Problem-solving Therapy May Boost Coping Skills, Mental Health

Study recommends online therapy group as complementary care for Cushing's

Somi Igbene, PhD avatar

by Somi Igbene, PhD |

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Problem-solving therapy (PST) may improve coping skills and mental health in people with Cushing’s disease by reducing negative attitudes toward problem-solving, depressive symptoms, and perceived stress, a new study has found.

The study, “Problem-solving therapy can reduce psychological distress in patients with Cushing’s disease: a randomized controlled trial,” was published in the journal Pituitary.

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Cushing’s disease is caused by benign or non-cancerous tumors in the brain’s pituitary gland. It leads to hypercortisolism or excessive levels of cortisol circulating in the body, leading to symptoms such as weight gain, fat accumulation, and skin problems.

Many studies have linked hypercortisolism to psychosocial problems, such as negative problem orientation (NPO) — when a person feels helpless to solve problems, views them as threatening, and doubts their ability to solve them. NPO can impair coping skills, increase psychological distress, and cause mental illness.

People living with Cushing’s report high rates of stress and depression that may be linked to poor problem-solving skills. PST is a cognitive behavioral therapy designed to reduce NPO and foster analytical problem-solving skills. However, its efficacy has not been tested in people with Cushing’s.

Now, scientists in Turkey have reported the findings of a study that compared the effects of PST and standard care on social problem-solving skills and psychological distress in 55 people diagnosed with Cushing’s.

Patients had a mean age of 46 years and had lived with Cushing’s for a median of 82 months (nearly seven years); 49 (89%) were female and 41 (74.5%) were in remission.

A total of 28 received online PST for 10 weeks, and 27 received standard care. All participants completed questionnaires to assess problem-solving capacity, psychological distress, general mental health, and quality of life before the intervention, as well as one week and 18 weeks after study completion.

Some of the questionnaires used included the Social Problem-Solving Inventory-Revised Short Form, the Beck depression inventory, the General health questionnaire-12, the Perceived stress scale, The Satisfaction with Life Scale, and the Cushing’s quality of life.

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What were the effects of problem-solving therapy?

NPO, positive problem orientation, and avoidance problem-solving were each evaluated in specific subscales of the problem-solving questionnaire. Participants rated the items on each questionnaire and scored points ranging from 0 to 20. Higher scores on negative problem orientation and avoidance problem-solving indicated poor problem-solving capacity, while higher scores on the positive problem orientation subscale reflected more efficient problem-solving ability, “viewing problems as opportunities or having a tendency to appraise problems as a challenge,” the researchers wrote.

Participants in the problem-solving therapy group had greater reductions in their NPO scores at the end of the study compared with those receiving usual care. Improvement in NPO were still evident 18 weeks after study completion. However, there was no difference in positive problem orientation, avoidance problem-solving, depression, anxiety, quality of life, perceived stress, and general mental health scores between the two groups over time.

In addition to significant reductions in NPO scores, participants in the therapy group who strictly adhered to and completed the intervention showed significant improvements in general mental health, perceived stress, and depressive symptoms compared with those receiving usual care. Improvements in depressive symptoms and perceived stress were lost at follow-up, but those associated with general mental health persisted.

“The results suggested that online group PST may be of value in the rehabilitation setting by decreasing negative problem orientation, depressive symptoms, and perceived stress in patients with [Cushing’s disease] and thus should be considered as a complementary care in [these] patients,” the researchers wrote.

They noted that more studies are needed to determine if other psychological interventions might be of benefit to Cushing’s patients.