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Final Report for The Rosalynn Carter Mental Health Journalism Fellowship, 1999-2000 Self-Help for Psychological Problems: Empowering, or Endangering?

By Annie Murphy Paul

Introduction

Say the words "self-help," and the image that leaps to many minds is a cheap paperback, written, perhaps, by Dale Carnegie or Norman Vincent Peale, the cover of which promises fame, fortune and a gaggle of new friends in thirty days or less. A visit to any bookstore will confirm that this genre is still alive and thriving. But in addition to such dubious works sometimes placed on the same shelf there's a new sort of self-help book, one that's written by legitimate experts, based on solid research, and presented in a serious and balanced manner.

Take, for example, Your Mental Health: A Layman's Guide to the Psychiatrist's Bible. Published in 1998 by Scribner, it's co-authored by Allen Frances, professor of psychiatry at Duke University and former chairman of the DSM-IV Task Force, and Michael B. First, associate professor of psychiatry at Columbia University and editor of the DSM-IV text and criteria. For each of twenty different types of psychological conditions, Drs. Frances and First offer a full description, a list of diagnostic criteria, an explanation of treatment options and suggestions for further reading. All this information is presented in clear, non-technical language, in a tone that's straightforward and reassuring.

For another example, turn to the website of the Anxiety Disorders Association of America (www.adaa.org). It offers detailed descriptions of anxiety disorders, answers to frequently-asked questions, research updates and treatment guides -- again, all put in easy-to-understand terms. The site also provides links to chat rooms, message boards and other sources of on-line support and information.

This is the new world of self-help, and it's growing fast. Americans spent $563 million on self-help books last year, and surfed an estimated 12,000 websites devoted to mental health. A report in the journal Behavioral Healthcare Tomorrow found that an estimated 40% of all health-related Internet searches are on mental health topics, and according to the National Mental Health Association, depression is the number-one most searched-for illness on the Web. Female baby boomers appear to be the most active users of self-help, but people of all ages, classes and ethnicities take advantage of these resources.

Nor are such resources limited to books and websites. Self-help videos and tapes (sometimes provided by health-maintenance organizations to their members) are becoming more popular, as are multimedia computer programs that help users work through their anxiety or depression. Mental-health professionals are even incorporating self-help into their treatments, supplementing their work with clients with take-home techniques like journal-writing and "bibliotherapy."

These developments are new enough that we know little about their current effects or future implications. Accurate, accessible self-help could help break down stigmas and stereotypes, reach under-treated communities, provide support and fellowship to sufferers, and create better-educated consumers. But it may also lead to dangerous self-treatment or self-medication, or to the financial and emotional exploitation of vulnerable people -- and it could mask basic deficiencies in our mainstream mental-health care system. This report will explore the promise and perils of the new self-help culture, with the ultimate purpose of informing other journalists about this important phenomenon and providing a foundation for their own reporting on the subject. (A version of this report, tailored to consumers, will also appear in Psychology Today magazine in early 2001.)

The report will begin by surveying the types of self-help available; will then evaluate the positive and negative aspects of self-help; will look at the factors driving the development of self-help; will examine some of the larger issues raised by self-help; and will conclude with an appendix listing recommended self-help books; recommended self-help websites; articles about self-help published in professional journals; and sources for journalists writing about self-help. Throughout the report I have noted specific examples of self-help in action (all studies mentioned are cited in the appendix), and have identified emerging trends in paragraphs marked "On the Horizon."

  • Types of Self-Help

Self-Help Books

The oldest and most familiar form of self-help, self-help books have lately reinvented themselves as reliable and accurate sources of information about mental illness. Titles such as Understanding Depression: A Complete Guide to Its Diagnosis and Treatment (Oxford University Press, 1993) and Triumph Over Fear: A Book of Help and Hope for People With Anxiety, Panic Attacks, and Phobias (Bantam, 1995) offer readers clear and concise information about their conditions and about options for treatment. Many such books include an appendix listing federal agencies, national non-profit organizations and other sources of additional help for those affected.

There are signs that the publishers of self-help books are now reaching out to new segments of the population: New self-help books written especially for men address issues like infertility, anger, and body image, while others, designed just for children, help them deal with depression, low self-esteem and attention-deficit disorder. Self-help with an explicitly religious theme (usually Christian) is another area of growth, as are self-help books intended for specific ethnic groups.

On the Horizon: The first "e-books" with a self-help theme are beginning to be produced (Adult Children: The Secrets of Dysfunctional Families and Affirmations for the Inner Child are two recent titles available on Microsoft Reader); given the popularity of the self-help genre, there are surely more - and hopefully more substantive ones! - to come.

