Bibliotherapy

Reading in nineteenth-century hospitals

A 1965 historical essay in the Bulletin of the Medical Library Association states that the history of bibliotherapy in America goes back at least to the early nineteenth century. It describes Benjamin Rush as one of the first Americans to recommend the use of bibliotherapy and John Minson Galt II as the first American to write an article on the subject. According to the essay, reading was considered one of the best therapeutic measures for people in mental hospitals, and by the middle of the nineteenth century every major mental hospital had a patients' library.

The International Federation for Biblio/Poetry Therapy publishes a timeline that dates reading and writing treatments for mentally ill patients at Pennsylvania Hospital to 1751. That timeline is the organization's own account and the page reviewed does not give sources for its entries, so it is cited here as the federation's description and not as an independent historical finding.

The term and its professional bodies

The federation's timeline states that the word 'bibliotherapy' was first used by Samuel Crothers in 1916. It places the founding of a Bibliotherapy Roundtable at St. Elizabeths Hospital by the librarian Arleen Hynes in the 1970s, the establishment of the National Association for Poetry Therapy in 1980, and the incorporation of the National Association for Biblio/Poetry Therapy in 1983. Credentialing became independent in 2002, and the body took its present name, International Federation for Biblio/Poetry Therapy, in 2014.

The same timeline also includes entries for antiquity, such as Roman and Egyptian examples, which the page presents without sources. This page does not rely on them. Other frequently repeated early attributions, including an inscription over a Greek library described as a 'healing place of the soul', and the contributions of Karl and William Menninger and Caroline Shrodes in the twentieth century, were not found in a free-access source that could be opened for this page, so they are not dated or described here.

From hospital libraries to self-help books

A 1997 meta-analysis of bibliotherapy in unipolar depression describes the approach used in clinical research at that time. The author writes that bibliotherapy usually uses a cognitive-behavioral approach, that the patient takes a standardized treatment home in book form and works through it more or less independently, and that contacts with therapists are only supportive or facilitative. In this research tradition the term refers to a form of self-help treatment, which differs from the literary uses described by arts organizations.

Two main senses of the word

Sources use 'bibliotherapy' in at least two ways. In psychology and primary care research it usually means self-help or guided self-help based on written material, often built on cognitive behavioral therapy. In education and arts-and-health research, 'creative bibliotherapy' refers to the use of stories and poems, for example in school programs delivered by teachers, and shared reading refers to groups that read literature aloud and discuss it. Reviews and trials of one sense should not be read as evidence about the other.

Related names and professional titles

The International Federation for Biblio/Poetry Therapy states that the terms poetry therapy, applied poetry facilitation, journal therapy, bibliotherapy, biblio/poetry therapy and poetry/journal therapy are all intended to reflect the interactive use of literature and writing to promote growth and healing, and it uses 'poetry therapy' as an umbrella term for all of them. Machipedia has separate pages on Poetry Therapy and Journal Therapy.

Books on prescription is the name given to schemes in which a health professional recommends a title or a library lends it. In England the Reading Well program is one such scheme, and its sponsors describe it as using helpful reading to support understanding and management of health and wellbeing. Machipedia groups bibliotherapy with Art Therapy as one of the creative arts therapies, and the federation's history notes that it has communicated with other creative arts therapy organizations. Related Machipedia pages include Psychotherapy, Mindfulness and Expressive Arts.

Self-help and guided self-help materials

In the self-help sense, a person reads structured written material and works through it largely independently, as described in the 1997 meta-analysis. Current NICE guidance on depression in adults describes guided self-help as printed or digital materials that follow the principles of structured cognitive behavioral therapy, structured behavioral activation, problem-solving or psychoeducation, together with support from a trained practitioner who facilitates the intervention, encourages completion and reviews progress. The guideline states that it usually consists of 6 to 8 structured regular sessions.

Books on prescription schemes

The Reading Agency states that Reading Well books are recommended by health experts and by people with lived experience of the conditions covered, and that a person can be recommended a title by a health professional or borrow one from a local library. The program is delivered by The Reading Agency with Libraries Connected, and is funded by Arts Council England, the Department for Digital, Culture, Media and Sport, and the Welsh Government. A US primary care trial tested a related model in which family physicians were trained to write a prescription to read a specific self-help book.

Shared reading and creative bibliotherapy

The Reader, a charity based in Liverpool, describes Shared Reading as bringing people together each week to share and discuss novels, short stories and poems, led through a network of volunteers and partners in settings that include schools, care homes, health and recovery settings and criminal justice settings. In a study of two weekly reading groups, one in a general practice surgery and one in a mental health drop-in center, the researchers identified literary form and content, group facilitation and group processes as possible catalysts for change.

A systematic review of creative bibliotherapy in schools reports that authors of the included studies described the selection of diverse and appropriate materials, structured interaction and trained delivery by school-based practitioners as important, while noting that these were neither necessary nor sufficient conditions. This page does not describe specific texts or session formats.

