A self-help book is better than sleep hygiene advice for insomnia: a randomized controlled comparative study

The objective was to compare the effects of two types of written material for insomnia in a randomized trial with follow-up after three months. Insomniacs were recruited through newspaper advertisements to a web-based survey with validated questionnaires about sleep, anxiety, depression, and use of sleep medications. A self-help book focusing on cognitive behavioral therapy for insomnia was compared to standard sleep hygiene advice; 77 and 78 participants were randomized to self-help book or sleep hygiene advice, respectively. The response rate was 81.9%. The self-help book gave significantly better scores on the sleep questionnaires compared to sleep hygiene advice. The proportion using sleep medications was reduced in the self-help book group, whereas it was increased in the sleep hygiene group. Compared to pre-treatment, the self-help book improved scores on the sleep (effect sizes 0.61-0.62) and depression (effect size 0.18) scales, whereas the sleep hygiene advice improved scores on some sleep scales (effect sizes 0.24-0.28), but worsened another (effect size -0.36). In addition, sleep hygiene advice increased the number of days per week where they took sleep medications (effect size -0.50). To conclude, in this randomized controlled trial, the self-help book improved sleep and reduced the proportion using sleep medications compared to sleep hygiene advice. The self-help book is an efficient low-threshold intervention, which is cheap and easily available for patients suffering from insomnia. Sleep hygiene advice also improved sleep at follow-up, but increased sleep medication use. Thus, caution is warranted when sleep hygiene advice are given as a single treatment.     

Do self-help books help?

Advice for a happier life is found in so-called ‘self-help books’, which are widely sold in modern countries these days. These books popularize insights from psychological science and draw in particular on the newly developing ‘positive psychology’. An analysis of 57 best-selling psychology books in the Netherlands makes clear that the primary aim is not to alleviate the symptoms of psychological disorders, but to enhance personal strengths and functioning. Common themes are: personal growth, personal relations, coping with stress and identity. There is a lot of skepticism about these self-help books. Some claim that they provide false hope or even do harm. Yet there are also reasons to expect positive effects from reading such books. One reason is that the messages fit fairly well with observed conditions for happiness and another reason is that such books may encourage active coping. There is also evidence for the effectiveness of bibliotherapy in the treatment of psychological disorders. The positive and negative consequences of self-help are a neglected subject in academic psychology. This is regrettable, because self-help books may be the most important—although not the most reliable—channel through which psychological insights find their way to the general audience.     

Self-Help Books Used by Religious Practitioners

Self-help books are frequently used by mental health professionals as adjuncts to the counseling process. This was the first study to assess self-help book utilization practices among explicitly religious practitioners. All practitioner members of the Christian Association for Psychological Studies (N = 784) were mailed a copy of the Self-Help Book Survey. Ninety-two percent of the 243 respondents used self-help books with clients at least some of the time. There were differences between master's and doctoral level respondents with respect to how self-help books were used and the criteria used in selecting self-help books for clients. Most books recommended were explicitly Christian in nature. Those self-help books most frequently recommended are listed and may be useful to practitioners who counsel Christian clients.     

The Uses of Juvenile Fiction and Self-Help Books With Stepfamilies

This article advocates the use of bibliotherapy as an adjunct to counseling with stepchildren and remarried adults. Information to guide the selection and use of fiction and self-help books for children and adolescents is provided. Also mentioned are other audiences and uses for the adolescent fiction.     

Resources on Same-Sex Couples for Therapists and Clients

SUMMARY

This article provides a brief annotated bibliography of resources for working with same-sex couples. We provide summaries of articles, book chapters, books, and web sites which we have found to be particularly helpful in working with same sex couples. Books covered include those targeted to therapists as well as those targeted to clients (self-help and bibliotherapy books).     

