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Bibliotherapy as an Adjunctive Treatment: Read all About it

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Abstract

This chapter defines bibliotherapy as psychotherapeutic programs presented in a written self-help format as opposed to fictional stories or religious texts. It outlines the research literature regarding the clinical effectiveness and cost-effectiveness of bibliotherapy for a wide variety of problems. It discusses the literature on process variables leading to therapeutic change in patients utilizing bibliotherapy. It addresses the role of bibliotherapy within the context of a stepped care and integrated care environment. It proposes adjunctive treatment as a research and dissemination agenda for the use of bibliotherapy. There are many obvious advantages to bibliotherapy over traditional psychotherapy such as the ability to self-pace, allowing individuals who are unable to receive mental health services due to geographical or transportational barriers receive treatment and providing cost-effectiveness for those who cannot afford psychotherapy or pharmacotherapy, privacy that can lessen stigmatization or labeling, and coping skills for life after treatment has ended. Despite these benefits, there are still many unknowns in the area of bibliotherapy such as for whom it is effective, for which psychological problems it is effective, what degree of adjunctive professional or nonprofessional help is needed, and what role bibliotherapy can play in integrated health care systems.

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... Bibliotherapy, which is the provision of psychological therapy through books or other written materials, may be particularly suited to the stroke population as it can be self-paced and is accessible by people with mobility restrictions (Jacobs and Mosco, 2008). Moreover, it can be delivered through existing public library networks (Chamberlain et al., 2008). ...
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Background: Psychological distress is common after stroke, and affects recovery. However, there are few evidence-based psychological treatments. This study evaluates a bibliotherapy-based approach to its amelioration. Aims: To investigate a stroke-specific self-management book, based on acceptance and commitment therapy (ACT), as a therapist-supported intervention for psychological distress after stroke. Method: The design was a single case, randomised non-concurrent multiple-baseline design (MBD). Sixteen stroke survivors, eight males and eight females (mean age 60.6 years), participated in an MBD with three phases: A (randomised-duration baseline); B (intervention); and follow-up (at 3 weeks). During the baseline, participants received therapist contact only. In the bibliotherapy intervention, participants received bi-weekly therapist support. The primary measures of psychological distress (General Health Questionaire-12; GHQ-12) and quality of life (Satisfaction with Life Scale; SWLS) were completed weekly. Secondary measures of mood, wellbeing and illness impact were completed pre- and post-intervention. Results: Omnibus whole-group TAU-U analysis was statistically significant for each primary measure with a moderate effect size on both (0.6 and 0.3 for GHQ-12 and SWLS, respectively). Individual TAU-U analyses demonstrated that the majority of individuals exhibited positive change. All the secondary measures showed significant pre-post improvements. Eighty-one per cent of participants reported the book was helpful and 81% also found the ACT-based sections helpful. Relative risk calculations showed finding the book helpful was associated with improvement in GHQ-12 and SWLS scores. Conclusions: ACT-based bibliotherapy, with therapist support, is a promising intervention for psychological difficulties after stroke.
... It has been recommended for treating unrelenting sub-thresholds depressive symptoms or mild-to-moderate depression by the UK National Institute for Clinical Excellence (NICE) in 2009 (Eum and Yim, 2015). It is an auxiliary tool used for treating neurosis and emotional or behavioral disorders thereby, it can be an effective therapeutic modality to treat PSD as well (Jacobs and Mosco, 2011;Eum et al., 2014). Poetry is another form of literature therapy, which improves cognitive functions post stroke and helps the patient return to a normal life. ...
Article
Post-stroke depression (PSD) is the most common mental health issue, afflicting around 33% of stroke survivors. PSD has a negative impact on the rehabilitation, recuperation of motor and cognitive deficits following stroke and significantly increases the chances of relapsing neurovascular events. It has been demonstrated that biological and psychological factors have a significant role in PSD. Numerous endeavors have been made to discover the risk factors and predictors of PSD. Screening and diagnosis also have gained attention; however, a suitable tool is yet to be developed. Medications are chosen based on their viability and reaction profile in the patients. Besides pharmacotherapy, psychotherapy treatment is also highly valued by both psychiatrists and stroke patients. Additional research is needed to examine the pathophysiology of PSD. This review attempts to highlight the existing evidence and gaps in the present knowledge of the predictors of PSD, incidence, prevalence, and etiology. Further, it also discusses the screening and diagnostic approaches, therapeutic modalities and management of PSD and the impact of pre-stroke depression on PSD.
... Therefore, emotional disorders such as depression and anxiety that appear after stroke must be dealt with effectively to help with rehabilitation (Aström et al. 1993). Literature treatment is an auxiliary tool that treats neurosis as well as emotional or behavioral disorders; thus, it might be an effective therapy method for PSD as well (Jacobs and Mosco 2011; Eum et al. 2014). ...
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Stroke is one of the leading causes of morbidity and long-term disability worldwide, and post-stroke depression (PSD) is a common and serious psychiatric complication of stroke. PSD makes patients have more severe deficits in activities of daily living, a worse functional outcome, more severe cognitive deficits and increased mortality as compared to stroke patients without depression. Therefore, to reduce or prevent mental problems of stroke patients, psychological treatment should be recommended. Literature and art therapy are highly effective psychological treatment for stroke patients. Literature therapy divided into poetry and story therapy is an assistive tool that treats neurosis as well as emotional or behavioral disorders. Poetry can add impression to the lethargic life of a patient with PSD, thereby acting as a natural treatment. Story therapy can change the gloomy psychological state of patients into a bright and healthy story, and therefore can help stroke patients to overcome their emotional disabilities. Art therapy is one form of psychological therapy that can treat depression and anxiety in stroke patients. Stroke patients can express their internal conflicts, emotions, and psychological status through art works or processes and it would be a healing process of mental problems. Music therapy can relieve the suppressed emotions of patients and add vitality to the body, while giving them the energy to share their feelings with others. In conclusion, literature and art therapy can identify the emotional status of patients and serve as a useful auxiliary tool to help stroke patients in their rehabilitation process.
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This study is a joint project involving alcohol-addiction experts and experts on comparative literature, who selected and defined the literary texts that were employed. The research included long-term alcohol abstainers, members of aftercare supportive-therapy groups (n = 68). The research aimed to obtain some basic information about their reading habits, to test their responsiveness to various types of literary text displaying varying attitudes to alcohol consumption, and to acquire the information necessary for a more intensive introduction of bibliotherapy into the therapy of alcohol dependence. The literary passages comprised two texts without reference to alcohol dependence (‘Der Panther’, Siddhartha), two displaying a critical attitude to alcoholism, by describing its negative aspects (John Barleycorn, L’Assommoir), and two without a critical attitude, i.e., with a positive approach to alcoholism (The Pickwick Papers, ‘In Taberna Quando Sumus’). The results showed a more positive response from the participants with higher education and established reading habits. The participants manifested a highly negative emotional response to the positive connotation of alcohol in the texts–an unexpected response after their long abstinence. Even short passages from literary works, appropriately and expertly differentiated, served to trigger or reinforce mentalisation-based reflective processes in addiction psychotherapy.
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We aimed to explore the effect of a poetry writing program for people who had experienced a serious illness. For this study we randomly assigned 28 volunteer participants with a history of serious illness, usually cancer, to one of two poetry writing workshops. Each group met weekly for 2 hours for 8 weeks. The second group was wait-listed to enable comparison between the two groups. We used the Kessler-10, a measure of wellbeing, before and after the workshops and also interviewed the participants at these times. Participants responded enthusiastically and each group demonstrated an increase in wellbeing over the course of their workshop, moving them from medium to low risk on the K10. Participants enjoyed the challenge of writing and the companionship of other group members. Psychiatrists, especially those working in liaison psychiatry, are in a position to encourage patients who have experienced a serious illness to explore writing as a way of coming to terms with their experiences.
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In a randomized waiting‐list controlled clinical trial cognitive‐behavioral bibliotherapy was investigated in heterosexual couples with sexual dysfunctions. After a 10‐week treatment participants (N = 199 couples) reported fewer complaints of low frequency of sexual interaction and general improvement of their sexual problem, and lower male posttreatment ratings of problem‐associated distress. At follow‐up gains with respect to frequency of sex and problem‐associated distress had eroded. Female participants with vaginismus posttreatment reported less complaints of vaginismus. However, female participants with dyspareunia reported more complaints of vaginal discomfort. These differences were maintained at follow‐up. An “intention‐to‐treat” analysis showed that the effects were robust to participant attrition. Treatment compliance was positively associated with outcome in females at posttreatment.
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Do you want to use bibliotherapy with clients but wonder about the size and mechanism of effectiveness? The authors report a meta-analysis of 29 outcome studies of cognitive forms of bibliotherapy for depression. Seventeen studies with stronger research designs (pretest-posttest waiting list control group) yielded a respectable effect size of 0.77, considered the best estimate of effect size from this study. This result compares favorably with outcomes from individual psychotherapy. In light of the substantial positive effects associated with bibliotherapy for depression, the authors discuss clinically relevant questions related to the use of cognitive bibliotherapy. These include why practitioners might consider the use of this technique, which individuals can benefit from this approach, and how professionals can structure care.
