There is strong evidence that self-help reading can help people with common mental health conditions, such as anxiety and depression, sometimes on its own or with other forms of treatment. We have several strong case studies showing the impact of Books on Prescription on individuals. Reading Well Books on Prescription and Mood-boosting Books take the following guidelines and studies into account.

National Institute for Care and Excellence guidelines

National Institute for Care and Excellence (NICE) guidelines recommend the effectiveness of self-help based on the principles of Cognitive Behavioural Therapy in the following areas:

• Common mental health disorders. See CG123 (2011)

• Commissioning stepped care for people with common mental health disorders. See CMG41 (2012) (implementation guide for CG123)

• Depression. See CG90 (2009)

• Generalised anxiety disorder and panic disorder (with or without agoraphobia ) in adults. See CG113 (2011)

• Anxiety: guide to self-help (implementation tool for CG113 refers to Books on Prescription as an accredited self-help resource). See CG113 (2011)

• Eating disorders. See CG9 (2004)

• Chronic fatigue syndrome/Myalgic encephalomyelitis. See CG53 (2007)

• Obsessive compulsive disorder (OCD) and body dismorphic disorder (BDD). See CG31 (2005)

• Forthcoming social anxiety disorder guideline due May 2013

For the NICE published clinical guidelines and the supporting evidence base for these guidelines visit the NICE website

There is also information on NICE-indicated Treatments for Depression and Anxiety on the IAPT website.

Selection of relevant self-help studies

Evidence indicates that guided self-help works and is more effective than unguided self-help. Whilst there does need to be more research into unguided self-help including books, the research supports the idea that unguided self-help is effective.

Whilst support and guidance increases the effectiveness of self-help, books alone are also helpful. They are a cost effective way of delivering information, a technique of proven effectiveness used by professionals and are a springboard into further professional help.

• 'A Meta- Analysis of Bibliotherapy Studies', Marrs, R.W, Concordia University, Journal of Community Psychology, Vol 23, no 6, (1995)

Abstract: The amount of therapist contact during bibliotherapy did not seem to relate to effectiveness, but there was evidence that certain problem types (weight loss and anxiety reduction) responded better with increased therapist contact. Recommendations for future research were given, especially for more research of the commonly purchased books and moderator analyses by personality and reading ability.

• 'Efficacy, Cost -Effectiveness and Acceptability of Self -Help Interventions for Anxiety Disorders: Systematic Review', Lewis, C., Peace, J. and Bisson, J. Cardiff University, British Journal of Psychiatry Vol 200, pp15-21, (2012)

Abstract: Self-help interventions for psychiatric disorders represent an increasingly popular alternative to therapist administered psychological therapies, offering the potential of increased access to cost-effective treatment. Results of the overall meta-analysis comparing self-help with waiting list gave a significant effect size of 0.84 in favour of self-help. Comparison of self-help with therapist administered treatments revealed a significant difference in favour of the latter with an effect size of 0.34. Self-help interventions appear to be an effective way of treating individuals with social phobias and panic disorders.

• 'Guided and Unguided Self-Help for Social Anxiety Disorder: Randomised Control Trial', Furmark, T. et al, The British Journal of Psychiatry, Vol 195, pp. 440-447 (2009)

Abstract: Unguided self-help through bibliotherapy can produce improvement for individuals with social anxiety disorder.

• 'Guided and Unguided Self-Help for Binge Eating', Loeb, K.L., Terence Wilson, G., Gilbert, J.S., Labouvie, E. in Behaviour Research and Therapy, Vol 38, Issue 3,pp. 259-272 (March 2000)

Abstract: This study compared the relative short and longer term efficacy of therapist-guided and unguided use of a cognitive behavioural self-help manual for binge eating (Fairburn, C.G. (1995) 'Overcoming Binge Eating'). Results indicate that both conditions represent viable means of treating binge eating. The guided self-help condition was notably superior in reducing the occurrence of binge eating and its associated symptomology.

• 'Self-help Interventions for Anxiety Disorder: An Overview', Cuijpers, P., Schuurmans, J., Current Psychiatry Reports, 2007, vol 9, pp.284-290

Abstract: No differences in effect sizes were found between studies that provided professional or paraprofessional support versus unguided self-help; or for studies in which written materials were used compared with studies in which audio/video or computerised materials were used.

• 'Guided Self-Help Cognitive Behavioural Therapy for Depression in Primary Care: A Randomised Control Trial', C. Williams, P Wilson, J Morrison, A McMahon, A. Walker, L Allen, A McConnachie, Y McNeill, L Tansey, PLOS One (January 2013)

Abstract: Access to cognitive behavioural therapy for depression is limited. One solution is self-help books. This trial compared Overcoming Depression: A Five Areas Approach book plus 3-4 short face to face support appointments with treatment as usual. The findings were that guided self-help is substantially more effective than treatment as usual.

