Effects of traditional Chinese culture-based bibliotherapy on the spiritual health of patients with liver cancer

BACKGROUND

Liver cancer is a serious global health problem and is associated with poor spiritual health. Bibliotherapy is beneficial in improving health outcomes in cancer patients, yet there is a lack of empirical evidence of its effect on the spiritual health of liver cancer patients in China. The study aimed to investigate the effects of bibliotherapy based on Chinese traditional culture on the spiritual health of patients with liver cancer in China. This study was approved by the Ethics Committee of Hunan Normal University School of Medicine and registered with the Chinese Clinical Trial Registry with the registration (No: 2021260), which registration in June 30th 2021.

METHODS

A total of 60 patients with liver cancer were divided into the intervention group (n = 30) and the control group (n = 30) through WeChat. The intervention group received bibliotherapy therapy based on traditional Chinese culture, while the control group received routine care. Spiritual health was assessed using the Spiritual Attitude and Involvement List (SAIL) and compared before and after the intervention between the two groups. The chi-square test and t-test were used to analyze the intervention effects.

RESULTS

The two groups were comparable in all baseline characteristics including the SAIL score. After 5 weeks of intervention, the score of SAIL increased significantly from 96.76 ± 15.08 to 106.93 ± 13.82 in the intervention group (t =  - 29.380, p < 0.001), while no significant difference in SAIL score was observed in the control group (from 95.27 ± 16.40 to 95.31 ± 16.24, t =  - 0.189, p = 0.852). Similar patterns were also observed in its three dimensions of connecting with oneself, connecting with the environment, and connecting with transcendence.

CONCLUSIONS

Our study showed that bibliotherapy based on traditional Chinese culture using the WeChat platform can greatly improve the spiritual health of patients with liver cancer and has the potential to be widely applied to cancer patients to improve their well-being.

Tell Me A Story: Promoting resiliency in military children with a bibliotherapy intervention

PURPOSE

Research demonstrates the complex effect of the military lifestyle on children of military members. Problem behaviors can manifest in military children as young as 6 years old (eg, physical violence). Some military children have better outcomes (ie, resiliency). These differences in outcomes are not fully understood; literature agrees that parent's interaction with their children predicts resiliency. Nurses can utilize resiliency interventions to improve the health and wellbeing of families. Tell Me A Story (TMAS), a bibliotherapy intervention, role models for parents reading with their children, using story as a platform to deal with issues in a safe way. The purpose of this pilot study was to determine if child resiliency increased and problem behavior decreased with TMAS participation.

DESIGN AND METHODS

A community-based study examined the impact of TMAS intervention on parent's perceptions of their school-aged children's behavior. Participants were active-duty military parents, recruited on or near seven military installations in the continental United States.

RESULTS

Child problem behavior showed a change from baseline, with sex and parental deployment factoring for improved or worsening behavior among children. Total and internalizing problem behavior scores increased after intervention if a parent was deployed. Girls experienced increased resiliency scores after TMAS intervention while boys experienced decreased scores.

PRACTICE IMPLICATIONS

Overall, TMAS intervention is beneficial for behavior and resiliency for some children and provides research for future programming offered by nurses for military families.

Reading the Child Within: How Bibliotherapy Can Help the Victim of Child Sexual Abuse

Bibliotherapy, the use of storytelling as part of the healing process, has been successfully incorporated into clinical practice for a variety of indications including psychological trauma. This therapeutic modality, which incorporates mindful meditation, non-threatening use of metaphor, and autonomic regulation, can help children and adults alike, who are willing to engage in a story. Yet, bibliotherapy has not been widely adapted as a routine part of the therapeutic toolbox in the context of sufferers of childhood sexual abuse. Here, we review current practices regarding the adjunctive use of bibliotherapy for victims of child sexual abuse, touch upon the theoretical basis of bibliotherapy, and lay out a number of readily-useable strategies for implementing bibliotherapy in one's practice.

Self-help with minimal therapist contact for obsessive–compulsive disorder: a review

Though there are effective psychological and drug treatments for obsessive–compulsive disorder (OCD), many patients remain inadequately treated or untreated. Making effective self-treatment guidance available may increase the number of patients being helped. In this review, database and manual literature searches were performed of case studies, open and randomised controlled trials (RCTs) of bibliotherapy, self-help groups, telecare and computer-aided self-help for OCD. We found no RCTs of bibliotherapy or self-help groups for OCD. Three open studies showed the efficacy of brief exposure and ritual prevention (ERP) instructions delivered by a live therapist by phone. A vicarious ERP computer program was effective in a small open study. Fully interactive computer-aided self-help by ERP for OCD was efficacious in two open studies and a large multicentre RCT, and in a small RCT compliance and outcome with that program was enhanced by brief scheduled support from a clinician. Although more research is needed, self-help approaches have the potential to help many more patients who would otherwise remain inadequately treated or untreated. Their dissemination could save resources used by health care providers. We propose a stepped care model for the treatment of OCD.

Cost-effectiveness analysis of parenting interventions for the prevention of behaviour problems in children

BACKGROUND

Behavior problems are common among children and place a high disease and financial burden on individuals and society. Parenting interventions are commonly used to prevent such problems, but little is known about their possible longer-term economic benefits. This study modelled the longer-term cost-effectiveness of five parenting interventions delivered in a Swedish context: Comet, Connect, the Incredible Years (IY), COPE, bibliotherapy, and a waitlist control, for the prevention of persistent behavior problems.

METHODS

A decision analytic model was developed and used to forecast the cost per averted disability-adjusted life-year (DALY) by each parenting intervention and the waitlist control, for children aged 5-12 years. Age-specific cohorts were modelled until the age of 18. Educational and health care sector costs related to behavior problems were included. Active interventions were compared to the waitlist control as well as to each other.

RESULTS

Intervention costs ranged between US$ 14 (bibliotherapy) to US$ 1,300 (IY) per child, with effects of up to 0.23 averted DALYs per child (IY). All parenting interventions were cost-effective at a threshold of US$ 15,000 per DALY in relation to the waitlist control. COPE and bibliotherapy strongly dominated the other options, and an additional US$ 2,629 would have to be invested in COPE to avert one extra DALY, in comparison to bibliotherapy.

CONCLUSIONS

Parenting interventions are cost-effective in the longer run in comparison to a waitlist control. Bibliotherapy or COPE are the most efficient options when comparing interventions to one another. Optimal decision for investment should to be based on budget considerations and priority settings.