  • Self-Help and Computers

In the decade or so since the Internet has become widely used, a bewildering array of self-help resources has become available electronically. The Web is able to offer comprehensive information that is easily accessible and free of charge; however, as it is almost entirely unregulated, it has also provided an outlet for inaccurate and misleading information. Separating the science from the snake oil is an important part of using Internet self-help; here, some signs to look for:

  • The owner of the site and the source of its financing are clearly marked; a physical address is offered in addition to an electronic one.
  • The site's confidentiality policy is clearly spelled out.
  • Advertising and products for sale (if any) are clearly separated from editorial content.
  • Online experts are identified by name, credentials and institution.
  • Information is based not on anecdotes or testimonials but on clinical studies published in medical or scientific journals, by authors from well-known institutions.
  • Information is reviewed by experts and updated often.

The most common type of information found on mental-health websites are descriptions of various psychological conditions, along with lists of symptoms and treatment options. Some sites offer more sophisticated tools; the Discovery Health site (www.discoveryhealth.com), for example, allows users to take the Center for Epidemiologic Studies Depression Scale, used by mental-health professionals since the 1970s to gauge symptoms of depression. (Though not comprehensive enough to be an accurate measure of clinical depression, it can identify those who ought to seek professional help.)

On the Horizon: Computer-aided diagnosis may prove to be especially useful in the identification of historically-stigmatized mental illnesses. Research has shown that people are more likely to accurately answer questions of an "embarrassing" or private nature when asked by a computer rather than a human being.

Example: David Shaffer and his colleagues at the Columbia University College of Physicians and Surgeons have developed a self-administered screening test for teenagers, designed to identify psychiatric problems like mood and anxiety disorders, substance abuse, schizophrenia and eating disorders. Some 70 organizations are now using the program, including Boys Town and government-run juvenile facilities.

The interactive nature of the Internet has also permitted the development of mental-health related chat rooms, bulletin boards, e-mailing lists and other types of online communities. The website Online Psych (www.onlinepsych.com), for example, offers more than 50 scheduled chats a week, as well as three chat rooms that are open 24 hours a day. (Many of these chat sessions are moderated by psychologists.) The site's message boards have drawn more than 40,000 postings in the last 10 months. Steve Bond, a Boston psychanalyst and the founder of Online Psych, has said that "my goal is for people to feel a sense of community. It's is more than informing; it's about real people relating to each other in this new medium."

Jerry Finn, a professor of psychology at Arizona State University, notes that online self-help groups offer some advantages over in-person ones, such as the elimination of time and distance barriers, the lack of group size restrictions, more variety and diversity of support, and anonymity for those who desire it.

Lastly, computers may be used to deliver automated self-help programs that provide feedback tailored to the individual user. Such programs appear to be most effective for people with mild to moderate psychological problems, and may someday be offered online.

Example: An evaluation of a multimedia self-help program, "Attacking Anxiety," performed by Arthur Finch and colleagues at Brigham Young University, found that 62 of 176 individuals suffering from anxiety achieved clinically significant improvement. An additional 40 achieved reliable change, despite the fact that these individuals had suffered from anxiety-based problems for years prior to their participation.

Example: Deborah J. Osgood-Hynes and her colleagues at Massachusetts General Hospital evaluated the efficacy of a self-help program, called COPE, for mild-to-moderate depression that combined treatment booklets and telephone calls to a computer-aided Interactive Voice Response system. Two-thirds of the participants saw a 50 percent or greater reduction in their depression-rating scores.

  • Self-Help Groups

Self-help groups with a mental-health theme, such as those run by Recovery Inc. and Emotions Anonymous, have flourished in this country since the 1970s, and now serve more people than professional therapists, according to Thomasina Jo Borkman, author of Understanding Self-Help and Mutual Aid (Rutgers University Press, 1999). These groups serve as forums for sharing information and advice, and offer their members the support and understanding they may only get from fellow sufferers. (Self-help groups may also be helpful to the families of the mentally ill.) Some participants may choose to be involved because they find the groups less intimidating or less potentially stigmatizing than professional treatment; others may attend the free meetings because they can't afford a therapist's fees.

Such groups have often been criticized by mental-health professionals; a survey of 1,103 psychologists found that they viewed professionally-led group therapy much more positively than they did self-help groups, according to Mark S. Salzer of the University of Pennsylvania.

