Bibliotherapy for stress management: a wellness intervention for first-year medical students
DOI:
https://doi.org/10.5195/jmla.2025.1830Keywords:
Bibliotherapy, Wellness, medical educationAbstract
Objective: This proof-of-concept study aimed to evaluate if a library-initiated program of bibliotherapy could be effective in reducing overall levels of stress and anxiety in first-year medical students.
Methods: This mixed-methods study consisted of an Interrupted Time Series (ITS) where participants established baseline levels of stress and anxiety by completing the 10-item Perceived Stress Scale (PSS-10) three times prior to intervention and three times following, with a bibliotherapy intervention delivered at the halfway point. Four focus groups were held following completion of the ITS with questions designed to solicit feedback related to how enjoyable and valuable participants found the study, as well as priorities for wellness.
Results: An independent samples t-test was conducted to compare mean PSS-10 scores in the pre-intervention group to those in the post-intervention group. The results indicate no significant difference between scores pre-intervention (M= 17.85, SD=6.76) and post-intervention (M=17.21, SD=6.87, t(162)=.604, two-sided p=.547, 95% CI [-1.46, 2.75]). Focus group analysis revealed that participants found involvement in the study to be a useful component of a personal wellness or mental health maintenance program.
Conclusions: Quantitative results did not achieve statistical significance, but analysis of focus groups indicates that participants derived benefit from involvement in the study, particularly related to the regular self-reflection required by completing the monthly PSS-10. The study is a successful proof-of-concept, indicating that medical students derive benefit from a librarian-led bibliotherapy program as part of student wellness.
References
Rothman EL. White coat: becoming a doctor at Harvard Medical School. New York: W. Morrow; 1999.
Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81(4):354-73. DOI:10.1097/00001888-200604000-00009.
Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, Shanafelt TD. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014;89(3):443-51. DOI:10.1097/ACM.0000000000000134.
Hill MR, Goicochea S, Merlo LJ. In their own words: stressors facing medical students in the millennial generation. Med Educ Online. 2018;23(1):1530558. DOI:10.1080/10872981.2018.1530558.
Czeisler ME, Lane RI, Petrosky E, Wiley JF, Christensen A, Njai R, Weaver MD, Robbins R, Facer-Childs ER, Barger LK, Czeisler CA, Howard ME, Rajaratnam SMW. Mental health, substance use, and suicidal ideation during the COVID-19 pandemic - United States, June 24-30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1049-57. DOI: 10.15585/mmwr.mm6932a1.
Pappa S, Ntella V, Giannakas T, Giannakoulis VG, Papoutsi E, Katsaounou P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain Behav Immun. 2020;88:901-7. DOI: https://doi.org/10.1016/j.bbi.2020.05.026.
Dedeilia A, Sotiropoulos MG, Hanrahan JG, Janga D, Dedeilias P, Sideris M. Medical and surgical education challenges and innovations in the COVID-19 era: a systematic review. In Vivo. 2020;34(3 Suppl):1603-11. DOI:10.21873/invivo.11950
Brewster L, McNicol S, eds. Bibliotherapy. 1st ed. London: Facet Publishing; 2018.
Panella NM. The patients' library movement: an overview of early efforts in the United States to establish organized libraries for hospital patients. Bull Med Libr Assoc. 1996;84(1):52-62.
Fanner D, Urqhuart C. Bibliotherapy for mental health service users part 2: a survey of psychiatric libraries in the UK. Health Info Libr J. 2009;26(2):109-17. DOI:10.1111/j.1471-1842.2008.00791.x.
Silverberg L. Bibliotherapy: the therapeutic use of didactic and literary texts in treatment, diagnosis, prevention, and training. J Osteopath Med. 2003;103(3):131-5. DOI:doi:10.7556/jaoa.2003.103.3.131.
Salimi S, Zare-Farashbandi F, Papi A, Samouei R, Hassanzadeh A. The effect of group bibliotherapy on the self-esteem of female students living in dormitory. J Educ Health Promot. 2014;3:89. DOI:10.4103/2277-9531.139643.
Park JH, Kim JY, Kim HO. Effects of a group poetry therapy program on stress, anxiety, ego-resilience, and psychological well-being of nursing students. Arch Psychiatr Nurs. 2022;41:144-52. DOI:10.1016/j.apnu.2022.07.027.
