A meta-analysis of bibliotherapy studies

The 100 most-cited articles on bibliotherapy: a bibliometric analysis

Bibliotherapy is an important part of art therapy and many publications regarding bibliotherapy have been published in the past. However, there has none about the scientometric study to systematically analyze the development and emerging research trends on bibliotherapy. Therefore, we performed a scientometric investigation to describe trends of this theme. All publications related to bibliotherapy published from 1980 to 2020 were identified and selected from Science Citation Index Expanded, Social Sciences Citation Index, and Arts & Humanities Citation Index of Web of Science Core Collection. VOSviewer was used to create collaborative network plots of countries, institutions, and authors and to perform cluster analysis of keywords. A total of 703 articles were searched, and we retrieved the 100 most cited articles published by 146 institutions from 15 countries in 57 academic journals. The United States occupied a leading position in the field of bibliotherapy and Linköping University was the most productive institution. Journal of Consulting and Clinical Psychology was the most productive journal. Andersson G, Carlbring P, and Cuijpers P may have an important influence on bibliotherapy research. The applications in depression, anxiety, panic disorder, insomnia, and aphasia are the hot themes. This scientometric review provided a comprehensive understanding of the bibliotherapy research using quantitative and qualitative methods, which can provide references for researchers in the bibliotherapy field. As investigators continue to work, we look forward to the development of bibliotherapy efficacy and the implementation form and steps.

Yes, I can! Development and validation of the self-efficacy for self-help scale

BACKGROUND

Self-help interventions for health complaints promise alleviation, for instance, of depressive symptoms, and have become increasingly popular. However, despite constant progress regarding digitally supported self-help, real-world uptake is low and motivational processes, like task-specific self-efficacy, are rarely investigated. Therefore, this study developed and tested the Self-Efficacy for Self-Help Scale (SESH).

METHODS

In a randomized controlled trial of a positive psychological online intervention to foster self-help, 344 adults (mean age = 49.26 years, SD = 27.85; 61.9 % female) completed SESH at three time points (pretest, posttest, 2-week follow-up). Psychometric testing included factorial validity, reliability (internal consistency, split-half), convergent validity (via depression coping self-efficacy), discriminant validity (via depression severity, depression literacy), sensitivity to change (due to the intervention), and predictive validity (via a theory of planned behavior questionnaire on self-help).

RESULTS

The unidimensional scale showed excellent reliability, construct validity, and predictive validity regarding self-help (the theory of planned behavior explained 49 % of variance in self-help intentions). The analysis did not clearly support sensitivity to change, however, as SESH scores did not change in the intervention group but were lower in the control group at posttest.

LIMITATIONS

The study was not representative of the population, and the intervention was not previously tested. Studies with longer follow-ups and more diverse samples are needed.

CONCLUSIONS

This study closes a gap in current self-help research by presenting a psychometrically sound measure to capture self-efficacy for self-help that can be used in epidemiological studies as well as clinical practice.

Use of a Self-guided Computerized Cognitive Behavioral Tool During COVID-19: Evaluation Study

BACKGROUND

Internet-based programs can help provide accessible and inexpensive behavioral health care to those in need; however, the evaluation of these interventions has been mostly limited to controlled trials. Data regarding patterns of use and effectiveness of self-referred, open-access online interventions are lacking. We evaluated an online-based treatment designed to address stress, depression, and conflict management, the Dartmouth PATH Program, in a freely available and self-guided format during the COVID-19 pandemic.

OBJECTIVE

The primary aim is to determine users' levels of stress and depression, and the nature of problems and triggers they reported during the COVID-19 pandemic. A secondary objective is to assess the acceptability and usability of the PATH content and determine whether such a program would be useful as a stand-alone open-access resource. The final objective is understanding the high dropout rates associated with online behavioral programs by contrasting the use pattern and program efficacy of individuals who completed session one and did not return to the program with those who came back to complete more sessions.

METHODS

Cumulative anonymous data from 562 individuals were analyzed. Stress triggers, stress responses, and reported problems were analyzed using qualitative analysis techniques. Scores on usability and acceptability questionnaires were evaluated using the sign test and Wilcoxon signed rank test. Mixed-effects linear modeling was used to evaluate changes in stress and depression over time.

RESULTS

A total of 2484 users registered from April through October 2020, most of whom created an account without initiating a module. A total of 562 individuals started the program and were considered in the data analysis. The most common stress triggers individuals reported involved either conflicts with family or spouses and work or workload. The most common problems addressed in the mood module were worry, anxiousness, or stress and difficulty concentrating or procrastination. The attrition rate was high with 13% (21/156) completing the conflict module, 17% (50/289) completing session one of the mood module, and 14% (16/117) completing session one of the stress module. Usability and acceptability scores for the mood and stress modules were significantly better than average. In those who returned to complete sessions, symptoms of stress showed a significant improvement over time (P=.03), and there was a significant decrease in depressive symptoms over all time points (P=.01). Depression severity decreased on average by 20% (SD 35.2%; P=.60) between sessions one and two.

CONCLUSIONS

Conflicts with others, worry, and difficulty concentrating were some of the most common problems people used the programs to address. Individuals who completed the modules indicated improvements in self-reported stress and depression symptoms. Users also found the modules to be effective and rated the program highly for usability and acceptability. Nevertheless, the attrition rate was very high, as has been found with other freely available online-based interventions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02726061; https://clinicaltrials.gov/ct2/show/NCT02726061.

Meditation and mindfulness reduce perceived stress in women with recurrent pregnancy loss: a randomized controlled trial

RESEARCH QUESTION

Can participating in a tailored 7-week meditation and mindfulness programme with additional standard supportive care versus standard supportive care only reduce perceived stress for women with recurrent pregnancy loss (RPL)?

DESIGN

A two-armed randomized controlled trial (RCT) with 12-month follow-up. In total 76 patients were enrolled and randomly assigned to either standard supportive care or to a 7-week meditation and mindfulness programme led by an instructor in addition to standard supportive care.

RESULTS

At intervention completion (after 7 weeks), perceived stress decreased significantly both in the intervention group (P = 0.001) and in the control group (P = 0.006). The decrease in perceived stress in the intervention group was significantly larger (P = 0.027) compared with the control group. At the 12-month follow-up perceived stress was still significantly decreased in both groups compared with baseline (P < 0.0001 in the intervention group and P = 0.002 in the control group).

