rowse G. Does improving sleep lead to better mental health?. A protocol for a meta-analytic review of randomised controlled trials . BMJ Open . 2017;7(9):e016873. doi:10.1136/bmjopen-2017-016873

Shanahan L, Copeland WE, Angold A, Bondy CL, Costello EJ. Sleep problems predict and are predicted by generalized anxiety/depression and oppositional defiant disorder . J Am Acad Child Adolesc Psychiatry . 2014;53(5):550–558. doi:10.1016/j.jaac.2013.12.029

Bowen KS, Uchino BN, Birmingham W, Carlisle M, Smith TW, Light KC. The stress-buffering effects of functional social support on ambulatory blood pressure . Health Psychol . 2014;33(11):1440–1443. doi:10.1037/hea0000005

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By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

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Home / Mental Health / 9 tips for coping with an anxiety disorder

9 tips for coping with an anxiety disorder

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Feeling situationally nervous (you’re about to take the stage) or having occasional feelings of anxiety is a normal part of life. However, having frequent and excessive anxiety , fear, terror or panic in everyday situations is not normal. These feelings are unhealthy and can affect your quality of life and prevent you from functioning normally.

  Common symptoms of anxiety disorders include:

• Feeling nervous

• Feeling helpless

• A sense of impending panic, danger or doom

• Increased heart rate

• Hyperventilation

• Trembling

• Obsessively thinking about the panic trigger

These feelings of anxiety and panic impact daily life. In addition to feeling bad, they can interfere with daily activities and even cause you to avoid places or situations.

While talking to your health care provider or mental health professional about your anxiety is a great place to start in overcoming anxiety, lifestyle changes and coping with anxiety strategies also can make a difference.

9 tips for coping with anxiety:

• Be physically active.   Exercise is a powerful stress reducer. Develop a routine so that you’re physically active most days of the week. It can improve your mood and help you stay healthy.
• Eat healthy foods.   A healthy diet that incorporates vegetables, fruits, whole grains and fish may help reduce anxiety.
• Make sleep a priority.   The brain needs sleep to thrive. Studies show that most adults need seven or more hours of sleep a night. Going to bed and waking at the same time also helps you create healthy sleep habits.
• Use stress management and relaxation techniques.   Mindfulness and meditation practices can reduce anxiety and increase calm.
• Avoid alcohol and recreational drugs.   While it may feel at the time that that glass of wine is helping you relax and feel better, these substances can cause or worsen anxiety.
• Quit smoking. Nicotine can exacerbate the symptoms of anxiety.
• Cut back or quit drinking caffeinated beverages.   Caffeine can exacerbate the symptoms of anxiety.
• Socialize.   Humans are social animals and human interaction is important. Being around loved ones can help you feel better.
• Keep a journal.   Keeping track of your personal life can help you identify what’s causing you stress and what seems to help you feel better.

If you have anxiety, seek help.

Anxiety is very common. You are not alone. You should see your health care provider if your anxiety is affecting your life and relationships. Your provider can help rule out any underlying physical health issues. A mental health professional can help you identify triggers and develop healthy response strategies.

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10 Best Problem-Solving Therapy Worksheets & Activities

Cognitive science tells us that we regularly face not only well-defined problems but, importantly, many that are ill defined (Eysenck & Keane, 2015).

Sometimes, we find ourselves unable to overcome our daily problems or the inevitable (though hopefully infrequent) life traumas we face.

Problem-Solving Therapy aims to reduce the incidence and impact of mental health disorders and improve wellbeing by helping clients face life’s difficulties (Dobson, 2011).

This article introduces Problem-Solving Therapy and offers techniques, activities, and worksheets that mental health professionals can use with clients.

Before you continue, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises explore fundamental aspects of positive psychology, including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.

This Article Contains:

What is problem-solving therapy, 14 steps for problem-solving therapy, 3 best interventions and techniques, 7 activities and worksheets for your session, fascinating books on the topic, resources from positivepsychology.com, a take-home message.

Problem-Solving Therapy assumes that mental disorders arise in response to ineffective or maladaptive coping. By adopting a more realistic and optimistic view of coping, individuals can understand the role of emotions and develop actions to reduce distress and maintain mental wellbeing (Nezu & Nezu, 2009).

“Problem-solving therapy (PST) is a psychosocial intervention, generally considered to be under a cognitive-behavioral umbrella” (Nezu, Nezu, & D’Zurilla, 2013, p. ix). It aims to encourage the client to cope better with day-to-day problems and traumatic events and reduce their impact on mental and physical wellbeing.

Clinical research, counseling, and health psychology have shown PST to be highly effective in clients of all ages, ranging from children to the elderly, across multiple clinical settings, including schizophrenia, stress, and anxiety disorders (Dobson, 2011).

Can it help with depression?

PST appears particularly helpful in treating clients with depression. A recent analysis of 30 studies found that PST was an effective treatment with a similar degree of success as other successful therapies targeting depression (Cuijpers, Wit, Kleiboer, Karyotaki, & Ebert, 2020).

Other studies confirm the value of PST and its effectiveness at treating depression in multiple age groups and its capacity to combine with other therapies, including drug treatments (Dobson, 2011).

The major concepts

Effective coping varies depending on the situation, and treatment typically focuses on improving the environment and reducing emotional distress (Dobson, 2011).

PST is based on two overlapping models:

Social problem-solving model

This model focuses on solving the problem “as it occurs in the natural social environment,” combined with a general coping strategy and a method of self-control (Dobson, 2011, p. 198).

The model includes three central concepts:

• Social problem-solving
• The problem
• The solution

The model is a “self-directed cognitive-behavioral process by which an individual, couple, or group attempts to identify or discover effective solutions for specific problems encountered in everyday living” (Dobson, 2011, p. 199).

Relational problem-solving model

The theory of PST is underpinned by a relational problem-solving model, whereby stress is viewed in terms of the relationships between three factors:

• Stressful life events
• Emotional distress and wellbeing
• Problem-solving coping

Therefore, when a significant adverse life event occurs, it may require “sweeping readjustments in a person’s life” (Dobson, 2011, p. 202).

• Enhance positive problem orientation
• Decrease negative orientation
• Foster ability to apply rational problem-solving skills
• Reduce the tendency to avoid problem-solving
• Minimize the tendency to be careless and impulsive

D’Zurilla’s and Nezu’s model includes (modified from Dobson, 2011):

• Initial structuring Establish a positive therapeutic relationship that encourages optimism and explains the PST approach.
• Assessment Formally and informally assess areas of stress in the client’s life and their problem-solving strengths and weaknesses.
• Obstacles to effective problem-solving Explore typically human challenges to problem-solving, such as multitasking and the negative impact of stress. Introduce tools that can help, such as making lists, visualization, and breaking complex problems down.
• Problem orientation – fostering self-efficacy Introduce the importance of a positive problem orientation, adopting tools, such as visualization, to promote self-efficacy.
• Problem orientation – recognizing problems Help clients recognize issues as they occur and use problem checklists to ‘normalize’ the experience.
• Problem orientation – seeing problems as challenges Encourage clients to break free of harmful and restricted ways of thinking while learning how to argue from another point of view.
• Problem orientation – use and control emotions Help clients understand the role of emotions in problem-solving, including using feelings to inform the process and managing disruptive emotions (such as cognitive reframing and relaxation exercises).
• Problem orientation – stop and think Teach clients how to reduce impulsive and avoidance tendencies (visualizing a stop sign or traffic light).
• Problem definition and formulation Encourage an understanding of the nature of problems and set realistic goals and objectives.
• Generation of alternatives Work with clients to help them recognize the wide range of potential solutions to each problem (for example, brainstorming).
• Decision-making Encourage better decision-making through an improved understanding of the consequences of decisions and the value and likelihood of different outcomes.
• Solution implementation and verification Foster the client’s ability to carry out a solution plan, monitor its outcome, evaluate its effectiveness, and use self-reinforcement to increase the chance of success.
• Guided practice Encourage the application of problem-solving skills across multiple domains and future stressful problems.
• Rapid problem-solving Teach clients how to apply problem-solving questions and guidelines quickly in any given situation.

Success in PST depends on the effectiveness of its implementation; using the right approach is crucial (Dobson, 2011).

Problem-solving therapy – Baycrest

The following interventions and techniques are helpful when implementing more effective problem-solving approaches in client’s lives.

First, it is essential to consider if PST is the best approach for the client, based on the problems they present.

Is PPT appropriate?

It is vital to consider whether PST is appropriate for the client’s situation. Therapists new to the approach may require additional guidance (Nezu et al., 2013).

Therapists should consider the following questions before beginning PST with a client (modified from Nezu et al., 2013):

• Has PST proven effective in the past for the problem? For example, research has shown success with depression, generalized anxiety, back pain, Alzheimer’s disease, cancer, and supporting caregivers (Nezu et al., 2013).
• Is PST acceptable to the client?
• Is the individual experiencing a significant mental or physical health problem?

All affirmative answers suggest that PST would be a helpful technique to apply in this instance.

Five problem-solving steps

The following five steps are valuable when working with clients to help them cope with and manage their environment (modified from Dobson, 2011).

Ask the client to consider the following points (forming the acronym ADAPT) when confronted by a problem:

• Attitude Aim to adopt a positive, optimistic attitude to the problem and problem-solving process.
• Define Obtain all required facts and details of potential obstacles to define the problem.
• Alternatives Identify various alternative solutions and actions to overcome the obstacle and achieve the problem-solving goal.
• Predict Predict each alternative’s positive and negative outcomes and choose the one most likely to achieve the goal and maximize the benefits.
• Try out Once selected, try out the solution and monitor its effectiveness while engaging in self-reinforcement.

If the client is not satisfied with their solution, they can return to step ‘A’ and find a more appropriate solution.

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Positive self-statements

When dealing with clients facing negative self-beliefs, it can be helpful for them to use positive self-statements.

Use the following (or add new) self-statements to replace harmful, negative thinking (modified from Dobson, 2011):

• I can solve this problem; I’ve tackled similar ones before.
• I can cope with this.
• I just need to take a breath and relax.
• Once I start, it will be easier.
• It’s okay to look out for myself.
• I can get help if needed.
• Other people feel the same way I do.
• I’ll take one piece of the problem at a time.
• I can keep my fears in check.
• I don’t need to please everyone.

5 Worksheets and workbooks

Problem-solving self-monitoring form.

Answering the questions in the Problem-Solving Self-Monitoring Form provides the therapist with necessary information regarding the client’s overall and specific problem-solving approaches and reactions (Dobson, 2011).

