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Background: Patients with anorexia nervosa have been consistently reported to show impairments in set shifting ability. Such deficits may be associated with characteristics commonly observed in this patient group, such as obsessive thoughts and behaviours around eating, maladaptive problem solving and a rigid thinking style. Objective: Much of the preceding literature on set shifting ability has involved inpatient samples meeting strict diagnostic criteria for anorexia nervosa. However most eating disorder patients are outpatients and commonly do not meet full criteria for anorexia nervosa. This study thus aimed to investigate the relationship between set shifting ability and psychological characteristics in a community sample of outpatients with symptoms of anorexia nervosa. Methods: Performance on selected measures of set-shifting ability (Wisconsin Card Sort Test, WCST; Delis-Kaplan Executive Function System, Hayling & Brixton) were compared between an eating disorders group comprising 17 female outpatients with symptoms of anorexia nervosa and a control group comprising 27 students. Set shifting performance was then correlated with eating disorder severity (Eating Disorders Examination), obsessive-compulsive symptoms (Yale-Brown Obsessive Compulsive Scale), and the Social Problem Solving Inventory. Results: The eating disorder group demonstrated significantly worse set shifting ability than the healthy control group on the primary outcome measure (WCST), with 47% of eating disorder participants showing impairment on this measure. Severity of obsessive-compulsive symptoms and an impulsive and careless approach to problem solving were associated with poorer scores on the WCST in the eating disorder group. Although the eating disorder group were significantly more impaired in set shifting than controls, set shifting ability was not associated with eating disorder severity. Conclusions: The results indicate that set shifting impairments are present in outpatients with eating disorders with anorexic symptoms, and may be trait characteristics. Impaired set shifting was associated with obsessive-compulsive symptoms and maladaptive problem solving. These findings highlight a need for neuropsychological assessment of eating disorder outpatients in order to identify individuals who may benefit from psychological interventions to reduce the impact of these impairments.

Suicidal behavior, including ideation and attempts, is a significant public health problem. Due to the complexity of suicidal behavior, it is necessary to consider an array of factors that could serve as risk and protective factors. Previous research has shown that deficits in social problemsolving ability are associated with increased risk for suicidal ideation and attempts; conversely, problem solving strengths are associated with reduced risk. This dissertation project, consisting of 3 individual manuscripts, was designed to explore the relationship between social problemsolving ability and suicidal behavior in low-income primary care patients. Furthermore, additional constructs including health related quality of life, interpersonal needs, neuroticism, and hopelessness were also explored as they related to social problem solving and suicidal behavior. In a sample of 220 primary care patients ages 19-79 (M = 44.08; SD = 12.11), we examined the following: 1) health related quality of life as a mediator of the relationship between social problem solving and suicidal behavior, 2) interpersonal needs as a mediator of the relationship between social problem solving and suicidal behavior, and 3) the potential mediating role of hopelessness on the relation between neuroticism and suicidal behavior and the moderating role of social problem-solving ability on these associations. Participants completed self-report questionnaires including the Social Problem Solving Inventory-Revised-Short Form, Suicidal Behaviors Questionnaire-Revised, Short-Form 36, Interpersonal Needs Questionnaire, NEO-Five Factor Inventory, and the Beck Hopelessness Scale. Scores were analyzed using bootstrapped mediation and moderated mediation techniques. In Manuscript 1 mediating effects were found for mental health related quality of life. In Manuscript 2 thwarted belongingness and perceived burdensomeness mediated the relationship between social problem solving and suicidal behavior. Finally, in Manuscript 3 there was a significant indirect effect of neuroticism on suicidal behavior through hopelessness, and this indirect effect was moderated by social problem-solving ability. Our findings indicate that social problem-solving ability serves as both a risk and protective factor for suicidal behavior and impacts other variables that influence suicide risk among primary care patients. Interventions that bolster social problem-solving ability may reduce suicide risk in primary care.

This study intended to investigate the role of perceived social problem solving, narcissism, self-esteem, and gender in predicting aggressive behaviors of high school students. The sample consisted of 825 participants recruited from five high schools in Ankara. Buss-Perry Aggression Questionnaire (BPAQ), D&#039 / Zurilla and Maydeu-Olivares Social Problem Inventory-Revised (SPSI-R), Ames, Rose, and Anderson Narcissistic Personality Inventory (NPI), and Rosenberg Self-Esteem Scale (RSES) were used as the data collection instruments. Standard Multiple Linear Regression Analyses were performed to investigate predictive value of social problem solving (i.e., negative problem orientation, rational problem solving, impulsivity/carelessness style, and avoidance style), narcissism, self-esteem, and gender in understanding high school students&rsquo / aggressive behaviors (i.e., physical aggression, anger, hostility, and verbal aggression). Results of the present study indicated that gender, narcissism, impulsivity/carelessness style, negative problem orientation, and rational problem solving were significantly related to adolescents&rsquo / physical aggressive behaviors. However, self-esteem and avoidance style did not significantly correlate with physical aggression. Moreover, negative problem orientation, narcissism, impulsivity/carelessness style and gender were significantly related to anger / conversely the relationship between anger and self-esteem, rational problem solving, and avoidance style were not significant. Furthermore, although there was a significant correlation between hostility and negative problem orientation, self-esteem, narcissism, and rational problem solving, there was no significant relationship between adolescent hostile behaviors and avoidance style, impulsivity/carelessness style, and gender. Finally, impulsivity/carelessness style, narcissism, rational problem solving, and gender were significantly related to adolescents&rsquo / verbal aggressive behaviors, nevertheless self-esteem, negative problem orientation, and avoidance style did not significantly correlate with verbal aggression. Theoretical and practical implications and recommendations for future research have been presented.

Problem-solving deficits and poor health–related quality of life are associated with suicide risk; yet, little is known about the interrelations between these variables. In 220 primary care patients, we examined the potential mediating role of physical and mental health–related quality of life on the relation between social problem–solving ability and suicidal behavior. Participants completed the Suicidal Behaviors Questionnaire-Revised, Social Problem Solving Inventory-Revised, and Short-Form 36 Health Survey. Utilizing bootstrapped mediation, our hypotheses were partially supported; mediating effects were found for mental health–related quality of life on the relation between social problem-solving and suicidal behavior. Physical health–related quality of life was not a significant mediator. Greater social problem–solving ability is associated with better mental health–related quality of life and, in turn, to less suicidal behavior. Interventions promoting social problem–solving ability may increase quality of life and reduce suicide risk in primary care patients.

In the present study, we examined whether social problem-solving processes would add predictive utility over loneliness in accounting for unique variance in ill-being (viz., depressive symptoms and suicide behavior) and well-being (viz., life satisfaction and positive affect) in a sample of 230 females. Results of hierarchical regression analyses indicated that social problem-solving processes added significant predictive utility in accounting for unique variance in depressive symptoms, life satisfaction, and positive affect. Moreover, negative problem orientation emerged as a significant unique predictor of both ill-being and well-being. In contrast, positive problem orientation emerged as a significant unique predictor of well-being and only one index of ill-being. Some implications of the present findings are discussed.

Recent changes in health care policy, which mandate the monitoring of illness symptoms and improving the satisfaction of medical patients, may shed light on possible points of intervention to improve patient-centered outcomes. Health-related quality of life (HRQL), or one’s appraisal of their mental and physical functioning, is a frequently-used metric relevant to improved health care outcomes. HRQL may be impacted by multiple inter- and intra-personal factors, whether an adaptive (e.g., social problem solving ability) or maladaptive effect (e.g., thwarted interpersonal needs, depression). We examined the association between social problem solving ability and mental and physical HRQL, and the potential mediating roles of thwarted interpersonal needs and depressive symptoms. Participants (N=223) were middle-aged and recruited from a primary care clinic. Our hypotheses that thwarted interpersonal needs and depressive symptoms would sequentially mediate the association between independent scales of social problem solving (negative problem orientation, positive problem orientation, rational problem solving, impulsive/careless style, avoidant style) and HRQL (mental and physical), were largely supported. Our findings highlight the importance of social problem solving ability as a potential point of intervention to improve mood, interpersonal functioning, and mental and physical health in an integrated care setting. Strategies such as Social Problem Solving Therapy might be particularly effective in bolstering social problem solving, with consequent beneficial effects on interpersonal functioning and mood, thereby improving overall health-related quality of life.

