4 Mar, 11 | by BMJ Group
How to be happier? It’s a constantly pertinent question. Aristotle was occupied with it nearly 2400 years ago, and the UK prime minister David Cameron is today, as he plans to replace GDP with happiness as the UK’s primary progress indicator.
So pertinent, in fact, that an entire industry has grown up confidently asserting (usually in an American accent) that it can make us happier, and a subset of this has ended up as the self-help section of your local bookshop.
The self-help book industry hasn’t been patiently waiting for the evidence to mount up before launching what is now a prolific, multi-million pound cultural phenomenon, so are any of these books doing anyone any good? Of the 90,711 results that searching under books for “self-help” at amazon.com brings up, is there any way of sifting out the actually helpful?
Robert Kelsey, himself author of the self-help tome What’s stopping you? has answers to this question. Speaking at the School of Life’s recent self-help summit in London, Kelsey described how a career moving between financial journalism, investment banking and popular book writing left him feeling a failure: “I got a bit depressed about all of this, and ended up in the wrong section of the bookshop, the self-help section, and slightly over-indulged myself.”
After this, and some sessions in a psychotherapist’s chair, Kelsey “came to realise that I hadn’t failed, it was my perception of failure that was the key issue here. I had an inability to learn from my experiences, because what was happening was I was interpreting set-backs as failure.”
This period of self help bingeing enabled Kelsey to spot what to avoid in that section of the bookshop. The first was hyper-titling – Unlimited power, Awaken the giant within, How to get everything that you want, faster than you ever though possible and Maximum achievement being offenders he charges.
Over-promising was the next: “they’re promising to change your life…they’re going to rewire you so you will be a completely new person.”
And finally over-simplification, such as Anthony Robin’s view that depression is simply a product of someone standing, talking, breathing and speaking in a particular way.
Kelsey decided to write his own, very different book, based not on a complete personality and/or life change, but on self-awareness and small, attainable changes (closer in fact to the ideas that cognitive behaviour therapy is based on). He wants readers to “become aware of the issue and accept who you are and actually navigate that. And low and behold and kapow! At that point…self-help books become fantastically helpful. They’re enormously strong in their descriptions of what’s going on and in some of the techniques they’re offering.”
Oliver Burkeman, also speaking at the summit, is another who’s taken up the problem of human happiness, and sorting the good advice from the bad – firstly for readers of his Guardian newspaper column and now for anyone who cares to buy his book Help! How to become slightly happier and get a bit more done.
Describing himself before the investigation as “a rational, non-gullible sort of person allergic to the cheesy promises of self-help gurus,” Burkeman’s voyage into self-improvement led him to conclude that some advice is “deeply insightful, non-perfectionistic, practical, wise and humane. The trick is learning to tell the difference.”
Echoing Kelsey, he cautions against an absolutist way of thinking – the New Year-style quick-fixes and ambitions to instantly and perfectly overhaul and change ourselves. Like Kelsey he points the finger at self-help fallacies, similarly noting high goals, fast changes and fresh starts.
Instead it’s the willingness “to make small, incremental adjustments, to tolerate imperfection and bumpy progress, and not to throw in the towel in frustration the moment something starts to go wrong.” This, he says, is what works; what will make us happier.
The specific advice he says does work is science-based. One example from his collection is how doing something incompatible with anger, such as reading or listening to music, is the best way to deal with the emotion. He writes the world of pop psychology holds that you need to do something cathartic, such as punch a pillow, but actually experiments have found that “venting” makes you feel more hostile.
Another is that focussed writing – as opposed to wallowingly self-absorbed journaling – can have mood-enhancing powers. Research has shown people who’ve experienced trauma, and are asking to write about it for restricted time periods, have rapid improvements in wellbeing compared to those who wrote about something else.
The final tip from Burkeman is not to be put off by cheesiness. He came to realise that “even the best and most scientifically credible advice can appear off-puttingly schmaltzy. At some point you’re going to have to swallow your pride and try something even though some cringe-inducing guru recommends it.”
The last thoughts on how to be happier at the summit were from Alain de Botton, and I’m going to let him have them here, too. As well as literature directly claiming to aid self-improvement, Botton said that any great book could be seen as self-help. This is a role of literature and the arts, to help us delve into ourselves and others, and help us understand how to live a better life. Not nearly enough research has been done on mental health and artistic literature to warrant an evidence-based justification, but, according to him, curling up with any good book really could make you that bit happier.
Self help and mental health: the evidence
Robert Gould and George Clum(1) conducted a meta-analysis of 40 self-help studies examining 61 treatments, using waiting-list, no treatment or placebo comparisons. They wrote: “no differences were found for unadulterated self-help treatments and those with minimal contact from a therapist or which were in fact therapist-assisted.” In particular they say “skills deficits and diagnostic problems, such as fears, depression, headache, and sleep disturbance” were “more amenable to self-help approaches.”
A meta analysis, by Pim Cuijpers(2), found six studies which looked at bibliotherapy (using an individual’s relationship to the content of books and poetry and other written words as therapy) and depression, and his results indicated the treatment was as effective as individual or group counselling. It “can be a cheap, efficient and high quality form of therapy,” he noted.
Following Cochraine guidelines, Deb Fanner and Christine Urquhart(3) looked at bibliotherapy for mental health service users in general, but again highlighted depression as an area with promising evidence of success: “overall our meta-analysis indicates that bibliotherapy was an effective intervention [for depression], although the evidence was drawn from small studies that were overall of a poor quality.”
1. Gould, Robert A. and Clum, George A. A meta-analysis of self-help treatment approaches. Clinical Psychology Review 1993;13(2):169-186.
2. Cuijpers, Pim. Bibliotherapy in unipolar depression: A meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry 1997;28(2):139-147.
3. Fanner, D and Urquhart, C. Bibliotherapy for mental health service users Part 1: a systematic review. Health Info Libr J. 2008;25(4):237-52.
Harriet Vickers is a multimedia intern, BMJ.