Abstract
The prevalence of depression, a mental health condition that affects many people, is rising. Oftentimes, low-intensity therapies are employed to help meet treatment demand. For instance, people with mild to moderate symptomology are frequently prescribed books on prescription schemes for bibliotherapy. To define bibliotherapy, it is the use of books as therapy in the treatment of mental or psychological disorders. The bibliotherapy meaning extends beyond just reading; it involves a deeper psychological engagement with the content. Depression symptoms can be successfully reduced using bibliotherapy. Bibliotherapy for depression has shown significant potential as an alternative to traditional therapies, especially in primary care settings. This study prospectively and qualitatively assessed the effect of bibliotherapy; specifically reading an affirmation book on participants suffering from depression.
Reading an affirmation book, “Affirmations for Glowing Skin” by Rhys Blanco. The author assessed the participants’ mental health one day before starting the book and for 7 days throughout reading the book. Based on the results of the present study, bibliotherapy could be a suitable approach for distribution. The study included various bibliotherapy activities designed to engage and benefit the participants. There are other ways to obtain bibliotherapy, including through the private purchase of self-help books or books on prescription programmes. The findings of this study support the fact that daily self-affirmations in our book effectively improve mental symptoms and self-perspectives.
Keywords; Depression; Bibliotherapy; Books; Positive psychology.
Introduction
For depression, pharmacological therapies are the most common treatment used in the primary care setting [1]. From 45.1 million in 1998 to 60 million in 2001, or 7.1% of all office visits in outpatient settings, there was an increase in the number of persons at least 18 years old for whom an antidepressant was included in their progress notes [2].
While psychotropic drugs have shown promise in treating mental and behavioural issues, there are risks and adverse effects associated with any medical intervention for depression [3]. According to Antonuccio et al., agitation, disturbed sleep, gastrointestinal issues, and sexual dysfunction are among the well-known short-term adverse effects of selective serotonin reuptake inhibitors (SSRIs), a family of antidepressant drugs that are frequently recommended in basic care [4].
In light of the potential hazards linked to antidepressants, it is crucial to examine if alternative non-pharmacological therapies could be provided in primary care settings to provide doctors with viable options that entail fewer health risks. The correlation between bibliotherapy and depression relief is increasingly recognized in psychological research. The bibliotherapy book for depression, ‘Affirmations for Glowing Skin’, demonstrates a practical application of this therapeutic approach. This is particularly crucial because patients in primary care settings frequently do not take antidepressant drugs as prescribed because of adverse effects, a lack of symptom improvement, or the possibility that their condition will worsen [5]. Researchers have found that doctors are open to prescribing non-pharmacological interventions for behaviour modification, like exercise [6], that patients gain from these interventions, and that doctors are looking for non-pharmacological interventions for depression as alternatives to medication [7].
The usage of self-help techniques in healthcare settings is growing. With over 100 programmes nationwide, book prescription programmes have grown in popularity in the UK [8]. The NICE guidelines for depression [8] support the use of self-help materials in the early treatment of mild and moderate depression within the stepped-care model. Self-help for depression, including bibliotherapy, provides an empowering approach for individuals coping with mental health challenges. Primary Care practitioners became interested in these programs when they were introduced [9].
Studies show that compared to treatment as usual, active control condition, and/or anti-depressant medications, psychological interventions targeted at preventing relapse and recurrence in patients with a history of depression and provided during the continuation or maintenance phase are effective in lowering the risk of relapse and recurrence [10-12]. This study prospectively and qualitatively assessed the effect of bibliotherapy; using guided reading therapy, as a form of bibliotherapy; specifically reading an affirmation book on participants suffering from depression.
Materials and Methods
Overall Study Design
Since a qualitative technique enables us to collect data directly from the viewpoint of patients, it was employed. It is founded on the constructivist perspective on science, which holds that inductive reasoning is essential to the development of the study and that knowledge is formed through interactions between the researcher and informants. As a result, qualitative approaches enable a deeper comprehension of patients’ viewpoints and do not have the constraints of quantitative surveys’ structured question types [13].
Intervention
Reading an affirmation book, “Affirmations for Glowing Skin” by Rhys Blanco [14]. The author assessed the participants’ mental health one day before starting the book and for 7 days throughout reading the book. The book environment comprehended that “Evoke surrender, Absolute effortlessness be a transparency for the Source of All Energy, Infinite has a symbol, a definition, a feeling! This is where we are all connected. A dimension that is the predecessor that is lighter than anything we call physical and also anything we imagine or think.”