Ask the client to complete the following:

• Describe the problem you are facing.
• What is your goal?
• What have you tried so far to solve the problem?
• What was the outcome?

Reactions to Stress

It can be helpful for the client to recognize their own experiences of stress. Do they react angrily, withdraw, or give up (Dobson, 2011)?

The Reactions to Stress worksheet can be given to the client as homework to capture stressful events and their reactions. By recording how they felt, behaved, and thought, they can recognize repeating patterns.

What Are Your Unique Triggers?

Helping clients capture triggers for their stressful reactions can encourage emotional regulation.

When clients can identify triggers that may lead to a negative response, they can stop the experience or slow down their emotional reaction (Dobson, 2011).

The What Are Your Unique Triggers ? worksheet helps the client identify their triggers (e.g., conflict, relationships, physical environment, etc.).

Problem-Solving worksheet

Imagining an existing or potential problem and working through how to resolve it can be a powerful exercise for the client.

Use the Problem-Solving worksheet to state a problem and goal and consider the obstacles in the way. Then explore options for achieving the goal, along with their pros and cons, to assess the best action plan.

Getting the Facts

Clients can become better equipped to tackle problems and choose the right course of action by recognizing facts versus assumptions and gathering all the necessary information (Dobson, 2011).

Use the Getting the Facts worksheet to answer the following questions clearly and unambiguously:

• Who is involved?
• What did or did not happen, and how did it bother you?
• Where did it happen?
• When did it happen?
• Why did it happen?
• How did you respond?

2 Helpful Group Activities

While therapists can use the worksheets above in group situations, the following two interventions work particularly well with more than one person.

Generating Alternative Solutions and Better Decision-Making

A group setting can provide an ideal opportunity to share a problem and identify potential solutions arising from multiple perspectives.

Use the Generating Alternative Solutions and Better Decision-Making worksheet and ask the client to explain the situation or problem to the group and the obstacles in the way.

Once the approaches are captured and reviewed, the individual can share their decision-making process with the group if they want further feedback.

Visualization

Visualization can be performed with individuals or in a group setting to help clients solve problems in multiple ways, including (Dobson, 2011):

• Clarifying the problem by looking at it from multiple perspectives
• Rehearsing a solution in the mind to improve and get more practice
• Visualizing a ‘safe place’ for relaxation, slowing down, and stress management

Guided imagery is particularly valuable for encouraging the group to take a ‘mental vacation’ and let go of stress.

Ask the group to begin with slow, deep breathing that fills the entire diaphragm. Then ask them to visualize a favorite scene (real or imagined) that makes them feel relaxed, perhaps beside a gently flowing river, a summer meadow, or at the beach.

The more the senses are engaged, the more real the experience. Ask the group to think about what they can hear, see, touch, smell, and even taste.

Encourage them to experience the situation as fully as possible, immersing themselves and enjoying their place of safety.

Such feelings of relaxation may be able to help clients fall asleep, relieve stress, and become more ready to solve problems.

We have included three of our favorite books on the subject of Problem-Solving Therapy below.

1. Problem-Solving Therapy: A Treatment Manual – Arthur Nezu, Christine Maguth Nezu, and Thomas D’Zurilla

This is an incredibly valuable book for anyone wishing to understand the principles and practice behind PST.

Written by the co-developers of PST, the manual provides powerful toolkits to overcome cognitive overload, emotional dysregulation, and the barriers to practical problem-solving.

Find the book on Amazon .

2. Emotion-Centered Problem-Solving Therapy: Treatment Guidelines – Arthur Nezu and Christine Maguth Nezu

Another, more recent, book from the creators of PST, this text includes important advances in neuroscience underpinning the role of emotion in behavioral treatment.

Along with clinical examples, the book also includes crucial toolkits that form part of a stepped model for the application of PST.

3. Handbook of Cognitive-Behavioral Therapies – Keith Dobson and David Dozois

This is the fourth edition of a hugely popular guide to Cognitive-Behavioral Therapies and includes a valuable and insightful section on Problem-Solving Therapy.

This is an important book for students and more experienced therapists wishing to form a high-level and in-depth understanding of the tools and techniques available to Cognitive-Behavioral Therapists.

For even more tools to help strengthen your clients’ problem-solving skills, check out the following free worksheets from our blog.

• Case Formulation Worksheet This worksheet presents a four-step framework to help therapists and their clients come to a shared understanding of the client’s presenting problem.
• Understanding Your Default Problem-Solving Approach This worksheet poses a series of questions helping clients reflect on their typical cognitive, emotional, and behavioral responses to problems.
• Social Problem Solving: Step by Step This worksheet presents a streamlined template to help clients define a problem, generate possible courses of action, and evaluate the effectiveness of an implemented solution.

If you’re looking for more science-based ways to help others enhance their wellbeing, check out this signature collection of 17 validated positive psychology tools for practitioners. Use them to help others flourish and thrive.

17 Top-Rated Positive Psychology Exercises for Practitioners

Expand your arsenal and impact with these 17 Positive Psychology Exercises [PDF] , scientifically designed to promote human flourishing, meaning, and wellbeing.

Created by Experts. 100% Science-based.

While we are born problem-solvers, facing an incredibly diverse set of challenges daily, we sometimes need support.

Problem-Solving Therapy aims to reduce stress and associated mental health disorders and improve wellbeing by improving our ability to cope. PST is valuable in diverse clinical settings, ranging from depression to schizophrenia, with research suggesting it as a highly effective treatment for teaching coping strategies and reducing emotional distress.

Many PST techniques are available to help improve clients’ positive outlook on obstacles while reducing avoidance of problem situations and the tendency to be careless and impulsive.

The PST model typically assesses the client’s strengths, weaknesses, and coping strategies when facing problems before encouraging a healthy experience of and relationship with problem-solving.

Why not use this article to explore the theory behind PST and try out some of our powerful tools and interventions with your clients to help them with their decision-making, coping, and problem-solving?

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .

• Cuijpers, P., Wit, L., Kleiboer, A., Karyotaki, E., & Ebert, D. (2020). Problem-solving therapy for adult depression: An updated meta-analysis. European P sychiatry ,  48 (1), 27–37.
• Dobson, K. S. (2011). Handbook of cognitive-behavioral therapies (3rd ed.). Guilford Press.
• Dobson, K. S., & Dozois, D. J. A. (2021). Handbook of cognitive-behavioral therapies  (4th ed.). Guilford Press.
• Eysenck, M. W., & Keane, M. T. (2015). Cognitive psychology: A student’s handbook . Psychology Press.
• Nezu, A. M., & Nezu, C. M. (2009). Problem-solving therapy DVD . Retrieved September 13, 2021, from https://www.apa.org/pubs/videos/4310852
• Nezu, A. M., & Nezu, C. M. (2018). Emotion-centered problem-solving therapy: Treatment guidelines. Springer.
• Nezu, A. M., Nezu, C. M., & D’Zurilla, T. J. (2013). Problem-solving therapy: A treatment manual . Springer.

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Treating anxiety disorders with therapy

Cognitive behavioral therapy (cbt) for anxiety, thought challenging in cbt for anxiety, exposure therapy for anxiety, complementary therapies for anxiety disorders, making anxiety therapy work for you, therapy for anxiety disorders.

Want to control your anxiety, stop worrisome thoughts, and conquer your fears? Here’s how therapy can help.

Whether you’re suffering from panic attacks, obsessive thoughts, unrelenting worries, or an incapacitating phobia, it’s important to know that you don’t have to live with anxiety and fear. Treatment can help, and for many anxiety problems, therapy is often the most effective option. That’s because anxiety therapy—unlike anxiety medication —treats more than just the symptoms of the problem. Therapy can help you uncover the underlying causes of your worries and fears; learn how to relax; look at situations in new, less frightening ways; and develop better coping and problem-solving skills. Therapy gives you the tools to overcome anxiety and teaches you how to use them.

Anxiety disorders differ considerably, so therapy should be tailored to your specific symptoms and diagnosis. If you have obsessive-compulsive disorder (OCD), for example, your treatment will be different from someone who needs help for anxiety attacks. The length of therapy will also depend on the type and severity of your anxiety disorder. However, many anxiety therapies are relatively short-term. According to the American Psychological Association, many people improve significantly within 8 to 10 therapy sessions.

While many different types of therapy are used to treat anxiety, the leading approaches are cognitive behavioral therapy (CBT) and exposure therapy. Each anxiety therapy may be used alone, or combined with other types of therapy. Anxiety therapy may be conducted individually, or it may take place in a group of people with similar anxiety problems. But the goal is the same: to lower your anxiety levels, calm your mind, and overcome your fears.

Online vs. in-person therapy

Accessing help online can help you avoid the expense and inconvenience of having to meet in-person and being in a familiar, comfortable environment can make it easier to talk openly about your issues. For many people with anxiety, online therapy can be just as effective as traditional, in-person therapy. Some online therapy platforms even accept insurance .

However, not all online therapy is the same. Communicating via a messaging app, phone, or email, for example, is no substitute for live face-to-face interaction using video chat.

Facial expressions, mannerisms, and body language are important tools in therapy. They allow your therapist pick up on any inconsistencies between your verbal and nonverbal responses, recognize things that you’re unable to put into words, and understand the true meaning behind what you’re saying. From your point of view, interacting face-to-face is crucial to building a strong connection with a therapist that so often determines the success of therapy.

Cognitive behavioral therapy (CBT) is the most widely-used therapy for anxiety disorders. Research has shown it to be effective in the treatment of panic disorder, phobias, social anxiety disorder, and generalized anxiety disorder, among many other conditions.

CBT addresses negative patterns and distortions in the way we look at the world and ourselves. As the name suggests, this involves two main components:

• Cognitive therapy examines how negative thoughts, or cognitions , contribute to anxiety.
• Behavior therapy examines how you behave and react in situations that trigger anxiety.

The basic premise of CBT is that our thoughts—not external events—affect the way we feel. In other words, it’s not the situation you’re in that determines how you feel, but your perception of the situation.

For example, imagine that you’ve just been invited to a big party. Consider three different ways of thinking about the invitation, and how those thoughts would affect your emotions.

Situation: A friend invites you to a big party

Thought #1: The party sounds like a lot of fun. I love going out and meeting new people!

Emotions: Happy, excited.

Thought #2:  Parties aren’t my thing. I’d much rather stay in and watch a movie.

Emotions: Neutral.

Thought #3: I never know what to say or do at parties. I’ll make a fool of myself if I go.

Emotions:  Anxious, sad.

As you can see, the same event can lead to completely different emotions in different people. It all depends on our individual expectations, attitudes, and beliefs.