Fiction-reading for good or ill: eating disorders, interpretation and the case for creative bibliotherapy research

Compared with self-help bibliotherapy, little is known about the efficacy of creative bibliotherapy or the mechanisms of its possible efficacy for eating disorders or any other mental health condition. It is clear, however, that fiction is widely used informally as a therapeutic or antitherapeutic tool and that it has considerable potential in both directions, with a possibly significant distinction between the effects of reading fiction about eating disorders (which may-contrary to theoretical predictions-be broadly negative in effect) or one's preferred genre of other fiction (which may be broadly positive). Research on creative bibliotherapy, especially systematic experimental research, is lacking and requires a medical humanities approach, drawing on knowledge and methods from psychology and cognitive literary studies as well as clinical disciplines to expand our understanding of how the dynamic processes of interpretation mediate between textual structures and characteristics of mental health and illness.

[New frontiers of therapy: bibliotherapy.]

Authors discuss therapeutic potential of reading activity, partially still unknown. Starting from Menninger's work in the early 30's until most recent studies from Frude, Berns, Comer who confirmed its efficacy in both the so-called non-organic diseases and chronic pathological conditions. Their studies strongly suggested psychobiological mechanisms through which reading activity exerts its therapeutic effects. The Authors of this paper hope that bibliotherapy in the next future may become a suitable tool in the therapeutical management of the these diseases.

Cost-effectiveness and long-term follow-up of three forms of minimal-contact cognitive behaviour therapy for severe health anxiety: Results from a randomised controlled trial

Strategies to increase the availability of cognitive behaviour therapy (CBT) for severe health anxiety (SHA) are needed, and this study investigated the cost-effectiveness and long-term efficacy of three forms of minimal-contact CBT for SHA. We hypothesised that therapist-guided internet CBT (G-ICBT), unguided internet CBT (U-ICBT), and cognitive behavioural bibliotherapy (BIB-CBT) would all be more cost-effective than a waiting-list condition (WLC), as assessed over the main phase of the trial. We also hypothesised that improvements would remain stable up to one-year follow-up. Adults (N = 132) with principal SHA were randomised to 12 weeks of G-ICBT, U-ICBT, BIB-CBT, or WLC. The primary measure of cost-effectiveness was the incremental cost-effectiveness ratio, or the between-group difference in per capita costs divided by the between-group difference in proportion of participants in remission. The Health anxiety inventory (HAI) was the primary efficacy outcome. G-ICBT, U-ICBT, and BIB-CBT were more cost-effective than the WLC. Over the follow-up period, the G-ICBT and BIB-CBT groups made further improvements in health anxiety, whereas the U-ICBT group did not change. As expected, all three treatments were cost-effective with persistent long-term effects. CBT without therapist support appears to be a valuable alternative to G-ICBT for scaling up treatment for SHA.

Skills Vs. Pills: Comparative Effectiveness for Low Sexual Desire in Women

This study compared the effectiveness of a skill-based bibliotherapy intervention and a placebo pill intervention purported to be efficacious in increasing women's sexual desire. Forty-five participants were randomized into the two groups after completing pretest measures of sexual desire and functioning. After completing their interventions, participants completed 6-week posttest and 12-week follow-up measures. Results demonstrated that when compared to the placebo pill group, the bibliotherapy group made statistically greater gains from pretest to follow-up in sexual desire and satisfaction. Nevertheless, the placebo pill group evidenced short-term improvements in sexual desire over time. Findings have implications for future research and current treatments for low sexual desire in women.

The long-term effects of bibliotherapy in depression treatment: Systematic review of randomized clinical trials

OBJECTIVE

Literature shows bibliotherapy can be helpful for moderate depression treatment. The aim of this systematic review is to verify the long-term effects of bibliotherapy.

METHODS

After bibliographic research, we included RCTs articles about bibliotherapy programme treatment of depression published in English language between 1990 and July 2017. All RCTs were assessed with Cochrane's Risk of Bias tool.

RESULTS

Ten articles (reporting 8 studies involving 1347 subjects) out of 306 retrieved results were included. All studies analyze the effects of bibliotherapy after follow-up periods ranging from 3months to 3years and show quiet good quality in methods and analyses. The treatment was compared to standard treatments or no intervention in all studies. After long-term period follow-ups, six studies, including adults, reported a decrease of depressive symptoms, while four studies including young people did not show significant results.

CONCLUSION

Bibliotherapy appears to be effective in the reduction of adults depressive symptoms in the long-term period, providing an affordable prompt treatment that could reduce further medications. The results of the present review suggest that bibliotherapy could play an important role in the treatment of a serious mental health issue. Further studies should be conducted to strengthen the evidence of bibliotherapy's efficacy.

[BIBLIOTHERAPY AS A CLINICAL TOOL AND ITS APPLICATIONS IN DIAGNOSIS, TREATMENT AND TEACHING MEDICINE]

Bibliotherapy, the practice of healing through stories, is described throughout this article. Case reports show how stories can be used as both a diagnostic tool and a treatment option. Family physicians use bibliotherapy in an all-inclusive manner to heal, consolidate and deepen patient-doctor relationships, help heal the healers and teach medicine. Stories are clinical tools that connect the patients' world with that of their doctors. Stories are a simple tool that don't require great skill and can enhance any patient or physician's experience.

Cost-Effectiveness of Four Parenting Programs and Bibliotherapy for Parents of Children with Conduct Problems

BACKGROUND

Parenting programs and self-help parenting interventions employing written materials are effective in reducing child conduct problems (CP) in the short-term compared to control groups, however evidence on the cost-effectiveness of such interventions is insufficient. Few studies have looked at the differences in effects between interventions in the same study design.

AIM

This study aimed to determine the cost-effectiveness of four parenting programs: Comet, Incredible Years (IY), Cope and Connect, and bibliotherapy, compared to a waitlist control (WC), with a time horizon of 4 months, targeting CP in children aged 3-12 years.

METHODS

This economic evaluation was conducted alongside an RCT of the four parenting interventions and bibliotherapy compared to a WC. The study sample consisted of 961 parents of 3-12 year-old children with CP. CP was measured by the Eyberg Child Behavior Inventory. Effectiveness was expressed as the proportion of "recovered" cases of CP. The time horizon of the study was four months with a limited health sector perspective, including parents' time costs. We performed an initial comparative cost analysis for interventions whose outcomes differed significantly from the WC, and later a cost-effectiveness analysis of interventions whose outcomes differed significantly from both the WC and each other. Secondary analyses were performed: (i) joint outcome "recovered and improved", (ii) intervention completers, (iii) exclusion of parents' time costs, (iv) exclusion of training costs.

