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 Depression  Holistic-online.com

Bibliotherapy

Bibliotherapy or reading therapy is a therapy in which a person suffering from depression reads self-help books and other motivational books in between therapies to speed up the recovery. Several controlled clinical trials have shown that bibliotherapy can give results comparable to that of drug therapy or psychotherapy. Furthermore, patients in bibliotherapy recovered faster from depression than those on conventional therapies; they tend to improve with time, as opposed to the remission observed with those on conventional therapy. They had better outlook on life. Bibliotherapy is also useful as a complementary therapy to speed up the recovery along with conventional therapy.

Bibliotherapy can be administered in one of two ways.

  1. The therapists can "prescribe" a self-help book for their patients to read between therapy sessions to increase the speed of learning and recovery. (complementary therapy)

  2. Individuals suffering from depression or anxiety can be given a self-help book to read as a self-administered treatment without any other drug therapy or psychotherapy. (stand-alone therapy)

First indication of the popularity of bibliotherapy came in a survey conducted in 1994. 500 American mental health professionals were asked if they "prescribed" books for patients to read between sessions to speed recovery. Seventy percent of the therapists polled indicated that they did use "bibliotherapy" with their patients, and 86 percent reported that the books were helpful to their patients.

The effectiveness of stand-alone bibliotherapy was evaluated in five published studies by a team of investigators headed by Dr. Forrest Scogin from the University of Alabama. These researchers evaluated the effectiveness of Dr. David Burns' "Feeling Good" as well as Dr. Peter Lewinsohn's "Control Your Depression," as self-administered treatments for depression. The investigators concluded that Feeling Good was as effective as a full course of individual psychotherapy or as treatment with the best antidepressant drugs.

The researchers noted that to be of significant help, the book must contain sound information about how to overcome depression. For example, those who read a copy of Victor Franki's book entitled "Man's Search for Meaning" had no significant improvement over those who read no book at all. However, those who read Dr. David Burns' Feeling Good book had shown statistically significant improvement. The Feeling Good book has a wealth of information about Depression in general and offers recommendation on how to cope with depression.

Interestingly, the mood scores of the patients who read Feeling Good were not significantly different at the follow-up evaluation two months later. They maintained their gains, and did not have relapse at the end of a two month period.

Next, investigators tried to determine whether bibliotherapy will have any lasting value in controlling depression and its effectiveness in treating people with major depression with additional clinical trials. 
The investigators selected 80 patients for this study and randomly assigned them two groups. The patients in the first group were given a copy of "Feeling Good" and were encouraged to read it within four weeks. This group was called the Immediate Bibliotherapy Group. The patients in the second group were told that they would be placed on a four-week waiting list before beginning treatment. This group was called the Delayed Bibliotherapy Group and served as a control group.

The depression levels of the two groups were similar at the beginning of the study as measured by standard depression tests. The average scores for both groups were around 20 or above indicating that they were similar to patients in most controlled-outcome studies of antidepressants or psychotherapy.
At the end of the four weeks the two groups were compared. The patients in the Immediate Bibliotherapy Group improved considerably. The average scores were around 10 or below, showing that they are not considered depressed anymore. The changes in depression were statistically and clinically significant. These patients also maintained their gains at the three- month evaluation and did not relapse. In fact, there was a tendency for continued improvement following the completion of the "treatment." The scores on depression tests were lower at the three- month evaluation.

In contrast, the patients in the Delayed Bibliotherapy Group (control group) barely changed, remaining around 20 at the four-week evaluation. This showed that the improvement from bibliotherapy was not just due to the passage of time. The control group was then given a copy of "Feeling Good" and were asked to read the book during the second four weeks of the study. Their improvement in the next four weeks was similar to that in the Immediate Bibliotherapy Group during the first four weeks. Interestingly, both groups did not relapse but maintained their gains at the three- month evaluation.

The results of this new study confirmed that bibliotherapy appeared to have substantial and lasting antidepressant effects. The investigators noted that at the end of the first four-week period, 70 percent of the patients in the Immediate Bibliotherapy Group no longer met the criteria for a major depressive episode (based on DSM IV criteria). In contrast, only 3 percent of the patients in the Delayed Bibliotherapy Group recovered during the first four weeks. At the three-month evaluation, when both groups had bibliotherapy, 75 percent of the patients in the Immediate and 73 percent of the patients in the Delayed Bibliotherapy Groups no longer qualified for a diagnosis of major depressive episode according to DSM criteria.

Another interesting aspect of this study was the magnitude of the depression reduction from bibliotherapy. In a large National Institute of Mental Health Collaborative Depression study, there was an average reduction in the Hamilton depression test of 11.6 points in the patients who received cognitive behavioral therapy from highly trained therapists for 12 weeks. This was very similar to the 10.6 point change observed in the patients who received bibliotherapy in the clinical trial after just four weeks. Thus, the amount of improvement in the bibliotherapy treatment appeared to be comparable to other current treatments. However, bibliotherapy seemed to work significantly faster.

A big problem with the drug therapy and other conventional therapies for depression is the drop out rate. Patients simply quit taking medication or go for therapies and slowly the depression shows up back. Significantly, the percentage of patients who dropped out of the bibliotherapy studies was very small (10 percent) as compared to the published outcome studies using drugs or psychotherapy, which typically have dropout rates from 15 to over 50 percent. The patients developed significantly more positive attitudes and thinking patterns after bibliotherapy. The bibliotherapy helped the patients to defeat depression by changing the negative thinking patterns that caused it.

The researchers concluded that the bibliotherapy was effective not only for patients suffering from depression, but it might also have a significant role in public education and in depression-prevention programs. They speculated that bibliotherapy might help prevent serious episodes of depression among individuals with a tendency toward negative thinking and mild levels of depression.

In 1997, the investigators did a three-year follow-up study of the patients. The patients had been found to maintain their mood improvement gains during this three- year period and did not have any relapse. Many of the patients (58 percent) said that their moods continued to improve following the completion of the initial study. 72 percent of the patients still were free of clinical depression (failed the criteria for a major depressive episode), and 70 percent had not sought or received any further treatment with drug therapy or psychotherapy during the follow-up period.

A 70 percent recovery rate is similar to the improvement rates reported for antidepressant medications as well as for cognitive behavioral therapy and for interpersonal therapy. Thus, at least in this experiment, bibliotherapy gave comparable rates to antidepressant therapy, cognitive behavioral therapy or interpersonal therapy.

Patients with more severe or chronic depressions need the help of a therapist and possibly an antidepressant medication in addition to bibliotherapy. Bibliotherapy is an effective complementary therapy for depression and can give results similar to drug therapy and psychotherapy. Cognitive bibliotherapy can be used between therapy sessions to speed the recovery from depression.

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