Febbraro GA. An investigation into the effectiveness of bibliotherapy and minimal contact interventions in the treatment of panic attacks. J Clin Psychol. 2005;61(6):763-79. DOI:10.1002/jclp.20097.
Sharp DM, Power KG, Swanson V. Reducing therapist contact in cognitive behaviour therapy for panic disorder and agoraphobia in primary care: global measures of outcome in a randomised controlled trial. Br J Gen Pract. 2000;50(461):963-8.
Nordin S, Carlbring P, Cuijpers P, Andersson G. Expanding the limits of bibliotherapy for panic disorder: randomized trial of self-help without support but with a clear deadline. Behav Ther. 2010;41(3):267-76. DOI:10.1016/j.beth.2009.06.001.
Andersson G, Bohman B, Carlbring P, Clevberger P, Ekselius L, Eriksson A, Eriksson A, Frykman M, Furmark T, Hedman E, Holmström A, Hållén A, Ihrfelt EN, Sonnenstein A, Spak M, Sparthan E, Tillfors M. Guided and unguided self-help for social anxiety disorder: randomised controlled trial. Br J Psychiatry. 2009;195(5):440-7. DOI:10.1192/bjp.bp.108.060996.
Smith J, Newby JM, Burston N, Murphy MJ, Michael S, Mackenzie A, Kiln F, Loughnan SA, O'Moore KA, Allard BJ, Williams AD, Andrews G. Help from home for depression: a randomised controlled trial comparing internet-delivered cognitive behaviour therapy with bibliotherapy for depression. Internet Interv. 2017;9:25-37. DOI:10.1016/j.invent.2017.05.001.
Kaptein AA. Writing cancer. Support Care Cancer. 2021;29(8):4375-80. DOI:10.1007/s00520-020-05920-0.
Djikic M, Oatley K, Moldoveanu MC. Opening the closed mind: the effect of exposure to literature on the need for closure. Creat Res J. 2013;25(2):149-54. DOI:10.1080/10400419.2013.783735.
van Krieken K. How reading narratives can improve our fitness to survive: a mental simulation model. NI. 2018;28(1):139-60. DOI:10.1075/ni.17049.kri.
Flood A. Publishers report sales boom in novels about fictional epidemics. The Guardian [Internet]. 2020 March 5 2020 [cited 27 March 2023]. https://www.theguardian.com/books/2020/mar/05/publishers-report-sales-boom-in-novels-about-fictional-epidemics-camus-the-plague-dean-koontz.
Scrivner C, Johnson JA, Kjeldgaard-Christiansen J, Clasen M. Pandemic practice: horror fans and morbidly curious individuals are more psychologically resilient during the COVID-19 pandemic. Pers Individ Dif. 2021;168:1-6. DOI: 10.1016/j.paid.2020.110397.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385-96. DOI:10.2307/2136404.
Bower P, Richards D, Lovell K. The clinical and cost-effectiveness of self-help treatments for anxiety and depressive disorders in primary care: a systematic review. Br J Gen Pract. 2001;51(471):838-45.
Yang E, Schamber E, Meyer RML, Gold JI. Happier healers: randomized controlled trial of mobile mindfulness for stress management. J Altern Complement Med. 2018;24(5):505-13. DOI:10.1089/acm.2015.0301.
Erogul M, Singer G, McIntyre T, Stefanov DG. Abridged mindfulness intervention to support wellness in first-year medical students. Teach Learn Med. 2014;26(4):350-6. DOI:10.1080/10401334.2014.945025.
Medvedev ON, Krägeloh CU, Hill EM, Billington R, Siegert RJ, Webster CS, Booth RJ, Henning MA. Rasch analysis of the Perceived Stress Scale: transformation from an ordinal to a linear measure. J Health Psychol. 2019;24(8):1070-81. DOI:10.1177/1359105316689603.
Taylor JM. Psychometric analysis of the Ten-Item Perceived Stress Scale. Psychol Assess. 2015;27(1):90-101. DOI:https://doi.org/10.1037/a0038100.
Krueger RA, Casey MA. Focus groups: a practical guide for applied research. 5th ed. Thousand Oaks, California: SAGE Publications; 2015.