RESULTS

All interventions apart from Connect significantly reduced CP compared to the WC. Of the other interventions Comet resulted in a significantly higher proportion of recovered cases compared to bibliotherapy. A comparative cost analysis of the effective interventions rendered an average cost per recovered case for bibliotherapy of USD 483, Cope USD 1972, Comet USD 3741, and IY USD 6668. Furthermore, Comet had an ICER of USD 8375 compared to bibliotherapy. Secondary analyses of "recovered and improved" and of intervention completers held Cope as the cheapest alternative. Exclusion of parents' time and training costs did not change the cost-effectiveness results.

DISCUSSION

The time horizon for this evaluation is very short. This study also had a limited costing perspective. Results may be interpreted with caution when considering decision-making about value for money. The inclusion of a multi-attribute utility instrument sensitive to domains of quality-of-life impacted by CP in children would be valuable so that pragmatic value for money estimations can be made.

IMPLICATIONS FOR FUTURE RESEARCH

Further studies are needed with longer follow-up periods to ascertain on the sustainability of the effects, and fuller economic evaluations and economic modeling to provide insights on longer-term cost-effectiveness. These results also raise the need to investigate the cost-effectiveness of the provision of these interventions as a "stepped care" approach.

CONCLUSIONS

The results suggest the delivery of different programs according to budget constraints and the outcome desired. In the absence of a WTP threshold, bibliotherapy could be a cheap and effective option to initially target CP within a limited budget, whereas Comet could be offered to achieve greater effects based on decision-makers' willingness to make larger investments. In its turn, Cope could be offered when targeting broader outcomes, such as symptom improvement, rather than clinical caseness.

Bibliotherapy: A Strategy to Help Students With Bullying

Use of bibliotherapy to address childhood teasing and bullying is an innovative approach school nurses should consider as they work to promote a healthy school environment. Children’s books serve as a unique conduit of exchange between parents, teachers, and children. Bibliotherapy, using books to help people solve problems, involves three stages: identification, catharsis, and insight. These stages lend themselves well to coping with the sensitivities related to teasing and bullying. Salient research findings pertinent to teasing and bullying have made their way into the children’s literature and have been well received by children and their families over the course of the Child Adolescent Teasing in Schools (CATS) book review project and web site development. After exposure to a fictional story about teasing and bullying, children have shared their own nonfictional account of this often devastating experience and have come to develop successful coping strategies for dealing with the teasing and bullying that takes place in schools nationwide.

Cognitive Therapy for Depression

Thirty-one community-residing older adults age 60 or over either received 16 sessions of individual cognitive psychotherapy (Beck, Rush, Shaw, & Emery, 1979) or read Feeling Good (Burns, 1980) for bibliotherapy. Posttreatment comparisons with the delayed-treatment control indicated that both treatments were superior to a delayed-treatment control. Individual psychotherapy was superior to bibliotherapy at posttreatment on self-reported depression, but there were no differences on clinician-rated depression. Further, bibliotherapy participants continued to improve after posttreatment, and there were no differences between treatments at 3-month follow-up. Results suggest that bibliotherapy and that individual psychotherapy are both viable treatment options for depression in older adults.

Qualitative analysis of bibliotherapy as a tool for adults who stutter and graduate students

PURPOSE

The purpose of this study was to investigate the use of bibliotherapy as a therapeutic tool for adults who stutter (AWS) and as an educational tool for graduate students in speech-language pathology. Bibliotherapy refers to the process of reading, reflecting upon, and discussing literature, often first person illness or disability narratives, to promote cognitive shifts in the way clients and clinicians conceptualize the experience of disability.

METHOD

Five AWS and six graduate students participated in supervised bibliotherapy using a stuttering memoir during therapy sessions. An inductive, qualitative analysis was utilized to analyze data collected from questionnaires and interviews. An additional deductive qualitative approach was utilized to explore how client data fit into an existing five-outcome model of bibliotherapy from the psychology literature.

RESULTS

Graduate students reported developing essential clinical skills for working with clients who stutter, including an improved understanding of the experience of people who stutter and an increased ability to form and strengthen the therapeutic alliance. Clients reported experiencing shifts in the cognitive and affective components of the disorder. Imposing the five-outcome model on client data indicates that at least two clients in the current study experienced all five outcomes of bibliotherapy. These include client experiences of involvement, identification, catharsis, insight and universalism.

CONCLUSION

Both graduate students and clients reported benefits from reading and discussing a memoir about stuttering. Bibliotherapy can be an effective tool in therapy and clinical education when used appropriately.

Treating Mothers of Aggressive Children: A Research Study

In this empirical investigation, three conditions in the group therapy of aggressive children were compared: Child only treatment, Mother + Child treatment, and a notreatment control. The 75 participating children, all Druze from two cities in Israel, were assigned equally and randomly to the three conditions, 25 children in each. In addition, the mothers of these children participated in the study, with 25 of them treated in groups. A semi-structured treatment program using bibliotherapy was conducted, with some modifications, in the two therapy conditions. Results indicated that, compared to the control group, both treatment conditions were effective in reducing aggression, although the Mother + Child condition showed significantly greater gains on the children's self-report measure. With regard to maternal coping, gains were greater in the Mother + Child treatment group than in the Child treatment group on four of six subscales. Finally, three associations were found between reductions in children's aggression and changes in maternal coping.

Mirror book therapy for the treatment of idiopathic facial palsy

We conducted a retrospective chart review to determine the effectiveness of treating idiopathic facial palsy with mirror book therapy in conjunction with facial physical rehabilitation. We compared outcomes in 15 patients who underwent mirror book therapy in addition to standard therapy with those of 10 patients who underwent standard rehabilitation therapy without the mirror book. Before and after treatment, patients in both groups were rated according to the Facial Grading System (FGS), the Facial Disability Index-Physical (FDIP), and the Facial Disability Index-Social (FDIS). Patients in the mirror therapy group had a mean increase of 24.9 in FGS score, 22.0 in FDIP score, and 25.0 in FDIS score, all of which represented statistically significant improvements over their pretreatment scores. Those who did not receive mirror book therapy had mean increases of 20.8, 19.0, 14.6, respectively; these, too, represented significant improvements over baseline, and thus there was no statistically significant difference in improvement between the two groups. Nevertheless, our results show that patients who used mirror book therapy in addition to standard facial rehabilitation therapy experienced significant improvements in the treatment of idiopathic facial palsy. While further studies are necessary to determine if it has a definitive, statistically significant advantage over standard therapy, we recommend adding this therapy to the rehabilitation program in view of its ease of use, low cost, and lack of side effects.

