The Effectiveness of Solution-Focused Brief Therapy in Healthcare Settings: A Systematic Review and Meta-Analysis

Background: Social workers are increasingly working in inter-professional teams in various healthcare settings to deliver integrative, collaborative and accessible psychosocial services. Unlike the many evidence-supported psychosocial interventions in specialty mental health outpatient clinics, few of them have been examined for delivery in healthcare settings. Solution-focused brief therapy (SFBT) is a strength-oriented, brief intervention that has received accumulating evidence for improving clients’ psychosocial, behavioral and physical wellbeing in various healthcare settings. Literature suggests that many manualized and potentially effective interventions are difficult to adopt into healthcare settings because of their length, but studies on SFBT report positive therapeutic change within 3-to-5 sessions. While RCTs of SFBT in healthcare settings are increasing, no systematic and/or meta-analytic review has evaluated studies in this area. This study reports a systematic review and meta-analysis of SFBT in healthcare settings.

Methods: Using the Cochrane-Guideline, this study searched for all published or unpublished randomized-controlled-trials of SFBT for patients’ psychosocial, behavioral and physical wellbeing in various healthcare settings. A set of pre-defined keywords were searched across six electronic databases, four professional websites and three major journals. A final sample of 9 studies were included and coded by two independent coders. Small sample size corrected Hedges’s g effect sizes were calculated and synthesized using a random-effects model (based on the Q statistic for heterogeneity). Outcome variables were grouped into three conceptually distinct groups (health-related psychosocial, behavioral and physical outcomes). Within each group, multiple effect sizes from the same study were merged by calculating a weighted average to ensure independence of data. No moderator analysis was conducted due to small sample size. This study also assessed publication bias and conducted risk of bias assessment.

Results: Nine studies (N=3,547 participants) reported an average age of 22.95 (SD=14.98, 7.40-43.46). Gender of the participants were evenly distributed and few studies reported participants’ racial background for meaningful report. Most studies (n=8, 88.9%) were in outpatient healthcare settings, and many focused-on obesity management (n=5, 55.6%). Visual and statistical analysis indicated absence of publication bias. Primary studies overall reported low risk of bias.

A random-effects model (Q=9.81, p<0.05) revealed a significant positive effect, d=0.34, p=0.02, of SFBT for health-related psychosocial outcomes (e.g. psychological distress, depression and/or anxiety). For health-related behavioral outcomes (e.g. dietary behaviors and physical activities), a random-effects model (Q=13.79, p<0.05) revealed a marginally significant positive treatment effect of SFBT for health-related behavioral outcomes in healthcare settings (d=0.28, p=0.06). The overall treatment effect of SFBT was insignificant for physical outcomes (e.g. BMI, individual strength, and fatigue), d=0.21, p=0.13).

Conclusion: Study results supported the use of SFBT in various healthcare settings for patients’ behavioral and psychosocial improvement. Strongest evidence lied in SFBT’s effectiveness for clients’ psychosocial outcomes and is consistent with the empirical literature that SFBT is most effective for internalizing disorders. There was a marginally significant treatment effect of SFBT for behavioral outcomes even though the study was underpowered. Implications of study findings for social work practice and research are discussed. Healthcare social workers are encouraged to utilize SFBT to better serve underserved/vulnerable populations.