[Read: Anxiety Disorders and Anxiety Attacks]

For people with anxiety disorders, negative ways of thinking fuel the negative emotions of anxiety and fear. The goal of cognitive behavioral therapy for anxiety is to identify and correct these negative thoughts and beliefs. The idea is that if you change the way you think, you can change the way you feel.

Speak to a Licensed Therapist

BetterHelp is an online therapy service that matches you to licensed, accredited therapists who can help with depression, anxiety, relationships, and more. Take the assessment and get matched with a therapist in as little as 48 hours.

Thought challenging—also known as cognitive restructuring—is a process in which you challenge the negative thinking patterns that contribute to your anxiety, replacing them with more positive, realistic thoughts. This involves three steps:

• Identifying your negative thoughts. With anxiety disorders, situations are perceived as more dangerous than they really are. To someone with a germ phobia, for example, shaking another person’s hand can seem life threatening. Although you may easily see that this is an irrational fear, identifying your own irrational, scary thoughts can be very difficult. One strategy is to ask yourself what you were thinking when you started feeling anxious. Your therapist will help you with this step.
• Challenging your negative thoughts. In the second step, your therapist will teach you how to evaluate your anxiety-provoking thoughts. This involves questioning the evidence for your frightening thoughts, analyzing unhelpful beliefs, and testing out the reality of negative predictions. Strategies for challenging negative thoughts include conducting experiments, weighing the pros and cons of worrying or avoiding the thing you fear, and determining the realistic chances that what you’re anxious about will actually happen.
• Replacing negative thoughts with realistic thoughts. Once you’ve identified the irrational predictions and negative distortions in your anxious thoughts, you can replace them with new thoughts that are more accurate and positive. Your therapist may also help you come up with realistic, calming statements you can say to yourself when you’re facing or anticipating a situation that normally sends your anxiety levels soaring.

How thought challenging works

To understand how thought challenging works in cognitive behavioral therapy, consider the following example: Maria won’t take the subway because she’s afraid she’ll pass out, and then everyone will think she’s crazy. Her therapist has asked her to write down her negative thoughts, identify the errors—or cognitive distortions—in her thinking, and come up with a more rational interpretation. The results are below.

Replacing negative thoughts with more realistic ones is easier said than done. Often, negative thoughts are part of a lifelong pattern of thinking. It takes practice to break the habit. That’s why cognitive behavioral therapy includes practicing on your own at home as well.

CBT may also include:

• Learning to recognize when you’re anxious and what that feels like in the body.
• Learning coping skills and relaxation techniques to counteract anxiety and panic.
• Confronting your fears (either in your imagination or in real life).

Anxiety isn’t a pleasant sensation, so it’s only natural to avoid it if you can. One of the ways that people do this is by steering clear of the situations that make them anxious. If you have a fear of heights, you might drive three hours out of your way to avoid crossing a tall bridge. Or if the prospect of public speaking leaves your stomach in knots, you might skip your best friend’s wedding in order to avoid giving a toast. Aside from the inconvenience factor, the problem with avoiding your fears is that you never have the chance to overcome them. In fact, avoiding your fears often makes them stronger.

[Read: Phobias and Irrational Fears]

Exposure therapy, as the name suggests, exposes you to the situations or objects you fear. The idea is that through repeated exposures, you’ll feel an increasing sense of control over the situation and your anxiety will diminish. The exposure is done in one of two ways: Your therapist may ask you to imagine the scary situation, or you may confront it in real life. Exposure therapy may be used alone, or it may be conducted as part of cognitive behavioral therapy.

Systematic desensitization

Rather than facing your biggest fear right away, which can be traumatizing, exposure therapy usually starts with a situation that’s only mildly threatening and works up from there. This step-by-step approach is called systematic desensitization . Systematic desensitization allows you to gradually challenge your fears, build confidence, and master skills for controlling panic.

Systematic desensitization involves three parts:

• Learning relaxation skills. First, your therapist will teach you a relaxation technique, such as progressive muscle relaxation or deep breathing. You’ll practice in therapy and on your own at home. Once you start confronting your fears, you’ll use this relaxation technique to reduce your physical anxiety response (such as trembling and hyperventilating) and encourage relaxation.
• Creating a step-by-step list. Next, you’ll create a list of 10 to 20 scary situations that progress toward your final goal. For example, if your final goal is to overcome your fear of flying, you might start by looking at photos of planes and end with taking an actual flight. Each step should be as specific as possible, with a clear, measurable objective.
• Working through the steps. Under the guidance of your therapist, you’ll then begin to work through the list. The goal is to stay in each scary situation until your fears subside. That way, you’ll learn that the feelings won’t hurt you and they do go away. Every time the anxiety gets too intense, you will switch to the relaxation technique you learned. Once you’re relaxed again, you can turn your attention back to the situation. In this way, you will work through the steps until you’re able to complete each one without feeling overly distressed.

Facing a fear of flying

Step 1: Look at photos of planes.

Step 2: Watch a video of a plane in flight.

Step 3: Watch real planes take off.

Step 4: Book a plane ticket.

Step 5: Pack for your flight.

Step 6: Drive to the airport.

Step 7: Check in for your flight.

Step 8: Wait for boarding.

Step 9: Get on the plane.

Step 10: Take the flight.

As you explore your anxiety disorder in therapy, you may also want to experiment with complementary therapies designed to bring your overall stress levels down and help you achieve emotional balance.

Exercise is a natural stress buster and anxiety reliever . Research shows that as little as 30 minutes of exercise three to five times a week can provide significant anxiety relief. To achieve the maximum benefit, aim for at least an hour of aerobic exercise on most days.

Relaxation techniques such as mindfulness meditation and progressive muscle relaxation, when practiced regularly, can reduce anxiety and increase feelings of emotional well-being.

[Read: Relaxation Techniques for Stress Relief]

Biofeedback uses sensors that measure specific physiological functions—such as heart rate, breathing, and muscle tension—to teach you to recognize your body’s anxiety response and learn how to control it using relaxation techniques.

Hypnosis is sometimes used in combination with CBT for anxiety. While you’re in a state of deep relaxation, the hypnotherapist uses different therapeutic techniques to help you face your fears and look at them in new ways.

There is no quick fix for anxiety. Overcoming an anxiety disorder takes time and commitment. Therapy involves facing your fears rather than avoiding them, so sometimes you’ll feel worse before you get better. The important thing is to stick with treatment and follow your therapist’s advice. If you’re feeling discouraged with the pace of recovery, remember that therapy for anxiety is very effective in the long run. You’ll reap the benefits if you see it through.

[Read: Finding a Therapist Who Can Help You Heal]

You can also support your own anxiety therapy by making positive choices. Everything from your activity level to your social life affects anxiety. Set the stage for success by making a conscious decision to promote relaxation, vitality, and a positive mental outlook in your everyday life.

Learn about anxiety. In order to overcome anxiety, it’s important to understand the problem. That’s where education comes in. Education alone won’t cure an anxiety disorder, but it will help you get the most out of therapy.

Cultivate your connections with other people. Loneliness and isolation set the stage for anxiety. Decrease your vulnerability by reaching out to others. Make it a point to see friends, join a self-help or support group, or share your worries and concerns with a trusted loved one.

Adopt healthy lifestyle habits. Physical activity relieves tension and anxiety, so make time for regular exercise. Don’t use alcohol and drugs to cope with your symptoms, and try to avoid stimulants such as caffeine and nicotine, which can make anxiety worse.

Reduce stress in your life. Examine your life for stress, and look for ways to minimize it. Avoid people who make you anxious, say no to extra responsibilities, and make time for fun and relaxation in your daily schedule.

For help finding an anxiety disorder therapist

Use the Find a Therapist Directory . (Anxiety Disorders Association of America)

Find Psychological therapies services . (NHS)

Find a Psychologist . (Anxiety Treatment Australia)

Search Anxiety/Panic . (Therapist Directory)

More Information

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• Anxiety - Worksheet to help you cope. (Centre for Clinical Interventions)
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BRIEF RESEARCH REPORT article

A network analysis of social problem-solving and anxiety/depression in adolescents.

• 1 Wenzhou Seventh People's Hospital, Wenzhou, China
• 2 Department of Psychology, School of Education, Wenzhou University, Wenzhou, China

Social problem-solving (SPS) involves the cognitive-behavioral processes through which an individual identifies and copes with everyday problems; it is considered to contribute to anxiety and depression. The Social Problem-Solving Inventory Revised is a popular tool measuring SPS problem orientations and problem-solving styles. Only a negative problem orientation (NPO) is considered strongly related to anxiety and depression. In the present study, we investigated the detailed connections among the five components of SPS and 14 anxiety-depression symptoms and specified the role of NPO and other components in the anxiety-depression network. We employed network analysis, constructed circular and multi-dimensional scaling (MDS) networks, and calculated the network centrality, bridge centrality, and stability of centrality indices. The results were as follows: (1) the MDS network showed a clustering of anxiety and depression symptoms, with NPO and avoidance style components from SPS being close to the anxiety-depression network (demonstrated by large bridge betweenness and bridge closeness); (2) the NPO and positive problem orientation from SPS were most influential on the whole network, though with an opposite effect; (3) strength was the most stable index [correlation stability (CS) coefficient = 0.516] among the centrality indices with case-dropping bootstraps. We also discussed this network from various perspectives and commented on the clinical implications and limitations of this study.

Introduction

Social problem-solving (SPS) is believed to be strongly related to anxiety and depression, which is very popular among Chinese people. For adults, 4% ( 1 ) before and 20.4% ( 2 ) during the COVID-19 epidemic suffer from anxiety and depression; for adolescent, the prevalent of anxiety and depression is 11.2%/14.6% ( 3 ) before and 19%/36.6% ( 4 ) during the epidemic. SPS plays a significant role in psychological adjustment and constitutes an important coping strategy that has the potential to reduce or minimize psychological distress ( 5 , 6 ). Previous research has found that strong SPS abilities reduce the morbidity associated with anxiety and depression by aiding young people in controlling and modifying their health behavior ( 7 ); they are of key importance in managing emotions and wellbeing ( 8 ). Conversely, poor problem orientation has consistently linked depression and anxiety ( 9 ). Furthermore, depressed patients frequently exhibit deficiencies in social problem-solving, producing fewer effective solutions than do normal control subjects ( 10 ).

