Is Bibliotherapy Effective? Is it Evidence-based?

What is Bibliotherapy?

Bibliotherapy is the use of books and reading materials as a therapeutic tool to address mental health issues. Its main advantages are ease of use, low cost, low staffing demands, and greater privacy. Here is a more in-depth article on bibliotherapy, what it is and how it works: Bibliotherapy: The Magical Healing Quality of Literature and also the following article discusses the tools and techniques available: Bibliotherapy Techniques - What Are They and Do They Work?

How Does Bibliotherapy Work?

Book Therapy’s online Bibliotherapy, Literature and Mental Health course takes you on a step-by-step course to show you how bibliotherapy works, the various tools and techniques available, how it serves as an adjunct to psychotherapy and counselling, why it supports cognitive behavioural therapy (CBT), resources and book recommendations available, plus tonnes more.

Is Bibliotherapy Effective? Is it Evidence-based?

The effectiveness of bibliotherapy can depend on various factors, such as the individual's specific needs and the quality of the reading material used. However, research suggests that bibliotherapy can be effective in treating a range of mental health conditions.

Effectiveness of Bibliotherapy in Reducing Symptoms of Anxiety and Depression in Children

For example, a systematic review published in the Journal of the American Academy of Child and Adolescent Psychiatry in 2016 found that bibliotherapy can be effective in reducing symptoms of anxiety and depression in children and adolescents. Depression and anxiety are the most common mental disorders in children and adolescents. The children, with the help of parents, applied the methods in the following self-help books, Helping Your Anxious Child: A Step-by-Step Guide that helped build anxiety management skills and Feeling Good that offers self-administered strategies of cognitive behavioural therapy for depression, to self-manage their symptoms of depression and anxiety.

Bibliotherapy is often used as a complement to other therapeutic approaches, such as cognitive-behavioral therapy and psychotherapy. It can also be a useful self-help tool for individuals who are not able to access traditional therapy or who prefer to work on their mental health on their own.

Effectiveness of Bibliotherapy for Depression & Anxiety in Adults

A meta-analysis published in the Journal of Consulting and Clinical Psychology in 2015 reviewed 29 studies that used bibliotherapy for the standalone treatment of depression in adults across 2,061 adults. The analysis found that bibliotherapy was showed a significant reduction in depression on a standalone basis and was equally as effective as face-to-face therapy or group therapy. The results also indicated that bibliotherapy may be more effective when the reading material is specifically designed for depression including both reading and writing therapies rather than general self-help books. The studies used a variety of different measures to assess depression, such as the Beck Depression Inventory and the Center for Epidemiologic Studies Depression Scale. This suggests that bibliotherapy can be a viable treatment option for individuals with depression who may not have access to or prefer not to pursue traditional forms of therapy.

Effectiveness of bibliotherapy for children with intellectual disability

In 2015, a study was undertaken in Tehran, Iran to determine whether bibliotherapy can help children with intellectual disability. Participants were selected among the students of four primary schools in Tehran. They received, for 3 years, a special bibliotherapy intervention provided by the public library in cooperation with a team of experts; The bibliotherapy sessions were held once a week during the academic year. The study found that bibliotherapy was effective in improving the children's social skills, communication skills, and emotional understanding. The researchers also found that the use of bibliotherapy was associated with improvements in the children's overall emotional wellbeing.

Effectiveness of bibliotherapy for children with a sibling with a disability

Growing up with a sibling who has a disability presents children with unique challenges and experiences that can impact their emotional wellbeing. As a result of the varying situations that arise due to their sibling's condition, these children may struggle to articulate their emotions or experience confusion. Bibliotherapy is an intervention that has been found to be helpful in enabling children to identify and express their feelings, as well as discover ways to cope with them. A study conducted by Dawn DeVries and Susan Sunden in 2019 provides evidence to support the identified benefits of bibliotherapy and further emphasizes the importance of creating opportunities for these children to interact with peers who are in similar situations and to have a safe space to express their feelings to supportive adults.

How Developmental Bibliotherapy Can Positively Affect Self-Care Behaviors

Developmental bibliotherapy is primarily utilized in educational or community environments to assist individuals, both children and adults, in coping with common life concerns.

Bibliotherapy: A Strategy to Help Students With Bullying

Gregory and Vessay illustrate how school nurses can utilize bibliotherapy to aid children in confronting issues of bullying. 

School nurses were encouraged to explore the use of bibliotherapy as an innovative method to address childhood teasing and bullying and promote a healthy school environment. Children's literature provides a unique communication channel between parents, teachers, and children.

Bibliotherapy encompasses three phases: identification, catharsis, and insight. Following the children's exposure to a fictional tale about teasing and bullying, children shared their personal non-fictional experiences with this distressing issue and acquired effective coping strategies to manage teasing and bullying situations that occur in schools.

Bibliotherapy to encourage self-care and self-management skills of the elderly

A study conducted by Frieswijk et al. in 2006 showed the beneficial impact of bibliotherapy on the self-care behaviors of somewhat fragile seniors residing in the community, thereby reducing their likelihood of being institutionalized in the future.

