Self-help book better than group-CBT for teenagers at risk of depression

These days, cognitive behavioural therapy (CBT) seems to be the psychological treatment of choice for all manner of mental disorders. But according to a new study, when it comes to preventing depression in teenagers, a self-help book might actually be more effective.

Eric Stice and colleagues recruited 225 adolescent school pupils at risk of depression. These teenagers reported experiencing sadness and had raised scores on a measure of depression, but they weren't actually depressed.

Some of the teenagers then took part in four sessions of group CBT, while others participated in supportive-expressive group therapy (a forum for discussing feelings in a safe environment), expressive writing sessions or diary writing. The remaining students either received 'bibliotherapy' in the form of a self-help book called 'Feeling Good', or they acted as 'waiting list' controls and received no intervention at all.

On the one hand, CBT outperformed most of the other treatments – its benefit versus no treatment was still apparent at two months follow-up, whereas the benefit of supportive-expressive therapy, expressive writing and diary writing only lasted one month.

But on the other hand, it was only the students given the 1980 edition of the book 'Feeling Good' who continued to show reduced depressive symptoms at six-month follow up. “The findings have public health implications”, the researchers said “because interventions such as bibliotherapy are very inexpensive and easy to disseminate relative to CBT and supportive-expressive interventions, which require skilled therapists”.

Moreover, drop out was greatest among the CBT teenagers, while being lowest among the teenagers engaged in supportive-expressive sessions or expressive writing, with bibliotherapy drop out being intermediate. “The finding that drop out rates were lowest for two interventions that focussed on emotional expression suggests that these types of programmes are perceived by participants to be particularly worthwhile”, the researchers said.
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Stice, E., Burton, E., Bearman, S.K. & Rohde, P. (2007). Randomised trial of a brief depression prevention programme: An elusive search for a psychosocial placebo control condition. Behaviour Research and Therapy, 45, 863-876.

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