Indicated cognitive behavioral group depression prevention compared to bibliotherapy and brochure control: acute effects of an effectiveness trial with adolescents

OBJECTIVE

We tested whether a brief cognitive behavioral (CB) group and bibliotherapy prevention reduce major depressive disorder (MDD) onset, depressive symptoms, and secondary outcomes relative to brochure controls in adolescents with self-reported depressive symptoms when school personnel recruit participants and deliver the intervention.

METHOD

Three hundred seventy-eight adolescents (M age = 15.5 years, SD = 1.2; 68% female, 72% White) with elevated self-assessed depressive symptoms were randomized to a 6-session CB group, minimal contact CB bibliotherapy, or educational brochure control. Participants were assessed at pretest, posttest, and 6-month follow-up.

RESULTS

CB group participants showed a significantly lower risk for major depressive disorder onset (0.8%), compared to both CB bibliotherapy (6.3%) and brochure control (6.5%; hazard ratio = 8.1 and 8.3, respectively). Planned contrasts indicated that CB group resulted in lower depressive symptom severity than brochure control at posttest (p = .03, d = 0.29) but not 6-month follow-up; differences between CB group and bibliotherapy were nonsignificant at posttest and 6-month follow-up. Condition effects were nonsignificant for social adjustment and substance use.

CONCLUSIONS

The finding that a brief CB group intervention delivered by real-world providers significantly reduced MDD onset relative to both brochure control and bibliotherapy is very encouraging, although effects on continuous outcome measures were small or nonsignificant and approximately half the magnitude of those found in efficacy research, potentially because the present sample reported lower initial depression.

Evidence-based, non-pharmacological treatment guideline for depression in Korea

Although pharmacological treatment constitutes the main therapeutic approach for depression, non-pharmacological treatments (self-care or psychotherapeutic approach) are usually regarded as more essential therapeutic approaches in clinical practice. However, there have been few clinical practice guidelines concerning self-care or psychotherapy in the management of depression. This study introduces the 'Evidence-Based, Non-Pharmacological Treatment Guideline for Depression in Korea.' For the first time, a guideline was developed for non-pharmacological treatments for Korean adults with mild-to-moderate depression. The guideline development process consisted of establishing several key questions related to non-pharmacologic treatments of depression, searching the literature for studies which answer these questions, assessing the evidence level of each selected study, drawing up draft recommendation, and peer review. The Scottish Intercollegiate Guidelines Network grading system was used to evaluate the quality of evidence. As a result of this process, the guideline recommends exercise therapy, bibliotherapy, cognitive behavior therapy, short-term psychodynamic supportive psychotherapy, and interpersonal psychotherapy as the non-pharmacological treatments for adult patients with mild-to-moderate depression in Korea. Hence, it is necessary to develop specific methodologies for several non-pharmacological treatment for Korean adults with depression.

Bibliotherapy for depression

Bibliotherapy can be used to treat mild to moderate depression or subthreshold depressive symptoms, as a sole or supplementary therapy. Bibliotherapy is a form of guided self-help. The patient works through a structured book, independently from the doctor. The role of the doctor is to support and motivate the patient as they continue through the book and to help clarify any questions or concerns the patient may have. Relevant books can be purchased or often borrowed from a library, with limited cost and good accessibility from a patient perspective. Patients need to have a reading age above 12 years and have a positive attitude toward self-help. Bibliotherapy has NHMRC Level 1 evidence of efficacy and no serious adverse effects have been reported. This article forms part of a series on non-drug treatments, which summarise the indications, considerations and the evidence, and where clinicians and patients can find further information.

Interventions for vaginismus

BACKGROUND

Vaginismus is an involuntary contraction of the vaginal muscles which makes sexual intercourse difficult or impossible. It is one of the more common female psychosexual problems. Various therapeutic strategies for vaginismus, such as sex therapy and desensitisation, have been proposed, and uncontrolled case series appear promising.

OBJECTIVES

To assess the effects of different interventions for vaginismus.

SEARCH METHODS

We searched the Cochrane Depression, Anxiety and Neurosis Group's Specialised Register (CCDANCTR-Studies and CCDANCTR-References) to August 2012. This register contains relevant randomised controlled trials from: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). We searched reference lists and conference abstracts. We contacted experts in the field regarding unpublished material.

SELECTION CRITERIA

Controlled trials comparing treatments for vaginismus with another treatment, a placebo treatment, treatment as usual or waiting list control.

DATA COLLECTION AND ANALYSIS

The review authors extracted data which we verified with the trial investigator where possible.

MAIN RESULTS

Five studies were included, of which four with a total of 282 participants provided data. No meta-analysis was possible due to heterogeneity of comparisons within included studies as well as inadequate reporting of data. All studies were considered to be at either moderate or high risk of bias. The results of this systematic review indicate that there is no clinical or statistical difference between systematic desensitisation and any of the control interventions (either waiting list control, systematic desensitisation combined with group therapy or in vitro (with women under instruction by the therapist) desensitisation) for the treatment of vaginismus. The drop-out rates were higher in the waiting list groups.

AUTHORS' CONCLUSIONS

A clinically relevant effect of systematic desensitisation when compared with any of the control interventions cannot be ruled out. None of the included trials compared other behaviour therapies (e.g. cognitive behaviour therapy, sex therapy) to pharmacological interventions. The findings are limited by the evidence available and as such conclusions about the efficacy of interventions for the treatment of vaginismus should be drawn cautiously.

A randomized clinical trial of online-biblio relationship education for expectant couples

This study evaluated the efficacy of a self-paced, Internet-based marriage and relationship skills education program ("Power of Two Online"). The program integrated an online intervention with print supplemental resources. New and expectant parents (n = 79) were randomly assigned to the 2-month intervention or placebo-control group. Assessments were conducted at baseline, 1-month, and 2-month follow-up intervals. Latent growth curve modeling was used to examine differences between conditions for marital satisfaction and conflict management. Participants who received the intervention reported trajectories of improved marital satisfaction and improved marital conflict management over time relative to controls. Implications for widespread dissemination of marriage and relationship education as a primary prevention tool are discussed.