CONCLUSION

This first RCT of a tailored meditation and mindfulness intervention for women with RPL documents that a 7-week daily at-home meditation and mindfulness programme combined with group sessions reduced perceived stress significantly more than a standard supportive care programme. Future studies should address the most effective format and the 'dose' needed for an impact on perceived stress levels.

Remote cognitive behavioral therapy for panic disorder: A meta-analysis

Cognitive behavioral therapy (CBT) is an established treatment for panic disorder (PD). Remote CBT (RCBT) is becoming increasingly popular and has the potential to enhance access to this treatment. The aim of this study was to examine the efficacy of RCBT for PD using a meta-analytic approach. An electronic database search was used to identify relevant articles and the references of previously completed reviews. Twenty-one studies (n = 1,604; mean age range: 31.9-43.9; mean female representation = 71 %) were included in the meta-analysis. 14/21 (67 %; n = 817 of the included studies were randomised controlled trials and 7/21 (33 %; n = 787) were open trials or non-randomised controlled trials. Pooled within-group effect sizes across all remote treatments for PD symptoms were large from pre-treatment to post-treatment (Hedges' g = 1.18; 95 % CI: 0.99-1.36) and pre-treatment to follow-up (Hedges' g = 1.51; 95 % CI: 1.22-1.79). Pooled between-group findings indicate that remote CBT treatments are more effective than passive control (Hedges' g = 1.17; 95 % CI: 0.85-1.50), but are similar to other active treatments on measures of PD symptoms (e.g., face-to-face CBT) (Hedges' g = 0.02; 95 % CI: -0.43 to 0.48). Internet-delivered CBT (Hedges' g = 1.10, 95 % CI: 0.91-1.30), videoconferencing-delivered CBT (Hedges' g = 1.40, 95 % CI: 0.85-1.95) and bibliotherapy-delivered CBT (Hedges' g = 1.51, 95 % CI: 0.95-2.06) each produce large effect sizes on measures of PD symptoms. The results have important implications for the dissemination of entirely remote stepped-care treatments for PD.

Proffering Connections: Psychologising Experience in Psychotherapy and Everyday Life

Conversation analytic research has advanced understanding of the psychotherapeutic process by understanding how psychotherapy is organised over time in and through interaction between clients and therapists. This study progresses knowledge in this area by examining how psychological accounts of experience are progressively developed across a range of helping relationships. Data include: (1) approximately 30 h of psychotherapy sessions involving trainee therapists; (2) approximately 15 h of psychotherapy demonstration sessions involving expert therapists; and (3) approximately 30 h of everyday conversations involving close friends or family members. This article reports an analysis of techniques that are used to bring together two experiences that were discussed separately, to proffer a candidate connection between them. This proffering of candidate connections was recurrently used in psychotherapy. If confirmed by a client, a proffered connection could be used to develop a psychological account of a client’s experiences, which could then warrant some psychological intervention. In contrast, the proffering of connections was observed in only one of the everyday conversations included in the current study, where it was used to develop psychological accounts of experience. This shows that although proffering candidate connections is an everyday interactional practice, it appears to be used with greater frequency in psychotherapy, to advance its specific institutional aims.

Bibliotherapy for Sexual Dysfunctions: A Systematic Review and Meta-Analysis

AIM

The objective of this study was to assess the efficacy of bibliotherapy for sexual dysfunctions, when compared with no treatment and compared with other interventions.

METHODS

MEDLINE, EMBASE, and PsycINFO were searched from 1970 to January 2020. Selection criteria were randomized controlled trials evaluating assisted or unassisted bibliotherapy for all types of sexual dysfunctions compared with no treatment (wait list or placebo) or with other psychological interventions. Bibliotherapy is defined as psychological treatment using printed instruction to be used by the individual or couple suffering from sexual dysfunction. Primary outcome measures were male and female sexual functioning level and continuation/remission of sexual dysfunction. Secondary outcomes were sexual satisfaction and dropout rate. Sexual functioning and sexual satisfaction were self-reported by participants using validated questionnaires.

RESULTS

Fifteen randomized controlled trials with a total of 1,113 participants (781 women; 332 men) met inclusion criteria. Compared with no treatment, unassisted bibliotherapy resulted in larger proportions of female participants reporting remission of sexual dysfunction, and sexual satisfaction was higher in treated participants, both female and male participants. Compared with no treatment, assisted bibliotherapy had significant positive effects on female sexual functioning; no effects on male sexual functioning were found. Results of unassisted and assisted bibliotherapy did not differ from those of other intervention types on any outcome. Throughout, no differences between study conditions were found regarding dropout rates. The certainty of the evidence for all outcomes was rated as very low.

CONCLUSION

We found indications of positive effects of bibliotherapy for sexual dysfunctions. Across studies, more significant effects were found for women than for men. However, owing to limitations in the study designs and imprecision of the findings, we were unable to draw firm conclusions about the use of bibliotherapy for sexual dysfunction. More high quality and larger trials are needed. Relevant outcome measures for future studies should be defined as well as unified grading systems to measure these endpoints. In addition, future studies should report on treatment acceptability and adherence. van Lankveld JJDM, van de Wetering FT, Wylie, K et al. Bibliotherapy for Sexual Dysfunctions: A Systematic Review and Meta-Analysis. J Sex Med 2021;18:582-614.

The effects of bibliotherapy on the mental well-being of informal caregivers of people with neurocognitive disorder: A systematic review and meta-analysis

BACKGROUND

The number of people with neurocognitive disorder is increasing, and the majority of them are cared for by informal caregivers in the community. Mental health problems are common among caregivers, however, professional support for them is often limited. Non-pharmacological self-help interventions, such as bibliotherapy, may improve mental well-being and has the potential for being integrated into clinical or social services.

OBJECTIVES

To explore what types of bibliotherapy have been used for improving the mental well-being of informal caregivers of people with neurocognitive disorders, and the effect on mental well-being outcomes.

DESIGN

A systematic review and meta-analysis.