Essentially, SPS involves the cognitive-behavioral processes through which an individual identifies and copes with everyday problems ( 11 ). It comprises problem orientation (a general motivational and appraisal component) and problem-solving style (the cognitive and behavioral activities a person uses to cope with problems). The Social Problem-Solving Inventory Revised (SPSI-R) provides a corresponding scale and comprehensive assessment of all theoretical components linked to contemporary models of social problem-solving [i.e., both problem orientation and problem-solving style ( 12 , 13 )]. The SPSI-R consists of a scale of 25 (in the short form) or 52 (in the long form) items, and is one of the most prominent instruments used to study SPS ( 14 ). The SPSI-R is a theory-based measure of SPS processes. It consists of five dimensions, as follows: (1) positive problem orientation (PPO), (2) negative problem orientation (NPO), (3) rational PPO problem-solving (RPS), (4) impulsivity/carelessness style (ICS), and (5) avoidance style (AS). The SPSI-R assesses a person's perception of his or her general approach to and styles of solving problems in everyday living that have repeatedly been found to be reliable and valid ( 15 , 16 ).

SPSI-R research has shown that SPS is an important measure of psychological distress, wellbeing, and social competence [i.e., depression, distress, anxiety, health-related behaviors, life satisfaction, optimism, situational coping, aggression, and externalizing behaviors ( 17 – 19 )]. Previous research has found that certain specific components of SPS can contribute significantly to anxiety and depression. For example, anxious and depressed patients may have difficulties at different stages of the problem-solving process ( 20 , 21 ); Kant et al. (author?) ( 22 ) found that all five problem-solving dimensions measured by the SPSI-R were significantly related to both anxiety and depression in at least one of two samples (i.e., the middle aged and elderly); additional follow-up analyses indicated that NPO contributed most to the significant mediating effect between problems and depression.

Specifically, NPO is strongly related to depression and emotional distress. Abu-Ghazal and Falwah ( 23 ) found that employing PPO to solve problems leads to positive psychological wellbeing, while NPO is associated with depression. In Australia, researchers examined the relationship between NPO and depression-anxiety in 285 young adults using the NPO dimensions of the SPSI-R, finding strong connections between the two ( 24 ). Additionally, many researchers have found that social anxiety is related to NPO ( 25 , 26 ). In Hungary, Kasik and Gál ( 27 ) studied the relationships among SPS, anxiety, and empathy in 445 Hungarian adolescents, finding that regardless of age, adolescents with an increased level of anxiety also have high levels of NPO and AS. Furthermore, studies have found a link between NPO and stress ( 28 – 32 ). Therefore, anxiety and depression have the strongest association with NPO, above all other SPS components ( 8 , 33 – 35 ), and success in reducing symptoms of anxiety and depression appears to be more strongly predicated on the absence of NPO than presence of PPO ( 34 ).

These studies suggest that NPO plays an important role in anxiety and depression. We also explored the detailed connections between problem-solving orientations (including NPO) and problem-solving styles with anxiety-depression symptoms. In other words, we integrated the components of SPS into the anxiety-depression network and investigated the link between these components and anxiety-depression symptoms. We identified the components of social problem-solving most strongly associated with certain symptoms in the anxiety-depression network and determined which components were most centrally located.

Thus, network analysis was employed to analyze the relationships among components of SPS and anxiety-depression symptoms, working from the bottom up, without applying any top-down construct consistent with the standard biomedical and reductionist model ( 36 ). A key premise of network theory is that psychopathological symptoms are interacting and reinforcing parts of a network, rather than clusters of underlying disorders ( 37 ). To test this argument, network analysis has been used to describe the relationships within and between disorders ( 37 ). The dynamics and interrelationships between comorbidities can be identified in network analysis and gaps not considered by factor analysis methods can be addressed ( 38 ). A network is defined as a set of nodes (symptoms) and edges (connections between nodes). In a network model, the symptoms themselves constitute the disorder. The onset and maintenance of symptoms are determined by tracing the pathways of the network ( 38 ).

In an estimated network structure, a centrality measure denotes the overall connectivity of a particular symptom (or component). Central nodes contribute the most to the interrelatedness of symptoms (or components) within the estimated network structure ( 39 , 40 ). A tightly connected network with many strong connections among the symptoms is considered risky because activation of one symptom can quickly spread to other symptoms, leading to more chronic symptoms over time ( 41 ). In other words, when a highly central component is activated (i.e., a person reports the presence of a symptom), it influences other components, causing them to become activated as well, and thus maintaining the network. Considering the importance of problem orientation and problem-solving styles to emotional wellbeing, the nodes should be strongly linked to symptoms of anxiety and depression. In addition, we calculated the bridge-centrality. Previous research has found that deactivating bridge nodes prevents the spread of comorbidity (i.e., one disorder activating another) ( 42 ). Through this network analysis, we gained insight regarding the relationship between SPS and anxiety-depression, which may have clinical implications such as helping to modify patients' problem-solving styles to alleviate related symptoms.

In summary, social problem solving is highly correlated with anxiety and depression and can lead to a number of mental illnesses. There are few study about how the aspects of social problem solving that contribute to depression and anxiety and how they both interact with each other. The present study is to explore the detailed connections between problem-solving orientations and problem-solving styles with anxiety-depression symptoms. NPO, specifically, is hypothesized to be related to depression and emotional distress. We characterized the network structure of SPS components and anxiety-depression symptoms using psychiatric and regular samples. We first investigated the node and bridge centrality, and then determined the stability of the centrality indices for the network.

Participants

The samples, consisting of adolescents aged 12–17 years, was obtained from a psychiatric hospital and two secondary schools, collected from October 2021 and completed in March 2022. The 100 adolescents from the hospital were outpatients who had mental health assessments done by psychiatrists. When patients enter the psychological assessment room, they are briefly introduced to the purpose of our study and then asked to fill out the relevant scales based on the most recent week. They could ask the psychiatrists for help if they have any questions. When the task was finished, the psychiatrists have a check to make sure that all responses are completed, and then the subject leaves the assessment room. The other 100 participants were randomly selected middle school students; they conducted the self-rating assessments while monitored by their teachers in the classrooms. All participants signed an informed consent form and were explained about the rules regarding anonymity, confidentiality, and their right to quit.

Ten samples (from the middle schools) were excluded from data collection because they failed the manipulation check ( 43 ). Therefore, 190 participants were included in the data analysis.

Hospital anxiety and depression scale

The HADS assesses both anxiety and depression, which commonly coexist ( 44 ). The measure is employed frequently, due to its simplicity, speed, and ease of use. Very few literate people have difficulty completing it. The HADS contains a total of 14 items, including seven for depressive symptoms (i.e., the HADS-D) and seven for anxiety symptoms (i.e., the HADS-A), focusing on symptoms that are non-physical. The correlations between the two subscales vary from 0.40 to 0.74 (with a mean of 0.56). The Cronbach's alpha for the HADS-A varies from 0.68 to 0.93 (with a mean of 0.83) and for the HADS-D from 0.67 to 0.90 (with a mean of 0.82). In most studies, an optimal balance between sensitivity and specificity was achieved when a cut point was set at a score of 8 or above on both the HADS-A and HADS-D. The sensitivity and specificity for both is 0.80. Many studies conducted around the world have confirmed that the measure is valid when used in a community setting or primary care medical practice ( 45 ).

SPSI-R (Chinese version)

There have been several revised versions of the SPSI-R for use in the Chinese language, such as the measure published by Siu and Shek ( 46 ) and Wang ( 47 ). The present study used the latter, which shows both good reliability and validity. The overall Cronbach's alpha is 0.85, and the RPS, AS, NPO, PPO, and ICS subscales are 0.85, 0.82, 0.70, 0.66, and 0.69, respectively. The SPSI-R uses a five-point Likert-type scale ranging from 0 to 4, as follows: (0) Not at all true for me, (1) slightly true for me, (2) moderately true for me, (3) very true for me, and (4) extremely true for me.

Network analysis

We used a Gaussian graphical model (GGM) to build the network via the R package (R Core Team version 4.1.3) qgraph (version 1.9.2) ( 48 , 49 ). GGMs estimate many parameters (i.e., 19 nodes required the estimation of 171 parameters: 19 threshold parameters and 19 * 18/2 = 171 pairwise association parameters) that would likely result in false positive edges. Therefore, it is common to regularize GGMs via a graphical lasso ( 49 – 51 ), leading to a sparse (i.e., parsimonious) network that explains the correlation or covariance among nodes with as few edges as necessary. Node placement was determined by the Fruchterman-Reingold (FR) algorithm, which places nodes with stronger average associations closer to the center of the graph ( 52 ). The R package qgraph was used to calculate and visualize the networks. We also measured the centrality and stability of the established network. The R package qgraph and estimatenetwork automatically implement the glasso regularization, in combination with an extended Bayesian information criterion (EBIC) model, as described by Foygel and Drton ( 53 ).

In network parlance, anxiety-depression symptoms and SPS components are “nodes” and the relationships between the nodes are “edges”. The edge between two nodes represents the regularized partial correlation coefficients, and the thickness of the edge indicates the magnitude of the association. The graphical lasso algorithm makes all edges with small partial correlations shrink to zero, and thus facilitates interpretation and establishment of a stable network, solving traditional lost-power issues that emerge from examining all partial correlations for statistical significance [for greater detail, see ( 54 )]. For the present network, we divided the components into three groups or communities: anxiety (seven symptoms), depression (seven symptoms), and SPS (five components).

Most network studies in psychopathology have used the FR algorithm to plot graphs ( 52 ). The FR algorithm is a force-directed graph method [see also ( 55 )] that is similar to creating a physical system of balls connected by elastic strings. Importantly, the purpose of plotting with a force-directed algorithm is not to place the nodes in meaningful positions in space, but rather to position them in a manner that allows for easy viewing of the network edges and clustering structures ( 56 ). We used the “circle” layout for easier viewing, which places all nodes in a single circle, with each group (or community) put in separate circles (see Figure 1A ). In addition, we employed a multi-dimensional scaling (MDS) approach to display the network (see Figure 1B ). MDS represents proximities among variables as distances between points in a low-dimensional space [e.g., two or three dimensions; ( 57 )]. MDS is particularly useful for understanding networks because the distances between plotted nodes are interpretable as Euclidean distances ( 56 ).

Figure 1 . Estimated network structure based on a sample of 190 adolescents. The network structure is a GGM, which is a network of partial correlation coefficients. Green edges represent positive correlations and red edges indicate negative correlations. The thickness of the edge reflects the magnitude of the correlation. (A) Network structure with the “circle” layout for easy viewing, but it is important to note that the node positions don't indicate Euclidean distances. (B) Network structure with MDS, showing proximities among variables as distances between points in a low-dimensional space.