However, some in the mental-health field are beginning to acknowledge the potential usefulness of self-help groups. Writes Ted R. Watkins of the University of Texas: "These groups, made up of individuals who are the closest to the day-to-day problems related to mental illness, have gained power, credibility, and legitimacy in the field. Their expertise is experiential, and their 'research' contribution comes from their cumulative experience as consumers of services provided by mental health professionals." He believes that "their unique contributions can add significantly to the relevance and effectiveness of services to persons with mental illness and their families."

A similar argument is made by Frank Riessman and David Carroll in Redefining Self-Help: Policy and Practice (Jossey-Bass, 1995): "Those in the educational, health care, and human service fields can infuse a sense of power by focusing on the vitality of individuals -- individuals who gain their strength from a community of people who share common experiences." They propose "a new paradigm, one that views people with problems as resources."

Sally H. Barlow of Brigham Young University argues that we simply don't know enough about self-help groups to assess their effectiveness: "Although traditional forms of group treatment have kept pace with empirical research, self-help groups have not," she reports in The International Journal of Group Psychotherapy. However, there is some limited evidence to suggest that self-help groups can be useful in some situations, even for the seriously mentally ill.

Example: Jean Caron of the University of Quebec found that involvement in a "partnership" self-help group assisted in the social reintegration of discharged psychiatric patients. Among the benefits of the group the patients rated most highly were hearing other participants share their experiences and expressing their own feelings about their return to the community. Nearly 60% of the participants have not been rehospitalized, and among those who have, there has been a significant reduction in the duration of hospitalizations.

  • Self-Help as a Part of Professional Therapy

Another recent trend is the incorporation of self-help into traditional therapy. Counselors may suggest particular books for clients to read (a practice known as "bibliotherapy"), or may ask them to write or draw about their feelings and bring the results to the therapy session for discussion. Some approaches combine self-help with the care of a primary-care doctor, rather than a psychologist or psychiatrist.

Example: A study now being conducted in Greenwich, Connecticut, is attempting to treat bulimia using self-help in conjunction with treatment by a primary-care doctor. The leader of the study, Christopher Fairburn, believes that it will demonstrate that many bulimics do not need traditional psychiatric therapy; instead, patients will learn to help themselves. "What we've done is change the treatment into a self-help format," says Dr. Fairburn. "If it works, it can be done anywhere."

Some therapy clients may supplement their sessions with self-help that is not assigned or supervised by a professional at all.

Example: Das Glasser of the California School of Professional Psychology found that, among users of an online group for anxiety disorder sufferers, more than half used the group as an adjunct to rather than a substitute for professional treatment. In fact, those who were involved in professional treatment in addition to their participation in the online group found the group more valuable than those using the group alone. Clients who got the most out of the group tended to access it frequently and to participate in supportive interactions with other group members.

A combination of therapy and self-help may work better than either alone, concludes Michael V. Pantalon of the Institute for Behavior Therapy, who examined the issue in Cognitive & Behavioral Practice. Ideally, the two complement and reinforce one another, providing a more continuous source of motivation and support. The use of self-help may also make patients less dependent on their therapists, and may facilitate their departure from therapy when they decide to do so.

In addition, self-help may be useful in easing patients into therapy, or acting as a stopgap when therapy is not available. Shela Halper, vice president of education for the National Mental Health Association, notes that many more Americans experience mental illness than seek treatment, either because they're not aware of the signs and symptoms or because they're afraid to talk to anyone about it. "Taking a self-screening test and then bringing the results to a psychiatrist can be the first step," she says.

When professional therapy is unavailable or sharply limited in duration, self-help is often better than no help at all.

Example: Bryan K. Fritzler of the University of Maine's Psychological Services Center evaluated a brief intervention for obsessive-compulsive disorder that consisted of five meetings with therapists, readings from When Once Is Not Enough: Help for Obsessive-Compulsives, and self-directed exercises. As a group, participants showed statistically significant improvement, and one-third of the clients met criteria for clinically significant improvement.

Example: Robert A. Gould of the Massachusetts General Hospital compared a self-help treatment for panic disorder with a wait-list control condition. The self-help treatment consisted of reading the book Coping With Panic, watching a 15-minute videotape providing information regarding panic attacks and instruction in diaphragmatic breathing, and the provision of a relaxation tape that taught progressive muscle relaxation. Evidence strongly supported the effectiveness of the self-help relative to the wait-list condition, both at post-treatment and at a 2-month follow-up. Specifically, the self-help subjects achieved significant improvement on measures of frequency of panic attacks, total severity of each attack, severity of physical symptoms, severity of catastrophic thoughts, agoraphobic avoidance, belief in the likelihood of having a panic attack, thoughts during a panic attack, and coping with panic attacks.

