Background: Training patients in structured problem solving strategies is one of the oldest cognitive behavioural therapy methods. Recent social, psychological and neuropsychiatric research provides a multifactorial rationale for methods that strengthen patients' ability to carry out stepwise problem solving in their real life problems. Aim: This paper reviews the rationale for Problem Solving Training with reference to recent biomedical and psychosocial research and describes several preliminary studies of its benefits. Method: A four-phase programme of 24 weekly or bi-weekly lessons in small groups begins with patient's pratical everyday problems before moving to gradually more complex and emotionally charged interpersonal, personal and crisis issues in an attempt to restore generic problem solving abilities and improve long-term recovery from schizophrenia. Results: Preliminary outcome studies show promising outcomes on a reduction in rehospitalizations as well as clinical, social and neurocognitive measures and a multi-centred randomized controlled study in progess. Conclusions: Renewed interest in cognitive functioning, including social problem solving skills and social cognition in schizophrenia has led us to reconsider the potential value of cognitive-behavioural problem solving training as a rehabilitation strategy.

Studies have shown that teaching persons with mental illness to identify and cope with their real-life problems yields substantial clinical improvements. In Italy a structured problem-solving group was established in a day treatment center in 2003. This column describes the approach and focuses on the outcomes achieved by 15 patients with severe mental illness who were in this group. After completion of the problem-solving program, significant improvements were noted in symptom scores on the Positive and Negative Syndrome Scale and in problem-solving and neurocognitive test performance, with further improvements six months after completion of the group sessions. Problem-solving training may contribute to improved neurocognition and symptoms.