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Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
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Discusses the methods by which psychologists, not psychology as a whole, contribute to social change. The role of the American Psychological Association is presented as a supporting rather than leading factor. It is emphasized "that understanding and prediction are better goals . . . than is control." It is proposed that the adaptive process be changed to achieve these goals. "2 alternative images -are presented= of what the popular conception of human nature might become" as a result of the psychological revolution. It is concluded that a "peaceful revolution based on a new conception of human nature" will result from the instillation of scientific facts in the public consciousness. (16 ref.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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To determine the efficacy of self-examination therapy in the treatment of generalized anxiety disorder, 38 adults volunteered for a study in which they were randomly assigned to self-examination therapy or to a delayed-treatment group. Analyses indicated that participants in self-examination therapy had significantly fewer symptoms of anxiety than did participants in the delayed-treatment group on the outcome measures of this study, which included ratings by trained clinicians and participants. The reduction in anxiety for people receiving self-examination therapy was maintained 3 months after treatment ended. The delayed-treatment group also showed significant improvement in anxiety symptoms after receiving self-examination therapy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Using meta-analysis, we examined the efficacy of self-administered treatments. Self-administered treatments were compared with no treatment and with therapist-administered treatments. Results indicated that self-administered treatments were reliably more effective than no treatment and that differences between self-administered and therapist-administered treatments were nonsignificant. Effect sizes for type of target problem (e.g., phobias, affective disturbances) were comparable. These results suggest that self-administered treatments in general are effective in comparison with no treatment. The limitations of this review are noted, including those that preclude the conclusion that self-administered treatments are as effective as therapist-administered programs. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This 271-item bibliography resulted from a tabulation of surveys of 47 university counseling centers regarding what they considered the most useful self-help resources available in each of 27 problem/concern categories (e.g., stress management, eating disorders, incest). The bibliography is divided into approximately 10 categories of bibliotherapy tools. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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We conducted an evidence-based review of psychological treatments for geriatric depression using coding criteria, and we identified six treatments to be beneficial: behavioral therapy, cognitive behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychody-namic therapy, and reminiscence therapy. Other interventions were found to be promising but were lacking replication. These findings suggest that (a) there are several treatment choices for consumers and practitioners across a relatively broad range of theoretical orientations and modalities, (b) there needs to be a recognition of the viability of psychological treatments for depressed elders by other disciplines, and (c) there is an opportunity to provide training in evidence-based treatments for present and future providers to the growing number of older adults.
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Objective:To examine the views hypochondriacal patients have of their physicians, and their physicians’ assessments of the hypochondriacal patients. Design:A sample of patients meeting DSM-III-R diagnostic criteria for hypochondriasis was obtained by screening consecutive medical outpatients. They underwent a battery of self-report questionnaires and structured interviews, their medical records were audited, and their physicians completed questionnaires about them. A random sample of nonhypochondriacal patients from the same clinic served as a comparison group. Setting:A large general medicine outpatient clinic of an academic teaching hospital. Patients:41 DSM-III-R hypochondriacs and 71 comparison patients. Measurements and main results:Hypochondriacal patients were more dissatisfied with their physicians than were comparison patients. Physicians rated the hypochondriacal patients as more frustrating to care for, more help-rejecting, and more demanding. Physician ratings of how hypochondriacal their patients were correlated significantly with their ratings of how frustrating they considered the patients (R2=0.36)and with objective measures of how hypochondriacal the patients were (incremental R 2=0.08).Physician estimates of anxiety and depression in the hypochondriacal patients were not statistically related to patient anxiety and depression. In contrast, physician estimates of patient anxiety and depression were significantly associated with the presence of anxiety and depression in comparison patients. Conclusions:The physician’s use of the term hypochondriasis is closely associated with his or her frustration with the patient and is associated with objective measures of the extent of hypochondriacal symptoms. In addition, the presence of DSM-III-R hypochondriasis impairs the physician’s accuracy in assessing the levels of the patient’s anxiety and depression.