REVIEW METHODS

Six databases were searched for relevant articles on July 1, 2019. Clinical trial registries and the reference lists of included studies were also searched. Both randomized controlled trials and quasi-experimental studies were included. The Cochrane Collaboration risk of bias tool for randomized controlled trials was used to assess the quality of studies. Review Manager 5.3 was used to analyze data, standardized mean difference (SMD) and 95% confidence interval (CI) were used to estimate the pooled treatment effect. Random effects models were used for meta-analyses. Funnel plot was not performed due to the limited number of studies. This systematic review was registered at PROSPERO (CRD42019129152).

RESULTS

Nine randomized controlled trials with 1036 informal caregivers were included. Most of the included studies had some aspects of bias. Three types of bibliotherapy were used. Bibliotherapy had a significant pooled medium to large effect on reducing depression at Z = 1.99 (SMD = -0.74, 95%CI = -1.47 to -0.01, p = .05), however, the heterogeneity was high (I² = 94%). For the subgroups, only the video-based bibliotherapy significantly reduced depression at Z = 2.78 (I² = 83%, SMD = -2.11, 95%CI = -3.6 to -0.62, p = .005). Bibliotherapy had a significant small to medium effect on caregiver's self-efficacy for dealing with problem behaviours at Z = 2.44 (I² = 0, SMD = 0.36, 95%CI = 0.05 to 0.67, p = .02), however, the effect on self-efficacy for obtaining respite was not significant (I² = 0, SMD =  0.17, 95%CI = -0.16 to 0.49, p = .32). The effect on decreasing state anxiety was significant at Z = 2.30 (I² = 22%, SMD = -0.22, 95% CI = -0.41 to -0.33, p = .02).

CONCLUSIONS

Bibliotherapy showed positive effects on reducing depression, improving self-efficacy for dealing with problem behaviors and reducing anxiety among informal caregivers. The effects on reducing depression should be viewed with caution due to high heterogeneity. The effects on other mental well-being outcomes are inconclusive due to limited number of studies and this underscores the need for further research.

A Randomized Study Comparing Video-Based Mindfulness-Based Cognitive Therapy With Video-Based Traditional Cognitive Behavioral Therapy in a Sample of Women Struggling to Achieve Orgasm

INTRODUCTION

This study examines the effectiveness of integrating mindfulness-based techniques within therapy for women suffering to achieve orgasm. Although widely applied in psychotherapy, this approach has only recently been introduced in the treatment of female sexual dysfunction.

AIM

To compare the effectiveness of a video-based self-administered treatment, rooted within the cognitive behavioral treatment (CBT) framework, with a video-based self-administered mindfulness treatment applying cognitive behavioral sexual therapy (mindfulness-based cognitive therapy), the latter of which was specifically created to increase women's ability to achieve orgasm.

METHODS

A convenience sample of 65 women suffering from difficulties to achieve orgasm, aged 18 to 58 years (mean = 32.66, standard deviation = 9.48), were randomly allocated using a randomization procedure to either a mindfulness-based cognitive therapy (N = 35) or CBT (N = 30) group. Each participant completed questionnaires before and after the start of treatment and 2 months after its completion.

MAIN OUTCOME MEASURE

We applied repeated-measure general linear models to compare the 2 groups (ie, between participant factor) on each dependent variable across time (ie, the within-participant factor). Compare mean analyses for paired samples were only conducted when the interaction effect between condition and time was significant (ie, P <.05).

RESULTS

Statistical analyses show that women in both groups presented increased sexual functioning (P = .001) and decreased sexual distress (P < .001), as well as improved desire, arousal, orgasm, and sexual satisfaction (P < .05) after their respective treatments. Contrary to our hypothesis, significant reductions in sexual pain were only observed in CBT participants.

CLINICAL IMPLICATIONS

To the best of our knowledge, this is the first study to apply a randomized allocation procedure to evaluate the effectiveness of a video-based mindfulness intervention for women struggling to achieve orgasm. These results should guide clinicians' decisions with respect to evaluating the relevance and the real added value of proposing mindfulness exercises to their patients with such difficulties.

CONCLUSION

When women suffering from difficulties to achieve orgasm are randomly assigned to a mindfulness group or an active control, improvements in sexual functioning and reductions in sexual distress can be observed after both treatments. Adam F, De Sutter P, Day J, et al. A Randomized Study Comparing Video-Based Mindfulness-Based Cognitive Therapy With Video-Based Traditional Cognitive Behavioral Treatment in a Sample of Women Struggling to Achieve Orgasm. J Sex Med 2020;17:312-324.

A Qualitative Exploration of South Korean Emerging Adults' Perspectives on Death and Suicide Through Short Stories

Despite the alarming suicide rate among South Korean emerging adults, relatively little is known about their unfettered perspectives on death and suicide. Therefore, an innovative data collection technique was developed to apprehend the meanings that emerging adults attribute to death and suicide in their explorations of the phenomena through a selection of short stories. A convenience sample (N = 114) responded to a survey in which participants transferred their feelings toward death and suicide to characters or events in the short stories. A qualitative content analysis revealed relatively permissive perspectives toward death and suicide. Negative perspectives on death are associated with societal victimization and positive perspectives with naturalistic fatalism. Positive perspectives on suicide are overwhelmingly rooted in existential, individual choices while negative perspectives focus on societal pressures. These perspectives contribute to illuminating tensions between traditionalist collectivism and contemporary individualism in Korean society that could inform suicide prevention initiatives for emerging adults.

Mindfulness for female outpatients with chronic primary headaches: an internet-based bibliotherapy

Our aim was to investigate effectiveness of mindfulness by bibliotherapy on disability, distress, perceived pain and mindfulness in women with tension headaches and migraines. Primary headaches have been of great interest to mental health researchers because of the high prevalence, as well as significant disability and distress in the affected people. Despite the promising results of in-person treatment and some limitations that such interventions may cause, patients may be encountered with problems when using health care services. The present study is a quasi-experimental randomized design with pre-test, post-test, and control group. The study population consisted of 1396 women with migraine headache referring to headache clinic of Baqiyatallah Hospital in Tehran. Of these, 30 patients (including tboh experimental and control group) were selected by objective sampling method and were randomly assigned to the two groups. The experimental group, in addition to medical treatment as usual, was treated for a period of 8 sessions by Mindfulness-based Stress Reduction Internet-based Bibliotherapy, but the control group used only the medical treatment. The sample had no attritions. Data were collected by the four scales of (DASS-21), Migraine Disability Assessment Test (MIDAS), McGill's Short Form Questionnaire (MPQ-SF), and Mindfulness Inventory (MAAS). We used covariance analysis to analyze the findings in the measured scales. MBSR-IBB treatment had no significant effect on pain sensory dimension (P <0.44), despite improvement of mindfulness (P <0.0001). In contrast, the greatest effect was on the level of disability (P <0.0001). We observed also a significant improvement in distress (P <0.0001). In conclusion, in spite of the presence of headaches, the mindfulness improved the quality of life and reduced the level of mental distress. In addition, using the Internet-based bibliotherapy method, these services can be used with easier access, lower cost, and more flexibility.

