Psychological Medicine

Review Article

Why is self-help neglected in the treatment of emotional disorders? A meta-analysis

P. C. A. M. DEN BOER a1c1, D. WIERSMA a1 and R. J. VAN DEN BOSCH a1
a1 Department of Psychiatry, University Hospital Groningen, Groningen, The Netherlands

Article author query
den boer pc   [PubMed][Google Scholar] 
wiersma d   [PubMed][Google Scholar] 
van den bosch rj   [PubMed][Google Scholar] 


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.

Method. 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.

c1 Dr Peter C. A. M. den Boer, Department of Psychiatry, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands. (Email: