The following is a result of a task which I got assigned for an interview process. The research and elaboration was limited to 5 hours.
Familiarize yourself with bibliotherapy and create a list of crucial considerations. Research the crucical consideration you evaluate as most important.
Guided-self-help: Focus on Bibliotherapy
- Using literature to support an increase in mental-well being
- Patient takes a standardized treatment home (in a book form) and work on it (more or less) independently
- Treatment with the computer can be as a form of bibliotherapy
Crucial Consideration (CC)
- A consideration such that, if it were taken into account, it would overturn the conclusions we would otherwise reach about how we should direct our efforts
- An idea or argument that might plausibly reveal the need for not just some minor course adjustment in our practical endeavors, but a major change of direction or priority
“If we have overlooked even just one such consideration, then all our best efforts might be for naught – or less. When headed the wrong way, the last thing needed is progress.”
Example from CE:
When considering an online cognitive-behavioral therapy (CBT) application, one of the biggest questions might be whether online therapy has evidence of working and, if so, in what contexts. This issue is likely large enough to be worth spending some unstructured research hours on but not large enough to warrant a separate supporting report.
- CE: Informed Consideration - Crucial Consideration
- Crucial Considerations and Wise Philanthropy
- Crucial considerations
- 'Crucial Considerations and Wise Philanthropy', by Nick Bostrom | Pablo's miscellany
|Crucial Consideration||Why is this crucial?||Previous knowledge, Guesses & Assumptions||Initial Quick Verification|
|Literacy rate of the target group.||Bibliotherapy does not work in a written form if people are not able to read.||In countries with the most severe mental health disorders the literacy rate is lower than in developed countries.Might differ significantly for the demographics (young vs old).||The literacy rate differs widely for the demographic and country.But “older than 15 years 86% are literate” .|
|Commitment and willingness to stay committed to bibliotherapy.||The most effective form of bibliotherapy does not help if only a small percentage of people actually commit to it initially and stick to this habit. Given bibliotherapy is effective, is it attractive for a large percentage of the population? Is there evidence for the attractiveness?||There is solid evidence for positive effects in bibliotherapy for guided & and unguided therapy. Furthermore for different types (online vs book) but also fantasy vs self-help. Nonetheless this is the effect for people who actively participated.Is bibliotherapy an attractive therapy method for the broad population? Even though the effects might be greater than different forms of therapy, this doesn’t help if only small percentages actually stick and commit to this kind of therapy.||No quick way to verify.|
|How long do you need to stick to it?||Actual available time that can be invested in bibliotherapy can be limited.||No assumption.||No quick way to verify.|
|Does it work unguided or only guided?Need for follow-up?||Guided bibliotherapy would increase the costs significantly and therefore decrease the cost-effectiveness.||According to the overviews the effect is also measurable for unguided bibliotherapy. Nonetheless it is smaller.||No quick way to verify.|
|For what type of psychiatric disorder is there evidence of the effectiveness of bibliotherapy? Are there differences between disorders?||If bibliotherapy only works for mental health disorders which only affect a small percentage of the population, this invention is not effective.||According to the overviews bibliotherapy works for a wide variety of common disorders.||No quick way to verify.|
|Are the effects short-term or long-term?||The overall effectiveness is decreased if the effects and outcomes of bibliotherapy are only short-term.||No assumption.||No quick way to verify.|
|Does the form of bibliotherapy differ widely for individuals?||If the personal preferences and the types of books help differ widely for persons, this decreases the effectiveness and introduces a matching problem - which is another research project.||No assumption.||No quick way to verify.|
|Is there a difference in the effectiveness based on the demographic (kids vs. older population)?||Is bibliotherapy more effective for certain demographics?||No assumption.||No quick way to verify.|
|Is enough material available in the right language?||Most self-help is probably targeted at western countries.There might be a need for translation. This scales with the consideration of personal preferences.||The translation of books and therapies is a one time process. Therefore I think this consideration can be overcome.||No quick way to verify.|
|Is there a quick and accessible way of publishing the material (Online vs printed)?||To scale the invention there is the need for an accessible and scalable method for publishing and spreading the material.||Smartphones and the internet are getting more and more common and can be used for publishing the material.||3.2 Billion people have access to the internet ~ 50% of the world population .|
Research on the most important CC: Commitment and willingness to stay committed to bibliotherapy.