Use of written cognitive–behavioural therapy self-help materials to treat depression

Both primary and secondary care practitioners often wish to offer their patients access to effective psychosocial interventions, yet the lengthy waiting-lists for specialised psychological or psychotherapeutic services create frustration among both referrers and their patients. There is therefore a need for new ways of accessing such treatments that can be delivered in most psychiatric team settings. For this to be realistic, such delivery must be possible within the time available to most practitioners (10–20 minutes for many consultant psychiatrists). One approach is to offer structured self-help materials.

The evidence base for cognitive—behavioural therapy in depression: delivery in busy clinical settings

The evidence base for cognitive–behavioural therapy (CBT) for depression is discussed with reference to the review documentTreatment Choice in Psychological Therapies and Counselling (Department of Health). This identifies the need to deliver evidence-based psychosocial interventions and identifies CBT as having the strongest research base for effectiveness, but does not cover how to deliver CBT within National Health Service settings. The traditional CBT model of weekly face-to-face appointments is widely offered, yet there is little evidence to support these traditions in the outcome literature. Reducing face-to-face contact by introducing self-help into treatment may be one method of improving access. The SPIRIT course is discussed which teaches how to offer core cognitive–behavioural skills using structured self-help materials.

Internet-Assisted Cognitive Behavioral Therapy

Internet-assisted cognitive-behavioral therapy (ICBT) is a way to deliver cognitive-behavioral therapy (CBT) that has been found to generate similar effects as face-to-face CBT in some studies. Results have been replicated by different research groups. This article presents the treatment format and reviews evidence for mood and anxiety disorders. Future developments are discussed, including the lack of theories specific for the treatment format and ways to handle comorbidity. Although some programs have been implemented there is a need for further studies in clinical settings. Overall, clinician-assisted ICBT is becoming one of the most evidence-based forms of psychological treatment.

Using Children’s Literature to Strengthen Social and Emotional Learning

The introductory article to this special edition of School Psychology International, “Using Children’s Literature to Strengthen Social and Emotional Learning,” describes the need for a broader base of support for children’s mental health needs. Both nationally and internationally, the limited number of mental health professionals demands alternative options for the delivery of mental health services. Schools are recommended as one proposed venue for providing these services to children and youth. As such, teachers need easy-to-use basic information about mental health resources that are viable, yet rely on minimal professional support and supervision. One option is bibliotherapy, using books and stories to support social emotional needs. From the mental health perspective of both prevention and intervention, bibliotherapy is proposed not just as a professional’s therapeutic tool, but also as a layman’s resource to address students’ basic social emotional needs. We offer resources from a website that includes basic bibliotherapy lesson plans, posters, activities, and video clips—all centered on the five foundational competencies identified by the Collaborative for Academic, Social, and Emotional Learning (CASEL). This website [ http://education.byu.edu/sociallearning ] is geared to educators and mental health professionals who work with elementary school children, ages 5–11.

Brief internet-based cognitive behavior therapy program with a supplement drink improved anxiety and somatic symptoms in Japanese workers

Background

Self-help cognitive behavior therapy (CBT) is a useful approach for the treatment of psychological problems. Recent research on the effectiveness of self-help internet-based CBT (ICBT) indicates that the paradigm moderately improves psychological problems. Furthermore, previous studies have shown that food and drinks containing supplements improve various health conditions. We investigated the effect of a brief self-help ICBT administered with a supplement drink on psychological well-being and somatic symptoms.

Methods

In total, 101 healthy workers were enrolled in the 4-week ICBT program, which consisted of psychoeducation on stress management, behavior activation, and cognitive restructuring. The supplement soft drink was taken every day during the program. The participants were instructed to watch on-demand video clips and read the self-help guidebook and supporting comic strip weekly on the Internet or smartphone. The Japanese version of the Profile of Mood States (POMS) was administered before and after completion of the program. Scores on the POMS tension-anxiety (POMS-TA), depression (POMS-D), and fatigue (POMS-F) subscales were used to assess the effect of the program. Somatic symptoms were assessed using the Brief Job Stress Questionnaire.

Results

In total, 75 participants continued the program for 4 weeks; however, of those, 27 failed to complete all weekly tasks or meet the post-assessment deadlines. Therefore, the data of 48 participants were included in the analysis. Pre-post intervention comparisons using paired t-tests revealed significant improvement on the POMS-TA, but not the POMS-D or POMS-F subscales. Moreover, participants reported a significant reduction in the severity of low back pain.

Conclusion

Our brief intervention moderately improved anxiety levels and the symptom of low back pain. These findings suggest that the brief ICBT program is effective in non-patient populations. Future directions for brief ICBT are discussed.

Trial registration

This study was registered on February 10, 2016 at UMIN. The registration number is UMIN000020962.

Effects of cognitive behavioral therapy with relaxation vs. imagery rescripting on test anxiety: A randomized controlled trial

BACKGROUND

Test anxiety is a common condition in students, which may lead to impaired academic performance as well as to distress. The primary objective of this study was to evaluate the effectiveness of two cognitive-behavioral interventions designed to reduce test anxiety. Test anxiety in the participants was diagnosed as social or specific phobia according to DSM-IV. Subsequently subjects were randomized to three groups: a moderated self-help group, which served as a control group, and two treatment groups, where either relaxation techniques or imagery rescripting were applied.

METHODS

Students suffering from test anxiety were recruited at two German universities (n=180). The randomized controlled design comprised three groups which received test anxiety treatment in weekly three-hour sessions over a period of five weeks. Treatment outcome was assessed with a test anxiety questionnaire, which was administered before and after treatment, as well as in a six-month follow-up.

