MEDICAL MATTERS:Bibliotherapy mightn't be for everyone, but at least books don't come with a long list of side effects, writes MUIRIS HOUSTON.
DOCTORS PRESCRIBE lots of things in their professional lives: from tablets to exercise to specific appliances. Recently there has been a growing interest in prescribing books as a treatment for people with different conditions.
Bibliotherapy, to give book prescribing its proper name, is defined as the use of reading material for therapeutic purposes. It is based on the concept that reading is a healing experience.
Although in its broadest definition the term refers to a wide range of reading materials, it is often of a more directed kind, where the health professional recommends specific books about particular conditions.
This approach is especially well developed in mental health, where it is not unusual for GPs and psychologists to suggest books on emotional problems. We now have evidence to show that reading self-help books based on cognitive behavioural therapy (CBT) may be effective in the treatment of mild to moderate anxiety and depression.
In a comprehensive review of this practice, published last year in the Journal of the Irish College of General Practitioners, psychologists Elaine Martin and Fiona Liddy noted that "bibliotherapy might therefore be considered as an adjunct to, or occasionally as an alternative to, traditional treatment in cases of mild to moderate mental health concerns".
They quote evidence from the National Institute for Clinical Excellence (NICE) in the UK which concluded that “high quality CBT based on bibliotherapy is often effective for the treatment of panic disorder, generalised anxiety, mild and moderate depression, bulimia and binge-eating disorders”.
Not surprisingly, the effectiveness of bibliotherapy is related to the quality of the self-help book. A study of one such book – Feeling Good: The New Mood Therapyby David Burns – found a bibliotherapy programme based on the book was as effective as a full course of psychotherapy or treatment with an antidepressant. And bibliotherapy following a short course of cognitive behavioural therapy seems to be especially effective.
People with a variety of anxiety disorders also benefit; those with milder symptoms do best with bibliotherapy. However, bibliotherapy appears to be less effective in the treatment of alcohol and drug addiction.
Writing also has therapeutic benefits. Scriptotherapy is well established in the US; there is a scientific literature around therapeutic writing in psychotherapy. Writing is quite different from talking. It helps patients work things out. It can create pathways to memories, feelings and thoughts – often ones they may not have recognised exist. But by becoming aware of ideas and inspirations, they are in a better position to express these.
The following is from a cancer patient in Britain: “I felt a strong inner compulsion to record what I was going through and made sure I had plenty of paper and pens in hospital. Even in the dark, one sleepless night, I wrote blindly, capturing images and fleeting thoughts without the fear they would have evaporated by the morning medicine round. I would rather throw them away in the cold light of day rather than feel I had let something precious and fleeting slip past irrevocably.
“Both writing and reading my diary entries have clarified my feelings and ideas.”
In Britain, general practitioners formally refer patients to bibliotherapy schemes.
Research into one such scheme by doctors at the University of Liverpool found that most reading groups do not have a targeted therapeutic function. Rather, certain prose passages may trigger reflection in the patient, offering both support and a more nuanced narrative of their own illness.
Following the success of the Dublin North Inner City Book Prescription Scheme, which started in 2007 and through which doctors in the area formally prescribed reading from a list of self-help books, a national bibliotherapy programme has just been launched.
“The Power of Words” is a collaboration between the Irish College of General Practitioners, the HSE and the Library Council. Some 30 books will be placed in all libraries in the State. Patients with psychological issues can then be “prescribed” a relevant text by doctors and psychologists. And if this form of guided self-treatment does not work, the person returns to the doctor to explore other treatment options.
Clearly bibliotherapy is not for everyone and it raises issues around health literacy. But we can be sure of one thing: books don’t come with a long list of side effects.
Dr Houston welcomes feedback from readers but regrets he cannot answer individual medical queries