We calculated several indices of node centrality to identify the symptoms or components most central to the network ( 58 ). For each node, we calculated the strength (i.e., the absolute sum of edge weights connected to a node), closeness (i.e., the average distance from the node to all other nodes in the network), betweenness (i.e., the number of times a node lies on the shortest path between two other nodes), and expected influence (i.e., the sum of edge weights connected to a node). For SPS and anxiety-depression networks considering the relationship in both direction (i.e., both positive and negative), strength rather than expected influence (which only calculates neutralized influence) is suitable. The node bridge strength is defined as the sum of the value of all edges connecting a given node in one community with nodes in other communities, and was computed by the R-package networktools ( 42 ). Higher node bridge strength values indicated a greater increase in the risk of contagion to other groups or communities ( 42 ).

Stability of centrality indices

We investigated the stability of centrality indices by estimating network models based on subsets of the data and case-dropping bootstraps ( n = 1,000). If correlation values declined substantially as participants were removed, we considered this centrality metric to be unstable. The robustness of the network was evaluated by the R-package bootnet using the bootstrap approach ( 54 ). This stability was quantified using the CS coefficient, which quantified the maximum proportion of cases with a 95% certainty that could be dropped to retain a correlation with an original centrality higher than 0.7 (by default) ( 54 ).

The students' average age was 15.54 years ( SD = 1.302); the group included 102 males and 88 females. We conducted descriptive statistics for the scores of each scale on different demographic variables. The results are shown in Table 1 , which demonstrate the number of participants in each group and the mean score and standard deviation (in the parenthesis) for each scale. Due to some missing data for some participants, the total the number of people with different conditions does not equal 190.

Table 1 . The descriptive statistics of the six SPS components, anxiety, and depression.

As for the network, ~41.5% of all 171 network edges were set to zero by the EBICglasso algorithms. Figure 1 presents the network of SPS components and anxiety-depression symptoms. Figure 1A displays an easily viewable circular network with weights on each edge. For example, the strongest edge (weight = 0.32) among the anxiety symptoms was between Btt 1 (“I get sort of a frightened feeling, like 'butterflies' in the stomach”) and Pnc (“I get sudden feelings of panic”). Among depression symptoms, the strongest edge (weight = 0.25) was between Chr (“I feel cheerful”) and Fnn (“I can laugh and see the funny side of things”). For SPS components, the strongest edge (weight = 0.46) was between PPO (positive problem orientation) and RPS (rational problem-solving). Figure 1B display the MDS network. Highly-related nodes appear close together, whereas weakly-related nodes appear further apart. The anxiety-depression symptoms and SPS components cluster within their own communities, and anxiety-depression nodes are closer to each other. The NPO (negative problem orientation) and AS (avoidance style) nodes are nearest to the anxiety-depression network, while other components are distant from that network.

Centrality indices

For the centrality indices, the values were scaled (i.e., normalized) relative to the largest value for each measure. Figure 2 shows the centrality indices, which are ordered by strength . For strength , Rlx (“I can sit at ease and be relaxed”) from the anxiety symptoms is the most central symptom, 2 followed by Frw (“I look forward with enjoyment to things”) from the depression symptoms and PPO (positive problem orientation) from the SPS components, indicating that these nodes had the strongest relationships to the other nodes. For closeness and betweenness , Frw again ranked the highest, indicating that it was closest to all other nodes in the network and on the shortest path between two other nodes. As for expected influence , considering the direction of the relationship (both positive and negative), Rlx and Pnc from the anxiety community was most positively and PPO most negatively influential on the whole network, indicating that Rlx may be an important risk factor and PPO an important protective factor. NPO most positively influenced the network from the SPS community, and Slw (“I feel as if I am slowed down”) did the same for the depression community.

Figure 2 . Centrality indices for the nodes of the present network including those for strength betweenness closeness expected influence. The values are normalized to be within the range of 0–1. The full names of the abbreviations can be found in Figure 1 .

We also calculated the bridge centrality indices (see Figure 3 ). Rlx, Frw , and NPO for anxiety-depression and SPS were found to have the strongest connections (i.e., bridge strength) with other communities ( 42 ). For bridge closeness, Frw, AS , and NPO ranked the highest. For bridge betweenness, Frw, AS , and ICS comprised the top three. For bridge expected influence, Rlx, Slw , and NPO were the most influential.

Figure 3 . Estimated bridge centrality indices for the present network, including bridge strength, bridge betweenness, bridge closeness, and bridge expected influence. The full names of the abbreviations for the nodes can be found in Figure 1 .

Stability of the centrality indices

Figure 4 shows that the average correlations dropped between the centrality indices of networks sampled with persons and the original sample. The stability levels of closeness and betweenness dropped steeply, while the stability levels of the node strength and expected influence less so. The Correlation-Stability (CS) coefficient value should preferably be above 0.5 and not be below 0.25 ( 59 ). In this research, the CS coefficient indicated that the betweenness [CS (cor = 0.7) = 0.205] was not stable, while the closeness [CS (cor = 0.7) = 0.437] was relatively stable in the subset cases. Node strength and expected influence performed best [CS (cor = 0.7) = 0.516], reaching the cutoff of 0.5 and indicating that the metric was stable. Therefore, we found that the order of node strength and expected influence were most interpretable (with some care), while the order of betweenness was not.

Figure 4 . Average correlations between the centrality indices of networks sampled with persons and the original sample. Lines indicate the means and areas ranging from the 2.5th quantile to the 97.5th quantile.

Anchored in the network perspective ( 39 ), this study illustrated the node pathways, central indices, and central bridging indices for the SPS and anxiety-depression networks. From a “network-network” perspective, the node connections were closer within (vs. between) the anxiety-depression and SPS networks, demonstrating their relative independence from one other. This result is in keeping with previous comorbidity studies of anxiety and depression that employed network analysis ( 60 , 61 ), underscoring that the SPS network is distant from the anxiety-depression network (though the NPO and AS nodes are close to the anxiety-depression network, which can be measured by bridge closeness, as seen in Figure 3 ). Further, the SPS seems more strongly related to anxiety than depression networks, given the longer mean distance from SPS to depression. The reason could be that anxiety is more related to problems or events (the uncertainty of the future) ( 62 ) while depression is more related to self (usually accompanied by low self-esteem, low self-efficacy, and hopelessness) ( 63 ). This explanation is reasonable but required further verifications. The MDS structure is a useful tool for displaying the spatial relationships of nodes, and thus its use should be encouraged in the future.

From a “nodes-in-network” perspective, the node centrality indices revealed that the NPO node from SPS and Rlx and Frw from anxiety-depression were likely to be the most central in the entire SPS-anxiety-depression network. Considering that mood disorders affect how people look at and deal with problems, it is appropriate to put anxiety, depression, and SPS components into a single network. In terms of clinical implications, from our results, we can infer that therapy will yield the greatest rewards by modifying NPO , encouraging relaxation training, and enhancing the expectation of enjoyment for coming things. In addition, the NPO and AS nodes are nearest to the anxiety-depression network, especial to the anxiety symptoms. Therefore, we may even consider that NPO and AS (very close to each other) are innate components of anxiety, as anxious people are worried about the future but do not positively view the problem and do not actively cope with the problem ( 64 ). However, this hypothesis requires further confirmation.

From a “network-node-network” perspective, the results of bridge centrality found that the NPO in SPS community had the strongest association (for both bridge strength and bridge closeness) with the anxiety-depression network, echoing previous research that NPO most strongly contributes to anxiety and depression. However, PPO is located away from the anxiety-depression network and the most negatively correlated ( 65 ), as can be seen from the low levels of bridge expected influence and bridge closeness. Furthermore, the RPS node is strongly connected with PPO but valued low in the four indices of bridge centrality, indicating its unimportance because both of them should “stay away” from the network which is main consists of negative nodes ( 66 ). In short, PPO is the protective and NPO the risk factor for the anxiety-depression network. In clinical settings, encouraging PPO and discouraging NPO would be an effective approach to reducing symptoms of anxiety and depression.

Some limitations of this research will direct future research. First, a cross-sectional design was adopted to build the SPS and anxiety-depression networks. Therefore, this study could not be used to ascertain whether anxiety-depression symptoms impact SPS components or vice versa. Thus, future work will adopt a longitudinal approach with repeated measures of anxiety-depression and SPS components to clarify the causal relationship between anxiety-depression and SPS components. Second, it is probable that the detected potential pathways among the components are limited to the SPSI-R and HADS scales applied. Self-report tools for the SPSI-R and anxiety-depression usually vary in their constructs. This diversity limits the connections that can be found in terms of network structure. Nevertheless, the scales we used are broadly employed; they were carefully implemented based on their psychometric constructs and applicability for adolescents. Therefore, the present research adds to the literature of how among adolescents, anxiety-depression symptoms may be associated with SPS components. This study may also act as an incentive for future research applying other scales for SPS and anxiety-depression to ascertain the stability of these novel findings.

Data availability statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Ethics statement

The studies involving human participants were reviewed and approved by Ethics Committee of Wenzhou Seventh People's Hospital. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin.

Author contributions

Q-NR conceived and designed the experiments. W-JY and CC performed the experiments. ZL, Q-NR, and W-JY wrote and revised the manuscript. ZL gave financial support. All authors contributed to the article and approved the submitted version.

This research was supported by the Medicine and Health Science and Technology Project of Zhejiang, China (No. 2019KY669), and Wenzhou Science and Technology Project of Zhejiang, China (Y20210112).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

1. ^ Following, the node labels with abbreviations will be in italics.

2. ^ Rlx (“I can sit at ease and be relaxed”) and Frw (“I look forward with enjoyment to things”) are not symptoms per se , but for measuring the symptoms “restless” and “pessimistic” using reverse questions.

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Keywords: network analysis, social problem-solving, anxiety, depression, adolescent

Citation: Ruan Q-N, Chen C, Jiang D-G, Yan W-J and Lin Z (2022) A network analysis of social problem-solving and anxiety/depression in adolescents. Front. Psychiatry 13:921781. doi: 10.3389/fpsyt.2022.921781

Received: 16 April 2022; Accepted: 21 July 2022; Published: 10 August 2022.

Reviewed by:

Copyright © 2022 Ruan, Chen, Jiang, Yan and Lin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Wen-Jing Yan, eagan-ywj@foxmail.com ; Zhang Lin, 409814552@qq.com

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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A network analysis of social problem-solving and anxiety/depression in adolescents

Qian-nan ruan.

1 Wenzhou Seventh People's Hospital, Wenzhou, China

De-Guo Jiang

Wen-jing yan.

