CBT-based self-help books can do more harm than good

Self-help books based on the traditional principles of CBT, including popular titles like 'CBT for Dummies', can do more harm than good, according to a new study. The risks were highest for readers described as 'high ruminators' - those who spend time mulling over the likely causes and consequence of their negative moods.

The new research focuses on the use of self-help books as a preventative intervention for people at risk of developing depression. Gerald Haeffel identified 72 undergrads at risk and allocated each of them randomly to work through one of three self-help books. A third of the students spent four weeks working through a traditional self-help CBT-based book, of the kind typically found in book stores, which involved learning the links between thoughts, behaviour and mood, as well as identifying negative thoughts and re-evaluating them. Another group of students followed a 'non-traditional' CBT-based self-help book, similar to the first but modified so that the task of identifying and challenging one's own negative thoughts was removed. The final group followed a book that taught academic skills such as time-management and memory aids.

Here's the bottom line: among students who tended to ruminate and who had suffered an increase in stress, those who followed the traditional CBT book displayed more depressive symptoms after the four-week study period than those who followed either of the other two books. At four-month follow-up, the traditional CBT study group as a whole tended to have more depression symptoms than the other groups, although high ruminating and stressed students in the traditional group remained the biggest losers.

Haeffel sounded some notes of caution - the findings may not generalise to non-student participants, the samples were fairly small, and the outcomes were based on depression symptoms, not clinically diagnosed depression. That said, the stressed, high ruminators in the traditional CBT group ended up scoring on the 'moderate' range of the depression scale at four-month follow up.

'The current results suggest that cognitive work-books as traditionally operationalised (and sold in stores) may not work for individuals who ruminate,' Haeffel said. 'For these individuals, a modified form of cognitive skills training that does not rely on identifying and disputing negative cognitions may be more effective.'

This latest warning about self-help comes after a study published in 2009 that showed use of positive mantras such as 'I'm a lovable person' can actually be harmful to people with low self-esteem.
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Haeffel, G. (2010). When self-help is no help: Traditional cognitive skills training does not prevent depressive symptoms in people who ruminate. Behaviour Research and Therapy, 48 (2), 152-157 DOI: 10.1016/j.brat.2009.09.016