As the Swiss author Henri Frederic Amiel said: ‘‘To know how to grow old is the master work of wisdom, and one of the most difficult chapters in the great art of living’’   Successful aging requires proactive resource management in the face of diminishing returns and increasing losses. In contemporary society, managing one's own aging process has become increasingly vital due to medical and social advancements that have extended the number of healthy post-retirement years. However, this stage of life lacks clear social roles and structure, necessitating proactive efforts to give it meaning. Self-management interventions can equip older individuals with the necessary abilities. Additionally, with a growing elderly population and healthcare cutbacks, increasing the self-management abilities of older people could alleviate some of the burden on the healthcare system. Higher self-management ability enables older individuals to maintain their independence for a longer time. In this study, researchers created a bibliotherapy programme specifically tailored for slightly to moderately frail older individuals (who are at risk of loneliness, depression, risk of falling and insomnia, chronic conditions, aimed at improving their self-management abilities so that they could enjoy social well-being (receive sufficient affection (acceptance of who they are) and enjoy a healthy level of status (what they do).

Participants were asked to participate in a correspondence course that focused on reading about examples of how fictitious characters found activities around self-management to be helpful for their psychological, physical and social well-being. The participants were then asked to engage in creative bibliotherapy by taking initiative, setting their own goals for self-care, cultivating hope and faith that they will be able to do some of the more challenging self-care tasks, building small habits to allow them to achieve these goals and committing to an action plan. Participants were also also to consider substitutes to activities and people that they enjoyed seeing which they may no longer be able to. The results were remarkable, and in this respect Bibliotherapy is a great prevention tool to prevent further aging and cognitive decline that is affordable and effective and can be completed daily, plus they could re-read the texts/literary interventions as needed so that they would always have something to draw on to motivate them.

Poetry Therapy: The Use of Poetry in Heart Attack Patients with Anxiety and PTSD

Patients often suffer from anxiety following a heart attack, while Stein et al. (2018) noted that conditions such as anxiety and post-traumatic stress disorder can also arise. These emotional responses are thought to stem from the pain experienced during the heart attack and the perception of the threat to life (death phobia). 

A study was conducted by health specialists in Iran to evaluate the impact of poetry on reducing anxiety and PTSD in heart attack patients. Poetry therapy was offered during four 45-minute sessions in a week. The poems were read two or three times, and the patients were encouraged to discuss specific concepts and semantics, as well as their communication with the poem, verse, or theme.

The poems were selected based on specific criteria, such as their language, emotion, and perceptible concepts, and were chosen from Persian-language poetry. Short, high impressive, and exhilarating poems were used, and were selected based on their rhythm, fluency, and personal interest.

The Benefits of Bibliotherapy 

Reading offers numerous benefits for both personal and intellectual development. Here are some of the key benefits of reading:

1. Mental Stimulation: Reading challenges your mind, keeping it active and engaged. It also helps to improve your memory and cognitive abilities.

2. Knowledge: Reading exposes you to a wide range of information, ideas, and perspectives, which can broaden your understanding of the world and deepen your knowledge on various topics.

3. Vocabulary: Reading is an excellent way to improve your vocabulary and language skills. The more you read, the more words you will be exposed to, and the better your language skills will become.

4. Relaxation: Reading can be a great way to unwind and reduce stress. It can help you escape from the pressures of daily life and transport you to other worlds.

5. Empathy and Understanding: Reading exposes you to a variety of perspectives and experiences, which can help you develop greater empathy and understanding for others.

6. Improved Focus and Concentration: Reading requires focus and concentration, which can help you develop these skills and improve your ability to stay focused on tasks.

7. Better Writing Skills: Reading can improve your writing skills by exposing you to different writing styles and techniques.

The Mental Well-being Benefits of Bibliotherapy

There are also several studies that support the mental wellbeing benefits of reading. Here are some examples:

1. A study published in the journal Social Science & Medicine found that reading for just six minutes can reduce stress levels by up to 68%.
2. A study published in the journal PLOS ONE titled How Does Fiction Reading Influence Empathy? found that reading can improve empathy and understanding of others' mental states.

3. A study published in the journal Neurology found that reading and other mentally stimulating activities can delay the onset of cognitive decline in older adults.

4. A study published in the journal Sleep Medicine found that reading before bed can improve sleep quality by reducing stress and promoting relaxation.

5. A study published in the Journal of Frontiers for Public Health found that reading can help to reduce symptoms of anxiety, depression, sleep issues and burnout during the Covid-19 pandemic, having a positive impact on our mental health.

Overall, these studies provide evidence that reading can have a significant positive impact on mental wellbeing, including reducing stress, improving empathy, delaying cognitive decline, improving sleep, and reducing symptoms of anxiety and depression.

If you enjoyed reading this you might find Book Therapy’s online Bibliotherapy, Literature and Mental Health course helpful. If you're interested in a bibliotherapy session, do get in touch here.

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