  • Factors Driving the Development of Self-Help
  • Restriction of Care by Health Maintenance Organizations

Though it's difficult to document a direct connection, the rise of HMOs in the late 1980s and the 1990s has paralleled the growth in legitimate self-help. The tactics by which HMOs reduce mental health care costs - limiting the number of sessions with a therapist, favoring short-term over long-term types of therapy, employing social workers and counselors rather than psychologists and psychiatrists, emphasizing the use of psychopharmaceutical drugs over talk therapy -- may leave consumers wanting more information or more support, both of which are amply available in a self-help format. Well aware of the HMOs' cost-cutting techniques, patients may also suspect that they are not receiving the best care for their condition, but merely the cheapest - an additional incentive to explore other options.

Another, less obvious effect of HMO cutbacks: Many psychologists and psychiatrists who have begun to see fewer clients for fewer sessions have turned to other sources of income, among them the production of self-help programs, books and websites.

  • Influence of Consumer Movement in Mental Health

The decades-old mental-health consumer movement has also had a powerful, though hard to measure, impact on the development of legitimate self-help. The movement began with the desire of many mentally ill people to have a hand in determining their own treatment and living arrangements, and their success at doing so has inspired a more general emphasis on "self-empowerment," on taking control of one's own mental health. Because self-help is initiated and controlled by the user herself, it has come to be viewed as a vehicle for such self-empowerment (whether it actually serves that function is a question addressed in the final section of this report).

  • Shifts in Attitude and Lifestyle

A variety of changes in attitude have contributed to the rise of legitimate self-help. We are more skeptical of authority these days, for example, and less willing to believe that "the experts" have all the answers. Americans are more apt to question their doctors' diagnosis or choice of treatment, and self-help resources allow them to explore alternative points of view.

We're more psychologically-minded than we once were, more at ease with the expression and analysis of emotions. Years of Oprah and Sally Jessy have made ordinary people comfortable with the ideas and vocabulary of psychology (at least in its pop form), and so more inclined to explore the world of self-help on their own.

Our approach to mental health care, as to so many other things, has become more consumerist in nature: We want choice, we want flexibility, we want to be able to "shop around" for the treatment that suits us best. Knowledge and expertise have become one more commodity to be bought and sold.

The hectic pace of our lives has led us to place a premium on fast, easy-to-understand information, available whenever we need it. A chat room that's open for business at 3 A.M. may fit into our schedules more readily than a weekly session with a therapist. Our constant mobility, too, has made it more difficult to develop stable, long-term relationships with mental-health professionals. A self-help book or tape, however, can come along with us wherever we go.

The occasional superficiality of self-help may even be one of its attractions: We're more likely to live life on the surface these days, and to disdain any treatment that goes too deep or demands too much effort. Likewise, the sunny optimism of self-help suits this prosperous and peaceful moment in our history; the related emphasis on "personal responsibility" echoes self-help's up-by-your-bootstraps ethos. (If such connections to larger political and social trends seem to overreach, recall for a moment the erstwhile popularity of years-long, five-days-a-week Freudian analysis, and try to imagine a widespread revival of that kind of treatment today.)

  • Evaluating Self-Help

  • Positive Aspects of Self-Help

There are, without a doubt, some very good things about the new prominence of legitimate self-help. Its widespread availability can make it a lifeline for people in isolated areas, where professional help may be hard to come by. It may be equally valuable to those who are too afraid or embarrassed to come forward with their psychological distress. (It's easy to see why those with agoraphobia or social anxiety, for example, would welcome self-help resources.) In a paradoxical fashion, the anonymity offered by the Internet may eventually help break down the fear of stigma, as sufferers educate themselves about their illness in private and are perhaps emboldened to seek out peers or professionals. Even the commodification of mental health that is encouraged by self-help may ultimately have beneficial effects: As long as there is money to be made from sharing information and promoting products related to mental health, the providers of these things will strive to make mental illness seem more acceptable and more common.

Self-help is a democratic form of information, available to all, and not limited to those with health insurance or to the even smaller group who can pay for therapy out of pocket. It brings people together over a common cause, and encourages them to share their feelings and experiences with one another.

It allows news of research findings and treatment options to spread quickly. It permits patients to educate themselves about their illness and its treatment, enabling them to make more informed decisions. It can fill in the many gaps created by our system of mental health care.

