Comparing different modes of delivery

Cognitive behavior therapy delivered by trained clinicians has been shown to be an effective treatment for childhood anxiety. However, the prevalence of anxiety disorders in children and adolescents, combined with the practical and psychological obstacles that often prevent families from accessing professional help, mean that alternative ways of reaching prospective clients must be explored. This pilot study aims to compare the relative efficacy of two different modes of delivering a family-focused, cognitive-behavioral intervention for children with an anxiety disorder. The two modalities compared were: a parent-delivered program (bibliotherapy) and a clinician-delivered program (individual therapy). Twenty-seven children aged between 7 and 14, together with their parents, were randomly assigned to one of the two conditions listed above. Results at post-treatment showed a significant improvement for children in both treatment conditions in terms of diagnostic status, number of diagnoses and severity of primary diagnosis at follow-up. Children in the bibliotherapy condition demonstrated a significant improvement over time in terms of child- and parent-reported anxiety levels. No differences were found between the two treatment conditions on any outcome measure. These results were maintained at 3- and 6-month follow-up. Although a pilot study, these data suggest that a bibliotherapy format of the intervention described may have potential merit. The implications for service delivery are discussed, as are the limitations of this research.     

Effectiveness of telephone-assisted parent-administered behavioural family intervention for preschool children with externalizing problem behaviour: a randomized controlled trial

Externalizing problem behaviour is one of the most common childhood disorders. Parent training is an effective treatment for these children and there is growing interest in the effects of parent-administered interventions with minimal therapist contact. This randomized controlled study examined the efficacy of a telephone-assisted parent-administered behavioural intervention (bibliotherapy) in families with preschool children with externalizing problem behaviour. Families were randomly assigned to a treatment group (n = 26) and an untreated waitlist control group (n = 22). The intervention comprised the reading of an 11 chapter self-help book and 11 weekly telephone consultations. Compared to the control group, the treatment group demonstrated significant decreases in parent-reported externalizing and internalizing child problem behaviour and dysfunctional parenting practices. Moreover, treated parents reported less parenting-related strains and decreases in parental depression, anxiety, and stress. The results suggest that telephone-assisted self-administered parent training is an effective alternative to more intensive forms of behavioural family intervention for preschool children with externalizing problem behaviour.     

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.     

Treatment of Premature Ejaculation by Bibliotherapy: An experimental study

In this research, bibliotherapy combined with a positive reinforcement procedure was applied to the treatment of premature ejaculation. The results indicate that it is possible to obtain significant improvement in ejaculatory latency by using only a self-administered treatment. Moreover, this study indicates that this improvement is identical to the one obtained when therapists conduct the treatment. Although more subjects treated by bibliotherapy quit the treatment, bibliotherapy was very useful     

Treating nighttime fears in young children with bibliotherapy: Evaluating anxiety symptoms and monitoring behavior change

ObjectiveChildren's nighttime fears are a normal part of child development and are transient for most children, but result in considerable distress for others. The present study evaluated a 4-week bibliotherapy intervention designed to treat young children with persistent and interfering nighttime fears utilizing a multiple baseline design.MethodNine children between 5 and 7 years of age with specific phobia diagnoses were randomized into one of three baseline control conditions (1, 2, or 3 weeks). The treatment protocol involved parents reading Uncle Lightfoot, Flip that Switch: Overcoming Fear of the Dark, Academic Version (Coffman, 2012) with their children over 4 weeks while engaging in activities prescribed in the book. Assessments took place at baseline, post treatment, and 1 month following treatment. Daily and weekly tracking of nighttime behaviors was also obtained.ResultsPre-post group analyses revealed that eight of the nine children demonstrated clinically significant change in anxiety severity. In addition, decreases in child-reported nighttime fears were observed, as were parent-reported decreases in separation anxiety and increases in the number of nights children slept in their own bed.ConclusionsThe present study provides initial support for the use of bibliotherapy in the treatment of nighttime fears. Further replication and evaluation are needed to determine appropriate length of treatment and long-term effects. Implications of the findings are discussed.     

