More than 5 percent of Americans suffer from depression or anxiety on an ongoing basis, and many turn to self-help books for knowledgeable advice. But these volumes differ dramatically in usefulness and accuracy, according to a new systematic study of 50 best-sellers.
"The tremendous variability we found was a surprise," said lead author Richard Redding, a professor of law at Chapman University and a former research professor of psychology at Drexel University. "There are some that are totally bogus, and some which are pretty good. If I were seeing patients, I would recommend some of the ones towards the top of our list."
The study, which targeted books on anxiety, depression or trauma, contains both good and bad news. On the one hand, 18 percent of the volumes — that is, nine out of the 50 — included advice the authors considered potentially harmful. One recurring example was a recommendation to take herbal supplements that could interact in harmful ways with other medications, advice the researchers found acceptable only if it included a caveat to check with your doctor first.
On the other hand, the authors found that 60 percent of the books were well-grounded in up-to-date research, featuring information on causes and cures that has been backed up by solid evidence. "Sixty percent is not great, but I was expecting it to be much lower," Redding said. "I was pleasantly surprised by that."
Topping their list is The OCD Workbook by Bruce M. Hyman, followed closely by Dying of Embarrassment by Barbara Markway; The Shyness and Social Anxiety Workbook by Martin M. Antony; Overcoming Compulsive Hoarding by Fugen Neziroglu; and Stop Obsessing by Edna B. Foa.
The lowest-ranked volume was How to Win Over Depression by Tim LaHaye. The co-author of the Left Behind series of novels popular among millennial-minded Christians, LaHaye has no background in psychology.
Redding and three colleagues — all university-affiliated psychologists with backgrounds in both research and clinical practice — selected the books by searching the online bookseller Amazon.com and the Barnes & Noble and Borders chains. All of the volumes were published between 1992 and 2005.
They evaluated each book in 19 categories, including:
• The author discloses the assumptions or values underlying the treatment approach.
• The book clearly articulates reasonable expectations about the benefits to expect from self-help therapy.
• The book provides specific and accurate guidance for the reader to self-diagnose.
• The book provides specific and accurate guidance for readers to measure their progress.
• Overall, this book is easy to understand by a layperson.
They found that a book's usability tracked quite closely with its accuracy; the understandable, well-written volumes were also most likely to contain good information. "The books that tend to be good tend to be good all-around," Redding said.
But they also found a troubling exception.
"One shortcoming we noticed in many of the books — even a lot of the good books — is they often failed to provide advice to readers on when they needed to seek professional help," Redding said. "Another common problem is they often failed to give adequate advice to readers in terms of how to monitor their progress; what to do if the suggestions in the book aren't effective; and what to do if they have a relapse."
Overall, the books that received the highest scores were those that focused on specific problems using a cognitive-behavioral perspective — that is, a structured, directive approach that encourages people to alter self-destructive thinking patterns.
Redding conceded that this approach is easier to quantify than some other types of psychology, but he said the researchers were aware of that potential bias and successfully avoided it.
"All four of us have different theoretical orientations," he said. "Most of us are pretty eclectic. We weren't biased in terms of the specific way measurements should be done. But with any therapeutic approach, there has to be some way to measure progress, and some way for the patient to know when to seek help."
Redding conceived of the study during one of his almost-weekly visits to his local Barnes & Noble, where he tends to gravitate toward the psychology section. One day it dawned on him that "these books are consumed by the millions, but nobody has ever evaluated their usefulness."
What's more, he realized, with the concept of "evidence-based practice" gaining in popularity, this was the perfect time to conduct such an evaluation.
"Over the last 15 years, there has been a lot of research that tries to identify, based on the science, what kind of treatments are appropriate for what kinds of psychological problems," he said. "Twenty or 30 years ago, that was totally up to the individual psychologist. Today, the American Psychiatric Association and the American Psychological Association both are working on treatment protocols for different types of disorders.
"It's much like with physical illnesses: If you have a certain type of heart problem, certain types of medication are called for and others are inappropriate. We're moving toward the same thing in psychology."
With that in mind, the researchers based their ratings in part on whether the books reflect "current research and knowledge." Since, by definition, that standard is constantly changing, Redding agreed that it would be useful to conduct such a survey every decade or so.
In the meantime, he hopes other academics use the template he and his colleagues developed to rate other types of self-help books — say, on parenting.
"There is a huge amount of research on effective parenting," he said. Redding conceded that evaluating a wide-ranging books on parenting could be difficult, but noted there have been many studies on such specific child-rearing topics as effective discipline practices, or how to deal with ADHD. It'd be relatively easy to assess the information in such volumes by comparing it to current thinking in the field, just as he and his colleagues did with depression an anxiety. "With a little modification," he said, "I think the rating scale we developed could be used in a variety of domains."
If others take him up on that challenge, it could mark the beginning of a new genre: self-help books for authors of self-help books. Early evidence suggests such work will find a receptive audience.
Are you on Facebook? Become our fan.