Bibliotherapy the write stuff can be good for you!

Rowena Perry BA Hons, PGDipLib, MCLIP Library Manager Health Informatics Shared Service Prospect Park Hospital Reading
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What is bibliotherapy?
The use of a self-help book to treat a disorder. highered.mcgrawhill.com/sites/0072986360/student_view0/c hapter19/glossary.html However not just any old self-help book will do

What is an information prescription?

Information prescriptions will contain a series of links or signposts to guide people to sources of information about their health and care for example information about conditions and treatments, care services, benefits advice and support groups. http://www.informationprescription.info/ From 2008, information prescriptions will be given to everyone with a long-term condition or social care need, in consultation with a health or social care professional. (The Department of Health white paper 'Our health, our care, our say' published in January 2006)
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Piloting the project

There are 20 pilot sites mainly NHS Trusts sometimes working with for eg the RNIB plus some local authorities The work they are doing includes:
identifying content sources that people should be signposted to establishing directories of content and compile the links that will point to the content generating a template to determine how a personalised information prescription is created and formatted for a specific point on a care pathway
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What are books on prescription

GPs or other clinicians prescribe from a list of clinician evaluated self-help books The patient takes the prescription to their local public library and borrows the book from there The most effective schemes involve followup or at least contact by a clinician One of the first schemes started in Cardiff in 2002 and bibliotherapy is now funded by the Welsh Assembly for the whole of Wales
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What is useful?
Good quality self help books Generally these are based on Cognitive Behavioural Therapy techniques - CBT is commonly based on the idea that how we think (cognition), how we feel (emotion and affect), and how we act (behaviour) all interact and go together. Source: http://en.wikipedia.org/wiki/Cognitive_behav ioral_therapy
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 For eg
Books in the series Overcoming published by Constable and Robinson Mind over mood by Dennis Greenburger and Christine Padesky Woman in your own right by Anne Dickson Head Injury: a practical guide by Trevor Powell

Beware of SHAM
The Self-Help and Actualisation Movement.
For eg Men are from Mars, Woman are from Venus hardback, paperback, CD, audio cassette, calendar, book of days Men Are from Mars, Women Are from Venus, Children Are from Heaven: How to Have Strong, Confident Children Mars and Venus Starting Over: A Practical Guide for Finding Love Again After a Painful Breakup, Divorce, or the Loss of Loved One (also available in large print)
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When is it useful?
When a patient has a mild or moderate mental health problem eg
Depression Panic disorder Obsessive Compulsive Disorder Anxiety

It is not suitable for more serious conditions such as

Personality disorder Schizophrenia
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Are there other types of bibliotherapy?

Creative bibliotherapy uses fiction, non-fiction and poetry and can lead on to Creative writing
This is more intensive and requires skilled staff (ie those with training/experience in working with people with mental health problems) to lead it There are additional benefits for example improving confidence, self - esteem and interpersonal skills by reading, discussing and debating in small informal groups.
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Who doesnt it suit?

Those who have literacy issues reading age of books can be high and chapters long The visually impaired Those who are so unwell that they lack the motivation to undertake self-help Some conditions are too critical/ complicated/ severe It wont suit some people but it can help many
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A word about EBM

What is evidence based medicine?
Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Source: http://www.cebm.net/
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Wheres the evidence I?

den Boer P C, Wiersma D, van den Bosch R J. (2004) Why is self-help neglected in the treatment of emotional disorders: a meta analysis. Psychological Medicine. 34 (6),p 959-971. Bibliotherapy for clinically significant emotional disorders is more effective than waiting-list or no treatment conditions. No difference was found between bibliotherapy and psychiatric treatment of relatively short duration.
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Wheres the evidence II?

Cuijpers P. (1997) Bibliotherapy in unipolar depression: a meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry. 28 (2),p 139-147. Bibliotherapy was an effective treatment modality in unipolar depression, which was no less effective than individual or group therapy.

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Wheres the evidence III?

Marrs R W. (1995) A meta-analysis of bibliotherapy studies. American Journal of Community Psychology. 23 (6),p 843-870. The overall results suggest that bibliotherapy has a moderate degree of effectiveness. It is possible that bibliotherapy is more useful for anxietyrelated problems rather than those problems associated with controlling the need for immediate gratification.
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Why do it?
Because it works and is cost effective? Because NICE say so? (NICE guidelines on depression, anxiety and eating disorders advocate the use of bibliotherapy as part of a stepped care programme.) It ticks lots of boxes both for the NHS and public libraries.

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 For a copy of the briefing paper please email: Rowena.perry@berkshire.nhs.uk

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