RESULTS

A repeated-measures ANOVA for participants with complete data (n=59) revealed a significant reduction of test anxiety from baseline to six-month follow-up in all three treatment groups (p<.001).

LIMITATIONS

Participants were included if they had a clinical diagnosis of test anxiety. The sample may therefore represent only more severe forms of text anxiety . Moreover, the sample size in this study was small, the numbers of participants per group differed, and treatment results were based on self-report. Due to the length of the treatment, an implementation of the group treatments used in this study might not be feasible in all settings.

CONCLUSIONS

Group treatments constitute an effective method of treating test anxiety, e.g. in university settings. Imagery rescripting may particularly contribute to treatment efficacy.

Acceptability of Bibliotherapy for Patients With Cancer: A Qualitative, Descriptive Study

PURPOSE/OBJECTIVES

To determine the acceptability of a self-help workbook, Mastering the Art of Coping in Good Times and Bad, for patients with cancer.
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RESEARCH APPROACH

Descriptive, qualitative.
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SETTING

Participants were recruited from the psychosocial support cancer centers of two tertiary care teaching hospitals in Montreal, Quebec, Canada.
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PARTICIPANTS

18 individuals diagnosed with cancer.
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METHODOLOGIC APPROACH

A semistructured interview guide with open-ended questions was used to gather feedback from participants about the workbook. 
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FINDINGS

18 participants completed the interviews from which the data emerged. Two main categories were identified from the respondents' interviews regarding the acceptability of the workbook. The first category focuses on content, whereas the other focuses on recommendations. Interviewees specified the following content as most helpful.

CONCLUSIONS

Bibliotherapy gives patients access to knowledge to help them cope and engage in their own self-management. The workbook Mastering the Art of Coping in Good Times and Bad may be an acceptable means of helping them manage their stress. 
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INTERPRETATION

Bibliotherapy is not only cost-effective and easy to administer but also an acceptable minimal intervention.

Predictors of IAPT psychological well-being practitioners’ intention to use CBT self-help materials routinely in their clinical practice

Despite efficacy and effectiveness evidence, and recommendations from the National Institute for Health and Care Excellence (NICE), use of CBT self-help materials remains inconsistent in UK mental health services. Since 2006, the Improving Access to Psychological Therapies (IAPT) programme has provided standardized training and mandates routine use of CBT self-help materials by their trainee psychological well-being practitioners (PWPs). This study tested whether the main constructs of the theory of planned behaviour (TPB; attitudes, subjective norms, and perceived behavioural control), past use, prior training and demographic characteristics, would predict PWPs’ intention to use self-help materials routinely in their clinical practice. Stage 1 utilized a standardized procedure to create measures for the constructs of TPB, before the design and testing of a web-based, cross-sectional questionnaire. In stage 2, the questionnaire was administered to a convenience sample of trainee PWPs (n = 94). Data was analysed using multiple linear regression, mediation analyses, and content analysis. TPB constructs predicted intention to use self-help materials, with only direct attitude contributing significantly to 70% of the variance in intention. Past use of materials predicted intention, via direct and indirect mediation. Qualitative data from 43 trainees highlighted clients’ experience of self-help materials as positive, albeit with some practical constraints. The results suggest that the main constructs of TPB have some utility in predicting trainee PWPs’ intention to use self-help materials routinely. Future prospective, longitudinal research could investigate actual use of self-help materials to elucidate cognitive factors involved in trainees’ clinical decision-making post-qualification.

A systematic review and meta-analysis of self-help therapeutic interventions for obsessive-compulsive disorder: Is therapeutic contact key to overall improvement?

BACKGROUND AND OBJECTIVES

The presence of obsessive-compulsive disorder (OCD) can result in low quality of life, with significant impairments in social and occupational functioning. An increase in the dissemination of self-help programs has been observed in the treatment of OCD, and has provided improved accessibility to treatment. The present study examined the efficacy of self-help interventions for OCD in the context of therapeutic contact.

METHODS

Randomised controlled trials and quasi-experimental studies were identified through computerised database searches. Self-help format (bibliotherapy, internet-based, computerised), and therapeutic contact were examined for their effect on treatment outcomes.

RESULTS

Eighteen studies targeting self-help for OCD met inclusion criteria with 1570 participants. The average post-treatment effect size (Hedges' g) of self-help interventions on primary outcomes was .51 (95% CI: .41 to 0.61). Subgroup analysis revealed large effect sizes for minimal-contact self-help (g = 0.91, 95% CI: 0.66 to 1.17), moderate effect sizes for predominantly self-help (g = 0.68, 95% CI: 0.40 to 0.96), and small effect sizes for self-administered self-help (g = 0.33, 95% CI: .18 to 0.47).

LIMITATIONS

A large variation of treatment approaches, amount of therapeutic contact, and risk of bias within each study may account for the large magnitude in effect sizes across studies. Additionally, the long-term follow-up effects of treatment approaches were not examined.

CONCLUSIONS

A growing body of literature supporting to the use of self-help treatments for OCD is evident, however, further investigation through use of randomised controlled trials is required, particularly the use of stepped care and long-term effectiveness.

Cost-effectiveness of i-Sleep, a guided online CBT intervention, for patients with insomnia in general practice: protocol of a pragmatic randomized controlled trial

BACKGROUND

Insomnia is a highly prevalent disorder causing clinically significant distress and impairment. Furthermore, insomnia is associated with high societal and individual costs. Although cognitive behavioural treatment for insomnia (CBT-I) is the preferred treatment, it is not used often. Offering CBT-I in an online format may increase access. Many studies have shown that online CBT for insomnia is effective. However, these studies have all been performed in general population samples recruited through media. This protocol article presents the design of a study aimed at establishing feasibility, effectiveness and cost-effectiveness of a guided online intervention (i-Sleep) for patients suffering from insomnia that seek help from their general practitioner as compared to care-as-usual.