‘Truths that Set Us Free?’: The Use of Rhetoric in Mind-Body-Spirit Books

This article provides a critical qualitative analysis of popular mind-body-spirit books. Typically, these books present a hybrid combining spirituality with self-help and popular psychology. They promise to soothe, heal, and liberate the reader from what is construed as a mundane, desolate life and an environmental and social context of despair. Constructions of transformation and liberation are pervasive in these books. The analysis attends to meaning and rhetoric. Three discourses are delineated, each of which constructs transformation and liberation. In addition, while it is assumed that the authors produce a particular version of spirituality in these books rather than present the truth in a value-neutral way, this analysis attends to the rhetorical strategies that can work to make the authors’ message appear as literal and factual to the reader.     

A Review of Published Self-help Books for Panic Disorder

This brief review of 14 self-help books on panic disorder compares: target group, treatment time, included components, existence of structured exercises, and whether or not daily record-keeping is encouraged. Six of the books cover all components deemed necessary for a multimodal cognitive-behavioral treatment package, and five of these are recommended. The reviews are followed by a brief summary of published bibliotherapy studies in which a selection of the books has been used. The results of these studies suggest that bibliotherapy is effective, with an effect size ranging from d = 0.5 to d = 1.5.     

Self-help groups for the bereaved: Theory,theology, and practice

Self-help groups for the bereaved are a relatively unexplored area of wholistic ministry. The article grows out of the author's experience as an advisor to a local chapter of The Compassionate Friends, a group of parents whose children have died. The article explores the self-help concept, describes the experience of losing a child and the way the self-help process functions in that dynamic, and enumerates some roles the author has been able to fill as an aid to a local chapter. Within that framework, the article shows the affinities between self-help and ministry.Dennis Klass, Ph.D., is Chairman of the Department of Religion at Webster College in St. Louis. He is also co-author ofThey Need to Know: How to Teach Children about Death, published by Prentice-Hall in 1979.     

An Interdepartmental Self-Management Lab: A Self-Help Approach to Student Development

The authors describe a self-help information and referral center for students that provides pamphlets, files, books, audiocassettes, videotapes, and computer programs on more than 100 topics related to health, personal growth, and academic skills. The center is located in a university library and is jointly sponsored by three departments.     

Self-Help Books: Some Ethical Questions

Self-help books may be a useful resource to counselors in their work with counselees. They may contribute, however, to the development of psychological problems or prevent people from seeking help when needed. The Utopia promised by self-help books may be a pathology in its own right as marketing experts “hype” a book beyond any reasonable evidence of its efficacy. Ethical questions are raised as well as action suggestions for authors, professional counselors, and professional organizations.     

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.     

StopPulling.com: An Interactive, Self-Help Program for Trichotillomania

Despite the widespread nature and significant impact of trichotillomania (TTM), relatively few controlled studies have evaluated treatment options for people with this disorder. Pharmacological treatment and behavior therapy are the two most widely accepted approaches to treating TTM, but few mental health professionals with appropriate expertise are available to provide care. The cost of treatment also is prohibitive in some cases. A number of self-help books are available for people with TTM, but no empirical data have documented associated outcomes. This paper describes the development and two phases of program evaluation for an alternative, Internet-based self-help treatment strategy for repetitive hair pulling. StopPulling.com is an on-line, interactive self-help approach derived from evidence-based cognitive behavioral models of treatment for TTM. Following program development, an initial test phase elicited feedback from individuals with repetitive hair pulling and professionals with expertise in the treatment of TTM or Web site development. StopPulling.com was modified in accordance with feedback from this initial test phase, and a revised version was made available to the public in January 2003. Preliminary data from 265 users of the program during the first year of public availability suggested significant improvement in symptoms, with some evidence that duration of program use accounted for reductions in symptom severity. Response rates were comparable to long-term follow-up after more intense cognitive behavioral treatment. StopPulling.com may provide a potentially useful self-help alternative or adjunctive strategy for repetitive hair pulling.     