影响阅读疗法对抑郁症疗效的多因素分析

目的探讨影响阅读疗法对抑郁症疗效的多因素。方法共103例抑郁症患者接受阅读疗法的干预,用24项汉密顿抑郁量表对其进行疗效评定,疗效好者为干预有效组,疗效差者为干预无效组,并分析影响阅读疗法对抑郁症疗效的有关因素。结果共103例抑郁症患者中,阅读疗法效果好者占74.76%,效果差者占25.24%;经单因素分析,两组在性别、受教育程度、抑郁症家族史、抑郁症发作次数、是否伴慢性躯体疾病、起病形式、治疗依从性、应对方式问卷的解决问题因子分、自责因子分、求助因子分、社会支持评定量表的主观支持因子分、客观支持因子分和支持利用度因子分等方面存在显著性差异（P〈0.05）;经多元逐步回归分析,影响阅读疗法疗效的主要因素依次为治疗依从性好（r=-0.61）、受教育程度高（r=-0.29）、SSRS支持利用度因子分高（r=3.72）、CMI求助因子分高（r=0.23）、不伴慢性躯体疾病（r=0.21）。结论阅读疗法对抑郁症的疗效受患者生理、心理、社会等多方面因素的影响。     

Bibliotherapy: the use of books in psychiatric treatment.

The guided use of selected books as an adjunct to treatment is applicable to patients in all stages of life and with a variety of problems. This paper describes the authors' experience using books as an adjunct to therapy with psychiatric patients. The authors define the term, review the literature, and set out the objectives of bibliotherapy. The paper presents some principles to follow when assigning books, and examples of books used for common problems. Finally, examples are given of bibliotherapy in action at two Ontario hospitals, and some future directions are suggested.     

A self-help behavioral activation treatment for geriatric depressive symptoms

This study investigated behavioral activation (BA) bibliotherapy as a treatment for late-life depressive symptoms. BA bibliotherapy was administered using Addis and Martell's Overcoming depression one step at a time as a stand-alone treatment that was completed by participants (N=26) over a 4-week period [Addis, M.E., & Martell, C.R. (2004). Overcoming depression one step at a time. Oakland, CA: New Harbinger Publications, Inc.]. Results of an immediate intervention group were compared with those of a delayed treatment control group and treatment response for both groups was evaluated at 1-month follow-up. Primary outcome results showed that symptoms on a clinician-rated measure of depressive symptoms, Hamilton Rating Scale for Depression, were significantly lower at post-treatment for those who received immediate BA bibliotherapy compared with those who were in the delayed treatment control condition. However, self-reported depressive symptoms (a secondary outcome measured via the Geriatric Depression Scale), were not significantly different at this period. Because study control was lost after the delayed treatment group received the intervention, within-subjects analyses examining both treatment groups combined showed that clinician-rated depressive symptoms significantly decreased from pre-treatment to both post-treatment and 1-month follow-up. Self-reported depressive symptoms were significantly lower from pre-treatment to 1-month follow-up. These findings suggest that BA may be useful in treating mild or subthreshold depressive symptoms in an older adult population.     

Amount of therapist contact and outcome in a multidimensional depression treatment program

An 8-week multidimensional program of behavioral management, cognitive restructuring, and assertiveness training was administered to depressed outpatients either individually with a single therapist (n = 12), in two small groups (n = 11), or one large group (n = 11), or as bibliotherapy (n = 12). A randomly assigned waiting list control group was also included (n = 10). Follow-up assessments were conducted at 18 weeks. Principal findings were that 1) there were no significant pretreatment differences among groups, 2) all treated groups including bibliotherapy improved substantially over the course of treatment, 3) the waiting list control group was unchanged during this same period, 4) there were no significant differences among treated groups at termination or at follow-up, nor did these groups change significantly over the period of follow-up. Thus the effectiveness of this multidimensional program was supported, but its efficacy was not systematically influenced by amount of therapist contact.     