METHODS/DESIGN

In a pragmatic randomized controlled trial, adult patients with insomnia disorder recruited through general practices are randomized to a 5-session guided online treatment, which is called "i-Sleep", or to care-as-usual. Patients in the care-as-usual condition will be offered i-Sleep 6 months after inclusion. An ancillary clinician, known as the psychological well-being practitioner who works in the GP practice (PWP; in Dutch: POH-GGZ), will offer online support after every session. Our aim is to recruit one hundred and sixty patients. Questionnaires, a sleep diary and wrist actigraphy will be administered at baseline, post intervention (at 8 weeks), and at 6 months and 12 months follow-up. Effectiveness will be established using insomnia severity as the main outcome. Cost-effectiveness and cost-utility (using costs per quality adjusted life year (QALY) as outcome) will be conducted from a societal perspective. Secondary measures are: sleep diary, daytime consequences, fatigue, work and social adjustment, anxiety, alcohol use, depression and quality of life.

DISCUSSION

The results of this trial will help establish whether online CBT-I is (cost-) effective and feasible in general practice as compared to care-as-usual. If it is, then quality of care might be increased because implementation of i-Sleep makes it easier to adhere to insomnia guidelines. Strengths and limitations are discussed.

TRIAL REGISTRATION

Netherlands Trial register NTR 5202 (registered April 17(st) 2015).

LONGITUDINAL COURSE OF POSTTRAUMATIC GROWTH AMONG U.S. MILITARY VETERANS: RESULTS FROM THE NATIONAL HEALTH AND RESILIENCE IN VETERANS STUDY

BACKGROUND

Posttraumatic growth (PTG) is increasingly recognized as an important psychosocial phenomenon, but few studies have evaluated the longitudinal course of PTG. This study identified courses of PTG over a 2-year period in a contemporary, nationally representative sample of U.S. military veterans, and examined sociodemographic, military, trauma, medical, and psychosocial predictors of PTG course.

METHODS

Data were based on a Web-based survey of a nationally representative sample of 1,838 U.S. veterans who reported at least one potentially traumatic event and provided data at two time points (October-December 2011 and September-October 2013).

RESULTS

Five different courses of PTG were identified--Consistently Low (33.6%), Moderately Declining (19.4%), Increasing PTG (16.8%), Dramatically Declining (15.7%), and Consistently High (14.5%). More than half (59.4%) of veterans who reported at least "moderate" PTG maintained that level of PTG 2 years later. Posttraumatic stress disorder symptoms, medical conditions, purpose in life, altruism, gratitude, religiosity, and an active reading lifestyle predicted maintenance or increase in PTG.

CONCLUSIONS

PTG has a heterogeneous course and is not only common, but can persist over time especially in the presence of posttraumatic stress and certain psychosocial factors. Clinicians and researchers should consider the personal growth that can result from trauma and help trauma survivors find ways to maintain this growth over time.

Remote cognitive-behavior therapy for obsessive-compulsive symptoms: A meta-analysis

Obsessive-compulsive disorder (OCD) is a chronic mental health condition that results in a significant societal burden. Remote treatments do not require the patient to attend traditional face-to-face treatment services and can be used as a way to overcome barriers to accessing face-to-face treatment. The aim of the current study was to synthesize the current literature on remote treatment for OCD using a meta-analytic approach. Relevant articles were identified through an electronic database search and the references of previously completed reviews on the topic of remote treatment for OCD were also reviewed. Eighteen studies (n=823; mean age=31.20 (SD=10.36); 56.2% female) were included in the meta-analysis. Within-group findings indicate that remote treatment for OCD produces a decrease in symptoms of a large magnitude (g=1.17; 95% CI: 0.91-1.43). Between-group findings indicate that remote treatment for OCD is more effective than control (g=1.06; 95% CI: 0.68-1.45) and outcomes are not meaningfully different from face-to-face treatment (g=-0.21; 95% CI: -0.43-0.02). Those methodologies that are low intensity produce a decrease in symptoms of a large magnitude (g=1.36, 95% CI: 1.00-1.72), as do higher intensity treatments (g=1.64, 95% CI: 1.33-1.95). These findings have important implications for the development of stepped-care treatments, which may be able to be delivered in a purely remote fashion.

Clinical Advances in Geriatric Psychiatry: A Focus on Prevention of Mood and Cognitive Disorders

The world population is aging at a rate unprecedented in human history, placing substantial pressure on health systems across the world along with concurrent rises in chronic diseases. In particular, rates of cognitive disorders and late-life affective disorders are expected to increase. In tandem with aging, there are robust predictions suggesting that rates of age-related cognitive decline and dementia, and geriatric depression, will increase, with serious consequences. Clearly innovative prevention and treatment strategies are needed. This article reviews the latest promising clinical advances that hold promise for assisting the prevention and treatment of depression, cognitive decline, and dementia.

Attitudes and Preferences towards Self-help Treatments for Depression in Comparison to Psychotherapy and Antidepressant Medication

Background: Self-help is an effective treatment for depression. Less is known, however, about how acceptable people find different self-help treatments for depression. Aims: To investigate preferences and attitudes toward different self-help treatments for depression in comparison to psychotherapy and antidepressants. Method:N = 536 people who were not actively seeking treatment for depression were randomly assigned to read about one of five treatment options (bibliotherapy, Internet-based self-help, guided self-help, antidepressants, or psychotherapy) before rating how acceptable they found the treatment. Participants also ranked the treatments in order of preference. Results: Psychotherapy and guided self-help were found to be the most acceptable and preferred treatment options. Antidepressants and bibliotherapy were found to be the least acceptable treatments, with antidepressants rated as the most likely to have side effects. Preference data reflected the above findings – psychotherapy and guided self-help were the most preferred treatment options. Conclusions: The findings highlight differences in attitudes and preferences between guided and unguided self-help interventions; and between self-help interventions and psychotherapy. Future research should focus on understanding why unguided self-help interventions are deemed to be less acceptable than guided self-help interventions for treating depression.

Information prescriptions, 1930-2013: an international history and comprehensive review

OBJECTIVES

Recently, government agencies in several countries have promoted information prescription programs to increase patients' understanding of their conditions. The practice has a long history and many publications, but no comprehensive literature reviews such as this.

METHODS

Using a variety of high-precision and high-recall strategies, the researcher searched two dozen online bibliographic databases, citation databases, and repositories, as well as many print sources, to identify and retrieve documents for review. Of these documents, ninety relevant English-language case reports, research reports, and reviews published from 1930-2013 met the study criteria.

RESULTS

Early to mid-twentieth century reports covered long-standing practices and used no rigorous research methods. The literature since the mid-1990s reports on short-term trial projects, especially of government-sponsored programs in the United States and United Kingdom. Although the concept of information prescription has been in the literature and practiced for decades, no long-term research studies were found.

