The Effect of Bibliotherapy on Depression 1 Running head: THE EFFECT OF BIBLIOTHERAPY ON DEPRESSION

This paper undertakes a non-exhaustive literature review of the use of bibliotherapy in the treatment of a single mental health condition – that of depression. Ten papers reporting on empirical studies were selected from this body of research. Various parts of these studies are compared and contrasted with each other in an effort to reach a thorough understanding of the benefits and limitations in the use of bibliotherapy as an intervention for depression. The full integrative paper includes the author’s personal reflections on her learning while completing a Master’s Degree at the Adler Graduate School. Many facets of coursework, internship experiences, and independent readings and trainings are examined for their impacts on the author’s professional and relevant personal development. An electronic and a bound copy are presented to the school’s library as part of its permanent record. According to school policy, it omits the portions including the author’s evaluations of the internships she completed and her examination of her development as a psychotherapist. The Effect of Bibliotherapy on Depression 3 The Effect of Bibliotherapy on Depression According to the World Health Organization, depression is the leading cause of disability and the fourth leading contributor to the global burden of disease in 2000 (WHO: Depression, n.d.). In the U.S. alone, the economic burden of depression was calculated to cost more than 83 billion dollars in 2000 (Greenberg, Kessler, Birnbaum, Leong, Lowe, Berglund, & Corey-Lisle, 2003). The scope of this problem is difficult to conceive. There are many factors which limit access to treatment of depression. Cost, convenience, and unwillingness to seek treatment in a mental health setting are all factors which can potentially be addressed through the use of bibliotherapy. Measurably useful methods that are also effective and cost-efficient are more and more being looked to as one response to the increasing pressures of managed care and increasing health care costs. The purpose of this paper is to explore the effect of using bibliotherapy (sometimes referred to as cognitive bibliotherapy) for the treatment of depression. Several studies of this intervention are reviewed and the benefits and pitfalls discussed. Comparison is made between numerous aspects of these studies including such factors as the time period involved, assessments used, participation criteria, treatment parameters, outcome findings and research design, among others. This paper is not intended to be an exhaustive literature review of all studies published on this topic. Not covered is any detailed consideration of the statistics used, nor is any meta-analysis performed on the findings. For the scope of this paper bibliotherapy is defined as the use of written materials expressly created with the intent of alleviating symptoms of depression in persons suffering from this illness. Many books are written about depression or in an attempt to help a person ameliorate his or her own depressed state. However, the studies considered distinguish between books that The Effect of Bibliotherapy on Depression 4 are primarily inspirational or informational and books which take as their main objective selfadministered course of treatment of depression. Additionally, though several computer programs have been created with the aim of treating people suffering from depression, they are not considered here. Although both types of interventions are meant to be read as well as typically based on a cognitive-behavioral framework, the use of computer-based treatments is a separate (though certainly related) field and has its own growing body of research. Finally, there are several studies of bibliotherapy for depression in combination with another mental or medical condition. Consideration of those studies is not undertaken here. Bibliotherapy in the Treatment of Depression Bibliotherapy treatment has been explored as a potential treatment for several mental disorders. The condition that has been studied most extensively in this context is depression. In all the studies considered here there were no findings of adverse effects from treatment with bibliotherapy. Furthermore, efficacy is demonstrated for several age groups and over varying time periods of treatment and post-treatment. In an early study in this area, Scogin, Hamblin and Beutler (1987) used three treatment conditions to investigate the efficacy of bibliotherapy for the amelioration of symptoms in mild to moderately depressed older adults. The bibliotherapy treatment condition was assessed three times over a two-month program. The first month was active treatment and there was a posttreatment follow-up one month later. The other two conditions consisted of a delayed condition which received the same treatment staggered one month behind the immediate treatment condition and an attention control treatment group. Of 29 original participants 60 years of age or older, only 20 completed the study – a sample too small to be generalizable. Although there was no significant relationship found between age or severity of depression on completion of the The Effect of Bibliotherapy on Depression 5 program, there was a correlation found between less education and lower socio-economic status and likelihood of dropping out of the study. This suggests characteristics that warrant further study as possible predictors of a candidate’s potential success in using bibliotherapy for depression. In a similar study seeking to expand on the findings of the 1987 study, Scogin, Jamison and Gochneaur (1989) conducted a comparison of cognitive bibliotherapy and behavioral bibliotherapy with mildly and moderately depressed older adults. Both bibliotherapy treatment groups made use of a self-help text; one employing cognitive therapy for the cognitive bibliotherapy group and the behavioral bibliotherapy group using a book based on a behavioral therapy approach. A delayed-treatment condition served as a control. Both versions of bibliotherapy were found to be efficacious, with no significant difference between them. The delayed treatment condition showed the same pattern of results as the preceding cohort. Scogin continues to be one of the most prolific researchers in the area of bibliotherapy treatment for depression. In 2004, he and colleagues extended the research on depressed older adults’ response to bibliotherapy by comparing treatment outcomes of individual psychotherapy and bibliotherapy and attempting to discover if one of these treatments is more effective than the other (Floyd, Scogin, McKendree-Smith, Floyd and Rokke). A delayed-treatment control condition was also present in this study. One finding that was unexpected was that while individual psychotherapy appeared to be superior at the time of post-treatment assessment, bibliotherapy participants continued to improve, and significant differences between the groups disappeared at the time of the three-month follow-up. In a further expansion of the investigation on the effect of bibliotherapy on depression, Bowman, Scogin and Lyrene (1995) completed a study weighing participant outcomes in each of The Effect of Bibliotherapy on Depression 6 three treatment conditions: bibliotherapy, self-examination therapy and a wait list control. The self-examination treatment condition consisted of giving participants a short booklet of guided activities for determining relevant topics in their lives and a flow-chart format for addressing their difficulties. The researchers’ hypothesis that bibliotherapy would demonstrate greater efficacy than self-examination therapy was not supported by their findings. Both treatment groups measured gains that were equally efficacious and gains were maintained at the one-month post-treatment follow-up. Control group participants, which were randomly assigned one of the two treatment groups after the one-month waiting period showed comparable gains as the original treatment groups. Likewise, in 1991, Wollersheim and Wilson undertook to contribute to this growing body of research and evaluated the comparative efficacy of contrasting treatment approaches for unipolar depression. In this study four treatment groups were used: coping group therapy, supportive group therapy, individual bibliotherapy using a self-help book describing how to use the principles of coping therapy, and delayed treatment. Their findings indicated significant improvement in all treatment conditions with the highest alleviation in the coping group treatment and bibliotherapy conditions. During the post-treatment to six-month follow-up period the coping group therapy participants showed additional and greater improvement than the other