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Reviews the current status of self-help behavioral treatment manuals. Organizing concepts and strategies for the development and evaluation of such programs are described. Programs that have been published or empirically tested for the treatment of phobias, smoking, obesity, sexual dysfunctions, assertiveness, child behavior problems, study skills, and physical fitness, as well as general instructional texts, are reviewed. It is concluded that the validation of available self-help behavior therapy manuals is extremely variable at the present time. It is suggested that future research evaluate manuals under conditions of intended usage, recruit clinically relevant Ss, employ follow-through and cost-effectiveness indices, include appropriate controls and follow-up assessments, and attempt to identify S or other clinical predictors of treatment outcome. The clinical and ethical issues raised by self-help programs are also briefly considered. (5 p ref)
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This study demonstrated that therapeutic empathy has a moderate-to-large causal effect on recovery from depression in a group of 185 patients treated with cognitive-behavioral therapy (CBT). The authors simultaneously estimated the reciprocal effect of depression severity on therapeutic empathy and found that this effect was quite small. In addition, homework compliance had a separate effect on clinical recovery, over and above the effect of therapeutic empathy. The patients of novice therapists improved significantly less than did the patients of more experienced therapists, when controlling for therapeutic empathy and homework compliance. Ss who terminated therapy prematurely were less likely to complete the self-help assignments between sessions, rated their therapists as significantly less empathic, and improved significantly less. Ss with borderline personality disorder improved significantly less, but they rated their therapists as just as empathic and caring as other patients. The significance of these findings for psychotherapy research, treatment, and clinical training is discussed.
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Group cognitive therapy (CT), focused expressive psychotherapy (FEP; a form of group experiential psychotherapy), and supportive, self-directed therapy (S/SD) were compared among 63 patients with major depressive disorder (MDD). Variation among patients' coping styles (externalization) and defensiveness (resistance potential) was used in a prospective test of hypothesized differential treatment-patient interactions. Results suggest that patient characteristics can be used differentially to assign psychotherapy types. Externalizing depressed patients improved more than nonexternalizing depressed patients in CT, whereas nonexternalizing (internalizing) patients improved most in S/SD. Conversely, high defensive (resistant) patients improved more in S/SD than in either FEP or CT, whereas low defensive patients improved more in CT than in S/SD.
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The efficacy of bibliotherapy for mildly and moderately depressed older adults was examined. Cognitive bibliotherapy and behavioral bibliotherapy were compared with a delayed-treatment control condition. Results indicate that the two experimental conditions were superior to the control condition, but that the cognitive and behavioral bibliotherapies were nondifferentially efficacious. Sixty-six percent of the subjects demonstrated clinically significant change. There were no specific effects associated with either the cognitive or the behavioral interventions. Treatment gains were maintained at 6-month follow-up. The implications of bibliotherapy for geriatric depression as an alternative or adjunct to traditional treatments are discussed.
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Asserts that G. M. Rosen (see record 1987-16844-001), in his statements about self-help books, failed to consider what is involved in selling books on any subject. It is acknowledged that some publishers' claims go beyond the author's intentions. The author attempts to place publishing into perspective for those psychologists who want to publish books that should be read by a general audience. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Of 45 Ss who began treatment for problem drinking, 21 males and 20 females completed enough sessions to be regarded as treated in 1 of 4 groups: (a) bibliotherapy, in which clients received self-help materials but no treatment sessions; (b) behavioral self-control training (BSCT), consisting of 6 weekly sessions; (c) BSCT plus 12 sessions of relaxation, communication, and assertion training; or (d) BSCT plus 12 wks of individually tailored broad-spectrum modules. Multimodal assessment was used to evaluate drinking behavior, life problems, and general functioning. All groups showed significant improvement on drinking measures and general improvement on other dimensions, a trend confirmed by collateral reports. Bibliotherapy clients spent more hours per week intoxicated than other groups, but no other significant group differences were observed. The degree to which therapists showed accurate empathy proved to be a good predictor of client outcome. (43 ref)
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The effectiveness of minimal-contact cognitive bibliotherapy was examined with a group of 80 depressed adults who were recruited from the community. Minimal-contact cognitive bibliotherapy was found to be superior to a waiting-list control group. The results were both statistically and clinically significant, and the treatment group maintained their levels of improvement at 3-month follow-up. The results also indicated significant decreases in dysfunctional attitudes and automatic negative thoughts after treatment. It appeared that the treatment also served a psychoeducational function. The interventive and preventive implications of these results are discussed.
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The majority of cases of clinical depression go unrecognized and untreated, despite the fact that depression is an eminently treatable disorder. The Agency for Health Care Policy and Research (AHCPR) recently published a set of clinical practice guidelines focused on depression in primary care settings. The review of the literature on which the guidelines are based is thorough and appropriate and should enhance the detection of depression and the quality of pharmacotherapy for depression. However, the guidelines encourage primary care physicians to provide pharmacotherapy to their depressed patients as the first line of treatment. The wisdom of this recommendation is questioned and revisions to the guidelines are suggested. Specifically, patients should be informed of the broad array of treatment options available and provided with a more balanced presentation of the potential benefits of psychotherapy for depression. Patients should decide which treatment alternative they wish to undergo.