What programs and bodies say it is for

The Reading Agency says Reading Well supports people to understand and manage their health and wellbeing using helpful reading, and that its health professional partners use the books to support people outside consultation time. The Reader states a belief that great literature is a tool for helping people survive and live well. The International Federation for Biblio/Poetry Therapy describes the use of literature and writing to promote growth and healing. These are statements of purpose and belief by the organizations, and are not research findings.

Conditions and groups studied

Research reviewed for this page focuses on depression and anxiety. Studies include adults with depression in primary care, children and adolescents with depression or anxiety, schoolchildren receiving creative bibliotherapy for mental health outcomes, and adults with a general practice diagnosis of depression taking part in reading groups. NICE also mentions that self-help materials may be considered for people waiting for a course of treatment for depression.

Self-help books for depression in adults

A systematic review published in the British Journal of General Practice in 2005 identified eleven randomized trials of self-help books for depression. None fulfilled CONSORT reporting guidelines, all were small, and the largest had 40 patients per group. A meta-analysis of six trials of one book against delayed treatment found a standardized mean difference of -1.36 (95% confidence interval -1.76 to -0.96). The authors concluded that for most books there is little direct evidence, and that there is weak evidence that bibliotherapy based on cognitive behavioral therapy is useful for some people when they are given some additional guidance.

A randomized trial in US primary care assigned 38 patients to usual care or to a physician prescription to read a cognitive behavioral self-help book. Overall outcomes did not differ and both groups reported decreases in depression symptoms; the small sample limits inference. The 1997 meta-analysis is cited for its description of the approach only, because its abstract does not report effect sizes.

What NICE guidance says

NICE guideline NG222 (2022) advises that for a new episode of less severe depression all treatments in its first table can be first-line, while the least intrusive and least resource intensive option, which it identifies as guided self-help, should be considered first. It defines guided self-help as materials combined with support from a trained practitioner. It does not describe unguided reading or literary bibliotherapy, and no NICE position on those is inferred here.

Children and adolescents

A 2018 meta-analysis of randomized trials of bibliotherapy for depression and anxiety in children and adolescents included eight studies with 979 participants. At the end of treatment it found a standardized mean difference of -0.52 (95% confidence interval -0.89 to -0.15) in favor of bibliotherapy, with no statistically significant difference in all-cause discontinuation compared with controls. Its subgroup analyses suggested greater benefit in depressed adolescents and less robust effects for anxiety in children. The authors noted possible publication bias.

A 2025 systematic review of creative bibliotherapy delivered by teachers to children aged 5 to 16 identified 23 studies, 12 of them student dissertations. Thirteen (57 percent) reported a positive effect on mental health outcomes. The authors concluded there are promising indications but no strong evidence, as few studies were well defended against risk of bias.

Reading groups and literary bibliotherapy

A 12-month study of shared reading groups for people with a general practice diagnosis of depression found evidence suggesting a reduction in depressive symptoms, but its authors state that clinical efficacy evidence was limited by small sample size, attrition and the lack of controls, and they called for larger trials. A PubMed search run for this page for randomized trials of reading groups for depression returned no controlled trial, so controlled evidence for literary bibliotherapy in adults is thin in the sources reviewed.

Care boundaries

Bibliotherapy is not a substitute for assessment or treatment by a mental health professional, and reading should not delay or replace necessary care. The NICE material reviewed applies guided self-help to people with less severe depression and pairs the materials with support from a trained practitioner, and it states that people have a right to decline treatment. The 2005 review found weak evidence that cognitive behavioral self-help books help some people when additional guidance is given, which does not cover severe illness or unguided use.

Harms and gaps in the evidence

The sources reviewed do not report systematic data on harms from reading-based approaches. The children and adolescent meta-analysis found no statistically significant difference in discontinuation between bibliotherapy and control conditions, and the authors of the school-based review say stronger trial designs are needed to identify both positive and negative effects. The sources reviewed do not address distress caused by particular content, difficulty with reading or literacy, or cost, so this page makes no statement on those points.

Training, facilitators and safeguarding

The International Federation for Biblio/Poetry Therapy describes three credentials. The certified poetry therapist and registered poetry therapist titles are conferred only on people who have completed graduate work in a mental health field and attained licensure, while the certified applied poetry facilitator works mainly with healthy populations, must be able to determine when a distressed individual needs referral to a mental health professional, and may work in a mental health setting under supervision. The federation describes itself as the only global independent credentialing organization in the field. No statutory training standard was identified for this page.

Reading Well and The Reader are delivered by organizations rather than by credentialed therapists. The Reader publishes guidelines for work with children and vulnerable adults and a child protection policy, but the pages reviewed do not set out facilitator qualifications. The sources reviewed do not describe training standards for librarians or other leaders of reading programs.