When self-help is no help: Traditional cognitive skills training does not prevent depressive symptoms in people who ruminate

A randomized trial was conducted to test the efficacy of three self-directed prevention intervention workbooks for depression. Cognitively at-risk college freshmen were randomly assigned to one of three conditions: traditional cognitive, non-traditional cognitive, and academic skills. Consistent with hypotheses, participants who were high in rumination and experienced stress exhibited significantly greater levels of depressive symptoms after completing the traditional cognitive skills workbook than after completing the other two workbooks. This pattern of results held post-intervention and 4 months later. These findings indicate that rumination may hinder ones ability to identify and dispute negative thoughts (at least without the help of a trained professional). The results underscore the importance of identifying individual difference variables that moderate intervention efficacy. They also raise concerns about the potential benefits of self-help books, an industry that generates billions of dollars each year.     

A systematic review of self-help for disfigurement: Effectiveness,usability, and acceptability

Self-help has been found to be efficacious in treating mood disorders, however, little is known about its use, effectiveness, or user satisfaction, in reducing distress associated with disfigurement. This review describes the content and focus of self-help interventions available in this area. A systematic search and appraisal protocol facilitated identification of studies, extraction of data, and appraisal of quality. Clinical trials were included if the primary method of intervention delivery was via self-help. Other types of study were included if they investigated user perspectives of a self-help intervention. Eleven studies covering a range of populations met the inclusion criteria. There is tentative support for the use of self-help to manage anxiety associated with disfigurement but little is known about the management of other psychosocial difficulties. Further research and intervention development is required to examine the effectiveness, acceptability, and utility of self-help in managing the appearance related distress associated with disfigurement.     

Outcome predictors in guided and unguided self-help for social anxiety disorder

Internet-based self-help with therapist guidance has shown promise as an effective treatment and may increase access to evidence-based psychological treatment for social anxiety disorder (SAD). Although unguided self-help has been suggested primarily as a population-based preventive intervention, some studies indicate that patients with SAD may profit from unguided self-help. Gaining knowledge about predictors of outcome in guided and unguided self-help for SAD is important to ensure that these interventions can be offered to those who are most likely to respond. Utilizing a sample of 245 patients who received either guided or unguided self-help for SAD, the present study examined pre-treatment symptoms and program factors as predictors of treatment adherence and outcome. The results were in line with previous findings from the face-to-face treatment literature: namely, the intensity of baseline SAD symptoms, but not depressive symptoms, predicted treatment outcomes in both unguided and guided self-help groups. Outcomes were unrelated to whether a participant has generalized versus specific SAD. Furthermore, for the unguided self-help group, higher credibility ratings of the treatment program were associated with increased treatment adherence. The findings suggest that guided and unguided self-help may increase access to SAD treatment in a population that is more heterogeneous than previously assumed.     

Self-help research and the public mental health system

Discusses views of self-help leaders, researchers, and policy makers from the public mental health system about collaborative research with self-help groups. Topics include assumptions underlying collaborative research, barriers to collaborative research, and the potential benefits of collaborative research. Special attention is given to the rationale and methods for including minorities in self-help research. Initial discussions were held at a meeting convened by the NIMH-funded Center for Self-Help Research and Knowledge Dissemination at the University of Michigan.     

Self-help conferences for people who stutter: a qualitative investigation

Self-help activities for people who stutter (PWS) have been gaining in popularity; however, there is a scarcity of evidence to support their utility in stuttering management. The purpose of this investigation was to understand the lived experience of individuals who attended a self-help conference(s) for PWS from the perspective of a PWS to learn its potential utility in stuttering management. The investigator used Interpretive Phenomenological Analysis (IPA) to systematically collect authentic data of this social phenomenon. Twelve participants were recruited from a self-help conference and the self-help community of PWS. Semi-structured interviews were conducted 4–18 months after each participant's last conference. Interviews were transcribed and analyzed. Themes were explained in investigator narratives and illustrated through participants’ quotes. Interpreted themes of the experience of having attended a self-help conference(s) for PWS included: socializing opportunities with other PWS, affiliation, redefining oneself and post-conference disclosures. A conclusion of the study was that the experience of having attended a self-help conference(s) for PWS helped to minimize negative impact that stuttering can have on daily functioning. It appears that self-help conferences were perceived as a safer or “stutter-friendly” environment and promoted social interaction, relationship building, and community building through planned and unplanned activities. Another conclusion was that the experience of having attended self-help conferences for PWS helped participants to communicate more easily. Reported increases in social activity and an “openness” about stuttering, suggest self-help conferences’ utility in stuttering management. These findings are supported by other studies about successful stuttering management and self-help activities for PWS. They have helped attendees who stutter to communicate more easily and suggest a reduction in the negative impact that stuttering has on their lives.Educational objectives: The reader will be able to: (1) describe recurring themes associated with the lived experience having attended a self-help conference(s) for people who stutter (PWS) from the perspective of a group of adults who stutter, and (2) describe the potential benefits of attending self-help conferences for PWS in order to make appropriate evidence-based referrals to self-help conferences for PWS.     