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This article reviews the theoretical and empirical literature associated with the mediators and moderators of change in cognitive therapy (CT) of depression. Covariation between change in cognition and change in depression, specific effects for cognitive versus behavioral components of CT, specific effects for CT versus other treatments, moderating influence of nonspecific and technical aspects of the therapeutic environment, and moderating influence of client characteristics are reviewed. The clinical implications of prior research and suggestions for future research on identifying the critical ingredients of change in CT of depression are discussed.
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A test of cognitive bibliotherapy knowledge wasdeveloped and evaluated. Fifty-seven items that relatedto the content of the book, Feeling Good (Burns, 1980),were administered to a total of 99 participants in two depression bibliotherapy studies and toa group of 22 community participants who had notreceived the treatment. Analyses of reliability andvalidity, including an item-response analysis, suggested a 23-item version of the test was optimal.Using the same data, we then tested the hypothesis thatpersons who had read the book would achieve higherscores than those who had not read the book. The test scores reliably distinguished betweenparticipants who had received the treatment and thosewho had not. Cross-validation was undertaken with 21older adult participants in an independent depressiontreatment study, with those who had read the bookachieving higher scores than those who had not.Potential clinical and research uses of the test areproposed.
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Bibliotherapy, the use of reading to produce affective change and to promote personality growth and development, is examined through a comprehensive analysis of the literature. A conceptual framework with which to review the available data is suggested. This framework looks at bibliotherapy in four ways: as self-actualization therapy, a strategy for attitudinal change, a method for self-concept improvement, and an instructional/didactic tool. The literature analysis reveals little systematic demonstration of the efficacy of bibliotherapy and cautions against special education utilization without controlled study. Until such research becomes available, the special educator should proceed slowly in use of this intervention. However, understanding of the principles, philosophy, and practices of bibliotherapy is seen as valuable for those personnel working with children who may profit from the exposure to reading materials directed to their specific problems.
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The therapeutic elements of four types of helping interactions (friends/family, religion, cinematherapy/bibliotherapy, and self-help groups), and their commonalities with traditional psychotherapy are explored. Empirical findings in these areas are discussed, along with suggestions for process and outcome research. Recommendations for the integration of self-help and paraprofessional counseling with professional therapy are presented.
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Aims: This review evaluates the evidence associated with the effectiveness of self-help materials designed to help individuals suffering with adult mental health (AMH) problems, and explores the methodological status of the field as well as issues associated with self-help delivery. Methods: An original second-order review perspective was used, where previous individual reviews are systematically retrieved, compared and contrasted qualitatively. Results: Self-help treatment manuals appear to be effective for several types of anxiety disorder as well as with assertiveness difficulties. There is early support for its use with depression. Less powerful and more variable evidence exists for its use with habit disorders and as a computer-delivered modality. Certain methodological limitations remain within the field including, for instance, compliance/drop-out and generalization issues. Conclusions: Self-help looks set to be an important component in AMH services. Studies do not seem to have attempted to fully evaluate the “added-value” dimensions which justify the use of self-help materials. Interventions should be offered which are based on a person's presenting difficulties, personal preferences and their individual characteristics. Several themes associated with the individual characteristics which might advantage the self-help modality are explored and some future research guidance is listed.
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Despite the limited, albeit positive, evidence of the efficacy of self-help books (SHBs), they are widely prescribed to patients by therapists. It appears that this is due in part to their great appeal to the general public. Based upon the available empirical studies, it appears that some SHBs are effective in changing problematic behaviors when used alone and when used in conjunction with therapy. In this article, the case is made for a SHB plus cognitive behavioral therapy as being more useful in some cases than a SHB alone, because the combination addresses the crucial and frequently cited issue of compliance with the directives of the treatment regimen in a SHB (Rosen, 1987). We offer recommendations for selecting and assigning SHBs that we believe are beneficial.
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The purpose of this study was to determine the effectiveness of minimal-contact cognitive bibliotherapy for treating depression and improving functional abilities in older adults with a physical disability. Subjects were randomly assigned to either an experimental group which participated in a 4-week cognitive bibliotherapy program or a 4-week delayed treatment control condition. Results indicate that treated subjects showed greater improvement on depressive symptoms than untreated subjects and that the treatment effect was maintained over a 6-month period. However, treated subjects were only slightly more improved than untreated subjects on clinical indicators of change. Amelioration in functional abilities was observed between the end of treatment and the 6-month follow-up. The discussion examines the implications of these findings for the treatment of depression in older persons with a disability.