2 Department of Psychology, School of Education, Wenzhou University, Wenzhou, China

Associated Data

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Social problem-solving (SPS) involves the cognitive-behavioral processes through which an individual identifies and copes with everyday problems; it is considered to contribute to anxiety and depression. The Social Problem-Solving Inventory Revised is a popular tool measuring SPS problem orientations and problem-solving styles. Only a negative problem orientation (NPO) is considered strongly related to anxiety and depression. In the present study, we investigated the detailed connections among the five components of SPS and 14 anxiety-depression symptoms and specified the role of NPO and other components in the anxiety-depression network. We employed network analysis, constructed circular and multi-dimensional scaling (MDS) networks, and calculated the network centrality, bridge centrality, and stability of centrality indices. The results were as follows: (1) the MDS network showed a clustering of anxiety and depression symptoms, with NPO and avoidance style components from SPS being close to the anxiety-depression network (demonstrated by large bridge betweenness and bridge closeness); (2) the NPO and positive problem orientation from SPS were most influential on the whole network, though with an opposite effect; (3) strength was the most stable index [correlation stability (CS) coefficient = 0.516] among the centrality indices with case-dropping bootstraps. We also discussed this network from various perspectives and commented on the clinical implications and limitations of this study.

Introduction

Social problem-solving (SPS) is believed to be strongly related to anxiety and depression, which is very popular among Chinese people. For adults, 4% ( 1 ) before and 20.4% ( 2 ) during the COVID-19 epidemic suffer from anxiety and depression; for adolescent, the prevalent of anxiety and depression is 11.2%/14.6% ( 3 ) before and 19%/36.6% ( 4 ) during the epidemic. SPS plays a significant role in psychological adjustment and constitutes an important coping strategy that has the potential to reduce or minimize psychological distress ( 5 , 6 ). Previous research has found that strong SPS abilities reduce the morbidity associated with anxiety and depression by aiding young people in controlling and modifying their health behavior ( 7 ); they are of key importance in managing emotions and wellbeing ( 8 ). Conversely, poor problem orientation has consistently linked depression and anxiety ( 9 ). Furthermore, depressed patients frequently exhibit deficiencies in social problem-solving, producing fewer effective solutions than do normal control subjects ( 10 ).

Essentially, SPS involves the cognitive-behavioral processes through which an individual identifies and copes with everyday problems ( 11 ). It comprises problem orientation (a general motivational and appraisal component) and problem-solving style (the cognitive and behavioral activities a person uses to cope with problems). The Social Problem-Solving Inventory Revised (SPSI-R) provides a corresponding scale and comprehensive assessment of all theoretical components linked to contemporary models of social problem-solving [i.e., both problem orientation and problem-solving style ( 12 , 13 )]. The SPSI-R consists of a scale of 25 (in the short form) or 52 (in the long form) items, and is one of the most prominent instruments used to study SPS ( 14 ). The SPSI-R is a theory-based measure of SPS processes. It consists of five dimensions, as follows: (1) positive problem orientation (PPO), (2) negative problem orientation (NPO), (3) rational PPO problem-solving (RPS), (4) impulsivity/carelessness style (ICS), and (5) avoidance style (AS). The SPSI-R assesses a person's perception of his or her general approach to and styles of solving problems in everyday living that have repeatedly been found to be reliable and valid ( 15 , 16 ).

SPSI-R research has shown that SPS is an important measure of psychological distress, wellbeing, and social competence [i.e., depression, distress, anxiety, health-related behaviors, life satisfaction, optimism, situational coping, aggression, and externalizing behaviors ( 17 – 19 )]. Previous research has found that certain specific components of SPS can contribute significantly to anxiety and depression. For example, anxious and depressed patients may have difficulties at different stages of the problem-solving process ( 20 , 21 ); Kant et al. (author?) ( 22 ) found that all five problem-solving dimensions measured by the SPSI-R were significantly related to both anxiety and depression in at least one of two samples (i.e., the middle aged and elderly); additional follow-up analyses indicated that NPO contributed most to the significant mediating effect between problems and depression.

Specifically, NPO is strongly related to depression and emotional distress. Abu-Ghazal and Falwah ( 23 ) found that employing PPO to solve problems leads to positive psychological wellbeing, while NPO is associated with depression. In Australia, researchers examined the relationship between NPO and depression-anxiety in 285 young adults using the NPO dimensions of the SPSI-R, finding strong connections between the two ( 24 ). Additionally, many researchers have found that social anxiety is related to NPO ( 25 , 26 ). In Hungary, Kasik and Gál ( 27 ) studied the relationships among SPS, anxiety, and empathy in 445 Hungarian adolescents, finding that regardless of age, adolescents with an increased level of anxiety also have high levels of NPO and AS. Furthermore, studies have found a link between NPO and stress ( 28 – 32 ). Therefore, anxiety and depression have the strongest association with NPO, above all other SPS components ( 8 , 33 – 35 ), and success in reducing symptoms of anxiety and depression appears to be more strongly predicated on the absence of NPO than presence of PPO ( 34 ).

These studies suggest that NPO plays an important role in anxiety and depression. We also explored the detailed connections between problem-solving orientations (including NPO) and problem-solving styles with anxiety-depression symptoms. In other words, we integrated the components of SPS into the anxiety-depression network and investigated the link between these components and anxiety-depression symptoms. We identified the components of social problem-solving most strongly associated with certain symptoms in the anxiety-depression network and determined which components were most centrally located.

Thus, network analysis was employed to analyze the relationships among components of SPS and anxiety-depression symptoms, working from the bottom up, without applying any top-down construct consistent with the standard biomedical and reductionist model ( 36 ). A key premise of network theory is that psychopathological symptoms are interacting and reinforcing parts of a network, rather than clusters of underlying disorders ( 37 ). To test this argument, network analysis has been used to describe the relationships within and between disorders ( 37 ). The dynamics and interrelationships between comorbidities can be identified in network analysis and gaps not considered by factor analysis methods can be addressed ( 38 ). A network is defined as a set of nodes (symptoms) and edges (connections between nodes). In a network model, the symptoms themselves constitute the disorder. The onset and maintenance of symptoms are determined by tracing the pathways of the network ( 38 ).

In an estimated network structure, a centrality measure denotes the overall connectivity of a particular symptom (or component). Central nodes contribute the most to the interrelatedness of symptoms (or components) within the estimated network structure ( 39 , 40 ). A tightly connected network with many strong connections among the symptoms is considered risky because activation of one symptom can quickly spread to other symptoms, leading to more chronic symptoms over time ( 41 ). In other words, when a highly central component is activated (i.e., a person reports the presence of a symptom), it influences other components, causing them to become activated as well, and thus maintaining the network. Considering the importance of problem orientation and problem-solving styles to emotional wellbeing, the nodes should be strongly linked to symptoms of anxiety and depression. In addition, we calculated the bridge-centrality. Previous research has found that deactivating bridge nodes prevents the spread of comorbidity (i.e., one disorder activating another) ( 42 ). Through this network analysis, we gained insight regarding the relationship between SPS and anxiety-depression, which may have clinical implications such as helping to modify patients' problem-solving styles to alleviate related symptoms.

In summary, social problem solving is highly correlated with anxiety and depression and can lead to a number of mental illnesses. There are few study about how the aspects of social problem solving that contribute to depression and anxiety and how they both interact with each other. The present study is to explore the detailed connections between problem-solving orientations and problem-solving styles with anxiety-depression symptoms. NPO, specifically, is hypothesized to be related to depression and emotional distress. We characterized the network structure of SPS components and anxiety-depression symptoms using psychiatric and regular samples. We first investigated the node and bridge centrality, and then determined the stability of the centrality indices for the network.

Participants

The samples, consisting of adolescents aged 12–17 years, was obtained from a psychiatric hospital and two secondary schools, collected from October 2021 and completed in March 2022. The 100 adolescents from the hospital were outpatients who had mental health assessments done by psychiatrists. When patients enter the psychological assessment room, they are briefly introduced to the purpose of our study and then asked to fill out the relevant scales based on the most recent week. They could ask the psychiatrists for help if they have any questions. When the task was finished, the psychiatrists have a check to make sure that all responses are completed, and then the subject leaves the assessment room. The other 100 participants were randomly selected middle school students; they conducted the self-rating assessments while monitored by their teachers in the classrooms. All participants signed an informed consent form and were explained about the rules regarding anonymity, confidentiality, and their right to quit.

Ten samples (from the middle schools) were excluded from data collection because they failed the manipulation check ( 43 ). Therefore, 190 participants were included in the data analysis.

Hospital anxiety and depression scale

The HADS assesses both anxiety and depression, which commonly coexist ( 44 ). The measure is employed frequently, due to its simplicity, speed, and ease of use. Very few literate people have difficulty completing it. The HADS contains a total of 14 items, including seven for depressive symptoms (i.e., the HADS-D) and seven for anxiety symptoms (i.e., the HADS-A), focusing on symptoms that are non-physical. The correlations between the two subscales vary from 0.40 to 0.74 (with a mean of 0.56). The Cronbach's alpha for the HADS-A varies from 0.68 to 0.93 (with a mean of 0.83) and for the HADS-D from 0.67 to 0.90 (with a mean of 0.82). In most studies, an optimal balance between sensitivity and specificity was achieved when a cut point was set at a score of 8 or above on both the HADS-A and HADS-D. The sensitivity and specificity for both is 0.80. Many studies conducted around the world have confirmed that the measure is valid when used in a community setting or primary care medical practice ( 45 ).

SPSI-R (Chinese version)

There have been several revised versions of the SPSI-R for use in the Chinese language, such as the measure published by Siu and Shek ( 46 ) and Wang ( 47 ). The present study used the latter, which shows both good reliability and validity. The overall Cronbach's alpha is 0.85, and the RPS, AS, NPO, PPO, and ICS subscales are 0.85, 0.82, 0.70, 0.66, and 0.69, respectively. The SPSI-R uses a five-point Likert-type scale ranging from 0 to 4, as follows: (0) Not at all true for me, (1) slightly true for me, (2) moderately true for me, (3) very true for me, and (4) extremely true for me.

Network analysis

We used a Gaussian graphical model (GGM) to build the network via the R package (R Core Team version 4.1.3) qgraph (version 1.9.2) ( 48 , 49 ). GGMs estimate many parameters (i.e., 19 nodes required the estimation of 171 parameters: 19 threshold parameters and 19 * 18/2 = 171 pairwise association parameters) that would likely result in false positive edges. Therefore, it is common to regularize GGMs via a graphical lasso ( 49 – 51 ), leading to a sparse (i.e., parsimonious) network that explains the correlation or covariance among nodes with as few edges as necessary. Node placement was determined by the Fruchterman-Reingold (FR) algorithm, which places nodes with stronger average associations closer to the center of the graph ( 52 ). The R package qgraph was used to calculate and visualize the networks. We also measured the centrality and stability of the established network. The R package qgraph and estimatenetwork automatically implement the glasso regularization, in combination with an extended Bayesian information criterion (EBIC) model, as described by Foygel and Drton ( 53 ).

