Bibliotherapy: Process, Benefits, Effectiveness

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Bibliotherapy: Process, Benefits, Effectiveness

THC Editorial Team May 22, 2021
Photo by Suad Kamardeen on Unsplash (article on bibliotherapy)
Photo by Suad Kamardeen on Unsplash

Contents

What Is Bibliotherapy?

Bibliotherapy is a creative arts therapy that uses literature and reading to assist individuals facing personal challenges and promote mental well-being. In this cost-effective form of therapy, books and stories are used in the therapeutic process and provide individuals with support, insight, self-awareness, understanding, guidance, or reassurance.1 Numerous genres of literature, including fiction, nonfiction, poetry, and self-help manuals, can be used in this form of treatment.

There are two primary forms of bibliotherapy: developmental bibliotherapy and clinical bibliotherapy.

Developmental bibliotherapy

  • This is primarily used for children, usually takes place in an educational setting or at home, and may involve teachers, librarians, and parents. This form of bibliotherapy aims to facilitate the child’s normal social development and provide the child with the resources and space to talk through and feel their emotions. Literature is used to educate children about feelings and behaviors and how to navigate and process them as they develop.2

Clinical bibliotherapy

  • This is used as an intervention for adults who are struggling with their mental health. This form of bibliotherapy involves a trained mental health or healthcare practitioner who uses literature to stimulate discussion of complicated feelings or facilitate the resolution of significant behavioral and emotional issues.3 Despite its potential benefits, clinical bibliotherapy is rarely used alone but rather is used as an adjunct to other therapeutic interventions.4

What Is the History of Bibliotherapy?

The use of literature as a healing method can be traced back to ancient Greece, when libraries were considered sacred places with the ability and power to cure.5 However, the term “bibliotherapy” was coined by American minister and essayist Samuel McChord Crothers in 1916. Crothers proposed and explained how literature could be used to counsel those who have mental conditions.4 During World War I and II, bibliotherapy was used to help returning soldiers deal with emotional wounds and trauma.5 In 1940, bibliotherapy gained more recognition when formally defined in Dorland’s Illustrated Medical Dictionary, a popular English-language medical reference book.4 Since then, bibliotherapy has become a widely used therapeutic intervention.

How Bibliotherapy Works – The Therapeutic Process

Since bibliotherapy can take on many forms and take place in various settings, there is no specific method of conducting it. Bibliotherapy can be as simple as assigning an individual a book to read. However, common bibliotherapy methods include reading books and then reflecting on them, usually through discussion with a trained individual who is able to break down the client’s thoughts and feelings about the text.6 It can also take place in a group therapy setting with other individuals experiencing similar issues.

Various texts can be used in bibliotherapy; thus, approaches to selecting the texts are also diverse. Self-help books are usually chosen by mental health professionals who have a background in psychology or psychiatry, while fiction and poetry are generally selected by scholars of English literature, librarians, and the clients themselves.Approaches to working with these different texts are also wide-ranging.1

The therapeutic process involved in bibliotherapy can be condensed into four main steps:

  1. Recognition or personal identification: The reader experiences a sense of familiarity with a theme or idea or identifies with a particular character.7 The latter is a central premise in developmental bibliotherapy with children.6
  2. Examination: The reader digs deeper into the issues they relate to in the book and begins to identify and react emotionally, potentially leading to psychological catharsis.7
  3. Juxtaposition: The reader, with the help of a therapist or other trained professional, develops a deeper understanding of and insight into how and why they relate to aspects of the text and feel the emotions evoked by the text.7
  4. Self-application: The reader incorporates the insights gained into their own life.7

Potential Benefits of Bibliotherapy

Research has shown that bibliotherapy results in numerous benefits with regard to mood, behavior, and general life functioning, including the following:

  • reduced depressive symptoms8
  • strengthened prosocial behaviors in children9
  • reduced internalizing and externalizing problems in children9
  • improved engagement and social interaction in older adults10
  • improved quality of life10
  • decreased perceived stress11
  • improved resilience11
  • improved mindfulness11

Additionally, studies have shown that the following conditions are improved by bibliotherapy:

Effectiveness of Bibliotherapy

Although bibliotherapy is a widely used, longstanding intervention, the research that has been conducted on its efficacy is not as strong as one would imagine. Effectiveness has been determined in specific populations; however, expanding these studies to further populations while focusing on a broader array of mental health conditions would strengthen the existing data.

Regardless of this, the studies that have focused on bibliotherapy so far display promising results, especially in cases where bibliotherapy is used as an adjunct treatment.

  • In 1999, Evans et al. studied the impact of manual-assisted cognitive behavioral therapy, or MACT, which was essentially a combination of traditional cognitive behavioral therapy (CBT) and bibliotherapy, on 34 patients who had recently performed a deliberate act of self-harm. MACT effectively reduced the rate of suicidal acts and depressive symptoms.15
  • In 2003, Apodaca and Miller conducted a meta-analysis of 22 studies involving self-help materials and found that bibliotherapy had a small to medium effect in reducing harmful drinking.13
  • In 2004, a team of British researchers conducted a pilot study analyzing the effect of 12 weekly sessions of 30-minute duration with a therapist who assisted clients with obsessive compulsive disorder (OCD) in using self-help materials. This intervention resulted in improved clinical outcomes in patients with OCD.14
  • In 2015, Montgomery and Maunders carried out a systematic review of multiple studies indicating that bibliotherapy improved internalizing, externalizing, and prosocial behavior in children aged 5 to 16. However, these effects were small to moderate in size.9
  • In 2015, James et al. reviewed six studies with a combined total of 426 participants and determined that bibliotherapy was as effective as CBT.17
  • In 2017, Gualano et al. conducted a systematic review of 18 randomized clinical trials. They determined that bibliotherapy was effective in reducing long-term symptoms of depression as well as potentially decreasing the need for further medication.8

Overall, bibliotherapy appears to be a convenient, straightforward, and cost-effective intervention. As previously mentioned, its effectiveness is increased when paired with an evidence-based psychotherapeutic intervention; however, it can still be beneficial when used independently.