Internet-delivered or mailed self-help treatment for insomnia?: a randomized waiting-list controlled trial

Cognitive Behavioral Therapy (CBT) is effective in reducing insomnia complaints, but the effects of self-help CBT have been inconsistent. The aim of this study was to determine the effectiveness of self-help for insomnia delivered in either electronic or paper-and-pencil format compared to a waiting-list. Participants kept a diary and filled out questionnaires before they were randomized into electronic (n = 216), paper-and-pencil (n = 205), or waiting-list (n = 202) groups. The intervention consisted of 6 weeks of unsupported self-help CBT, and post-tests were 4, 18, and 48 weeks after intervention. At 4-week follow-up, electronic and paper-and-pencil conditions were superior (p < .01) compared to the waiting-list condition on most daily sleep measures (Δd = 0.29-0.64), global insomnia symptoms (Δd = 0.90-1.00), depression (Δd = 0.36-0.41), and anxiety symptoms (Δd = 0.33-0.40). The electronic and paper-and-pencil groups demonstrated equal effectiveness 4 weeks after treatment (Δd = 0.00-0.22; p > .05). Effects were sustained at 48-week follow-up. This large-scale unsupported self-help study shows moderate to large effects on sleep measures that were still present after 48 weeks. Unsupported self-help CBT for insomnia therefore appears to be a promising first option in a stepped care approach.

Efficacy trial of a brief cognitive-behavioral depression prevention program for high-risk adolescents: effects at 1- and 2-year follow-up

OBJECTIVE

To evaluate the effects of a brief group cognitive-behavioral (CB) depression prevention program for high-risk adolescents with elevated depressive symptoms at 1- and 2-year follow-up.

METHOD

In this indicated prevention trial, 341 at-risk youths were randomized to a group CB intervention, group supportive expressive intervention, CB bibliotherapy, or educational brochure control condition.

RESULTS

Significantly greater reductions in depressive symptoms were shown by group CB participants relative to brochure control participants by 1-year follow-up and bibliotherapy participants by 1- and 2-year follow-up but not relative to supportive expressive participants. Supportive expressive participants showed greater symptom reduction than CB bibliotherapy participants did at 2-year follow-up. Risk for onset of major or minor depression over the 2-year follow-up was significantly lower for group CB participants (14%; odds ratio = 2.2) and CB bibliotherapy participants (3%; odds ratio = 8.1) than for brochure controls (23%).

CONCLUSIONS

Results indicate that this group CB intervention reduces initial symptoms and risk for future depressive episodes, although both supportive expressive therapy and CB bibliotherapy also produce intervention effects that persist long term. Indeed, CB bibliotherapy emerged as the least expensive method of reducing risk for future episodes of depression.

The effectiveness of bibliotherapy in alleviating tinnitus-related distress

OBJECTIVE

The present study examined the efficacy of bibliotherapy in assisting individuals experiencing distress related to tinnitus.

METHODS

One hundred sixty-two tinnitus sufferers from Australia participated in a study designed to examine the effectiveness of a cognitive-behaviorally based self-help book in reducing distress. To maximize the ecological validity of the findings, we excluded no individuals interested in treatment for tinnitus-related distress.

RESULTS

The experimental condition lost 35% of participants at postassessment, compared to 10% in the control group. In an analysis of participants who completed postintervention assessment, those assigned to the intervention condition, who received a tinnitus self-help book, showed significantly less tinnitus-related distress and general distress 2 months later compared to those assigned to the waiting list control condition. The intervention group's reduction in tinnitus-related distress and general distress from preintervention to postintervention 2 months later was significant, and these participants maintained a significant reduction in distress on follow-up 4 months after they received the tinnitus self-help book. A long-term follow-up of all participants, who at that time had received the book at least a year previously, showed a significant reduction in tinnitus distress. Although these group differences and pre-post changes were significant, effect sizes were small. Intention-to-treat analyses showed no significant effect for between-groups analyses, but did show a significant effect for the 1-year follow-up pre-post analysis.

CONCLUSION

Information on the effectiveness of using a self-help book, without therapist assistance, in alleviating distress is important, as bibliotherapy can provide inexpensive treatment that is not bound by time or place.

Does providing extended relapse prevention bibliotherapy to problem gamblers improve outcome?

Relapse rates among pathological gamblers are high with as many as 75% of gamblers returning to gambling shortly after a serious attempt to quit. The present study focused on providing a low cost, easy to access relapse prevention program to such individuals. Based on information collected in our ongoing study of the process of relapse, a series of relapse prevention booklets were developed and evaluated. Individuals who had recently quit gambling (N = 169) were recruited (through media announcements) and randomly assigned to a single mailing condition in which they received one booklet summarizing all of the relapse prevention information or a repeated mailing condition in which they received the summary booklet plus 7 additional booklets mailed to them at regular intervals over the course of a year period. Gambling involvement over the course of the 12-month follow-up period, confirmed by family or friends, was compared between the two groups. Results indicated that participants receiving the repeated mailings were more likely to meet their goal, but they did not differ from participants receiving the single mailing in frequency of gambling or extent of gambling losses. The results of this project suggest that providing extended relapse prevention bibliotherapy to problem gamblers does not improve outcome. However, providing the overview booklet may be a low cost, easy to access alternative for individuals who have quit gambling.

Randomized trial of a brief depression prevention program: an elusive search for a psychosocial placebo control condition

This trial compared a brief group cognitive-behavioral (CBT) depression prevention program to a waitlist control condition and four placebo or alternative interventions. High-risk adolescents with elevated depressive symptoms (N=225, M age=18, 70% female) were randomized to CBT, supportive-expressive group intervention, bibliotherapy, expressive writing, journaling, or waitlist conditions and completed assessments at baseline, termination, and 1- and 6-month follow-up. All five active interventions showed significantly greater reductions in depressive symptoms at termination than waitlist controls; effects for CBT and bibliotherapy persisted into follow-up. CBT, supportive-expressive, and bibliotherapy participants also showed significantly greater decreases in depressive symptoms than expressive writing and journaling participants at certain follow-up points. Findings suggest there may be multiple ways to reduce depressive symptoms in high-risk adolescents, although expectancies, demand characteristics, and attention may have contributed to the observed effects.