Article
Investigated the identity of users of bibliotherapy, problems for which bibliotherapy is applicable, and specific reading resources that are being used effectively, via a survey of 158 psychotherapists. 51% of respondents indicated that they used bibliotherapy; there was a significant correlation between years of practicing individual therapy and use of bibliotherapy. Several problem areas (e.g., sexual dysfunction, weight control, divorce, parenting, assertiveness training) are listed along with their reported levels of effectiveness. 23 books frequently named by therapists are listed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Research suggests that bibliotherapy is a popular research tool in studies of self-help programs, but remains less convincing as a treatment modality. Conceptual and design problems in the use of bibliotherapy are discussed. There appears to be increased interest in bibliotherapy among practitioners, and survey literature suggests that it is widely used with certain groups. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Examines self-help programs, reported during 1978–1979, dealing with phobias, assertiveness, obesity, smoking, physical fitness, child behavior problems, sexual dysfunctions, and academic performance. General instructional texts and additional areas that have received attention are also discussed. It is concluded that the validation of available self-help behavior therapy manuals remains highly variable. The use of some programs is indicated, but current data suggest that the employment of certain do-it-yourself behavior change programs without professional assistance is ill-advised. (3 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Demonstrates that self-help programs are experiencing explosion growth; that psychologists are to be credited with a substantial body of research dating back to the 1970s; that this research demonstrates the potential of self-help programs; that some psychologists have failed to heed the results of studies by rushing to market with exaggerated product claims; and that the American Psychological Association has itself set a poor example and failed to advance clear standards. These points are not intended as a criticism of self-help. Rather, they serve as an observation of psychology's failure to advance self-care. Psychologists are encouraged to meet the challenge that self-care presents. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Reviews the effectiveness of bibliotherapy with respect to academic achievement, assertiveness, attitude change, behavioral change, fear reduction, helper effectiveness, marital or couple accord, self-development, and therapeutic gains. Research indicates that bibliotherapy is effective for assertiveness, attitude and behavioral change, self-development, and therapeutic gains. Also discussed are ways in which bibliotherapy can be used as an adjunct to counseling with respect to therapy with individuals and groups and guided reading in school settings. It is concluded that counselors should be aware that bibliotherapy is an emerging discipline and that positive recommendations of its value exceed available documentation of its usefulness. (63 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Originally published in Contemporary Psychology: APA Review of Books, 1981, Vol 26(3), 189-191. Presents guidelines for the review of self-help books in Contemporary Psychology. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Mental health problems contribute 23% to the global burden of disease in developed countries (WHO, 1999). In the U.K., recent legislation attempts to address this by modernizing mental health services so that they provide evidence based, accessible and non-discriminatory services for both serious and common mental health problems. Cognitive behaviour therapy (CBT) has a robust evidence base that fits very well with the thrust of policy. However, CBT's delivery systems are rooted in traditional service models, which pay little attention to the growing evidence base for brief and single-strand treatments over complex or multi-strand interventions. Services characterized by 9-5 working, hourly appointments and face-to-face therapy disenfranchise the majority of people who would benefit from CBT. In this paper we argue that the evidence exists for service protocols that promote equity, accessibility and choice and that CBT services should be organized around multiple levels of entry and service delivery rather than the more usual secondary care referral systems.
Article
Panic disorder with or without agoraphobia is a prevalent clinical disorder which places heavy demands on treatment resources in primary care. The efficiency of delivery of psychological treatments for this disorder is therefore important. Previous research has focused on psychological treatments delivered with reduced therapist contact but methodological problems preclude firm conclusions. The present study investigated the relevance of therapist contact in cognitive behaviour therapy for panic disorder and agoraphobia, taking account of previous methodological problems. One hundred and four patients suffering from DSM III-R panic disorder with or without agoraphobia were randomly allocated to receive cognitive behaviour therapy with either, ‘standard’ therapist contact, ‘minimum’ therapist contact or as a bibliotherapy. All patients were seen by the same therapist and all received an identical treatment manual. Treatment response, as measured by patient and therapist report scales of anxiety, depression, and agoraphobic avoidance, was analysed in terms of both traditional statistical significance and clinical significance of outcome. At treatment end-point the ‘standard’ therapist contact and ‘minimum’ therapist contact groups showed significant reductions pre- to post-treatment on all measures. Pre- to post-treatment reductions for the bibliotherapy group were significant on therapist- and patient-rated measures of anxiety only. The ‘standard’ therapist contact group was consistently significantly improved in comparison to the bibliotherapy group. Significant differences between the ‘standard’ and ‘minimum’ therapist contact groups were found on therapist-rated anxiety only. Assessment of clinical significance of treatment outcome showed further differences between treatment groups with the ‘standard’ therapist contact group showing the largest proportion of patients achieving clinically significant change on all measures both at treatment end-point and at 6-month follow-up. Copyright © 2000 John Wiley & Sons, Ltd.