Introduction: Despite advances in smoking cessation interventions, the majority of smokers who seek treatment will relapse. To better understand nicotine dependence, and relapse risk factors this study tested for potential relationships between social problem-solving, negative affect, and smoking urges during a baseline smoking cue exposure trial. Methods: aA part of a larger cessation study. 51 male and 50 female physically inactive, sedentary smokers with the intention to quit smoking, and bioverified smoking abstinence (CO < 11ppm) completed demographic questionnaires, the Social Problem-Solving Inventory-Revised: Short-Form, and questionnaires related to smoking history and demographic characteristics. In addition, participants completed a baseline 5-minute relaxation session followed by a 5-minute imaginal and in vivo smoking cue exposure trial. Participants completed pre and post cue exposure measures of urge and affect. Analysis: t-tests were used to validate the effect of cue exposure procedures on urge and negative affect. Multivariate linear regression models assessed the strength of possible relationships between social problem-solving, gender, negative affect, and urge to smoke. Results: Smoking urge and negative affect significantly increased from pre to post exposure. Women and men did not differ on any measure of social problem-solving, affect, or smoking urge. In regression models, the social problem-solving composite score was not statistically associated with post-cue exposure urge strength (as measured by the Questionnaire for Smoking Urges-Brief) when controlling for cigarettes per day or level of nicotine dependence. Greater pre-test negative problem orientation was significantly correlated with pre-post increases in negative affect (a predictor of relapse). In models with a gender and negative problem orientation interaction, negative problem orientation became a stronger predictor of negative affect, although the interaction term was non-significant. Impulsive-careless problem-solving styles and negative affect were also found to be significantly associated with post-exposure urge strength. Conclusions: A 5-minute smoking cue exposure trial produced a reliable increase in smoking urge and negative affect among treatment-seeking smokers who were abstinent for at least three hours. Future research of social problem-solving, stress and coping and negative affect within cue reactivity paradigms may provide insights for integrating cue exposure treatments and counseling-based smoking cessation interventions. / Public Health

Previous research has indicated that depression and thinking style (rumination versus distraction) interact to influence cognitive processing. Depressed ruminators produce more categoric autobiographical memories (AM) (i.e., a summary of repeated memories), and also demonstrate poorer SPS performance than depressed distracters and matched controls. The quality of AM retrieval during SPS is also related to the effectiveness of SPS solutions such that categoric AM retrieval during SPS contributes to poorer SPS. Therefore, the first aim of this thesis was to extend previous work by further investigating how an induced rumination/distraction influences subsequent AM retrieval during SPS and SPS performance. The first two studies examined how thinking style influences SPS and AM retrieval during SPS in a dysphoric (study 1) versus clinically depressed sample (study 2). The results indicated that rumination has a detrimental effect on SPS in both dysphoric and clinically depressed samples, with more pronounced effects in the clinical group. Rumination also appeared to influence AM retrieval during SPS for the clinically depressed group but not the dysphoric group. Moreover, in both samples, SPS performance was associated with the type of AM retrieval involved in the SPS process. As most studies investigating cognitive processes in depression have focused on Western people, a second aim of this thesis was to examine the association between thinking style, AM retrieval and SPS performance in depression from a cross-cultural perspective. The first cross-cultural study (Study 3) looked at AM retrieval on the AMT cueing task and the second cross-cultural study (Study 4) investigated whether these associations between thinking style, SPS and AM retrieval would vary across different cultures. Culture interacted with depression to influence AM retrieval on the AMT cueing task. However study 4 demonstrated that there seemed to be no interaction between culture, rumination and depression on SPS performance and AM retrieval during SPS.