Shahaf-Oren B, Madan I, Henderson C. "A lot of medical students, their biggest fear is failing at being seen to be a functional human": disclosure and help-seeking decisions by medical students with health problems. BMC Med Educ. 2021;21(1):599. DOI:10.1186/s12909-021-03032-9.
Christopher AN. Interpreting and using statistics in psychological research. Los Angeles: SAGE Publications; 2017.
Onwuegbuzie AJ, Dickinson WB, Leech NL, Zoran AG. A qualitative framework for collecting and analyzing data in focus group research. Int J Qual Methods. 2009;8(3):1-21. DOI:10.1177/160940690900800301.
Chambless DL, Hollon SD. Defining empirically supported therapies. J Consult Clin Psychol. 1998;66(1):7-18. DOI:10.1037//0022-006x.66.1.7.
Azezz T. Read-o-Meter 2010 [March 21 2024]. Available from: https://niram.org/read/.
Dyrbye LN, Shanafelt TD, Sinsky CA, Cipriano PF, Bhatt J, Ommaya A, West CP, Meyers D. Burnout among health care professionals: a call to explore and address this underrecognized threat to safe, high-quality care. NAM Perspect. 2017. DOI:https://doi.org/10.31478/201707b.
Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, Sen S, Mata DA. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA. 2016;316(21):2214-36. DOI:10.1001/jama.2016.17324.
AAMC Group on Student Affairs. Recommendations regarding health services for medical students [internet]. Washington, DC: AAMC [rev. 25 Jun 1992; cited 13 Jan 2024]. https://www.aamc.org/professional-development/affinity-groups/gsa/health-services-recommendations.
Liaison Committee on Medical Education. Functions and structure of a medical school: standards for accreditation of medical education programs leading to the MD degree [internet]. Washinton, DC: LCME [rev. Nov 2023; cited 13 Jan 2024]. https://lcme.org/wp-content/uploads/2023/11/2024-25-Functions-and-Structure_2023-11-15.docx.
Vogel L. Medicine is one of the loneliest professions. CMAJ. 2018;190(31):E946-E. DOI:10.1503/cmaj.109-5640.
Alkureishi ML, Jaishankar D, Dave S, Tatineni S, Zhu M, Chretien KC, Woodruff JN, Pincavage A, Lee WW. Impact of the early phase of the COVID-19 pandemic on medical student well-Being: a multisite survey. J Gen Intern Med. 2022;37(9):2156-64. DOI:10.1007/s11606-022-07497-2.
Ardekani A, Hosseini SA, Tabari P, Rahimian Z, Feili A, Amini M, Mani A. Student support systems for undergraduate medical students during the COVID-19 pandemic: a systematic narrative review of the literature. BMC Med Educ. 2021;21(1):352. DOI:10.1186/s12909-021-02791-9.
Monroy-Fraustro D, Maldonado-Castellanos I, Aboites-Molina M, Rodríguez S, Sueiras P, Altamirano-Bustamante NF, de Hoyos-Bermea A, Altamirano-Bustamante MM. Bibliotherapy as a non-pharmaceutical Intervention to enhance mental health in response to the COVID-19 pandemic: a mixed-methods systematic review and bioethical meta-analysis. Front Pub Health. 2021;9(629872). DOI:10.3389/fpubh.2021.629872.
Peper E, Wilson V, Martin M, Rosegard E, Harvey R. Avoid Zoom fatigue, be present and learn. NeuroRegulation. 2021;8(1):47-56. DOI:10.15540/nr.8.1.47.
Morley Eramo KA, Morin RA, LaVertu AE, Deford KR, Quinn T, Samiean S. Case study: Library Fun Labs: a successful experiment in crafting community. In: Gillum S, Williams N, eds. Planning and promoting events in health sciences libraries: success stories and best practices. Lanham, MD: Rowman & Littlefield; 2021. p.115-25.
American Medical Association. AMA code of medical ethics- opinion 8.13 physician competence, self-assessment & self-awareness [Internet]. 2016. cited 27 Jul 2023]. https://code-medical-ethics.ama-assn.org/ethics-opinions/physician-competence-self-assessment-self-awareness.
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