In network parlance, anxiety-depression symptoms and SPS components are “nodes” and the relationships between the nodes are “edges”. The edge between two nodes represents the regularized partial correlation coefficients, and the thickness of the edge indicates the magnitude of the association. The graphical lasso algorithm makes all edges with small partial correlations shrink to zero, and thus facilitates interpretation and establishment of a stable network, solving traditional lost-power issues that emerge from examining all partial correlations for statistical significance [for greater detail, see ( 54 )]. For the present network, we divided the components into three groups or communities: anxiety (seven symptoms), depression (seven symptoms), and SPS (five components).

Most network studies in psychopathology have used the FR algorithm to plot graphs ( 52 ). The FR algorithm is a force-directed graph method [see also ( 55 )] that is similar to creating a physical system of balls connected by elastic strings. Importantly, the purpose of plotting with a force-directed algorithm is not to place the nodes in meaningful positions in space, but rather to position them in a manner that allows for easy viewing of the network edges and clustering structures ( 56 ). We used the “circle” layout for easier viewing, which places all nodes in a single circle, with each group (or community) put in separate circles (see Figure 1A ). In addition, we employed a multi-dimensional scaling (MDS) approach to display the network (see Figure 1B ). MDS represents proximities among variables as distances between points in a low-dimensional space [e.g., two or three dimensions; ( 57 )]. MDS is particularly useful for understanding networks because the distances between plotted nodes are interpretable as Euclidean distances ( 56 ).

Estimated network structure based on a sample of 190 adolescents. The network structure is a GGM, which is a network of partial correlation coefficients. Green edges represent positive correlations and red edges indicate negative correlations. The thickness of the edge reflects the magnitude of the correlation. (A) Network structure with the “circle” layout for easy viewing, but it is important to note that the node positions don't indicate Euclidean distances. (B) Network structure with MDS, showing proximities among variables as distances between points in a low-dimensional space.

We calculated several indices of node centrality to identify the symptoms or components most central to the network ( 58 ). For each node, we calculated the strength (i.e., the absolute sum of edge weights connected to a node), closeness (i.e., the average distance from the node to all other nodes in the network), betweenness (i.e., the number of times a node lies on the shortest path between two other nodes), and expected influence (i.e., the sum of edge weights connected to a node). For SPS and anxiety-depression networks considering the relationship in both direction (i.e., both positive and negative), strength rather than expected influence (which only calculates neutralized influence) is suitable. The node bridge strength is defined as the sum of the value of all edges connecting a given node in one community with nodes in other communities, and was computed by the R-package networktools ( 42 ). Higher node bridge strength values indicated a greater increase in the risk of contagion to other groups or communities ( 42 ).

Stability of centrality indices

We investigated the stability of centrality indices by estimating network models based on subsets of the data and case-dropping bootstraps ( n = 1,000). If correlation values declined substantially as participants were removed, we considered this centrality metric to be unstable. The robustness of the network was evaluated by the R-package bootnet using the bootstrap approach ( 54 ). This stability was quantified using the CS coefficient, which quantified the maximum proportion of cases with a 95% certainty that could be dropped to retain a correlation with an original centrality higher than 0.7 (by default) ( 54 ).

The students' average age was 15.54 years ( SD = 1.302); the group included 102 males and 88 females. We conducted descriptive statistics for the scores of each scale on different demographic variables. The results are shown in Table 1 , which demonstrate the number of participants in each group and the mean score and standard deviation (in the parenthesis) for each scale. Due to some missing data for some participants, the total the number of people with different conditions does not equal 190.

The descriptive statistics of the six SPS components, anxiety, and depression.

As for the network, ~41.5% of all 171 network edges were set to zero by the EBICglasso algorithms. Figure 1 presents the network of SPS components and anxiety-depression symptoms. Figure 1A displays an easily viewable circular network with weights on each edge. For example, the strongest edge (weight = 0.32) among the anxiety symptoms was between Btt 1 (“I get sort of a frightened feeling, like 'butterflies' in the stomach”) and Pnc (“I get sudden feelings of panic”). Among depression symptoms, the strongest edge (weight = 0.25) was between Chr (“I feel cheerful”) and Fnn (“I can laugh and see the funny side of things”). For SPS components, the strongest edge (weight = 0.46) was between PPO (positive problem orientation) and RPS (rational problem-solving). Figure 1B display the MDS network. Highly-related nodes appear close together, whereas weakly-related nodes appear further apart. The anxiety-depression symptoms and SPS components cluster within their own communities, and anxiety-depression nodes are closer to each other. The NPO (negative problem orientation) and AS (avoidance style) nodes are nearest to the anxiety-depression network, while other components are distant from that network.

Centrality indices

For the centrality indices, the values were scaled (i.e., normalized) relative to the largest value for each measure. Figure 2 shows the centrality indices, which are ordered by strength . For strength , Rlx (“I can sit at ease and be relaxed”) from the anxiety symptoms is the most central symptom, 2 followed by Frw (“I look forward with enjoyment to things”) from the depression symptoms and PPO (positive problem orientation) from the SPS components, indicating that these nodes had the strongest relationships to the other nodes. For closeness and betweenness , Frw again ranked the highest, indicating that it was closest to all other nodes in the network and on the shortest path between two other nodes. As for expected influence , considering the direction of the relationship (both positive and negative), Rlx and Pnc from the anxiety community was most positively and PPO most negatively influential on the whole network, indicating that Rlx may be an important risk factor and PPO an important protective factor. NPO most positively influenced the network from the SPS community, and Slw (“I feel as if I am slowed down”) did the same for the depression community.

Centrality indices for the nodes of the present network including those for strength betweenness closeness expected influence. The values are normalized to be within the range of 0–1. The full names of the abbreviations can be found in Figure 1 .

We also calculated the bridge centrality indices (see Figure 3 ). Rlx, Frw , and NPO for anxiety-depression and SPS were found to have the strongest connections (i.e., bridge strength) with other communities ( 42 ). For bridge closeness, Frw, AS , and NPO ranked the highest. For bridge betweenness, Frw, AS , and ICS comprised the top three. For bridge expected influence, Rlx, Slw , and NPO were the most influential.

Estimated bridge centrality indices for the present network, including bridge strength, bridge betweenness, bridge closeness, and bridge expected influence. The full names of the abbreviations for the nodes can be found in Figure 1 .

Stability of the centrality indices

Figure 4 shows that the average correlations dropped between the centrality indices of networks sampled with persons and the original sample. The stability levels of closeness and betweenness dropped steeply, while the stability levels of the node strength and expected influence less so. The Correlation-Stability (CS) coefficient value should preferably be above 0.5 and not be below 0.25 ( 59 ). In this research, the CS coefficient indicated that the betweenness [CS (cor = 0.7) = 0.205] was not stable, while the closeness [CS (cor = 0.7) = 0.437] was relatively stable in the subset cases. Node strength and expected influence performed best [CS (cor = 0.7) = 0.516], reaching the cutoff of 0.5 and indicating that the metric was stable. Therefore, we found that the order of node strength and expected influence were most interpretable (with some care), while the order of betweenness was not.

Average correlations between the centrality indices of networks sampled with persons and the original sample. Lines indicate the means and areas ranging from the 2.5th quantile to the 97.5th quantile.

Anchored in the network perspective ( 39 ), this study illustrated the node pathways, central indices, and central bridging indices for the SPS and anxiety-depression networks. From a “network-network” perspective, the node connections were closer within (vs. between) the anxiety-depression and SPS networks, demonstrating their relative independence from one other. This result is in keeping with previous comorbidity studies of anxiety and depression that employed network analysis ( 60 , 61 ), underscoring that the SPS network is distant from the anxiety-depression network (though the NPO and AS nodes are close to the anxiety-depression network, which can be measured by bridge closeness, as seen in Figure 3 ). Further, the SPS seems more strongly related to anxiety than depression networks, given the longer mean distance from SPS to depression. The reason could be that anxiety is more related to problems or events (the uncertainty of the future) ( 62 ) while depression is more related to self (usually accompanied by low self-esteem, low self-efficacy, and hopelessness) ( 63 ). This explanation is reasonable but required further verifications. The MDS structure is a useful tool for displaying the spatial relationships of nodes, and thus its use should be encouraged in the future.

From a “nodes-in-network” perspective, the node centrality indices revealed that the NPO node from SPS and Rlx and Frw from anxiety-depression were likely to be the most central in the entire SPS-anxiety-depression network. Considering that mood disorders affect how people look at and deal with problems, it is appropriate to put anxiety, depression, and SPS components into a single network. In terms of clinical implications, from our results, we can infer that therapy will yield the greatest rewards by modifying NPO , encouraging relaxation training, and enhancing the expectation of enjoyment for coming things. In addition, the NPO and AS nodes are nearest to the anxiety-depression network, especial to the anxiety symptoms. Therefore, we may even consider that NPO and AS (very close to each other) are innate components of anxiety, as anxious people are worried about the future but do not positively view the problem and do not actively cope with the problem ( 64 ). However, this hypothesis requires further confirmation.

From a “network-node-network” perspective, the results of bridge centrality found that the NPO in SPS community had the strongest association (for both bridge strength and bridge closeness) with the anxiety-depression network, echoing previous research that NPO most strongly contributes to anxiety and depression. However, PPO is located away from the anxiety-depression network and the most negatively correlated ( 65 ), as can be seen from the low levels of bridge expected influence and bridge closeness. Furthermore, the RPS node is strongly connected with PPO but valued low in the four indices of bridge centrality, indicating its unimportance because both of them should “stay away” from the network which is main consists of negative nodes ( 66 ). In short, PPO is the protective and NPO the risk factor for the anxiety-depression network. In clinical settings, encouraging PPO and discouraging NPO would be an effective approach to reducing symptoms of anxiety and depression.

Some limitations of this research will direct future research. First, a cross-sectional design was adopted to build the SPS and anxiety-depression networks. Therefore, this study could not be used to ascertain whether anxiety-depression symptoms impact SPS components or vice versa. Thus, future work will adopt a longitudinal approach with repeated measures of anxiety-depression and SPS components to clarify the causal relationship between anxiety-depression and SPS components. Second, it is probable that the detected potential pathways among the components are limited to the SPSI-R and HADS scales applied. Self-report tools for the SPSI-R and anxiety-depression usually vary in their constructs. This diversity limits the connections that can be found in terms of network structure. Nevertheless, the scales we used are broadly employed; they were carefully implemented based on their psychometric constructs and applicability for adolescents. Therefore, the present research adds to the literature of how among adolescents, anxiety-depression symptoms may be associated with SPS components. This study may also act as an incentive for future research applying other scales for SPS and anxiety-depression to ascertain the stability of these novel findings.