References

  1. Brewster, L., & McNicol, S. (2020). Bibliotherapy in practice: A person-centered approach to using books for mental health and dementia in the community. Medical Humanities. Advance online publication.
    https://doi.org/10.1136/medhum-2020-011898
  2. Suvilehto, P., Kerry-Moran, K. J., & Aerila, J. A. (2019). Supporting children’s social and emotional growth through developmental bibliotherapy. In Story in children’s lives: Contributions of the narrative mode to early childhood development, literacy, and learning (pp. 299–314). Springer, Cham.
    https://doi.org/10.1007/978-3-030-19266-2
  3. McMillen, P. S. (2006). A therapeutic collaboration: The Bibliotherapy Education Project at Oregon State University. OLA Quarterly, 12(2), 14–15.
  4. McCulliss, D. (2012). Bibliotherapy: Historical and research perspectives. Journal of Poetry Therapy, 25(1), 23–38.
    https://doi.org/10.1080/08893675.2012.654944
  5. Windhorse Integrative Mental Health. (n.d.). Saved by the book. Retrieved April 20, 2021, from
    https://www.windhorseimh.org/saved-by-the-book/
  6. Lucas, C. V., & Soares, L. (2013). Bibliotherapy: A tool to promote children’s psychological well-being. Journal of Poetry Therapy, 26(3), 137–147.
    https://doi.org/10.1080/08893675.2013.823310
  7. Hynes, A. M., & Hynes-Berry, M. (1986/1994). Bibliotherapy- The interactive process: A handbook. North Star Press.
  8. Gualano, M. R., Bert, F., Martorana, M., Voglino, G., Andriolo, V., Thomas, R., Gramaglia, C., Zeppegno, P., & Siliquini, R. (2017). The long-term effects of bibliotherapy in depression treatment: Systematic review of randomized clinical trials. Clinical Psychology Review, 58, 49–58.
    https://doi.org/10.1016/j.cpr.2017.09.006
  9. Montgomery, P., & Maunders, K. (2015). The effectiveness of creative bibliotherapy for internalizing, externalizing, and prosocial behaviors in children: A systematic review. Children and Youth Services Review, 55, 37–47.
    https://doi.org/10.1016/j.childyouth.2015.05.010
  10. DeVries, D., Bollin, A., Brouwer, K., Marion, A., Nass, H., & Pompilius, A. (2019). The impact of reading groups on engagement and social interaction for older adults with dementia: A Literature review. Therapeutic Recreation Journal, 53(1).
    https://doi.org/10.18666/TRJ-2019-V53-I1-8866
  11. Sharma, V., Sood, A., Prasad, K., Loehrer, L., Schroeder, D., & Brent, B. (2014). Bibliotherapy to decrease stress and anxiety and increase resilience and mindfulness: A pilot trial. Explore, 10(4), 248–252.
    https://doi.org/10.1016/j.explore.2014.04.002
  12. Jahanpour, F., Armoon, B., Mozafari, N., Motamed, N., Poor, D. I., & Mirzaee, M. (2019). The comparison of the effect of poetry therapy on anxiety and post-traumatic stress disorders in patients with myocardial infarction. Journal of Poetry Therapy, 32, 214–222.
    https://doi.org/10.1080/08893675.2019.1639884
  13. Apodaca, T. R., & Miller, W. R. (2003). A meta-analysis of the effectiveness of bibliotherapy for alcohol problems. Journal of Clinical Psychology, 59(3), 289–304.
    https://doi.org/10.1002/jclp.10130
  14. Lovell, K., Ekers, D., Fulford, A., Baguley, C., & Bradshaw, T. (2004). A pilot study of a self-help manual with minimal therapist contact in the treatment of obsessive-compulsive disorder. Clinical Effectiveness in Nursing, 8(2), 122–127.
    https://doi.org/10.1016/j.cein.2004.05.004
  15. Evans, K., Tyrer, P., Catalan, J., Schmidt, U., Davidson, K., Dent, J., Tata, P., Thornton, S., Barber, J., & Thompson, S. (1999). Manual-assisted cognitive-behaviour therapy (MACT): A randomized controlled trial of a brief intervention with bibliotherapy in the treatment of recurrent deliberate self-harm. Psychological Medicine, 29(1), 19–25.
    https://doi.org/10.1017/s003329179800765x
  16. Mehdizadeh, M., & Khosravi, Z. (2019). An inquiry into the effectiveness of bibliotherapy for children with intellectual disability. International Journal of Developmental Disabilities, 65(4), 285–292.
    https://doi.org/10.1080/20473869.2018.1466509
  17. James, A. C., James, G., Cowdrey, F. A., Soler, A., & Choke, A. (2015). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews, 2015(2), CD004690.
    https://doi.org/10.1002/14651858.CD004690.pub4

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