Manual assisted cognitive treatment for deliberate self-harm in borderline personality disorder patients

This study examines the efficacy of a short-term individual therapy, Manual Assisted Cognitive Treatment (MACT), which was developed to treat parasuicidal (suicidal or self-harming) patients. In this trial, MACT was modified to focus on deliberate self-harm (DSH) in patients with borderline personality disorder (BPD). Thirty BPD patients who were engaged in DSH while in ongoing treatments, i.e., treatment-as-usual (TAU), were randomly assigned to receive MACT (N = 15) or not. DSH and level of suicide ideation were assessed at the baseline, at completion of the MACT intervention, and six months later. Results indicated that MACT was associated with significantly less frequent DSH upon completion of the intervention and with significantly decreased DSH frequency and severity at the six months follow-up. Moreover, MACT's contribution to reducing DSH frequency and severity was greater than the contribution by the amount of concurrent treatments. In contrast, MACT did not affect the level of suicide ideation and time-to-repeat of DSH. In conclusion, MACT seems to be a promising intervention for DSH in patients with BPD. More definitive studies are needed.

Bibliotherapy for children with anxiety disorders using written materials for parents: A randomized controlled trial

The current trial examined the value of modifying empirically validated treatment for childhood anxiety for application via written materials for parents of anxious children. Two hundred sixty-seven clinically anxious children ages 6-12 years and their parents were randomly allocated to standard group treatment, waitlist, or a bibliotherapy version of treatment for childhood anxiety. In general, parent bibliotherapy demonstrated benefit for children relative to waitlist but was not as efficacious as standard group treatment. Relative to waitlist, use of written materials for parents with no therapist contact resulted in around 15% more children being free of an anxiety disorder diagnosis after 12 and 24 weeks. These results have implications for the dissemination and efficient delivery of empirically validated treatment for childhood anxiety.

Evaluation of therapist-supported parent-implemented CBT for anxiety disorders in rural children

Supplementing bibliotherapy with therapist-client communication has been shown to be an effective way of providing services to under-resourced and isolated communities. The current study examined the efficacy of supplementing bibliotherapy for child anxiety disorders with therapist-initiated telephone or email sessions, or with client-initiated contact in a randomised trial using a waitlist control. Participants were 100 anxiety-disordered children and their parents from rural and remote communities. All treatment conditions resulted in improvement on self-report measures and clinician rated severity. Telephone sessions produced superior outcomes with 79% of children being anxiety disorder free post-treatment compared with 33% of email and 31% of client-initiated participants. The results suggest that therapist supplemented bibliotherapy could provide an efficacious treatment option for families isolated from traditional treatment services.

Sexual assault prevention with college-aged women: a bibliotherapy approach

The present research evaluated the efficacy of a skills-based bibliotherapy approach to sexual assault prevention for college-aged women. One hundred and ten participants were followed prospectively for 16 weeks. A self-help book, written by the authors, was compared to a wait-list control on several self-report measures. Results revealed significant differences between groups, with bibliotherapy participants reporting decreased participation in risky dating behaviors and improvement in sexual communication strategies across a variety of dating situations. However, results suggested that the self-help book was no more effective than the wait-list control in reducing rates of sexual victimization. Limitations of the study and directions for future sexual assault prevention research with women are discussed.

Brief Report: A "Storybook" Ending to Children's Bedtime Problems--The Use of a Rewarding Social Story to Reduce Bedtime Resistance and Frequent Night Waking

OBJECTIVE

To evaluate the efficacy and acceptability of a social story with tangible rewards to reduce children's disruptive bedtime behavior and frequent night waking.

METHOD

Four children (ages 2 to 7), with clinically significant disruptive bedtime behavior, received the intervention, which consisted of a social story (The Sleep Fairy) that sets forth (a) parental expectations for appropriate bedtime behavior and (b) rewards for meeting those expectations.

RESULTS

Parent sleep diaries indicated that children had a 78% average decrease in frequency of disruptive bedtime behaviors from baseline to intervention, with another 7% decrease at 3-month follow-up. Night wakings, a problem for 2 children during baseline, were not a problem during intervention and follow-up. Parents reported improved daytime behavior for 3 of the 4 children. Parents gave the intervention high acceptability ratings and maintained a high level of treatment fidelity.

CONCLUSIONS

Use of a social story helped parents implement a multicomponent intervention using a familiar bedtime routine, thereby increasing the likelihood that implementation and effects occurred. The book format makes this intervention widely available to parents and professionals, with minimal costs and inconvenience.

Minimal intervention programs for weight loss in heart transplant candidates: a preliminary examination

CONTEXT

Overweight can be a contraindication for cardiac transplantation, and empirical findings suggest that obesity may pose serious posttransplant health risks that can increase morbidity and mortality.

OBJECTIVE

This study assessed the relative effectiveness of 2 minimal intervention programs to assist weight loss in heart transplant candidates.

DESIGN

A randomized trial was employed to assess changes in body weight.

SETTING

A large, tertiary care hospital in a Southern locale.

PATIENTS

Forty-three heart transplant candidates (74% men, 79% married, 86% white), with a mean pretreatment body mass index of 32.4 (SD = 4.4).

INTERVENTIONS

Patients were randomly assigned to a bibliotherapy weight-loss program or a bibliotherapy plus telephone contact weight-loss program.

MAIN OUTCOME MEASURES

Change in body weight over 3 months and return rate of measures of program adherence (3-day food diaries and self-monitoring postcards).

RESULTS

An intent-to-treat analysis showed a significant weight loss at posttreatment for the sample as a whole. Within-group analyses indicated that a significant weight change (P < .05) in the telephone contact group (mean [SD] = -2.76 [4.96] kg) but not the bibliotherapy-only group (mean [SD] = -1.02 [2.97] kg). Participants in the telephone contact group returned more 3-day food diaries and self-monitoring postcards, with pounds lost significantly correlated with the number of completed self-monitoring postcards. These findings suggest that a minimal intervention program involving information plus limited professional contact may represent a viable approach to assisting overweight transplant candidates in weight management.

Differential effects of manual assisted cognitive behavior therapy in the treatment of recurrent deliberate self-harm and personality disturbance: the POPMACT study

A total of 480 patients were treated in a large, multicenter randomized trial of a brief form of cognitive therapy, manual-assisted cognitive behavior therapy (MACT) versus treatment as usual (TAU) for recurrent deliberate self-harm. Each patient was randomized after a self-harm episode assessed at an accident and emergency center and followed up over 1 year. The main hypothesis tested was that those allocated to MACT would have a lower proportion of self-harm episodes in the succeeding year. A total of 60% of those allocated to MACT had face-to-face treatment and 430 (90%) of all patients had self-harm data recorded after 1 year. Although the results showed no significant difference between those repeating self-harm in the MACT group (39%) compared with the TAU group (46%) (P = 0.20), the treatment was cost effective (10% cheaper than TAU) and the frequency of self-harm episodes was fewer (50%) in the MACT group. A total of nine of 10 patients had some personality disturbance (42% of these with disorder), and for those where information on parasuicide events was collected, the proportion having a repeat episode ranged from 33% to 63% for different personality disorders. Those with BPD were most likely to repeat episodes quickly (mean 89 days for 25% to repeat) with dissocial personality disorder (equivalent mean 384 days) the slowest to repeat. Total costs were significantly greater in those with personality disorder and were reduced in those allocated to MACT; this saving was reversed in those with borderline disorder. On average, MACT appeared to increase the cost of those patients with BPD (BPD) and reduce the cost of those with other personality disorders. It is concluded that MACT has value in preventing self-harm cost effectively but this appears to be confined mainly to those who do not have BPD.