• Impact of support on the effectiveness of written cognitive behavioural self-help: A systematic review and meta-analysis of randomised control trials, P Farrand, J Woodford, Clinical Psychology Review 33 (2013), pp. 182-5.

Abstract: The main conclusion from this study is that much greater research should be directed towards examining the relationship between the type and modality of support for CBT self-help and effectiveness. With respect to implementation, there remains cautious support for the continued adoption of written CBT self-help interventions within mental health service developments.

• 'Self-Help Treatment of Chronic Fatigue in the Community: A Randomised Control Trial', T Chalder, P. Wallace, S Wessely, British Journal of Health Psychology, vol 2, pp. 189-197 (1997)

Abstract: The provision of a self‐help booklet and specific advice during a consultation with a research nurse was more effective than no treatment at improving fatigue and psychological distress. General practitioners should be encouraged to use self‐help literature in the management of patients with chronic fatigue.

• Cognitive Behaviour Therapy for Low Self-Esteem: A Preliminary Randomised Control Trial in a Primary Care Setting, P. Waite, F McManus, R. Shafran, Journal of Behaviour Therapy and Experimental Psychiatry, vol 43, issue 4, pp. 1049-1057 (2012)

Abstract: This paper reports on a randomised control trial of cognitive behaviour therapy for low self-esteem (LSE) using Melanie Fennell's cognitive conceptualisation and transdiagnostic treatment approach. The preliminary findings suggest that a focused, brief CBT intervention can be effective in treating LSE and associated symptoms and diagnoses in a clinically representative group of individuals with a wide range of different and co-morbid disorders.

Books on Prescription model

There is evidence to suggest that the Books on Prescription model is an effective method of delivering self -help reading.

• 'Bibliotherapy as a Means of Delivering Psychological Therapy', Neil Frude, Clinical Psychology, vol 39, pp. 8-10 (2004)

Abstract: There is good evidence that the use of bibliotherapy employing high-quality books as represented by Books on Prescription is effective. The results of several studies have demonstrated therapeutic effects, and cost efficiencies.

• 'An Evaluation of Books on Prescription Wales', All Wales Alliance (2006)

Abstract: In the first nine months of the Welsh Books on Prescription scheme, 15,326 books were borrowed in 15 library authorities. Titles most frequently borrowed related to the treatment of depression. The evaluation identified the need for greater standardisation in the reporting of data, the need to raise awareness of the scheme amongst prescribers and potential users and research to better evaluate impact.

• 'Evidence Review of BOP and Creative Bibliotherapy Projects in Libraries', Journal of Psychiatric and Mental Health Nursing, D Chamberlain, vol 15 (2008)

Abstract: This systematic review identifies evidence to support the use of bibliotherapy in the treatment of mental disorder, specifically anxiety and depression especially where people participate fully. The review analyses local BOP schemes and suggests interventions were cost effective, elicited a positive response from patients, improved patient self management and resulted in better patient - doctor relationships. It identified patient impact as a key gap in the evidence base and the need for better evaluation.

• Public Health Devon: Reading Well Books on Prescription evaluation report

Abstract: An evaluation conducted by Public Health Devon, which suggests that working in partnership with libraries is an effective delivery model to reach all groups of the population including those in lower socioeconomic groups.

Creative reading

Reading novels and poetry can reduce stress and boost mood.

• 'Galaxy Commissioned Stress Research', Mindlab International, Sussex University (2009)

Abstract: Tested against other forms of relaxation, reading was proved 68% better at reducing stress levels than listening to music; 100% more effective than drinking a cup of tea, 300% better than going for a walk and 700% more than playing video games. Reading for as little as 6 minutes is sufficient to reduce stress levels by 60%, slowing heart beat, easing muscle tension and altering the state of mind.

• 'The Future of Reading: A Public Value Project', Arts Council England (2009)

Abstract: People understand that reading brings benefits - they attach value to it. It offers relaxation, stimulation, knowledge and self-development, new perspectives on life and inspiration. Libraries are a key local reading resources although some readers have an inaccurate picture of the modern library reading service.

• 'Short- and Long-Term Effects of a Novel on Connectivity in the Brain', Gregory S. Berns, Kristina Blaine, Michael J. Prietula and Brandon E. Pye, Brain Connectivity, V3, N6, 2013

Abstract: This research focuses on whether reading a novel causes measurable changes in the resting state connectivity of the brain and how long these changes persist. On days after reading, significant increases in connectivity were centred on hubs in the left angular/supramarginal gyri and right posterior temporal gyri. These hubs correspond to regions previously associated with perspective taking and story comprehension, and the changes exhibited a timecourse that decayed rapidly after the completion of the novel. Long term changes in connectivity were observed in the bilateral somatosensory cortex, suggesting a potential mechanism for "embodied semantics".

