There are times on the podcast when I come across very interesting and very, very surprising research. Today’s topic definitely came from one of these great finds, and I want to share it with you because it is so fascinating that I’m sure we will all learn a lot today. If you’re interested in clinical psychology then definitely read on!
This episode has been sponsored by Formulation In Psychotherapy. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it.
Why Even Look At Bibliotherapy?
Before I explain what Bibliotherapy is, I want to mention first why people are getting interested in exploring such an old approach to therapy. And it mainly comes down to when we are looking for mental health interventions we are always looking for approaches that are scalable. This means we need interventions that can be provided effectively to a lot of people at the same time, and ideally at a low cost.
There are a lot of reasons why scalability is important. For example, economic reasons are very important, especially when the future of many economies look negative for the foreseeable future which means government cutbacks are inevitable. Other factors are moral. As well as mental health is a global health problem and there are nowhere near enough mental health practitioners to provide individual treatment to everyone who needs it.
Additionally, when people tend to think about scalability, the argument tends to turn towards thinking about new technologies. Such as, guided apps or using Artificial Intelligence to provide people with interactions like those given by a therapist.
Personally, as a part of my placement year at the time of writing, I looked at the effects and effectiveness of mobile mental health apps. As part of new behavioural interventions and it is interesting, but the paragraph below is very valid from personal experience.
However, whilst these technologies are very exciting. There is a very real risk the appeal of their novelty does in fact tend to overshadow the usefulness of older technologies.
And that’s where Bibliotherapy comes in.
What Is Bibliotherapy?
In its most basic form, Bibliotherapy is book therapy where clients are given a specialised workbook to work through their difficulties and improve their mental health. Originally, this was started in 1980 by David Burns who published a book that introduces readers to Cognitive Behavioural Therapy for the treatment of depression.
Then over the decades there have been other guided books published that produced CBT for a range of conditions, and new types of therapies too. For example, there are books for Dialectical Behavioural Therapy and Acceptance and Commitment Therapy.
Resulting in Bibliotherapy being a realistically available treatment option for a lot of people.
What Is The Case For Bibliotherapy?
Nonetheless, despite the amount of research highlighting the effectiveness of Bibliotherapy, it hasn’t been readily adopted.
For instance, there were some very rigorous studies conducted in 1980 where Bibliotherapy was used as a control group compared to more intensive forms of therapy. But there was a massive problem for the researchers, the Bibliotherapy therapy group did just as well as the more intensive group of participants.
Now this wasn’t because the intensive therapies were bad. It was because Bibliotherapy was so good.
Then other studies have confirmed this in more recent years. Like a meta-analysis from 2004 compared the effects of cognitive Bibliotherapy for depression, and in-person cognitive behavioural therapy. The results showed Bibliotherapy was just as good as the in-person therapy. As well the authors noted that there was no additional benefit to in-person therapy compared to Bibliotherapy.
That’s just amazing to me. Because I know from my Police Psychology book, book forms of the cognitive interview can be highly effective, but until now I hadn’t connected book forms to therapy. This just shows the importance of always trying to push the boundaries of what we are currently doing as psychologists.
Furthermore, generally speaking, the vast majority of research into Bibliotherapy has highlighted its positive effects, with the only main source of disagreement being the size and source of these effects.
Therefore, some researchers have proposed that giving clients with common mental health conditions an appropriate book, with some but not much supervision, can be just as effective as individual psychotherapy.
Now before we go on, let’s just imagine what this claim would mean for mental health services. Instead of having a maximum capacity that you cannot go over whatsoever. This has the potential to free you up, because if you’re full up and thirty people come to you with mild depression. Normally you would have to send them away and add them to a waiting list.
Resulting in them not being helped and their conditions would get worse. But with
Bibliotherapy, you would almost certainly be able to treat them.
That’s great!
Of course, there will always be some details to work out. Like, what mental health conditions does it apply to? There is thankfully a good case for mild depression, but it wouldn’t be as effective for more serve conditions.
Then you could question how precisely close is Bibliotherapy compared to individual therapy in effectiveness? Amongst other questions.
However, even with these questions, I think it is safe to say Bibliotherapy could transform mental health services.
Another Three Possible Implications:
Additionally, Bibliotherapy does have some other implications for mental health. Which I think are very important to talk about now.
Firstly, Bibliotherapy could be a great control group or at least an option to compare the evaluation of new technologies. Due to new technologies are often compared to individual therapies because these tend to be more cost-effective and scalable.
However, those two comparisons aren’t always the most important comparison points, because books are relatively cheap so it almost destroys the cost-effective argument.
Therefore, the most important question for these new technologies aren’t are they better than a therapist? But are they better than a book?
It definitely adds a new interruption of the pen is mightier than the sword!
Secondly, it could make us slightly more questioning of highly personalised forms of psychotherapy. Since if we want to provide mental health care for a lot of people having it manualised is very helpful as it helps with scalability. Then it is even better if we can just give the clients the manual to the therapy itself.
Personally, I was rather shocked when I read this, because if you’re been listening to the podcast for a while, you know I am a massive supporter of formulation. This area focuses on personalised therapies, but I now believe there is room for both. There is a room for manualised therapies for the more mild mental health conditions when that is effective, but personalised therapies are needed for where Bibliotherapy and others fail to be effective.
There is room for both in my opinion.
Finally, if you’re interested in addressing the global mental health crisis. Then books could be extremely useful because they’re cheap and easy to distribute, and they are very effective.
Therefore, this is definitely an option we could look to investigate more and leverage.
Conclusion:
Of course Bibliotherapy is definitely not a cure-all type of therapy and there are some limitations. Yet Bibliotherapy is supported by a lot of evidence, but of course a lot more is needed if Bibliotherapy is ever going to go into the mainstream. As well as there is still a universality problem that greatly limits Bibliotherapy on the global stage.
For Bibliotherapy to work, it needs people who are able to read, and thankfully tons of people around the world can read and write. But the global literacy rate is only around 85%, and in most developing countries (where therapy is needed most) it is closer to 60% to 70%, so that is a lot of people in possible need that cannot use Bibliotherapy in the slightest.
So to wrap up today’s episode, I think there is a lot of potential for Bibliotherapy because of the current research and the scalability of it all. Bibliotherapy has the potential to help tons of people who currently don’t receive any treatment.
The future could be very bright indeed. Especially if we look to both newer and older forms of technology.
I really hope you have enjoyed today’s clinical psychology podcast episode.
If you want to learn more, please check out:
Formulation In Psychotherapy. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it.
Have a great day!
Clinical Psychology References:
Gregory, R. J., Schwer Canning, S., Lee, T. W., & Wise, J. C. (2004). Cognitive Bibliotherapy for Depression: A Meta-Analysis. Professional Psychology: Research and Practice, 35(3), 275–280.
https://doi.org/10.1037/0735-7028.35.3.275
Cuijpers, P. (1997). Bibliotherapy in unipolar depression: a meta-analysis. Journal of behavior therapy and experimental psychiatry, 28(2), 139-147.
"Literacy Statistics Metadata Information Table". UNESCO Institute for Statistics. September 2015. Archived from the original on 2 June 2017. Retrieved 19 November 2015.
https://www.psychologytoday.com/us/blog/philosophy-and-therapy/202203/the-case-bibliotherapy
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