Beware the unproven claims of self-help culture

A massive self-help industry has grown up worldwide in recent times – books, DVDs, films, courses, seminars, retreats – all designed to help people deal with all sorts of problems – psychological, financial, health, relationships and many more. Is this a positive development? The situation is reviewed by neuroscience journalist Maia Szalavitz in July's Scientific American; she warns that we should choose self-help products with a keen eye lest we do ourselves more harm than good.

The self-help industry is huge: it is valued in the US at about $12 billion. Self-help books are the most popular products; more than 45,000 books designed to help people to live happier lives have been published. Although studies have shown that research-based self-help can benefit people, particularly those with anxiety, depression and drug addiction, more than 95 per cent of self-help books and programmes have never been scientifically evaluated (JC Norcross and others in Self-Help That Works).

It is important to know how to protect yourself from potentially dangerous self-help rituals by learning to recognise dubious experts and by understanding how peer pressure impairs judgment.

Many people suffer from anxiety disorders and turn to self-help programmes, some of which work. The best of those that have been studied apply cognitive behaviour therapy. Cognitive behaviour therapy teaches how to detect and deflect anxious and negative thoughts. A 2013 Cochrane review concluded that anxiety disorders are best treated by consulting a professional therapist, but also that “self-help is probably better than no treatment”.

Researchers have also examined 12-step programmes, whereby members support one another in following guidelines to help them cope with addictions. Alcoholics Anonymous is the best-known. Studies have shown that addicts who willingly participate in AA are more likely to stop drinking than those who do not. AA’s own surveys show that a majority of newcomers stop attending in the first six months. But one study cited by Szalavitz showed that two-thirds who stayed with it for at least 27 weeks were still off alcohol 16 years later.

Be choosy

How do you pick a self-help programme that is likely to be helpful? Szalavitz advises picking only those programmes backed up by independent data showing that this general approach works. The absence of published literature to support a programme is a red flag.

Secondly, any good self-help programme in the anxiety, depression and addiction areas would emphasise that the new coping skills will take time to master: at least many months and probably years. Promises of quick results are red flags.

Self-help groups can be perilous, because one becomes subject to peer pressure, which can over-ride one’s better judgment. It has happened that group members advised newcomers to stop taking psychiatric drugs on the grounds that the drugs impede recovery. Some vulnerable individuals obliged and relapsed into depression or other disorder, in some cases resulting in suicide.

In particular Szalavitz warns against getting involved with charismatic guru-type leaders who offer intense group retreats over several days that will lead to dramatic rebirth. She recounts a tale of one group that was led into the Arizona desert in 2009 by a leader who put them through several days of intense meditation, fasting, self-hypnosis, sermons and discussions in which they shared intimate details of their lives. He then took them to a ceremony in a sweat lodge. The stressful conditions and exhortations of the leader made the participants very susceptible to peer pressure and obedient to the leader. The sweat-lodge conditions were extreme. Three people died and 18 were hospitalised for problems ranging from heat exhaustion to kidney failure.

On a more mundane level, the biggest drawback I see with self-help programmes is the commitment required to get results, and the difficulty of sticking with them in the absence of a structured approach supervised by a professional. Changing behaviour is hard work, and it is all too easy to give up when you are working alone.

Considering the amount of self-help material I have accumulated over the years, I should be the healthiest, happiest, wealthiest man in Ireland, but I am not. There are no magic bullets.

William Reville is an emeritus professor of biochemistry at UCC. understandingscience.ucc.ie