  • Negative Aspects of Self-Help

But self-help also has significant potential drawbacks. As already noted, many self-help websites contain inaccurate or even deliberately misleading information. Claudine Singer, an analyst with the Internet research firm Jupiter Communications, has estimated that of 17,000 medical sites on the Web, only 200 may be considered legitimate. Due to the often ambiguous nature of mental illnesses, websites with a mental-health focus may be particularly subject to abuse. (Of course, books and other media may also convey faulty information.)

Even when the information on offer is of good quality, users may misread or misinterpret it, or apply it inappropriately. Self-help offers boundless information, but little guidance on how to evaluate it or use it. Subtleties, caveats and warnings may be overlooked; readers may become unduly alarmed or dangerously complacent. People whose significant problems might once have led them to seek out a professional may now believe, erroneously, that they can diagnose, treat, or medicate themselves. Conversely, the availability of self-help may place a difficult burden on people -- especially the seriously mentally ill -- who feel that they should be able to help themselves, but cannot.

Given American's increasingly consumerist orientation, noted above, there's the danger that we may shop around until we find the diagnosis or treatment we desire, rather than accepting that which will really help. The abundance of self-help information, and its supportive, encouraging tone, may also lead some to inaccurately diagnose an illness in themselves or others, to see pathology where none exists. If the recipients of poor self-help information subsequently seek out professional help, they may insist on inappropriate courses of action or manifest fears about perfectly legitimate treatments

Finally, the turn to self-help or alternative treatments may itself be a sign, not of empowerment, but of distress or desperation.

Example: A study performed by Jane C. Weeks and Harold J. Burstein of the Dana-Farber Cancer Institute in Boston found that women with breast cancer who seek alternative therapies like herbs or acupuncture in addition to standard treatment may be unusually worried and depressed and in need of help in coping with their fears about the disease. Women who sought out alternative treatments, compared with women who did not, reported a lower quality of life, more depression, more fear of recurrence of cancer and less sexual satisfaction.

V. Larger Questions Posed by Self-Help

In addition to the concrete and specific questions generated by self-help, the phenomenon also raises some larger philosophical issues. Such as: What happens to people who can't help themselves? The flip side of the "empowerment" advertised by self-help is the expectation that everyone can, and should, be able to solve their own problems. Our infatuation with the promise of self-help may send an unintended message: When it comes to mental and emotional problems, you're on your own. We must take care that the ready availability of self-help does not become an excuse for inaction or indifference on the part of those who might otherwise feel obligated to offer help. If self-help is the only help there is, we'll soon find ourselves in a society in which the strong aid themselves and the weak are left to founder.

Another danger is the use of self-help rhetoric to disguise less-than-progressive agendas. HMOs, for example, often employ the language of self-empowerment when limiting access to mental-health professionals and offering self-help materials as an (inadequate) substitute. Self-help is only empowering when it's a genuine choice.

Self-help tends to exaggerate a tendency already present in psychology as a whole, one that views mental distress as an individual problem, emerging in isolation from society. To the extent that self-help encourages people to address their problems on their own, they may never make important connections between their condition and larger social forces -- connections that are clearly crucial in, say, anorexia nervosa, but which may also play a role in disorders like depression or anxiety.

The rise of self-help has real consequences for the nature and influence of authority. Though it has often acted as a healthy corrective to the overreliance on "experts," self help also has the potential to undermine legitimate authority and to devalue genuine wisdom and experience. As beneficial as the wide dissemination of knowledge may be, it can't replace the trained evaluation and application of that knowledge on the part of psychologists, psychiatrists and other mental-health professionals.

Self-help's emphasis on pure, unencumbered information may end up denigrating human connection and affiliation. Many studies have shown that, in therapy, it's often the relationship that heals -- and self-help is therapy stripped of the relationship. There's a danger that self-help users may come regard to mental-health professionals as mere dispensers of information, as middlemen to be dispensed with -- when in truth, techniques that are overwhelmingly effective in therapy may be useless when read about on a website or practiced in a workbook.

Similarly, the growing prevalence of self-help may lead to a dumbing-down of psychological knowledge, to a pervasive oversimplification of precise or complicated concepts. We can see this happening on "self-help" talk shows such as the one hosted by Laura Schlessinger; on Dr. Laura's show, psychology is wielded as a weapon, used to judge and deride, to urge rigid and simplistic "solutions" to genuine and complex problems.

* * *

Reading over these "larger questions," I'm reminded that it's always easier to criticize than to praise, to see potential pitfalls rather than promising opportunities. Still, I'd like to conclude this report on a positive note, because I really do believe that self-help -- the legitimate kind -- holds out remarkable promise. Like any powerful tool, it must be used carefully, but in the right hands it has the capacity to lift many, many people out of the suffering caused by mental illness. So -- empowering or endangering? Both, of course, but I hope fervently for the former.