Case study: bibliotherapy and extinction treatment of obsessive-compulsive disorder in a 5-year-old boy

Cognitive-behavioral therapy (CBT) is an effective treatment for childhood obsessive-compulsive disorder (OCD). However, no case studies of children younger than 7 years old have been published. This case report describes a 5-year-old boy with severe OCD. Treatment consisted of parent- and teacher-directed extinction of compulsive reassurance-seeking, and bibliotherapy with an age-appropriate book on OCD. Compulsive behavior decreased rapidly and remained at a low level through the remainder of treatment. At posttreatment and at 1- and 3-month follow-up assessments, the patient's OCD symptoms were markedly improved. This report suggests that very young children may respond well to brief CBT.     

Multiple Opportunities for Creating Sanctuary

This article describes the experience of five change agents from a diverse group of settings: two residential treatment programs for children and adolescents, a group home for disturbed adolescents, a residential substance abuse program for urban women, and an acute care psychiatric inpatient unit. What all of these innovators share is a willingness to engage in the challenging and complex process of changing their systems to better address the needs of the traumatized children, adolescents, and adults who populate their various programs. Using the Sanctuary Model as originally applied to a specialty inpatient psychiatric program for adult survivors of childhood abuse as their guide, the leaders of each of these organizations discuss the process of change that they are directing.     

A Randomized Controlled Trial of Bibliotherapy for Carers of Young People With First-Episode Psychosis

Caring for young people with first-episode psychosis (FEP) is challenging and can adversely affect carer well-being, with limited evidence-based support materials available. We aimed to examine whether completion of a self-directed problem-solving bibliotherapy among carers of young people with FEP led to a better experience of caring, less distress and expressed emotion, and better general health than carers who only received treatment as usual (TAU). A randomized controlled trial was conducted across two early-intervention psychosis services in Melbourne, Australia. A total of 124 carers were randomized to problem-solving bibliotherapy intervention (PSBI) or TAU and assessed at baseline, 6-week and 16-week follow-up. Intent-to-treat analyses were carried out and indicated that recipients of PSBI had a more favorable experience of caring than those receiving TAU, and these effects were sustained at both follow-up time points. Across the other measures, both groups demonstrated improvements by week 16, although the PBSI group tended to improve earlier. The PSBI group experienced a greater reduction in negative emotional evaluations of the need to provide additional support to young people with FEP than the TAU group by week 6, while the level of psychological distress decreased at a greater rate from baseline to 6 weeks in the PSBI compared with the TAU group. These findings support the use of problem-solving bibliotherapy for first-time carers, particularly as a cost-effective adjunct to TAU.Key words: burden, experience of caregiving, expressed emotion, problem-solving, self-help     

Who uses bibliotherapy and why? A survey from an underserviced area.

OBJECTIVE: To assess which mental health therapists use bibliotherapy, their reasons for doing so, and rationale for recommending specific titles. To review the book selected most often in several categories, using prepublished criteria for reviewers of self-help books. METHOD: We sent a survey to all therapists in a Northern Ontario community requesting information on therapist demographics, the respondent's practice, the use of bibliotherapy, and details of the book most often prescribed in various categories. RESULTS: Of 112 surveys, 62 were returned, for a response rate of 55%. Sixty-eight percent of respondents indicated that they used bibliotherapy. The most common reason for recommending books was to encourage self-help. There was a significant relation between greater counselling experience and increased use of bibliotherapy. Three of the 5 books reviewed were based on empirical theory; only 1 met all the guidelines. CONCLUSION: Most therapists recommend books to their clients, but there is little empirical evidence of efficacy. Counsellors should review the books recommended and discuss them with the client. Client opinion should be solicited and effectiveness measured.     

Cognitive therapy for depression: a comparison of individual psychotherapy and bibliotherapy for depressed older adults

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 (Bums, 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.     