Data collection
The author predesigned a questionnaire to assess the participants’ mental health and perspectives for 7 days starting from pre-starting reading the book. The questions were as follows:
|
Questions: |
| 1) How do you feel? 1 to 10 and comment |
| 2) How do you feel about yourself? 1 to 10 and comment |
| 3) How do you feel about all living things? 1 to 10 and comment |
| 4) How connected do you feel with the world? 1 to 10 and comment |
| 5) Were you more confident in yourself than yesterday? Yes/no |
| 6) Do you love yourself more than yesterday? Yes/no |
| 7) Do you feel happier than yesterday? Yes/no |
| 8) Other comments? Things noticed that were different? |
Are there better example to use for the days?
Results
This study followed three female participants for 7 days. Here, I will state examples of the participants’ answers to the questions.
Pre-reading day
| -When asked how they feel?
Participant (1) gave herself (2 out of 10) and participant (2) gave herself (4 out of 10).
-When asked about how they feel about themselves today? Participant (1): “I do not even know myself anymore. I deserve to give myself a 2.5, I feel.” like I haven’t done a lot with my life. I am overweight; my career is almost deteriorating. And I do not feel attractive anymore. It’s much effort just to be alive. But there is always light at the end of the tunnel. I hope so.” Participant (2) just gave herself “5 out of 10.” |
Day (1) of Reading:
| -When asked how they feel?
Participant (1): “I can rate myself a 5 today. I am feeling much better today. I read the book in the morning, and it gave me more energy. The relaxation message is on top is what I can say.” Participant (2): “Score: 4. A little bit off to be honest, I feel disconnected and not excited even though exciting things are happening to me, can’t connect with them.” Participant (3): “Score: 6 – better sleep than yesterday, I fell asleep after reading quite fast.”
-When asked if they are more confident today than yesterday? Participant (1) and Participant (2) did not feel more confident than yesterday; while Participant (3) stated that she felt more confident. -Interestingly, all of the participants stated that they love themselves more and feel happier today. |
Day 3 of Reading:
| -When asked how they feel?
Participant (1): “I can rate myself a 6.9 today. I am feeling neutral today. Not sad or happy. It’s just in the middle. I do not know. It is a mixture of feelings.” Participant (2): “2. The Israel – Gaza situation is everyone on the news and I feel so hopeless. It makes me incredibly sad that lives are being lost each minute of the day. I read somewhere that 1 Palestinian kid is killed every 15 minutes, and I thought this was horrendous. I have a hard time setting emotional boundaries so I’m letting this get to me more than it should.” Participant (3): “Score: 8 – good, a bit tired but more relaxed than the last days.”
-When asked if they are more confident today than yesterday? All participants stated that they felt more confident than yesterday. Participant (1) reported, “Definitely, I do think that I look happier in the mirror.” -Participant (2) commented: “The book has been helpful, the daily affirmations and reminders help a lot when I do breathing exercises at the same time and becomes even better once I play some chill music.” |
Day (7) of Reading:
| -When asked how they feel?
Participant (1): “Internally, I rate myself an 8. I am feeling good, gentle, and blessed to be alive. It’s a bit calm today. Let’s wait for tomorrow. Externally, I can rate myself a 7.9. I am feeling my skin and seeing the results. I love my chocolate skin, and I am starting to love the results my body is producing.” Participant (2): “Score: 7. I feel happy-ish today. I exercised, took a sunbath, and I’ve generally been okay. My news consumption went significantly down from last week, so it has been easier to focus on good things.” Participant (3): “Score: 7 alright in general, not as good as yesterday; I’ve got a lot of stress today.”
-When asked if they are more confident today than yesterday? All participants stated that they felt more confident than yesterday. Participant (2) reported, “Every day gets better. However, I have a small pimple on my face. Even though the rest of my skin looks great, this pimple annoyed me, especially because it’s on my nose.” -Participant (2) commented: “The book has been helpful. The daily affirmations and reminders help a lot when I do breathing exercises simultaneously and become even better once I play some chill music.”