I welcome comments and questions about this report: You may reach me at 718-488-9729, or at anniempaul@aol.com

Appendix A: Recommended Self-Help Books

General Self-Help Resources

The Authoritative Guide to Self-Help Resources in Mental Health

By John C. Norcross, Linda Frye Campbell and Thomas P. Smith

Guilford, 2000

The Best Self-Help and Self-Awareness Books: A Topic-by-Topic Guide to Quality Information

By Stephen B. Fried and G. Ann Schultis

American Library Association, 1995

Caring for the Mind: The Comprehensive Guide to Mental Health

By Dianne and Robert Hales

Bantam Books, 1995

The Columbia University College of Physicians and Surgeons Complete Home

Guide to Mental Health

By Frederic I. Kass, John M. Oldham, Herbert Pardes, and Lois B. Morris

Henry Holt, 1995

The Essential Guide to Mental Health: The Most Comprehensive Guide to Psychiatry for Popular Family Use

By Jack M. Gorman

Griffin Trade Paperback, 1998

The Insider's Guide to Mental Health Resources Online

By John Grohol

Guilford Press, 2000

Your Mental Health: A Layman's Guide to the Psychiatrist's Bible

By Allen Frances and Michael B. First

Scribner, 1999

Self-Help Resources on Anxiety

An End to Panic: Breakthrough Techniques for Overcoming Panic Disorder

By Elke Zuercher-White

New Harbinger Publications, 1998

Anxiety & Depression: The Best Resources to Help You Cope

Edited by Rich Wemhoff

Resource Pathways, 1998

Don't Panic: Taking Control of Anxiety Attacks

R. Reid Wilson, Ph.D.

HarperCollins, 1996

Triumph Over Fear: A Book of Help and Hope for People With Anxiety, Panic Attacks, and Phobias

By Jerilyn Ross and Rosalynn Carter

Bantam, 1995

Self-Help Resources on Depression

Feeling Good: The New Mood Therapy

By David D. Burns

Avon, 1992

Understanding Depression: A Complete Guide to Its Diagnosis and Treatment

Donald F. Klein, M.D., and Paul H. Wender, M.D.

Oxford University Press, 1993

The Depression Workbook: A Guide for Living With Depression and Manic Depression

By Mary Ellen Copeland and Wayne London

New Harbinger Press, 1992

Self-Help Resources on Obsessive-Compulsive Disorder

Getting Control: Overcoming Your Obsessions and Compulsions

By Lee Baier

Plume, 1992

The OCD Workbook: Your Guide to Breaking Free from Obsessive-Compulsive

Disorder

Hyman, Bruce M. Pedrick, Cherry.

New Harbinger Publications, 1999

Over and Over Again: Understanding Obsessive-Compulsive Disorder

By Fugen A. Neziroglu and Jose A. Yaryura-Tobias

Jossey-Bass, 1997

Stop Obsessing! How to Overcome Your Obsessions and Compulsions

By Edna B. Foa and Reid Wilson

Bantam, 1991

Self-Help Resources for Trauma and PTSD

Coping with Post-Traumatic Stress Disorder

By Carolyn Simpson and Dwain Simpson

Rosen Publishing Group, 1997

Coping with Trauma: A Guide to Self-Understanding

By Jon G. Allen

American Psychiatric Press, 1995

Trauma and Recovery

By Judith Lewis Herman, M.D.

Basic Books, 1997

Books About Self-Help

Oracle at the Supermarket: The American Preoccupation with Self-Help Books By Steven Starker

Transaction Publications, 1988

Redefining Self-Help: Policy and Practice

By Frank Riessman and David Carroll

Jossey-Bass, 1995

Self-Help and Support Groups: A Handbook for Practitioners

Kurtz, Linda Farris.

Sage Publications, 1997

Support Systems and Community Mental Health

By Gerald Caplan

Behavioral Publications, 1974

Understanding Self-Help and Mutual Aid: Experiential Learning

In the Commons

By Thomasina Jo Borkman

Rutgers University Press, 1999

Appendix B: Recommended Self-Help Websites

Government Websites

Knowledge Exchange Network (operated by the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, and the Center for Mental Health Services)

www.mentalhealth.org

National Center for PTSD (operated by the U.S. Department of Veterans Affairs)

www.dartmouth.edu/dms/ptsd

National Institute of Mental Health

www.nimh.nih.gov

NIMH's Depression / Awareness, Recognition, and Treatment (D/ART)

www.nimh.nih.gov/dart/index.htm.

