Alan Kazdin and Stacey Blase of Yale University recently wrote an article claiming that psychotherapy—the primary vehicle for addressing mental health issues—was fundamentally unable to meet the needs of the population at large, prompting a firestorm of reactions from mental health professionals across the globe (who weren’t happy). However, one of their most compelling points related to the current and future role of science-based self-help articles, books, and websites (like this one), and their role in filling the needs of those for whom psychotherapy is not an option.
Psychotherapy is Available to Everyone
The goal of psychological treatment is to reduce the individual and societal (including monetary) burden of psychological, emotional, cognitive, and behavioral impairments. And quite a burden it is. In the U.S. alone, 50% of the population will meet actual (DSM IV) criteria for a psychiatric disorder at one point in their lifetime, and 25% of the population will meet criteria during any given year. Keep in mind, these numbers are underestimations as one can easily be impaired emotionally, cognitively, or behaviorally without meeting strict criteria for formal diagnosis and categories such as marital, relationship or family problems are unaccounted for entirely.
The Financial Burden of Emotional Distress and Mental Illness
In addition to the emotional distress suffered by the individuals and their families, mental health issues have financial consequences as well. Although there are no existing estimates of the total costs of impairments in mental and emotional health, we do know some specifics. For example, annual health care expenditures on anxiety disorders alone are over $40 billion a year and a single episode of major depression can cost 5 weeks of productivity, costing employers $36 billion a year. In one survey, employees were asked to report the number of days they were unable to perform their jobs. The majority of disability days were due to mental and emotional issues, outnumbering those lost due problems related to physical health.
Just When You Thought We Had Too Many Therapists
Currently, the primary method of delivering psychological services is via one-to-one psychotherapy (primarily to individuals but also to couples, families, and groups). There are currently an estimated 700,000 therapists in the entire U.S. (an obvious boon to the sofa industry). That many therapists might sound like a lot but consider that if a minimum of 25% of the population requires therapy a year—75 million people—the one-to-one model of treatment cannot possibly cover them all.
Evidence-Based Self-Help to the Rescue
Today there are countless self-help books, articles, websites, tapes, and programs on the market but until recently, the vast majority of them have been decidedly non-scientific (I’m looking at you, The Secret). Fortunately, self-help interventions based on actual research evidence is finally on the rise. Evidence-based self-help includes treatments and interventions that target both specific issues (such as panic attacks or ADHD) as well as general ones (such as emotional resilience, stress, or happiness).
Indeed, new studies are finding that science-based self-help interventions are as effective as individual psychotherapy! In addition, a growing number of evidence-based self-help websites, articles and books now also focus on prevention (e.g., stress management, emotional and cognitive resilience, treating emotional and psychological wounds, and other preventative measures).
As a mental health professional in private practice, I can easily attest that my own articles and books have reached an audience that is orders of magnitude larger than the number of patients I’ve been able to see in a full-time practice spanning more than twenty years. Although I’d like to believe I’m far more effective in person than I am via the written page, when I receive an email from someone on the other side of the country or of the world, telling me they found help or solace in something I wrote, the satisfaction I feel is as meaningful as that which I experience in face-to-face therapy sessions.
Mental health professionals should not feel threatened by the rise of evidence-based self-help but encouraged by the ability of the written word to expand the very purpose and mission to which we all subscribe—improving the emotional, mental, cognitive, and behavioral health, of as many people in as many counties as we possibly can.
Speaking of science-based self-help, check out my new book: Emotional First Aid: Practical Strategies for Treating Failure, Rejection, Guilt, and Other Everyday Psychological Injuries (Hudson Street Press, 2013).
Copyright 2013 Guy Winch
Reference: Kazdin, A..E.,& Blasé, S. L., “Rebooting Psychotherapy Research and Practice to Reduce the Burden of Mental Illness,” Psychological Science, 2011 6(1) 21-37.