Dear Editor:

We thank Dr. Siamian for the thoughtful commentary on our article, “Literary Prescriptions: Applying Bibliotherapy in a Psychotherapeutic Context.”1 The letter addresses important questions about how bibliotherapy is operationalized, how its effects are measured, how the data should be most faithfully interpreted, and how we wisely integrate such interventions in optimal treatment plans.

We agree that research on bibliotherapy frequently overlaps with guided self-help. This important limitation we attempted to clarify in our original article, specifically how most meta-analyses in clinical populations include some element of clinician contact, often through 5- to 15-minute weekly telephone calls or emails, and many protocols combine bibliotherapy with exercises or other therapeutic tasks.2 Cuijpers et al2 even suggested that phone contact seems necessary to prevent patients from prematurely giving up. Our goal was not, therefore, to note all observed effect sizes as being solely from reading material in isolation, but to describe the evidence as it exists in practical application models that can translate into ways to incorporate therapeutic reading into clinical care. It would be helpful for future studies to disentangle reading alone, brief clinician contact alone, and their combination to see not only the contribution of each component but also whether clinician contact is needed for patients to engage in care.

We also agree that heterogeneity across populations, reading/learning/media materials, amount of clinician guidance, and ultimate outcome measures warrant caution. We would, however, clarify that our discussion of conditions beyond major depressive disorder (MDD) was not based simply on extrapolating MDD findings. The MDD vignette served as the principal clinical example, while discussion of anxiety, sexual dysfunction, and alcohol-related problems drew from meta-analytic evidence examining those outcomes directly.3–5 At the same time, the quality and age of this evidence vary substantially, and we do not intend to suggest that bibliotherapy has similar efficacy across all psychiatric diagnoses. Indeed, our conclusion specifically called for research comparing individual reading/learning/media materials, diagnoses, and delivery formats.1

The suggestions for expanded indexing terms are also on target. While keyword selection does not alter the underlying evidence, the potential benefit of bibliotherapy for expanding psychiatric care makes it especially important to enhance discoverability for clinicians and researchers searching by diagnosis or treatment/intervention type. We defer to the journal’s editorial expertise and indexing conventions regarding final terminology.

Ultimately, we believe Dr. Siamian’s commentary helps reinforce our central thesis: bibliotherapy should not be viewed as a uniform, stand-alone, and clinician-independent intervention. More useful research would ask which patients benefit from which learning materials, under what type and dose of clinician guidance, and in which therapeutic contexts. Our goal was to encourage thoughtful, well-chosen, patient-centered reading (or learning via other forms of media) as an adjunct within a comprehensive treatment plan while emphasizing the need for more rigorous research.

We are very grateful for Dr. Siamian’s excellent insights and engagement that help clarify our treatment ideas and intentions.

With regards,

Andrew B. Correll, MD; Terry L. Correll, DO; and Matthew C. Correll, MS-2

Mr. A. Correll is a third-year psychiatry resident Wright State University Boonshoft School of Medicine, Dayton, Ohio. Dr. T. Correll is Clinical Professor, Department of Psychiatry, Wright State University Boonshoft School of Medicine, Dayton, Ohio. Mr. M. Correll is a second-year medical student at Wright State University Boonshoft School of Medicine, Dayton, Ohio.

Funding/financial disclosures. No funding was received for the preparation of this letter. 

References

  1. Correll AB, Correll TL, Correll MC. Literary prescriptions: applying bibliotherapy in a psychotherapeutic context. Innov Clin Neurosci. 2024;21(7–9):15–21.
  2. Cuijpers P. Bibliotherapy in unipolar depression: a meta-analysis. J Behav Ther Exp Psychiatry. 1997;28(2):139–147. 
  3. Marrs RW. A meta-analysis of bibliotherapy studies. Am J Community Psychol. 1995;23(6):843–870. 
  4. Apodaca TR, Miller WR. A meta‐analysis of the effectiveness of bibliotherapy for alcohol problems. J Clin Psychol. 2003;59(3):289–304. 
  5. van Lankveld JJDM. Bibliotherapy in the treatment of sexual dysfunctions: a meta-analysis. J Consult Clin Psychol. 1998;66(4):702–708.