Data availability statement

Ethics statement.

The studies involving human participants were reviewed and approved by Ethics Committee of Wenzhou Seventh People's Hospital. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin.

Author contributions

Q-NR conceived and designed the experiments. W-JY and CC performed the experiments. ZL, Q-NR, and W-JY wrote and revised the manuscript. ZL gave financial support. All authors contributed to the article and approved the submitted version.

This research was supported by the Medicine and Health Science and Technology Project of Zhejiang, China (No. 2019KY669), and Wenzhou Science and Technology Project of Zhejiang, China (Y20210112).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

1 Following, the node labels with abbreviations will be in italics.

2 Rlx (“I can sit at ease and be relaxed”) and Frw (“I look forward with enjoyment to things”) are not symptoms per se , but for measuring the symptoms “restless” and “pessimistic” using reverse questions.

Problem Solving and Emotion Coping Styles for Social Anxiety: A Meta-analysis of Chinese Mainland Students

• Original Article
• Published: 28 June 2023

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• Zehua Dong 1 ,
• Ming Ming Chiu 2 ,
• Shuqi Zhou 3 &
• Zihong Zhang 4  

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Studies of how positive and negative coping styles affect social anxiety show mixed results. Hence, our two meta-analyses determined the overall effect sizes of problem solving-focused coping (PSC) styles and emotion-focused coping (EFC) styles on social anxiety in mainland China (PSC: k  = 49 studies, N  = 34,669; EFC: k  = 52, N  = 36,531). PSC was negatively linked to social anxiety (− .198), and EFC was positively linked to social anxiety (.223). In years with more national income, PSC’s and EFC’s effect sizes were larger. PSC’s effect sizes were smaller among rural students (vs. urban students), larger among older students (university, high school, middle school), and larger in cross-sectional (vs. longitudinal) studies. When using SAD (vs. others) social anxiety measures, PSC effect sizes were larger, but EFC effect sizes were smaller. EFC effect sizes were larger in studies with convenience (vs. representative) samples. Gender, single child status, and coping style measurement showed no moderation effects. These findings suggest that using problem solving-focused coping styles rather than emotion-focused may reduce social anxiety, so future experimental studies can test this idea more rigorously.

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Data Availability

The data of this research used is presented in Table 1 in the manuscript. Inquiries about the specific data used in this study can be directed to the corresponding author.

*Primary studies included in the meta-analysis

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This study was supported by the Zhejiang Research Institute of Education Science (GH2023268).

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ZD wrote the introduction, literature review, did the analysis, wrote up method, results, and discussion parts. MMC gave feedbacks and revised the paper. SZ gave feedbacks and finalized the paper. ZZ participated in the coding process. All authors contributed to the article and approved the manuscript.

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Dong, Z., Chiu, M.M., Zhou, S. et al. Problem Solving and Emotion Coping Styles for Social Anxiety: A Meta-analysis of Chinese Mainland Students. Child Psychiatry Hum Dev (2023). https://doi.org/10.1007/s10578-023-01561-6

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Problem Solving Buffers the Brain Against Anxiety

A new study shows why working through a few problems may be an anxiety elixir..

Posted January 17, 2018

• What Is Anxiety?
• Find a therapist to overcome anxiety

When it comes to managing anxiety , science just lent more credibility to the advice to “stay busy.” Engaging the brain to stay busy with problem-solving appears to be an effective buffer against debilitating anxiety, especially in those prone to the worst of the condition, according to a new brain imaging study from Duke University researchers.

The research team assessed a group of 120 participants to find out which were most at-risk in terms of responding to anxiety triggers. Peoples' brains most prone to anxiety tend to display a bigger response to threats and a lower response to rewards, so researchers exposed participants to stimuli designed to trigger a response from the brain areas most associated with threats and rewards (the amygdala and ventral striatum, respectively).

They also asked the participants to complete a problem-solving task (a simple memory problem involving a little math) to stimulate activity in their brains’ executive control center—the seat of problem-solving—the dorsolateral prefrontal cortex (DPC).

Brain imaging showed that the highest threat and lowest reward responses predicted high levels of anxiety in participants who had low or average DPC activity, but not in participants with high DPC activity. In other words, stimulating the problem-solving center of at-risk individuals’ brains seemed to protect them from the worst effects of anxiety. A follow-up evaluation and brain scan of the study participants seven months later confirmed the initial findings.

"These findings help reinforce a strategy whereby individuals may be able to improve their emotional functioning—their mood, their anxiety, their experience of depression —not only by directly addressing those phenomena, but also by indirectly improving their general cognitive functioning," said study co-author Ahmad Hariri, a professor of psychology and neuroscience at Duke.

Though the results are promising, a couple of caveats are worth noting. The most important is a matter of interpretation: the study could be interpreted to show that pre-existing wiring of certain brains provides this in-built anxiety protection, while other brains simply lack it. If that’s the case, then it wouldn’t be accurate to say that problem-solving is an effective buffer against anxiety for anyone with the condition, but only those with brains fortunate enough to be wired that way.

On the other hand, it’s also possible that the effect is a matter of degree. Perhaps some brains are wired a bit more fortunately, but maybe it just takes a little more problem-solving stimulation in other brains to catalyze the same protective effect.

Those questions remain open, at least for now. In the shorter term, the results point to new directions in anxiety research and give anxiety sufferers a worthwhile reason to stay busy.

The study was published in the journal Cerebral Cortex .

© David DiSalvo

David DiSalvo is a science and technology writer working at the intersection of cognition and culture.

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Understanding what emotional intelligence looks like and the steps needed to improve it could light a path to a more emotionally adept world.

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Not everyone needs therapy

Stress, anxiety and loneliness can signal a time for reflection and change, and do not necessarily require therapy.

As I walk around my neighborhood, listening to podcasts, I am bombarded by ads hailing the virtues of online mental health services: “Are you stressed, anxious? See a therapist! Everyone could use therapy!” But this is not true.

Mental health problems such as stress, anxiety and loneliness are a rising concern in America, especially for children and teens . Loneliness has been declared an epidemic. Psychological suffering can signal a time for reflection and change, but it does not always require therapy. There are many resources that can help alleviate stress, anxiety and loneliness without turning to the limited resource of a therapist.

What therapy is and what it isn’t

Therapy is a science-backed treatment addressing mental health symptoms that cause significant problems in daily functioning. For instance, mindfulness-based stress reduction for anxiety or cognitive processing therapy for post-traumatic stress disorder. Sessions focus on setting goals for change , developing and practicing skills that improve psychological health, and an ongoing evaluation of progress toward goals and continued treatment needs.

Therapy involves developing trust and rapport because the therapist-patient relationship is proven as the most essential predictor of positive change . But building this trust and rapport in therapy is not the same as chatting about a symptom such as stress for an hour.

Therapy skeptics declare, “I’m not paying to talk to a friend.” They are correct.

Therapists are not patients’ friends, in part because it is one-sided sharing. Therapists have specialized training. They have an ethical responsibility to help patients develop insight and build skills.

Therapy is not about venting. It’s about change.

Who needs therapy and who does not

People need therapy when their mental health symptoms are causing serious impairments in their daily functioning — in close relationships, work performance, sleep or social activities. For instance, if a person’s work stress overwhelms them to the point that they miss work and are subsequently at risk of losing their job.

They don’t need therapy when they are able to manage their symptoms well — if they feel stressed about their work but continue to perform well, have a supportive network of family and friends, engage in meaningful activities outside work and do not have significant levels of depression and anxiety .

As Tracy Dennis-Tiwary writes in her book, “Future Tense: Why Anxiety Is Good For You (Even Though It Feels Bad),” we have become a “fragile people” when it comes to feeling uncomfortable. But we don’t need to schedule a therapy appointment when we feel bad. We need to learn how to feel the emotions and cope.

“Most of the time, anxiety is a healthy human emotion,” Dennis-Tiwary wrote in an email. “And the only way to learn to cope is to build skills in experiencing and working through anxiety.” What can become more problematic than the anxiety itself is the “meta-anxiety,” or the anxiety about our feelings of anxiety, she said.

How to build coping skills

Therapy offers tools and support, which can be helpful and make us feel good, but when we are not suffering from “clinical” symptoms — those causing significant impairment in daily functioning — those tools and support are available outside the therapist’s office. Here are some ways to build coping skills:

• Check out workbooks related to your concern. There are many science-backed interventions (the most popular being cognitive behavioral therapy and acceptance and commitment therapy ) that experts have packaged into a workbook format for people to do independently.
• Read memoirs of people who have experienced similar challenges. Connecting with another’s experience can reduce feelings of separateness and provide a model for how to cope.
• Use mental health and meditation apps to access many of the basic coping tools that therapists teach, such as meditation (Calm, Insight Timer) and labeling emotions (How We Feel).
• Listen to psychology-focused podcasts such as “ The Psychology Podcast ” and “ All in the Mind ,” and search for episode topics or experts in your area of interest, such as anxiety over a relationship or stress about work.
• Consider a coach who specializes in the area where you want to make change, such as your career or parenting. Therapists can coach, but coaches don’t need to be therapists. There are important differences between coaching and therapy .
• Identify community groups. Support from others enduring a similar struggle can, in many cases, have a greater effect than talking in one-on-one therapy. Examples include groups that focus on addiction, grief or meditation.

If you have tried these strategies and do not feel better, or if people close to you have expressed concern about changes in your behaviors such as being more withdrawn or irritable, your symptoms may need professional support. The clearest sign of needing mental health treatment immediately is any safety concern such as considering suicide or engaging in self-harm.

Making changes to improve your life is like gardening — you have to dig into the soil, plant seeds of change, tend to the fragile new plants and flowers to make sure they survive, give them water and nutrients, and remove weeds. A therapist can help when mental health symptoms make it hard to grab the shovel to start, but most people can be their own gardeners.

Emily Edlynn, PhD, is a clinical psychologist and director of pediatric behavioral medicine at Oak Park Behavioral Medicine in Oak Park, Ill. She is the author of “ Autonomy-Supportive Parenting: Reduce Parental Burnout and Raise Competent, Confident Children ” and the co-host of the “ Psychologists Off the Clock ” podcast.

We welcome your comments on this column at [email protected] .

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