-Comments: “Comparing myself one week ago vs now, I think there are small changes, but at the same time, they feel huge. I started pretty much hating myself and my life, and now I can see and express gratitude for so many things. Even though the recent conflicts in the Middle East have made me so sad and contributed a great deal to my depression, reading positive affirmations at least helped me stay grounded and showed me a lot of good things that made me feel great.” Participant (1): “Thank you for the book, Rhys. What I can say is that the book has helped me through my healing process. It has helped me get through the toughest time in my life. Of course, I have gone through some therapy and the book has been a great tool to push me through the day and night.” |
Discussion
Summary of the results
Prior to reading the book, all of the participants rated themselves with scores ranging from 2 to 4 out of 10. They stated that they did not even know themselves, and they wanted to be alone all the time. Interestingly, once they started reading the affirmations, these rates markedly increased. The concept of bibliotherapy depression treatment is grounded in the therapeutic power of reading and self-reflection. The book gave them more energy, and they slept better. They felt more connected to nature, less anxious, and increasingly confident with more self-love.
In the middle of this journey (specifically on Day 3), the participants recorded more progress as the daily affirmations, as well as the breathing exercises, helped them to appreciate themselves and their surroundings and be more focused.
The effectiveness of bibliotherapy for mental health issues was clear by the end of this study. At the end of this journey (On Day 7), the participants felt better about their internal self and their physical appearance. The participants reported being so proud of themselves, seeing how much life is becoming beautiful, and their skin is doing wonders because of the skincare routines. Reading therapy for adults with depression is an innovative approach that merits further exploration. This study provides evidence that reading helps depression, offering a non-invasive and accessible treatment option. Participants had access to various bibliotherapy resources, enhancing their engagement in the treatment. The participants thanked the author for the book, as it helped them through their healing process and get through the toughest time in their lives.
The current study’s findings support the effectiveness of the affirmations book “Affirmation Book for Glowing Skin” [14] in relieving depressive symptoms and elevating emotions of well-being. Based on the results of the present study, bibliotherapy could be a suitable approach for distribution. There are other ways to obtain bibliotherapy, including through the private purchase of self-help books or books on prescription programmes.
Literature review
Approximately half a million books on prescription have been loaned out by participating libraries since 2013, and 93% of libraries in England are involved in books on prescription programmes. These books are prescribed by GPs, IAPT services, and other medical experts, among other sources. But in England, self-referrals account for the most majority (80% in 2013) [15].
According to the Psychiatric Morbidity Survey, there is a connection between socioeconomic hardship and common mental health conditions, including depression. There was a higher likelihood of co-morbid mental health disorders among those who reported receiving the Employment and Support Allowance (ESA), a benefit intended for people unable to work due to illness or disability. Almost half of them claimed having attempted suicide. Bibliotherapy, especially with regard to literature on prescription systems, may be very effective in reaching these susceptible people. The benefits of bibliotherapy are evident in the improved mental health scores post-intervention. While books on prescription schemes are available to anyone with a free library membership and, as such, are open to all socioeconomic groups, other self-help interventions, such as computerised self-help or apps that target mental health disorders, require the user to have access to technology (e.g., a computer, an internet provider, or a smartphone, etc.) [16].
There were several methodological limitations in this study. It is important to evaluate the results cautiously. The limited sample size and absence of a control group may have caused the lack of main reliable effects. Even if the counsellor and the participant were merely providing support to each other rather than actively engaging in a therapeutic connection, the interpersonal relationship itself may have been a useful component of therapy.
Conclusion
Based on the results of the present study, bibliotherapy could be a suitable approach for distribution. This study underscores the importance of non-pharmacological treatments for depression, providing a viable alternative to medication. Self-help therapy, particularly through bibliotherapy, offers a promising avenue for mental health improvement. There are other ways to obtain bibliotherapy, including through the private purchase of self-help books or books on prescription programmes. The findings of this study support the fact that daily self-affirmations in our book effectively improve mental symptoms and self-perspectives.
Recommendations
Future research should aim to (1) enlist a clinical sample of participants with a diagnosis of depression, (2) incorporate a control group that receives therapy as usual or no treatment, and (3) enlist a larger sample that is ethnically and gender diverse. Those with mild to moderate symptomology who might not be presenting through regular channels or who might not be given priority for high-intensity therapies because of lengthy treatment waiting lists could benefit from bibliotherapy. Currently, there are many options for bibliotherapy consumers to obtain self-help books, including through books on prescription programmes or through private purchases of self-help books. Because the recommended titles are supported by evidence, the latter option is better. Contact us to for more info.
References
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