CONCLUSIONS

Most of the literature is anecdotal concerning small pilot projects. The reports investigate physician, patient, and librarian satisfaction but not changes in patient knowledge or behavior. Many twenty-first century projects emphasize materials and projects from specific government agencies and commercial enterprises.

IMPLICATIONS

While the practice is commonly believed to be a good idea and there are many publications on the subject, few studies provide any evidence of the efficacy of information prescriptions for increased patient knowledge. Well-designed and executed large or long-term studies might produce needed evidence for professional practice.

A multicentre randomised controlled trial of a carer supervised culturally adapted CBT (CaCBT) based self-help for depression in Pakistan

BACKGROUND

Cognitive Behaviour Therapy (CBT) based self-help has been found to be effective for treating depression and anxiety. There is some evidence to suggest that CBT needs to be culturally adapted for it to be effective in non-Western cultures. CBT is not widely used in low and middle income countries and there is a need to test its effectiveness in different settings and formats, including self-help.

METHODS

We describe a RCT of a Culturally adapted CBT (CaCBT) based self-help manual in Pakistan. The trial was conducted in psychiatry departments in three cities. Assessments were carried out at baseline and at 12 weeks, using Hospital Anxiety and Depression Scale, Bradford somatic Inventory and brief disability Questionnaire.

RESULTS

At the end of the trial CaCBT based self-help was found to be effective against care as usual in reducing the symptoms of depression and anxiety, as well as somatic symptoms and disability.

LIMITATIONS

This study was conducted only in secondary care and required either patient or a carer to be able to read and write.

CONCLUSIONS

This is the first study outside West of a CBT based self-help intervention for depression. This study highlights the importance of using cost effective interventions in developing world in low intensity formats. Future studies should focus on trying these resources in different settings, like primary care, and with the use of audio/video or multimedia resources to improve compliance in patients with lower literacy.

An evaluation of a Books on Prescription scheme in a UK public library authority

This article discusses an evaluation of a Books on Prescription (BOP) scheme in a UK public library authority. The research was carried out by Rebecca Furness and submitted as a dissertation for the MSc Information and Library Management to Northumbria University. The dissertation was supervised by Biddy Casselden at Northumbria University and was awarded a distinction. The dissertation identified areas for development for BOP schemes and made specific recommendations that could make the schemes more accessible, enabling significant numbers of people to lead more fulfilling lives. Because this study focuses on mental health and the role that UK public libraries have in supporting well-being, it is a good illustration of the wide-ranging nature of subjects welcomed for the Dissertations into practice feature.

Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults

BACKGROUND

Anxiety disorders are the most common mental health problems. They are chronic and unremitting. Effective treatments are available, but access to services is limited. Media-delivered behavioural and cognitive behavioural interventions (self-help) aim to deliver treatment with less input from professionals compared with traditional therapies.

OBJECTIVES

To assess the effects of media-delivered behavioural and cognitive behavioural therapies for anxiety disorders in adults.

SEARCH METHODS

Published and unpublished studies were considered without restriction by language or date. The Cochrane Depression, Anxiety and Neurosis Review Group's Specialized Register (CCDANCTR) was searched all years to 1 January 2013. The CCDANCTR includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). Complementary searches were carried out on Ovid MEDLINE (1950 to 23 February 2013) and PsycINFO (1987 to February, Week 2, 2013), together with International trial registries (the trials portal of the World Health Organization (ICTRP) and ClinicalTrials.gov). Reference lists from previous meta-analyses and reports of randomised controlled trials were checked, and authors were contacted for unpublished data.

SELECTION CRITERIA

Randomised controlled trials of media-delivered behavioural or cognitive behavioural therapy in adults with anxiety disorders (other than post-traumatic stress disorder) compared with no intervention (including attention/relaxation controls) or compared with face-to-face therapy.

DATA COLLECTION AND ANALYSIS

Both review authors independently screened titles and abstracts. Study characteristics and outcomes were extracted in duplicate. Outcomes were combined using random-effects models, and tests for heterogeneity and for small study bias were conducted. We examined subgroup differences by type of disorder, type of intervention provided, type of media, and recruitment methods used.

MAIN RESULTS

One hundred and one studies with 8403 participants were included; 92 studies were included in the quantitative synthesis. These trials compared several types of media-delivered interventions (with varying levels of support) with no treatment and with face-to-face interventions. Inconsistency and risk of bias reduced our confidence in the overall results. For the primary outcome of symptoms of anxiety, moderate-quality evidence showed medium effects compared with no intervention (standardised mean difference (SMD) 0.67, 95% confidence interval (CI) 0.55 to 0.80; 72 studies, 4537 participants), and low-quality evidence of small effects favoured face-to-face therapy (SMD -0.23, 95% CI -0.36 to -0.09; 24 studies, 1360 participants). The intervention was associated with greater response than was seen with no treatment (risk ratio (RR) 2.34, 95% CI 1.81 to 3.03; 21 studies, 1547 participants) and was not significantly inferior to face-to-face therapy in these studies (RR 0.78, 95 % CI 0.56 to 1.09; 10 studies, 575 participants), but the latter comparison included versions of therapies that were not as comprehensive as those provided in routine clinical practice. Evidence suggested benefit for secondary outcome measures (depression, mental-health related disability, quality of life and dropout), but this evidence was of low to moderate quality. Evidence regarding harm was lacking.

AUTHORS' CONCLUSIONS

Self-help may be useful for people who are not able or are not willing to use other services for people with anxiety disorders; for people who can access it, face-to-face cognitive behavioural therapy is probably clinically superior. Economic analyses were beyond the scope of this review.Important heterogeneity was noted across trials. Recent interventions for specific problems that incorporate clinician support may be more effective than transdiagnostic interventions (i.e. interventions for multiple disorders) provided with no guidance, but these issues are confounded in the available trials.Although many small trials have been conducted, the generalisability of their findings is limited. Most interventions tested are not available to consumers. Self-help has been recommended as the first step in the treatment of some anxiety disorders, but the short-term and long-term effectiveness of media-delivered interventions has not been established. Large, pragmatic trials are needed to evaluate and to maximise the benefits of self-help interventions.