Article
Gerald M. Rosen has reminded us of the contributions of two task forces that addressed self-help therapies. The problems with self-administered treatments that were discussed in the recent Journal of Clinical Psychology special section (Volume 59, Number 3) also were discussed by these task forces. One of the primary problems is the lack of quality control and, in particular, the fact that self-help books without empirical support can be marketed to the public. There is not sufficient data available to reach conclusions regarding the overall impact of self-help books. Additional research and empirical support are needed for self-administered treatments; however, requiring such research support prior to publication would be holding self-help books to a higher standard than is currently required for psychologists (and other therapists) providing services. Our belief is that self-administered treatment is at least benign and potentially helpful to most consumers. © 2003 Wiley Periodicals, Inc. J Clin Psychol.
Article
Current traditional methods of mental healthcare service delivery, based on ‘specialists’ providing ‘outpatient appointments’ for formal therapy, are often inappropriate for the needs of patients in primary care. The estimated numbers of adults with mental health problems are immense, and it is this, combined with Department of Health initiatives aimed at improving choice and access, which make it essential that new ways of delivering services are explored. This trial examines the use of an assisted self-help treatment package for mild to moderate stress/anxiety [Assisted Bibliotherapy (AB)] with an adult clinical population referred by their general practitioner. Assisted Bibliotherapy is a brief intervention (8 weeks), with limited therapist contact (20-min sessions). Non-parametric statistical testing of scores from the Zung Anxiety Scale and the Clinical Outcomes in Routine Evaluation (CORE) questionnaire indicated positive results. There was significant improvement at post-treatment, which was maintained at 3 month follow-up. The results from this trial and a previous trial of AB by Kupshik & Fisher in 1999, indicate that it is an effective treatment which could be used as part of a stepped care approach to managing and treating stress/anxiety in primary care.
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Anxiety disorders are estimated to affect 26.9 million individuals in the United States at some point during their lives. This study used the human capital approach to estimate the direct and indirect costs of these highly prevalent disorders. In 1990, costs associated with anxiety disorders were $46.6 billion, 31.5% of total expenditures for mental illness. Less than one-quarter of costs associated with anxiety disorders were for direct medical treatment; over three-quarters were attributable to lost or reduced productivity. Most of these indirect costs were associated with morbidity, as mortality accounted for just 2.7% of the total. Greater availability of effective, relatively low-cost outpatient treatment could substantially reduce the economic and social burden of these common and often crippling disorders. Anxiety 2:167–172 (1996). © 1996 Wiley-Liss, Inc.
Article
Depression is a prevalent and expensive condition. Many patients are seeking and receiving treatment for depression in the primary care setting where pharmaceutical interventions prevail as the predominant treatment. While psychotropic medications can certainly help ameliorate mental and behavioral problems, all medical interventions carry with them certain risks and side effects. A natural multiple-baseline (across participants), single-case experimental design was used in a pilot study to evaluate the feasibility of “behavioral prescriptions” for cognitive-behavioral bibliotherapy with five depressed patients in a primary care setting. Results indicated that final depression self-report scores were lower than baseline and pre-treatment reports for every participant. At three month follow-up, three out of five participants reported no symptoms of depression, one participant reported minimal symptoms of depression, and one participant reported mild symptoms of depression. Behavioral prescriptions for cognitive bibliotherapy warrant further controlled research and may offer a cost-effective and practical treatment alternative to the pharmaceutical intervention of depression in primary care.
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We propose a psychotherapy treatment implementation model whereby adequate levels of independent treatment components (delivery, receipt, and enactment) are prerequisite to asserting whether a valid clinical trial has been conducted. The delivery component refers to the accuracy of treatment presentation, receipt refers to the accuracy of the client's comprehension of treatment, and enactment refers to the extent of out of session application initiated by the client. Clinical scientists regularly address one or two of these components, but rarely all three, according to a survey we report. Sources and effects of model deficits, i.e., inadequate levels of treatment components, as well as methods of component assessment and induction, are discussed. We conclude that faults in any one of the components drain validity proportional to the degree of deficit, and that clinical trials have often incorrectly been considered fair tests, resulting in biased efficacy judgments.
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We conducted a meta-analysis of 40 self-help studies examining 61 treatments which used as control groups no-treatment, wait-list, or placebo comparisons. We found an overall treatment effect size for self-help interventions of 0.76 at posttreatment and an effect size of 0.53 at follow-up. Studies that used a more stringent control group — placebo — had a lower mean effect size than studies utilizing a no-treatment control. No differences were found for unadulterated self-help treatments and those with minimal contact from a therapist or which were in fact therapist-assisted. Some target problems were more amenable to self-help approaches, including skills deficits and diagnostic problems, such as fears, depression, headache, and sleep disturbance. Habit disturbances such as smoking, drinking, and overeating, were less amenable to self-help treatments. Compliance with the treatment regimen was found to improve treatment effects. While effect size was negatively related to duration of treatment, this effect was largely a function of duration being confounded with type of problem. Results were examined from the perspective of problems that are targetable with self-help approaches. Recommendations for improvements in research design for future studies are also made.
