Why is self-help neglected in the treatment of emotional disorders? A meta-analysis.
BACKGROUND
Although the burden of emotional disorders is very high, mental health care is only available to a minority of patients. The literature suggests that self-help strategies, both bibliotherapy and self-help groups alike, are effective for various, less serious complaints but it is unclear whether available data support a role for self-help in treatment protocols for patients with clinically significant emotional disorders.


METHODS
We searched the literature with a focus on 'anxiety' and/or 'depressive disorder'. Standardized assessment of diagnosis or symptoms and randomized controlled trials were inclusion criteria for a meta-analysis.


RESULTS
The mean effect size of self-help (mainly bibliotherapy) v. control conditions is 0.84, and 0.76 for follow-up; the effect sizes of self-help v. treatment are -0.03 and -0.07 respectively. A longer treatment period is more effective.


CONCLUSIONS
Bibliotherapy for clinically significant emotional disorders is more effective than waiting list or no treatment conditions. The dearth of studies on self-help groups for emotional disorders does not permit an evidence-based conclusion concerning the effects of self-help groups. No difference was found between bibliotherapy and psychiatric treatment of relatively short duration.
den Boer
P C A M
PC
Department of Psychiatry, University Hospital Groningen, Groningen, The Netherlands. p.c.a.m.den.boer@acggn.azg.nl
Wiersma
D
D
Van den Bosch
R J
RJ
D001008:Anxiety Disorders / Q000523:psychology* / Q000628:therapy*; D001638:Bibliotherapy; D003866:Depressive Disorder / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D012657:Self-Help Groups; D016896:Treatment Outcome