A systematic review of minimal-contact psychological treatments for symptom management in irritable bowel syndrome

OBJECTIVE

Psychological treatments are effective in alleviating symptoms of IBS but are not widely available. The need for wider dissemination of treatments has encouraged the development of 'minimal-contact' therapies requiring fewer resources than existing psychological treatments which rely on face-to-face contact.

METHOD

Using comprehensive search terms, the Embase, Medline and PsychInfo databases (all years) were searched.

RESULTS

Twelve studies--nine RCTs and three non-controlled preliminary studies - meeting inclusion criteria were reviewed and assessed for quality using objective criteria. Apart from one study of expressive writing, all interventions were based on cognitive (and/or) behavioural principles or hypnosis and tended to be adaptations of existing therapist-led interventions. Compared to control conditions, minimal-contact interventions were efficacious, the majority of studies showing statistically significant improvements by the end of treatment. For cognitive-behaviour-therapy-based interventions effects sizes were large. The two studies that compared minimal-contact with therapist-delivered interventions broadly suggest comparable outcomes between these modalities.

CONCLUSIONS

Minimal-contact cognitive-behavioural interventions show promise in the treatment of IBS. Because of the lower quality of studies of hypnosis and those involving interventions delivered entirely remotely, further support is needed before such approaches can be recommended for widespread use. More generally, future research should use representative samples, active control conditions, and intention to treat analysis. Nonetheless, existing high quality studies suggest that minimal-contact therapies may be a safe, effective means of achieving scaleability of psychological treatments for IBS.

Web-based cognitive-behavioral therapy for auditory hallucinations in persons with psychosis: a pilot study

CBT for Psychosis (CBTp) is an empirically-supported intervention for schizophrenia, but few people have access to it in the U.S. "Coping with Voices" is an interactive, computerized self-directed web-based CBTp program developed to increase access to CBTp with the objective of reducing the severity, distress, and functional impairment caused by auditory hallucinations. This open pilot study tested the feasibility and effects of this new intervention. Twenty-one individuals with schizophrenia spectrum disorders and auditory hallucinations were enrolled in the individual-based 10-session Coping with Voices program at one of 4 community mental health centers. High levels of participant satisfaction with the program were found, with most reporting that the program was engaging and helped them manage their symptoms. Seventeen participants (81%) completed more than 50% of the scheduled program sessions (i.e., 6 or more sessions), and were defined as "exposed" to the program. Exposed participants showed statistically significant reductions from baseline to post-treatment in several measures of auditory hallucinations, including overall severity and the perception of voices as an "outside entity" and intensity of "negative commentary," as well as reductions in other psychotic symptoms, and overall psychopathology. This study supports the feasibility of the web-based Coping with Voices program and its potential clinical benefits, and suggests that more rigorous research is warranted to evaluate its effects.

Cost-effectiveness of nurse-led self-help for recurrent depression in the primary care setting: design of a pragmatic randomised controlled trial

BACKGROUND

Major Depressive Disorder is a leading cause of disability, tends to run a recurrent course and is associated with substantial economic costs due to increased healthcare utilization and productivity losses. Interventions aimed at the prevention of recurrences may reduce patients' suffering and costs. Besides antidepressants, several psychological treatments such as preventive cognitive therapy (PCT) are effective in the prevention of recurrences of depression. Yet, many patients find long-term use of antidepressants unattractive, do not want to engage in therapy sessions and in the primary care setting psychologists are often not available. Therefore, it is important to study whether PCT can be used in a nurse-led self-help format in primary care. This study sets out to test the hypothesis that usual care plus nurse-led self-help for recurrent depression in primary care is feasible, acceptable and cost-effective compared to usual care only.

DESIGN

Patients are randomly assigned to 'nurse-led self-help treatment plus usual care' (134 participants) or 'usual care' (134 participants). Randomisation is stratified according to the number of previous episodes (2 or 3 previous episodes versus 4 or more). The primary clinical outcome is the cumulative recurrence rate of depression meeting DSM-IV criteria as assessed by the Structured-Clinical-Interview-for-DSM-IV- disorders at one year after completion of the intervention. Secondary clinical outcomes are quality of life, severity of depressive symptoms, co-morbid psychopathology and self-efficacy. As putative effect-moderators, demographic characteristics, number of previous episodes, type of treatment during previous episodes, age of onset, self-efficacy and symptoms of pain and fatigue are assessed. Cumulative recurrence rate ratios are obtained under a Poisson regression model. Number-needed-to-be-treated is calculated as the inverse of the risk-difference. The economic evaluation is conducted from a societal perspective, both as a cost-effectiveness analysis (costs per depression free survival year) and as a cost-utility analysis (costs per quality adjusted life-year).

DISCUSSION

The purpose of this paper is to outline the rationale and design of a nurse-led, cognitive therapy based self-help aimed at preventing recurrence of depression in a primary care setting. Only few studies have focused on psychological self-help interventions aimed at the prevention of recurrences in primary care patients.

TRIAL REGISTRATION

NTR3001 (http://www.trialregister.nl).

Supported self-management: a simple, effective way to improve depression care

OBJECTIVES

To introduce supported self-management (SSM) for depression, examine it through the use of a quality assessment framework, and show its potential for enhancing the Canadian health care system.

METHOD

SSM is examined in terms of quality criteria: relevance, effectiveness, appropriateness, efficiency, safety, acceptability, and sustainability. Critical research is highlighted, and a case study is presented to illustrate the use of SSM with depressed patients.

RESULTS

SSM is defined by access to a self-management guide (workbook or website) plus encouragement and coaching by health care provider, family member, or other supporter. It has high relevance to depression care in Canada, high cost-effectiveness, high appropriateness for most people with depression, and high safety. Acceptability of this intervention is more problematic: many providers remain doubtful of its acceptability to their poorly motivated patients. Sustainability of SSM as a component of mental health care will require ongoing knowledge exchange among policy-makers, health care providers, and researchers.

CONCLUSION

The introduction of SSM represents a unique opportunity to enhance the delivery of depression care in Canada. Actively engaging the distressed individual in changing depressive patterns can improve outcomes without mobilizing substantial new resources. Over time, we will learn more about making SSM compatible with constraints on provider time, increasing access to self-management tools, and evaluating the benefit to everyday clinical work.