I was asked by a friend to write a short piece on research evidence backing up therapeutic uses of reading & writing to be used in a local initiative supporting health workers in a diverse range of settings.  Today's and tomorrow's post give the piece with hyperlinks to the various research studies that I mention.  A combination of the two posts is downloadable as a Word doc or as a PDF file.

initial comments: There are very many ways that people use reading and writing to reduce suffering and increase well-being.  So someone studying to gain an education is likely to benefit both themselves and others (Loucks, Gilman et al. 2014).  Similarly reading around a subject in order to tackle it more effectively (for example, cooking, DIY, or raising babies) is also likely to be helpful.  At a more psychological level, reading stories can deepen our understanding and connection with others (Gabriel and Young 2011, Kidd and Castano 2013) and help change behaviours for the better (Houston, Allison et al. 2011, Lee, Talwar et al. 2014).  In the following couple of sections however – on reading and on writing – I will keep a narrower focus, looking at evidence supporting more directly “therapeutic” methods.  Although numerous research studies have explored this narrower therapeutic territory, there are still many claimed therapeutic uses of reading and writing that, as yet, have not been tested in any rigorous way.  As Ralph Sockman put it “The larger the island of knowledge, the longer the shoreline of wonder.”

therapeutic benefits from reading: A particularly well-researched approach to “therapeutic reading” is a rapidly growing set of studies using a mix of education, self-monitoring & skills development (typically cognitive behavioural) for a widening variety of psychological problems (Kilbourne 2012).  Studies have looked at the value of simply reading relevant books (Lancee, van den Bout et al. 2012), at reading more carefully designed “work books”, and at computer and internet delivered materials.  Although it is likely that – with increasing sophistication of both programmes and target audiences (Wuthrich, Rapee et al. 2012, Anderson, Price et al. 2013) – computer & smart phone delivery will become dominant, at present simple printed materials are often as helpful as other more hi-tech options (Wagner, Penelo et al. 2013).  Currently improved outcomes seem less dependent on how reading material is delivered and more dependent on how much additional person-to-person support is provided.  Typically, unsupported reading of evidence-based material is more helpful than no intervention at all.  However even quite simple forms of additional person-to person support (via email, discussion groups, online interaction, messaging, email, and face-to-face) often significantly boosts outcomes (Hilvert-Bruce, Rossouw et al. 2012, Lancee, van den Bout et al. 2013).

The value of other kinds of reading intervention is currently less well supported by research.  This is usually because adequate investigations simply haven’t been done, not because studies have shown the interventions to be ineffective.  It can be helpful here to remember Irvin Yalom’s listing of therapeutic mechanisms that can operate in groups: cohesiveness, altruism, universality, interpersonal learning (input & output), catharsis, instillation of hope, identification, family re-enactment, self-understanding, guidance, and existential factors (Yalom and Leszcz 2005).  Yalom’s model would benefit from being updated with further research, but it nicely illustrates the varying mix of therapeutic mechanisms that can operate in reading and writing groups.  Such groups may take so many diverse forms – consider the differences & overlaps between, for example, library-based reading groups in the UK (Whelan 2013), trauma story telling groups for child soldiers in Africa (Ertl, Pfeiffer et al. 2011), and reminiscence-based groups for depressed older people (Hallford and Mellor 2013).  It’s very likely that most of these and other approaches do some good.  Why bother to try analysing how much benefit a particular intervention achieves and what mechanisms are particularly helpful in producing the benefit?  Well, as the famous social psychologist Kurt Lewin put it “There’s nothing so practical as a good theory”.  If we have a pretty clear idea of key mechanisms that help to make a particular reading approach useful, then we can adapt the intervention to boost or add to these central mechanisms and then check that this increases the value of what we’re doing. 

Anderson, P. L., M. Price, S. M. Edwards, M. A. Obasaju, S. K. Schmertz, E. Zimand and M. R. Calamaras (2013). "Virtual reality exposure therapy for social anxiety disorder: a randomized controlled trial." J Consult Clin Psychol 81(5): 751-760.

Ertl, V., A. Pfeiffer, E. Schauer, T. Elbert and F. Neuner (2011). "Community-implemented trauma therapy for former child soldiers in northern Uganda." JAMA 306(5): 503-512.

Gabriel, S. and A. F. Young (2011). "Becoming a vampire without being bitten." Psychological Science 22(8): 990-994.

Hallford, D. and D. Mellor (2013). "Reminiscence-Based Therapies for Depression: Should They Be Used Only With Older Adults?" Clinical Psychology: Science and Practice 20(4): 452-468.

Hilvert-Bruce, Z., P. J. Rossouw, N. Wong, M. Sunderland and G. Andrews (2012). "Adherence as a determinant of effectiveness of internet cognitive behavioural therapy for anxiety and depressive disorders." Behaviour Research and Therapy 50(7–8): 463-468.

Houston, T. K., J. J. Allison, M. Sussman, W. Horn, C. L. Holt, J. Trobaugh, M. Salas, M. Pisu, Y. L. Cuffee, D. Larkin, S. D. Person, B. Barton, C. I. Kiefe and S. Hullett (2011). "Culturally appropriate storytelling to improve blood pressure." Annals of Internal Medicine 154(2): 77-84.

Kidd, D. C. and E. Castano (2013). "Reading literary fiction improves theory of mind." Science 342: 377-380.

Kilbourne, A. M. (2012). "E-health and the transformation of mental health care." Psychiatr Serv 63(11): 1059.

Lancee, J., J. van den Bout, M. J. Sorbi and A. van Straten (2013). "Motivational support provided via email improves the effectiveness of internet-delivered self-help treatment for insomnia: a randomized trial." Behav Res Ther 51(12): 797-805.

Lancee, J., J. van den Bout, A. van Straten and V. I. Spoormaker (2012). "Internet-delivered or mailed self-help treatment for insomnia? A randomized waiting-list controlled trial." Behaviour Research and Therapy 50(1): 22-29.

Lee, K., V. Talwar, A. McCarthy, I. Ross, A. Evans and C. Arruda (2014). "Can Classic Moral Stories Promote Honesty in Children?" Psychological Science 25(8): 1630-1636.

Loucks, E. B., S. E. Gilman, C. J. Howe, I. Kawachi, L. D. Kubzansky, R. E. Rudd, L. T. Martin, A. Nandi, A. Wilhelm and S. L. Buka (2014). "Education and Coronary Heart Disease Risk: Potential Mechanisms Such as Literacy, Perceived Constraints, and Depressive Symptoms." Health Education & Behavior.

Wagner, G., E. Penelo, C. Wanner, P. Gwinner, M.-L. Trofaier, H. Imgart, K. Waldherr, Ç. Wöber-Bingöl and A. F. K. Karwautz (2013). "Internet-delivered cognitive–behavioural therapy v. conventional guided self-help for bulimia nervosa: long-term evaluation of a randomised controlled trial." British Journal of Psychiatry 202(2): 135-141.

Whelan, G. (2013). “An evaluation of the social value of the Get into Reading initiative in Wirral, Merseyside.” Applied Health and Wellbeing Partnership, Centre for Public Health, Liverpool John Moores University.

Wuthrich, V. M., R. M. Rapee, M. J. Cunningham, H. J. Lyneham, J. L. Hudson and C. A. Schniering (2012). "A Randomized Controlled Trial of the Cool Teens CD-ROM Computerized Program for Adolescent Anxiety." Journal of the American Academy of Child and Adolescent Psychiatry 51(3): 261-270.

Yalom, I. and M. Leszcz (2005). “The theory and practice of group psychotherapy (5th ed).” New York, Basic Books.