Evaluating the Effectiveness of ACT for Anxiety Disorders in a Self-Help Context: Outcomes From a Randomized Wait-List Controlled Trial

Rigorous evaluations of cognitive behavioral self-help books for anxiety in pure self-help contexts are lacking. The present study evaluated the effectiveness of an Acceptance and Commitment Therapy (ACT) self-help workbook for anxiety-related concerns, with no therapist contact, in an international sample. Participants (N = 503; 94% mental health diagnosis) were randomized to an immediate workbook (n = 256) or wait-list condition (n = 247). Assessments at pretreatment, 12 weeks, 6 months, and 9 months evaluated anxiety and related symptoms, quality of life, and ACT treatment processes (e.g., psychological flexibility). Participants in the wait-list arm crossed over to the workbook following the 12-week assessment. The workbook condition yielded significant improvements on all assessments from pre- to posttreatment relative to wait-list, and these gains were maintained at follow-ups. The pattern observed in the wait-list condition was virtually identical to the active treatment arm after receiving the workbook, but not before. Attrition was notable, but supplemental analyses suggested dropout did not influence treatment effects for all but one measure. Overall, findings provide preliminary support for the effectiveness of this self-help workbook and suggest ACT-based self-help bibliotherapy might be a promising low-cost intervention for people experiencing significant anxiety-related concerns.     

Ellis and Epictetus: Dialogue vs. Method in Psychotherapy

Some recent commentators have found problems in the scientific status of Ellis's REBT, which seem not to be present in Beck's CBT. We argue that this may be partly because they drew differently from the traditions of thought available to them, which appears most clearly in their first published articles. Beck's articles were more in the modern medical tradition, whose history forms part of the search for method leading to abstract knowledge and control that has been so powerful a feature of Western culture. Ellis was more discursive in style and drew more explicitly on the dialogic tradition, in which obstacles to self-awareness and freedom are removed by enlisting the power of reason through question and answer. Socrates and Epictetus are the classical representatives of this tradition, and Ellis's first article shows clear signs of being modelled on Epictetus. Later, however, though continuing in this tradition in his personal style and popular self-help books, Ellis also developed abstract models and methods that belong to the medical tradition. His dual allegiance has made him vulnerable to criticism from both sides.     

Good feelings in christianity and buddhism: religious differences in ideal affect

Affect valuation theory (AVT) predicts cultural variation in the affective states that people ideally want to feel (i.e., "ideal affect"). National and ethnic comparisons support this prediction: For instance, European Americans (EA) value high arousal positive (HAP) states (e.g., excitement) more and low arousal positive (LAP) states (e.g., calm) less than Hong Kong Chinese. In this article, the authors examine whether religions differ in the ideal affective states they endorse. The authors predicted that Christianity values HAP more and LAP less than Buddhism. In Study 1, they compared Christian and Buddhist practitioners' ideal affect. In Studies 2 and 3, they compared the endorsement of HAP and LAP in Christian and Buddhist classical texts (e.g., Gospels, Lotus Sutra) and contemporary self-help books (e.g., Your Best Life Now, Art of Happiness). Findings supported predictions, suggesting that AVT applies to religious and to national and ethnic cultures.