Reading Between the Lines, Bibliotherapy

Have you ever heard of bibliotherapy? I’m always trying to identify ways to start working on recovery from depression, but I never thought much about one of the first steps I took – reading. I was surprised to learn that reading books for medical treatment dates to World War II, when it proved effective for wounded veterans. Bibliotherapy also seems to be helpful for depression. Even though I first learned that “depression” was the name for my problems when I was in my twenties, a couple of decades went by before I really studied the disorder. That may seem odd since I’d been in therapy on and off for many years and had also taken a number of antidepressants. I think the delay in trying to learn more was one sign of my resistance to treatment as well as a denial of how seriously depression was affecting my life. Besides that, neither psychotherapy nor medication had helped me for very long. Something was missing, and reading about how I could help myself opened new possibilities. It was like the healing effect of writing. There was something about getting new concepts and ideas into my mind, as well as down on paper, that made an enormous difference. These activities helped me get a real start on recovery.

Feeling Good

There are claims that reading self-help books on depression may be do more than get you started. There is some evidence that it may also work as the primary therapy for major depressive disorder. I find that a bit far-fetched. Even if I could have read all the thousands of self-help books on depression, that activity alone would never have dealt with the severe illness I lived with. Apparently, though, working with the best self-help books can work for people with mild to moderate depression. If you’re familiar with David Burns’ classic Feeling Good: The New Mood Therapy, you can read in the introduction about formal studies on the therapeutic effectiveness of reading self-help books – specifically that one. In the study Burns discusses, about 75% of the participants no longer met the criteria for a major depressive episode after four weeks spent reading his book – using no other therapy. All had met the criteria for major depressive disorder (not just a single episode) going into the study. That rate of recovery is impressive, even though it was clear that those with severe depression needed additional help. But did recovery hold up over time? To answer that question, the participants were interviewed and tested again after three years.

The diagnostic findings at the three-year evaluation confirmed [earlier improvement] — 72% of the patients still did not meet the criteria for a major depressive episode and 70 percent did not seek or receive any further treatment with medications or psychotherapy during the follow-up period. … While it is encouraging that many patients seem to respond to reading Feeling Good, it is also clear that some patients with more severe or chronic depressions will need the help of a therapist and possibly an antidepressant medication as well. p. xxviii

One or two studies are hardly conclusive, but these were promising findings. More recently, several studies have been conducted on the effectiveness of other self-help manuals. For the most part, the findings are similar to the studies from the 1990s cited by Burns.

Cognitive Behavioral Therapy

Feeling Good and most of the popular self-help workbooks use the model of Cognitive Behavioral Therapy (CBT). This approach helps you identify specific patterns of thinking that support a negative view of yourself and reinforce the emotional lows of depression. The method teaches you to counteract these habitual patterns with more realistic ones so that your mind opens to a balanced interpretation of experience rather than one that is always negative. CBT techniques lend themselves especially well to working on your own. Many therapists either provide worksheets for daily practice or recommend the use of workbooks that include blank forms in which you can note these patterns and then write your own words to counteract them. I would imagine, then, that the benefit of workbooks comes not just from reading but also from interacting with the content and practicing new skills. For me, both the reading and writing have helped a lot because I find there’s a powerful restorative effect from formulating words and concepts to pinpoint what I’m experiencing.

Reading and Neuroplasticity

There doesn’t seem to be a lot of research about why bibliotherapy works, but I’ve run into untested ideas that relate the process of reading to the recent emphasis on neural plasticity. That’s the ability of the brain to form new neural circuits and activate areas of the brain that haven’t been functioning well. The concept is that learning by reading helps form new circuits that can change habitual thought patterns. By introducing new possibilities and neural connections, parts of the brain that are less, or more, active under the influence of depression can be restored to a the patterns of non-depressed brains. But whatever might be going on with the brain, I know I’ve felt more hope for recovery and made progress on my own by reading books – and, just as important, reading blogs and other online sources of information. The process of absorbing new ideas through the impact of written words can be helpful whether or not you like to use workbooks and practice exercises. Written by: John Folk-Williams, Storied Mind, Twitter: @StoriedMind The views of the article and writer and are not expressly the views of Exult Healthcare, although Exult Healthcare has consulted the author for use and proper attribution of the article.

Reading Between the Lines, Bibliotherapy

Feeling Good

Cognitive Behavioral Therapy

Reading and Neuroplasticity

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