Substance Abuse and Mental Health Services Administration

www.samhsa.gov

Non-Profit Websites

American Psychiatric Association

www.psych.org

Anxiety Disorders Association of America

www.adaa.org

The Health on the Net Foundation

www.hon.ch

The HelpCenter of the American Psychological Association

www.helping.apa.org

The International Society for Mental Health Online

www.ismho.org

National Alliance for the Mentally Ill

www.nami.org

National Depressive and Manic-Depressive Association

www.ndmda.org

National Mental Health Association

www.nmha.org

The Suicide Prevention Advocacy Network

www.spanusa.org

Commercial Websites

The Anxiety Network

www.anxietynetwork.com

Internet Mental Health

www.mentalhealth.com

Mental Health Net --- Self-Help Resources

www.mentalhelp.net/selfhelp.htm

Online Psych

www.onlinepsych.com

Self-Help and Psychology Magazine

www.shpm.com

Appendix C: Journal Articles on Self-Help

Baer, Lee. Greist, John H.

An interactive computer-administered self-assessment and self-help program for behavior therapy.

Journal of Clinical Psychiatry. Vol 58(Suppl 12), 1997, 23-28.

Barlow, Sally H. Burlingame, Gary M. Nebeker, R. Scott. Anderson, Ed.

Meta-analysis of medical self-help groups.

International Journal of Group Psychotherapy. Vol 50(1), Jan 2000.

Caron, Jean. Bergeron, Nicole.

A self-help partnership group for people who have experienced psychiatric hospitalization: An exploratory study.

Canada's Mental Health. Vol 43(2), Sum 1995, 19-28.

Chamberlin, Judi. Rogers, E. Sally. Ellison, Marsha Langer.

Self-help programs: A description of their characteristics and their members.

Psychiatric Rehabilitation Journal. Vol 19(3), Jan 1996, 33-42.

Citron, Manulyn. Solomon, Phyllis. Draine, Jeffrey.

Self-help groups for families of persons with mental illness: Perceived benefits of helpfulness.

Community Mental Health Journal. Vol 35(1), Feb 1999, 15-30.

Constantino, Vic. Nelson, Geoffrey.

Changing relationships between self-help groups and mental health professionals: Shifting ideology and power.

Canadian Journal of Community Mental Health. Vol 14(2), Fal 1995, 55-70.

Finch, Arthur E. Lambert, Michael J. Brown, George.

Attacking anxiety: A naturalistic study of a multimedia self-help program.

Journal of Clinical Psychology. Vol 56(1), Jan 2000, 11-21.

Finn, Jerry.

Computer-based self-help groups: A new resource to supplement support groups.

Social Work with Groups. Vol 18(1), 1995, 109-117.

Fritzler, Bryan K. Hecker, Jeffrey E. Losee, Melinda C.

Self-directed treatment with minimal therapist contact: Preliminary findings for obsessive-compulsive disorder.

Behaviour Research & Therapy. Vol 35(7), Jul 1997, 627-631.

Glasser Das, Andria Rae.

The new face of self-help: Online support for anxiety disorders.

Dissertation Abstracts International: Section B: the Sciences &

Engineering. Vol 59(7-B), Jan 1999, 3691.

Gould, Robert A. Clum, George A.

Self-help plus minimal therapist contact in the treatment of panic disorder: A replication and extension.

Behavior Therapy. Vol 26(3), Sum 1995, 533-546.

Grayson, Jonathan B.

GOAL: A behavioral self-help group for obsessive-compulsive disorder.

Crisis Intervention & Time-Limited Treatment. Vol 5(1-2), 1999, 95-107.

Greist, John H.

Computer interviews for depression management.

Journal of Clinical Psychiatry. Vol 59(Suppl 16), 1998, 20-24.

Hecker, Jeffrey E. Losee, Melinda C. Fritzler, Bryan K. Fink, Christine M.

Self-directed versus therapist-directed cognitive behavioral treatment for panic disorder.

Journal of Anxiety Disorders. Vol 10(4), Jul-Aug 1996, 253-265.

Honikman, Jane I.

Role of self-help techniques for postpartum mood disorders.

Miller, Laura J. (Ed); et al. Postpartum Mood Disorders. (pp. 195-215). American Psychiatric Press, 1999.

Johnson, W. Brad. Johnson, William L.

Self-help books used by religious practitioners.

Journal of Counseling & Development. Vol 76(4), Fal 1998, 459-466.

Johnson, W. Brad. Johnson, William L. Hillman, Casey.