Which percentage of people actually commit and stick to the therapy, so they are affected by the positive outcomes?
Even if bibliotherapy itself is evaluated as an effective treatment for mental health disorders, the effects will be small, if only a small percentage of people are actually attracted and even fewer commit to this habit.
I evaluated this crucial consideration as the most important one - even though I also think this is the hardest one to research. There is plenty of literature available for the effects of different types of bibliotherapy: guided and unguided, different methods, like books and internet-based, for different demographics, and many more. Nonetheless most of this literature does not mention or focus on the actual delivery, only on the effects of participants who committed to and successfully completed the whole program.
This consideration is strongly neglected in most of the literature I read on the topic of bibliotherapy. In my opinion there are multiple reasons why this consideration is not addressed in most literature.
In all of the studies participants are actively recruited (often from a certain demographic, like students). Therefore there is always an initial investment from the participants into the study, as they are actively interested in participating. As in every study including participants there are multiple screening processes. There are certain criteria for participants to be actually included within the study - before even starting with the program: the screening process.
Furthermore often participants are rewarded with money for their participation.
Lastly, in the interest of research, data is gathered during the program. Therefore multiple questionnaires and telephone interviews are often conducted during the bibliotherapy program, or after the program. Even though the bibliotherapy is sometimes unguided, this process of assessment is necessary to gather the data for the research.
All of this results in an active monitoring of the participants which in my opinion results in a more active participation and stronger commitment.
In the final evaluation of the effect of bibliotherapy, participants who did not actively commit or did not fulfill all of their assessments, are often excluded from the final data analysis. The researchers are often only interested in the effect of participants who fully committed to the program.
To summarize this, there are multiple steps in studies of bibliotherapy which result in a selection bias:
- The multiple screening processes.
- The monitoring during the study (even though the bibliotherapy is described as unguided).
- The exclusion from the final evaluation if the minimum criteria for the assignments are not fulfilled (which includes not committing to the bibliotherapy and not reading the assignments).
Therefore studies often don’t evaluate the initial attractiveness of bibliotherapy for the broader population, and no statement can be made about the effect on people who only partially (or less) commit.
To get a broader picture, an interesting research question is: “How many people read regularly? For whom is this a habit?”
Introducing bibliotherapy as a self-therapy introduced a new habit. For people who are already regular readers it will be easier to commit and stick to the bibliotherapy, for non-avid readers this will be harder.
Nonetheless, given the time frame, I could not find reliable data of regular readers worldwide. This data point would allow for another rough estimate, as, according to my assumption, bibliotherapy will have stronger effects for regular readers.
Another interesting research objective is the number of people who actually want to read more and/or regularly (independent of their reasons), but are failing to accomplish this.
This process is similar to bibliotherapy, as most people are interested in improving their mental health, but often fail to introduce the tools into their life - especially in self-therapy.
During the 2 hours of research on this crucial considerations I would conclude with the following:
The initial literature review gives me the impression that bibliotherapy is a promising tool and has effects on a wide variety of mental health disorders.
Nonetheless these effects were mostly measured on participants who committed to a whole program and finished their assignments. In this crucial consideration I’m interested in the percentage of participants who do not fulfill these criteria.
I recommend further research on this crucial consideration. In the next steps I would try to find further resources on the research questions I proposed.
Additionally I would try to contact authors of promising studies and ask them about my crucial consideration - often this objective is excluded from the literature on purpose due to the publication bias.
I cannot neither confirm nor falsify my crucial consideration at this point in time.
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