A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessments as early interventions for posttraumatic stress disorder

BACKGROUND

It is unclear what psychological help should be offered in the aftermath of traumatic events. Similarly, there is a lack of clarity about the best way of identifying people who are unlikely to recover from early posttraumatic symptoms without intervention.

OBJECTIVE

To determine whether cognitive therapy or a self-help booklet given in the initial months after a traumatic event is more effective in preventing chronic posttraumatic stress disorder (PTSD) than repeated assessments.

DESIGN

Randomized controlled trial. Patients Motor vehicle accident survivors (n = 97) who had PTSD in the initial months after the accident and met symptom criteria that had predicted persistent PTSD in a large naturalistic prospective study of a comparable population.

SETTING

Patients were recruited from attendees at local accident and emergency departments.

INTERVENTIONS

Patients completed a 3-week self-monitoring phase. Those who did not recover with self-monitoring (n = 85) were randomly assigned to receive cognitive therapy (n = 28), a self-help booklet based on principles of cognitive behavioral therapy (n = 28), or repeated assessments (n = 29).

MAIN OUTCOME MEASURES

Symptoms of PTSD as assessed by self-report and independent assessors unaware of the patient's allocation. Main assessments were at 3 months (posttreatment, n = 80) and 9 months (follow-up, n = 79).

RESULTS

Twelve percent (n = 12) of patients recovered with self-monitoring. Cognitive therapy was more effective in reducing symptoms of PTSD, depression, anxiety, and disability than the self-help booklet or repeated assessments. At follow-up, fewer cognitive therapy patients (3 [11%]) had PTSD compared with those receiving the self-help booklet (17 [61%]; odds ratio, 12.9; 95% confidence interval, 3.1-53.1) or repeated assessments (16 [55%]; odds ratio, 10.3; 95% confidence interval, 2.5-41.7). There was no indication that the self-help booklet was superior to repeated assessments. On 2 measures, high end-state functioning at follow-up and request for treatment, the outcome for the self-help group was worse than for the repeated assessments group.

CONCLUSIONS

Cognitive therapy is an effective intervention for recent-onset PTSD. A self-help booklet was not effective. The combination of an elevated initial symptom score and failure to improve with self-monitoring was effective in identifying a group of patients with early PTSD symptoms who were unlikely to recover without intervention.

Using Poetry to Discover and Share Significant Meanings in Child and Adolescent Mental Health Nursing

TOPIC

Does writing and reading poetry help nurse-therapists, students, and clients reflect on significant meanings and gain a greater understanding of intense clinical situations?

PURPOSE

To describe the use of poetry in managing intense feelings, discuss the relevant literature, articulate how students and clients responded to the use of poetry, and address the limitations of such an approach.

SOURCES

Published literature, clinical expertise, and poems written by the author.

CONCLUSIONS

Writing and reading poetry helps clinicians, students, and clients give voice to situations that touch their hearts. Poetry and literature should be used more extensively in clinical and educational settings.

Bibliotherapy: the therapeutic use of didactic and literary texts in treatment, diagnosis, prevention, and training

The term bibliotherapy has been defined by Russell and Shrodes as "a process of dynamic interaction between the personality of the reader and literature--an interaction which may be used for personality assessment, adjustment, and growth." In the clinical setting, the dynamics that promote change in a patient-reader can include identification, projection, introjection, catharsis, and insight. Clinicians may use bibliotherapy as a tool for patient treatment, medical diagnosis, and the prevention of illness related to psychosocial dysfunction, allowing for gradual and mutual insight into patient complaints over time. Bibliotherapy may display efficacy on intellectual, psychosocial, interpersonal, emotional, and behavioral levels. The author identifies two basic types of resources that are useful to clinicians administering bibliotherapy: didactic texts, which are instructive, and imaginative literature, which can be a literary text, biography, or autobiography and fosters an imaginative response from the patient-reader. The author identifies the advantages and risks of using bibliotherapy and explores its possible applications in osteopathic medical education, encouraging osteopathic medical educators to familiarize themselves with this treatment modality.

The effectiveness of self-administered treatments: a practice-friendly review of the research

Self-administered treatments are a cost-effective way to treat a broad spectrum of people. This article focuses on the existing research of self-administered treatments and their effectiveness when integrated with ongoing practice or when implemented alone. Evidence for their effectiveness is mixed; self-help has been proven successful in the treatment of depression, mild alcohol abuse, and anxiety disorders. It has proven less successful for smoking cessation and moderate to severe alcohol abuse. When determining whether self-administered treatment is appropriate, individual characteristics and attitude as well as the nature and severity of the problem should be taken into consideration. In addition, because many self-help treatments have not been evaluated, caution should be exercised when implementing self-administered treatment, and progress should be carefully monitored.

Integrating self-help books into psychotherapy

This article describes a systematic and integral method of incorporating self-help books into psychotherapy as a collaborative function. We address the distinctions between self-help and bibliotherapy, consider bibliotherapy as adjunctive or integrative to psychotherapy, and outline the multiple uses of bibliotherapy for clinical purposes. How to apply self-help books in psychotherapy and ways to select books are illustrated by a case example. Indications and contraindications for bibliotherapy in therapy are outlined.

Bibliotherapy as an adjunct to psychotherapy for depression in older adults

Bibliotherapy, reading a self-help book for the treatment of psychological problems, has been shown to be effective as a "stand-alone" treatment for depression. Many practitioners recommend self-help books as an adjunct to treatment. This article offers some guidelines for the use of bibliotherapy as an adjunct to individual psychotherapy with depressed older adults. Two clinical cases demonstrate how bibliotherapy can be used effectively in conjunction with individual psychotherapy.