Toward guidelines for the development, evaluation, and utilization of Christian self-help materials.

Journal of Psychology & Theology. Vol 25(3), Fal 1997, 341-353.

Kieken, Anna Carroll.

Women readers of self-help books: The role of interpersonal factors in behavior change.

Dissertation Abstracts International: Section B: the Sciences & Engineering.

Vol 58(11-B), May 1998, 6238.

King, Storm A. Moreggi, Danielle.

Internet therapy and self-help groups -- the pros and cons.

Gackenbach, Jayne (Ed); et al. Psychology and the Internet: Intrapersonal, Interpersonal, and Transpersonal Implications. (pp. 77-109) Academic Press, 1998.

Lieberman, Morton A.

Self help groups serving the seriously mentally ill.

Soreff, Stephen Michael (Ed); et al. Handbook for the Treatment of the Seriously Mentally Ill. (pp. 487-501). Hogrefe & Huber, 1996.

Osgood-Hynes, Deborah J. Greist, John H. Marks, Issac M. Baer, Lee.

Heneman, Susan W. Wenzel, Keith W. Manzo, Peter A. Parkin, J. Richard.

Spierings, Christopher J. Dottl, Susan L. Vitse, Helene M.

Self-administered psychotherapy for depression using a telephone-accessed computer system plus booklets: An open U.S.-U.K. study.

Journal of Clinical Psychiatry. Vol 59(7), Jul 1998, 358-365.

Pantalon, Michael V. Lubetkin, Barry S. Fishman, Steven T.

Use and effectiveness of self-help books in the practice of cognitive and behavioral therapy.

Cognitive & Behavioral Practice. Vol 2(1), Win 1995, 213-228.

Salzer, Mark S. Rappaport, Julian. Segre, Lisa.

Professional appraisal of professionally led and self-help groups.

American Journal of Orthopsychiatry. Vol 69(4), Oct 1999, 536-540.

Shepherd, Matthew D. Schoenberg, Mike. Slavich, Susan. Wituk, Scott.

Warren, Mary. Meissen, Greg.

Continuum of professional involvement in self-help groups.

Journal of Community Psychology. Vol 27(1), Jan 1999, 39-53.

Vogel, Howard S. Knight, Edward. Laudet, Alexandre B. Magura, Stephen.

Double trouble in recovery: Self-help for people with dual diagnoses.

Psychiatric Rehabilitation Journal. Vol 21(4), Spr 1998, 356-364.

Watkins, Ted R. Callicutt, James W.

Self-help and advocacy groups in mental health.

Watkins, Ted R. (Ed); Callicutt, James W. (Ed); et al. Mental Health Policy and Practice Today. (pp. 146-162). Sage Publications, 1997.

White, Jim.

Stresspac: A controlled trial of a self-help package for the anxiety disorders.

Behavioural & Cognitive Psychotherapy. Vol 23(2), 1995, 89-107.

Wituk, Scott. Shepherd, Matthew D. Slavich, Susan. Warren, Mary L.

Meissen, Greg.

A topography of self-help groups: An empirical analysis.

Social Work. Vol 45(2), Mar 2000, 157-165.

Appendix D: Sources for Journalists Writing About Self-Help

Marla Bolotsky

Managing editor and director of online information for the Henry J. Kaiser Family Foundation

Email: marla.bolotsky@latimes.com

Tom Ferguson, M.D.

Psychiatrist and author of The Ferguson Report, a newsletter about the online health industry

Phone: 512-474-1141

Email: doctom@doctom.com

John Grohol, Psy.D.

Psychologist and an expert on online mental health resources

For contact info, see http://psychcentral.com/feedback.htm

Shela Halper

Senior Director of Public Education for the National Mental Health Association

Phone: 703-838-7533

Email: shalper@nmha.org

Marlene Maheu, Ph.D.

Psychologist and editor of Self-Help & Psychology Magazine

Phone: 858-277-2772

John Norcross, Ph.D.

Professor of psychology at the University of Scranton and an expert on self-help mental-health resources

Phone: 570-941-7638

Email: norcross@uofs.edu

John T. Pardeck, Ph.D.

Professor of social work at Southwest Missouri State University and an expert on bibliotherapy

Phone: 417-836-6322

Email: jtp121f@smsu.edu

Gerald Rosen, Ph.D.

Professor of psychology and psychiatry at the University of Washington and an expert on mental-health self-help

Phone: 206-343-9474

Forrest Scogin, Ph.D.

Professor of psychology at the University of Alabama and an expert on mental-health self help

Phone: 205-348-1924

Email: fscogin@bama.ua.edu

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