The effects of bibliotherapy on orgasmic dysfunction and couple interactions: An experimental study

In this research, bibliotherapy was used in the behavioral treatment of orgasmic dysfunction in women. Women of the experimental group had to read a book developed by Heiman, LoPiccolo & LoPiccolo. Moreover, each week a female therapist called each subject to discuss the problems related to the treatment and to support them. Control subjects were included in a waiting list group. Results at the end of the treatment and at the follow-up suggested a significant increase of sexual arousability, sexual satisfaction and sexual repertoire of the subjects and their partners. However, the results do not indicate any change in the orgasmic response.     

Combination of multiple-family therapy with parallel groups

Parallel groups for children, adolescents, and parents have been a usual modality in the Community Guidance Center for over 12 years. This has provided effective therapeutic intervention. However, an inherent difficulty in these groups was discussion with parents about the identified patient's progress. Various methods, on a trial-and-error basis, were attempted. The most successful process, which evolved four years ago, is a multiple-family-therapy session combined with the parallel groups. The multiple-family-therapy group provides an interface for five subsystems [parents and children, also forming families; trainees; staff], opens communication to parents about the child's progress and includes the parent more viably in the treatment process. It provides greater awareness and opportunity for work toward family and individual goals with major focus on communication skills, role modeling for parents and trainees, and realistic goal setting.     

Children of depressive parents and psychiatrically inconspicuous parents in the child and adolescent psychiatry--a comparison study

The present study evaluates the pathogenetic effects of parentally depressions on the children and adolescents in this families. Tested were 100 patients from the Department of Child and Adolescent Psychiatry and Psychotherapy at the University Medical Center Hamburg-Eppendorf (UKE). 50 children and adolescents with at least one depressive parent were related to the investigation group. In addition the control group consisted of 50 children and adolescents with psychiatrically normal parents. We assume that children with a depressive parent need more and longer treatment and the diagnosis will differ from the control group. Furthermore we assume that children of the investigation group are environed more by psychosocial strains. In fact the results proof that children with a depressive parent need significant longer outpatient treatment and a significant increased number of inpatient treatment, appearing syndromes are not specific though. All in all the children of the investigation group are exposed more by psychosocial strains. Further results show, that this children consult more mental institutions and attending therapists commend more often an aftertreatment. Advising to our results children and adolescents with a depressive parent need obviously more treatment than the control group. Therefore an extension of therapeutic and preventive treatment as well as psychological attendance for families with a depressive parent is necessary.     

A comparison of personality variables in autistic and mentally retarded children

Personality characteristics of 35 severely mentally retarded children, including 11 with Down's Syndrome, and 32 autistic children evaluated on the basis of the Behavior Rating Instrument for Autistic Children are compared and discussed. The children, 48 boys and 19 girls, ranged in age from 4 to 12 years. Rating on five scales pertaining to nature and degree of relationship to an adult as a person, communication, vocalization and expressive speech, drive for mastery, and psychosexual development, all described in some detail, indicated that the severely retarded group scored significantly higher in each area. Also higher for that group were the correlations between various scales. It is suggested that severely retarded children, particularly those with Down's Syndrome, are less disturbed, and better integrated than autistic and that fragmentation, compartmentalization and lack of generalization between key areas of function are specific factors in the autistic process.This study was supported in part by National Institute of Mental Health Grant MH-00982.     

MULTIPLE SCLEROSIS IN CHILDHOOD: A NEW LOOK

Five patients (four female, one male) with multiple sclerosis were managed at the Hospital for Sick Children, London, between January 1978 and June 1983. The age at which first symptoms occurred varied from three to 14 years. Focal seizures occurred in three cases and an encephalopathic process in three cases, and there was evidence of progressive intellectual deterioration in all five children. Computed tomography showed low-density lesions in the white matter of all five. Electroencephalograms were abnormal in all cases, and in two the disturbance was severe. Oligoclonal bands were present in the cerebrospinal fluid of two children. Four of the five children had abnormal responses to pattern-reversal stimulus.     

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.