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The evidence base for cognitive-behavioural therapy (CBT) for depression is discussed with reference to the review document Treatment Choice in Psychological Therapies and Counselling (Department of Health). This identifies the need to deliver evidence-based psychosocial interventions and identifies CBT as having the strongest research base for effectiveness, but does not cover how to deliver CBT within National Health Service settings. The traditional CBT model of weekly face-to-face appointments is widely offered, yet there is little evidence to support these traditions in the outcome literature. Reducing face-to-face contact by introducing self-help into treatment may be one method of improving access. The SPIRIT course is discussed which teaches how to offer core cognitive-behavioural skills using structured self-help materials.
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The present article presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of per- sonal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of ob- stacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from four principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. The more de- pendable the experiential sources, the greater are the changes in perceived self- efficacy. A number of factors are identified as influencing the cognitive processing of efficacy information arising from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and be- havioral changes. Possible directions for further research are discussed.
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The guided use of selected books as an adjunct to treatment is applicable to patients in all stages of life and with a variety of problems. This paper describes the authors' experience using books as an adjunct to therapy with psychiatric patients. The authors define the term, review the literature, and set out the objectives of bibliotherapy. The paper presents some principles to follow when assigning books, and examples of books used for common problems. Finally, examples are given of bibliotherapy in action at two Ontario hospitals, and some future directions are suggested.
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Data are presented from a survey of 123 practicing psychologists in 36 states concerning attitudes and prescriptive practices with regard to self-help books. Tables are provided indicating those self-help works most frequently read and prescribed by responding psychologists, along with ratings of quality and helpfulness. Results indicate widespread readership and prescription of popularized self-help books among psychologists and a positive evaluation of their utility. Questions as to how and why these works are being used are explored.
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126 community Ss (mean age 39.4 yrs) participated in a 10-wk weight reduction program; 4 groups used a behavioral manual, 4 groups used an alternate manual under varying degrees of therapist guidance, and 1 group served as a delayed-treatment control. Results at posttreatment and 3-, 6-, and 16-mo follow-ups supported the behavioral manual's effectiveness in producing modest weight loss. The manual could be applied under varying degrees of therapist guidance without significant differences in effectiveness, but with increased cost-effectiveness as therapist contact decreased. (7 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Clients seem already to be reading on their own for help with difficult life situations. As nurses we can further help clients by referring them to appropriate literary resources.
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We estimate in dollar terms the economic burden of depression in the United States on an annual basis. Using a human capital approach, we develop prevalence-based estimates of three major cost-of-illness categories: (1) direct costs of medical, psychiatric, and pharmacologic care; (2) mortality costs arising from depression-related suicides; and (3) morbidity costs associated with depression in the workplace. With respect to the latter category, we extend traditional cost-of-illness research to include not only the costs arising from excess absenteeism of depressed workers, but also the reductions in their productive capacity while at work during episodes of the illness. We estimate that the annual costs of depression in the United States total approximately 43.7billion.Ofthistotal,43.7 billion. Of this total, 12.4 billion-28%-is attributable to direct costs, 7.5billion177.5 billion-17%-comprises mortality costs, and 23.8 billion-55%-is derived from the two morbidity cost categories. Depression imposes significant annual costs on society. Because there are many important categories of cost that have yet to be estimated, the true burden of this illness may be even greater than is implied by our estimate. Future research on the total costs of depression may include attention to the comorbidity costs of this illness with a variety of other diseases, reductions in the quality of life experienced by sufferers, and added out-of-pocket costs resulting from the effects of this illness, including those related to household services. Finally, it may be useful to estimate the additional costs associated with expanding the definition of depression to include individuals who suffer from only some of the symptoms of this illness.
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Relatively brief interventions have consistently been found to be effective in reducing alcohol consumption or achieving treatment referral of problem drinkers. To date, the literature includes at least a dozen randomized trials of brief referral or retention procedures, and 32 controlled studies of brief interventions targeting drinking behavior, enrolling over 6000 problem drinkers in both health care and treatment settings across 14 nations. These studies indicate that brief interventions are more effective than no counseling, and often as effective as more extensive treatment. The outcome literature is reviewed, and common motivational elements of effective brief interventions are described. There is encouraging evidence that the course of harmful alcohol use can be effectively altered by well-designed intervention strategies which are feasible within relatively brief-contact contexts such as primary health care settings and employee assistance programs. Implications for future research and practice are considered.