By Sarah Perini and Ronald Rapee
The concept of psychological self-help, whether it is online, the traditional book, or the newer smartphone app, is one that elicits divided reactions. On the one hand, self-help is often the butt of jokes. Think Bridget Jones’s Diary, the comedy book and film about a single woman in her 30s, a self-confessed self-help devotee who consults numerous tomes in her pursuit to lose weight, get a man, and be happy. On the other hand, self-help is enormously popular – the sheer number of self-help resources consumed every year suggests that many of us like the idea of getting assistance with life’s problems in an easy, accessible, and low-cost way.
Psychological self-help resources are available for a whole range of topics, from general areas like happiness and self-esteem, to highly specific problem-focused topics such as coping with post-traumatic stress after a car accident, or parenting a child with Asperger’s syndrome. Some of the most popular include those that aim to help people manage anxiety, high stress, and depression — conditions that will affect approximately one in two people at some time in their life. But with so many self-help resources available, in both paper and digital form, it is worth reflecting on a few key questions. Does self-help for emotional health work? What should consumers look for when choosing self-help resources? And, in an age of increasing demand on health services, what role can self-help play in keeping our population well?
The short answer to the first question is “yes”. There are now many carefully conducted, scientific studies that show that people can learn to be less anxious, depressed, and stressed with the assistance of self-help materials. Much of this work has used printed books to deliver self-help advice, while some of the more recent research is based on Internet programs, and some very new work is beginning to assess the value of information delivered through smartphones. In all cases the effects are much the same. People who read and apply information they learn through self-help materials are consistently less anxious, stressed, or depressed than people in comparison groups.
Evidently, quality self-help tools can deliver enormous benefits. But how does the consumer best choose which self-help resources to use? If one does an Internet search of the words “stress,” “anxiety,” or “depression,” paired with the term “self-help,” thousands of options come up. What steps can the consumer take to make sure they are accessing quality and evidence-based advice?
One simple way to narrow the options is to check whether the website, application, or book author is linked to a reputable institution. Do some background research into the qualifications and experience of the author/s, and check that these are relevant to the topic area. Keep a healthy dose of scepticism for “cure all” or “quick fix” claims, as well as those websites that encourage you to buy expensive products. Reputable self-help resources will acknowledge the limitations of their approach, and won’t claim that they can help everyone. Finally, check to see whether the advice has been tried and tested in well-conducted research. Unless it has, you are really just getting the author’s personal opinion. And don’t just take their word for it. Properly conducted scientific research is almost always published in reputable scientific journals where it is carefully checked by other scientists.
The emergence of quality and evidence-based self-help has important implications for broad scale health systems, as well as individuals. One example of this can be found in the United Kingdom. In 2006 a leading British economist, Richard Layard, released an influential report called, “The Depression Report”. Why would an economist write a report on depression? Well, because depression, like any other health condition, costs society money. Obviously, treatment incurs a cost. But, as Layard argues, the costs of not treating depression are vastly greater. When people feel depressed or anxious, they take more time off work. They don’t concentrate as well, and are less productive when they go to work. Where the symptoms are severe, they are often unable to work at all, relying on savings, family support, or welfare benefits to survive. So, Layard crunched the numbers and found that leaving depressed and anxious people untreated costs the economy 20 times the amount it would cost to provide an effective treatment service.
So what does this have to do with self-help? Well, the UK government paid attention to these figures, and decided to roll out a vast, nationwide project called “Improving Access to Psychological Therapies”. They made a commitment to providing effective help for depressed and anxious people living in the United Kingdom. The system they adopted is widely known as Stepped Care. Stepped Care means that people with mild to moderate depression, and those with anxiety, are given low intensity interventions first. They are generally not sent straight to a clinical psychologist or psychiatrist; they are not put on medication or not taken into an expensive treatment facility. Rather, they are often first given quality information and tools to help them manage their own symptoms… essentially, self-help. After they have tried this option, the person is reassessed by a health professional. Those that are still struggling with anxiety or depression are then given a higher intensity intervention, such as face-to-face psychological therapy and/or medication. But many do not need this higher intensity treatment. For a significant proportion, quality self-help is enough to get them feeling and functioning well.
This Stepped Care process has several advantages. First, more people are able to access the service, including those in rural and remote areas. Secondly, people are not “over-treated” – that is, they are not given more intense treatment than they require. Finally, the money saved when a proportion of people get better with self-help can then be spent on higher intensity interventions for those who really need them. The Stepped Care process recognises that different people have different needs, and that a one-size-fits all approach may not be the best one.
Clearly self-help does have a role to play when it comes to emotional health. When good resources are used, they can deliver great benefits to individual consumers and the broader community. So, the next time you encounter self-help, don’t just dismiss it as a Bridget Jones style joke. Take some time to evaluate its quality. It may help more than you think.
Sarah Perini, MA, is Director of the Emotional Health Clinic at Macquarie University in Australia, where she teaches post-graduate psychology students how to conduct effective treatment. She is an experienced clinical psychologist who has treated hundreds of stressed and anxious patients. She has also worked in a range of clinics and hospitals and has published several academic articles. She is the co-author of 10 Steps to Mastering Stress: A Lifestyle Approach, Updated Edition, with David H. Barlow, Ph.D. Ronald M. Rapee, Ph.D.
Ronald M. Rapee, PhD, is Distinguished Professor of Psychology at Macquarie University, Sydney and Director of the Centre for Emotional Health. Professor Rapee’s primary research focuses on the understanding and management of anxiety and related disorders across the lifespan. He has established a number of internationally used treatment programs and was recently awarded the Order of Australia for his contributions to clinical psychology.