Using a children's book to prepare children and parents for elective ENT surgery: results of a randomized clinical trial

OBJECTIVE

We evaluated the effects of surgery preparation using a children's book on pre- and postoperative anxiety and distress in 2-10 years old children undergoing tonsillectomy and/or adenoidectomy and their mothers.

METHODS

Parents of the experimental group were given the preparation book during the preoperative visit at the hospital, whilst control subjects did not receive the book. Data collection was conducted on the evening prior to surgery (T1), and the evening post surgery (T2). At these two points in time, mothers completed a self-designed feeling states checklist and the state anxiety scale of the State and Trait Anxiety Inventory to assess their perceptions of the child's distress and their own level of anxiety. At T2, nurses were asked to give ratings of patient-caregiver variables, such as level of anxiety, cooperation with care or level of information. The sample under study consisted of 160 mother/child dyads in the experimental group and 240 controls.

RESULTS

We found that mothers who received the book exhibited less self-reported state anxiety prior to the operation compared to mothers who did not. Simultaneously, children of the experimental group showed less distress in 4 of 11 feeling states. Nurses assessed the mothers of the experimental group to participate more in the child's care than control mothers.

CONCLUSIONS

The results demonstrated that our preparation book can provide educational and anxiety-reducing benefits. Given the relatively low production costs and its easy administration, it can be recommended as a popular, practical and cost-efficient tool to prepare children and parents for surgery and hospitalization.

The role of bibliotherapy in health anxiety: an experimental study

Despite its high prevalence and implications for health care resources, health anxiety is generally considered difficult and expensive to manage. Structured self-help materials (bibliotherapy) using a cognitive behaviour therapy (CBT) treatment approach have been shown to be clinically effective. This experimental study investigated the effects of bibliotherapy on patients who had been identified as demonstrating health concerns. The 40 participants (patients drawn from GP surgeries) were randomly allocated to two groups, one receiving bibliotherapy and the other not. Half the patients had a medically diagnosed problem. Anxiety was assessed before and after the bibliotherapy intervention, which took the form of a cognitive-behavioural self-help booklet for health anxiety sufferers. Patients in the bibliotherapy group showed reduced levels of anxiety at post-test, even when they also had an identifiable physical problem. These results are consistent with the idea that self-help materials can be an effective and accessible intervention in CBT, although further research is recommended.

Storybook-based communication intervention for girls with Rett syndrome and their mothers

PURPOSE

Storybook reading provides a natural language learning context in which to support early symbolic communication. In this study, we explored the impact of (1) resting hand splints, (2) light tech augmentative communication systems such as voice-output devices and symbols, and (3) very basic parent training on the symbolic communication and labelling behaviours of six girls with Rett syndrome.

METHOD

Mothers and daughters were videotaped as they read familiar and unfamiliar storybooks in their homes.

RESULTS

Group and individual data collected from the six girls indicated that they became more active and successful participants in the interactions during storybook reading. The girls employed a wider range of communication modes and increased the frequency of their labelling. Familiar storybook reading encouraged greater symbolic communication than unfamiliar storybooks in half the girls.

CONCLUSION

This study suggests that motivated parents may not require expensive technologies or lengthy training in order to enhance their children's early communication and participation in storybook reading.

A bibliotherapy approach to relapse prevention in individuals with panic attacks

The present study examined a relapse prevention (RP) program delivered via bibliotherapy in the treatment of individuals with panic attacks. Compared with a wait list control group, individuals receiving RP exhibited significant reductions on measures of frequency of panic attacks, panic cognitions, anticipatory anxiety, avoidance, and depression. In addition, individuals in the RP group were more likely to attain a "clinically significant change" in status on both panic-free status and level of avoidance more frequently than individuals in the control group. When compared with treatment effects evaluated in two prior phases of the study, the obtained results appear to be the product of a synchronous effect of bibliotherapy and minimal phone contact during the 6-month follow-up period. The results reflect the importance of brief therapist contact in increasing motivation for active participation in bibliotherapy interventions.

[Video technology--a medium for milieu therapy?]

Video technology has been in use in the psychiatric field for more than 20 years for diagnostic, scientific, co-therapeutic or educational purposes. However, little is known of its potential applications and impact as an instrument in psychotherapy or environmental therapy. For this reason a new cinematographic project applying widespread video technology in environmental therapy, too, has been launched. All patients at our psychiatric hospital are involved in film selection, can cooperate at different organizational levels, and have regular opportunities to see films. The technical, the organizational and, in particular, the legal preconditions are set out, followed by a report on experience gained in use of video films within the setting of a psychiatric hospital. Reference is also made to economic aspects, therapeutic effects and contraindications.

Use of SELF-HELP MANUALS to Treat Problem Drinkers

In spite of research findings indicating that alcohol abusers may benefit from self-help manuals, health care providers have been slow to recognize their potential usefulness. As self-care strategies grow more popular and funding for traditional forms of alcohol treatment diminish, health care providers need to look more seriously at these materials. They also need to be aware of new innovations such as self-help materials that can be purchased on diskette. It may not be long before computerized materials sit next to printed manuals on bookstore shelves, and nurses need to know which materials to recommend.

Bibliotherapy: an indirect approach to treatment of childhood aggression

The process of group therapy with five aggressive young boys, utilizing bibliotherapy as its primary mode of intervention, was investigated and is illustrated in this paper. The rationale for using affective bibliotherapy in a group context is given, the content of the program is described, and the process is fully displayed. The effectiveness of the treatment was studied in a single-subject design, comparing treatment children with their matched counterparts. Results pointed to reduced aggression of all the five treatment students, compared with no change in the control children, by self- and teacher report. In addition, results based on an analysis of transcripts showed increased constructive behavior in group for all participants. Although these results should not be generalized, they suggest an interesting line of research for future investigation.

Characteristics of couples applying for bibliotherapy via different recruitment strategies: a multivariate comparison

This study compared characteristics of couples with different sexual dysfunctions who were recruited for participation in a bibliotherapy program via two routes: in response to media advertisements and through their presence on a waiting list for therapist-administered treatment in an outpatient sexology clinic. Data were collected from 492 subjects (246 couples). Male sexology patients were younger than media-recruited males. However, type of sexual dysfunction accounted for a substantially larger proportion of variance in the demographic and psychometric data. An interaction effect of recruitment strategy and sexual dysfunction type was found with respect to female anorgasmia. We conclude from the absence of differences between the two study groups that the Wills and DePaulo (1991) model of help-seeking behavior for mental problems does not apply to couples with sexual dysfunctions joining a bibliotherapy program who either primarily requested professional treatment or who responded to media advertising.