• 'Reading Literary Fiction Improves Theory of Mind', David Cromer Kidd, Emmanuelle Castano, Science, 18 Oct 2013, v 342, N 6156, pp 377-380

Abstract: Understanding others' mental state is a crucial skill that enables the complex social relationships that characterise human society. This skill is known as Theory of Mind. The results of five experiments show that reading literary fiction temporarily enhances ToM. More broadly, they suggest that ToM may be influenced by engagements with works of art.

Reading groups

Social reading activity can promote well being, combat isolation and bring people together in supportive communities.

• 'Reading Groups in Libraries, Mapping Survey Findings', The Reading Agency, 2008

Abstract: Public libraries support a vast network of reading groups and have catered for a huge increase in participation in recent years. It is estimated that there are around 20,000 library linked reading groups catering fro a wide range of communities, interests and abilities.

• 'Reading Groups and Public Libraries Research', The Reading Agency / BML, 2002

Abstract: Over 60% of people surveyed said that being in a reading group helped them get more out of reading and provided an opportunity for pure enjoyment. Significant proportions of reading group members benefited from the social and learning aspect of reading groups, the opportunity to relax and increased self-confidence.

• A National Public Library Development Programme for Reading Groups, The Reading Agency, 2004

Abstract: Being a member of a reading group supports learning, provides opportunities for relaxation and enjoyment, develops individual confidence and self-esteem, builds a feeling of longing and inclusion, promotes a sense of well being and can provide a life-line in difficult circumstances.

• 'Reading Between the Lines: The Experiences of Taking Part in Community Reading Project', S Hodge, J Robinson, P Davis, Medical Humanities, vol 33, pp. 100-104 (2007)

Abstract: The findings show that reading groups do not have to have a specific, targeted therapeutic function, their primary purpose being broadly literary, with literature itself trusted to serve both a coalescing social purpose and to offer non-specified but individual therapeutic benefits. Further work should be undertaken to explore the social and therapeutic benefits of reading literature in community settings.

• 'An Investigation into the Therapeutic Benefits of Reading in Relation to Depression and Well-Being', J Billington, C Dowrick, A Hamer, J Robinson, C Williams, Liverpool Health Inequalities Institute (2010)

Abstract: Clinical data indicates significant improvement in the mental health of depressed patients in the 12 month period they attended Get Into Reading Reading Groups. The findings offer a preliminary evidence base for the efficacy of inexpensive and humane psychosocial intervention, which will inform the development and design of the intervention, as well as choices regarding outcome measures, in the design of a future randomised controlled trail.

The health and well-being value of public libraries

Public libraries play an important role in the health and well-being of local communities.

• Audit of Bibliotherapy/Books on Prescription Practice in England, D.Hicks, 2004

Abstract: The findings from this mapping project identifies that bibliotherapy is represented by a broad and diverse spectrum of activity polarised around library based creative practice using imaginative literature and established reading development tools and self help reading delivered through books on prescription schemes and self-help reading library collections. The audit provides indications of the value of a more joined up approach combining creative best practice with practical self-help approaches.

• Public Library Activity in the Areas of Health and Well-Being, D. Hicks, C.Creaser et al, MLA, 2010

Abstract: The research identifies a wide range of health and well being activity in libraries, and that some core services delivering health and well being benefits, e.g. housebound library services, services for visually impaired people and creative activity such as reading groups, are not automatically seen as part of the library health offer. There is a need for a clearly defined public library health and well being offer aligned with local and national health and social care priorities.

• 'The Public Library as Therapeutic Landscape: A Qualitative Study', Liz Brewster, Health and Place 26 (2014) 94-99

Abstract: This paper uses data from a qualitative study conducted with people with mental health problems to outline the role of the public library as a therapeutic landscape. It situates the public library as a space that it simultaneously familiar and welcoming, comforting and calming and empowering.

• The Public Library Health Offer, The Reading Agency and The Society of Chief Librarians.

Abstract: The research identifies a wide range of health and well being activity in libraries, and that some core services delivering health and well being benefits, e.g. housebound library services, services for visually impaired people and creative activity such as reading groups, are not automatically seen as part of the library health offer. There is a need for a clearly defined public library health and well being offer aligned with local and national health and social care priorities.

Support for Reading Well Books on Prescription

"I am delighted to have been involved in this exciting project to bring help to the millions of people who suffer with anxiety and depression.

"I am sure GPs and other health professionals will value the Reading Well Books on Prescription scheme. Cognitive behavioural therapy (CBT) can be a highly effective talking treatment for people with common mental health problems. This core list of 30 CBT based self help books will be a real boost to the treatments currently available. It is not designed to replace existing care, but provide added value and guidance.

"The self help approaches described are endorsed in guidelines from the National Institute for Health and Clinical Excellence (NICE). Evidence is growing that it can really make a difference."

Paul Blenkiron
Consultant in Adult Psychiatry in York, with a special interest in CBT and NICE Fellow