JPCB Journal

Bibliotherapy focuses on how literature helps to heal through words. It is an old discipline and was used to try to relieve the mental state of the surviving soldiers of the first World War [1]. More precisely, in the literature, it is defined as an active self-help, brief, nonpharmacological intervention that applies either with cognitive therapy or behavioral therapy techniques [2]. Here, selfhelp is one of the key words that can be highlighted; it means that it is easily accessible to patients and does not necessarily require the presence of a health professional. It is not a medical discipline, but it could be used as an accompanying method of care. Single studies, systematic reviews and meta-analyses have already demonstrated positive results concerning the use of bibliotherapy as adjunct care in people presenting mild to moderate depressive, stress, and anxiety symptoms [2-4]. In this pilot study, we wanted to collect small-scale initial data on bibliotherapy to obtain preliminary results for a larger study focused on a specific type of patient. Here, we sought to first identify whether reading can improve signs of depression and anxiety when used alone in the general population.

We performed a survey in Toulouse, France, on a small sample of 30 people. Between March and April 2022, two questionnaires were delivered to this sample: the first one had to be completed before reading, and the second one had to be completed after a continuous or discontinuous reading of one hour. To evaluate the effects of reading on the respondent, the Hospital Anxiety and Depression scale was used. It is a structured self-questionnaire of 14 items, is an indicator of depressive and anxiety disorders, evaluates an index of symptomatic severity and measures state variables. Moreover, the questionnaires also included questions about whether respondents were regular readers, their type of reading, and whether they were aware of the word bibliotherapy and its meaning. Among the 30 participants, only 25 responded to the two questionnaires. Before answering the items of the HAD scale, we established a profile of the participants. Among them, 96% consider themselves to be regular readers, and 56% claim to read between 7 and 12 books per year. Furthermore, only 28% were aware of the word bibliotherapy. Prior to a reading session, 21 of the participants out of 25 had a depression score between 0-7, meaning no signs of depression (84%), whereas two people had a score between 8 and 10, meaning possible depression, with moderate symptoms (8%, n=25), and two other people had a score between 11 and 15, meaning probable depression with medium to severe symptoms (8%, n=25). The mean score for depression before reading was 5,28 +/- 3,47. On the other hand, we observed much higher anxiety scores among the 25 participants, and the average value before reading was 9,04 +/- 3,36. Indeed, 9 people had an anxiety score between 11 and 15, meaning probable anxiety with medium to severe symptoms (36%, n=25), five between 8 and 10, meaning possible anxiety with moderate symptoms (20%, n=25) and 11 between 0 and 7, meaning no signs of anxiety (44%, n=25). This means that 56% experienced moderate to severe symptoms related to anxiety. Now, if we take the participants’ HAD scores after a reading session, we will observe a more marked improvement in symptoms for anxiety scores than for depression scores. For anxiety, we go from a mean score of 9.04 to a score of 6.84 +/- 3,71 after reading. Among these results, 16 out of 25 participants had a score between 0 and 7 (64%), 5 between 8 and 10 (20%, n=25) and finally 4 between 11 and 15 (16%, n=25). This shows that after a reading session, participants with moderate to severe symptoms rated their anxiety status as improved. Thus, reading could have a real benefit in patients suffering from anxiety states.

However, regarding the results for depression, we had a less clear improvement of the scores. The average score was 4.56 +/- 3.30 after reading compared to 5.28 before reading. We observe that for 75% of the participants with a score greater than or equal to 10, there is no improvement in their score. This could lead us to say that during signs of moderate to severe depression, reading is not sufficient in itself but could be used as adjunct care in the context of supervised psychotherapy. Furthermore, we also observe that reading has an impact on the general well-being of the participants; among them, 84% stated that they felt a sense of well-being because of their regular reading and that they had already read books that were psychologically beneficial to them. Regarding their reading session conducted before the second questionnaire, we find fiction books at the top of the reading list with 68%; moreover, they also confirmed that their reading had been beneficial to them, for 52% it allowed them to escape from their daily life, 12% to find peace, 16% to be more serene, 12% to reflect, 4% to adopt another point of view, and 4% to better understand their situation. According to our respondents experiencing symptoms of anxiety, reading is perceived mainly as an escape from their daily lives because among the 52% who found reading to be an escape, 40% of them were respondents with a moderate to severe anxiety score. However, our study has limitations. We must consider that we have a small sample size, which leads us to have results that cannot be statistically significant, but we have clinical results that remain very encouraging. It will lead us later to develop a larger study with a much larger sample, so we can have statistical and clinical relevance. Indeed, it would be interesting to study the effects of bibliotherapy in prevention in patients suffering from dermatoses because of their condition, they can also suffer from stress and anxiety in everyday life. In conclusion, based on these results, many of the responses support the idea that bibliotherapy could be an additional way to support patients with signs of depression and/or anxiety. Although not all our participants showed symptoms of depression or anxiety, and despite our small sample size, the vast majority shared that reading was beneficial to them daily. Therefore, bibliotherapy could also be defined as an art of self-care through books.

Conflict of interest: Marketa Saint Aroman; Angela Agaësse are employed by Pierre Fabre.

Funding: This study was granted by the Patient centricity department of Pierre Fabre.

Data availability statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.

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References

1. Stip E, Linda Ö, and Karim AA. (2020) “Bibliotherapy: reading OVID during COVID.” Frontiers in Psychiatry 2020: 1278.
2. Gualano MR, Bert F, Martorana M, Voglino G, Andriolo V, et al (2017)”The long-term effects of bibliotherapy in depression treatment: Systematic review of randomized clinical trials.” Clinical psychology review 58: 49-58.
3. Reeves T (2010) “A controlled study of assisted bibliotherapy: an assisted self-help treatment for mild to moderate stress and anxiety.” Journal of psychiatric and mental health nursing 17.2: 184-190.
4. Jones Freda A (2002) “The role of bibliotherapy in health anxiety: an experimental study.” British Journal of Community Nursing 7.10: 498504.