When are self-help programs "helpful"?
by Srini Pillay, MD, Harvard Health Blog
February 02, 2017
For some people, a “self-help” program can be a useful addition to professional services, or even be enough by itself. Despite the good intentions of the creators of such programs, the degree and quality of research backing up their claims vary. What’s more, people also vary in how well they use such programs.
Given the increasing number of books, tapes, podcasts, programs, and apps that claim to provide self-help, it is important to think about a few principles that may help you choose a program and use its information more effectively. Here are some factors to consider when evaluating self-help programs for any challenge you may be facing.
Is the program’s approach backed up by good data?
The quality of research in self-help is highly variable. For example, although self-help treatments for anxiety may be more effective than placebo but less effective than face-to face studies for the treatment of anxiety disorders, many of the studies showing this have not been well-controlled trials. For that reason, it is important to examine whether a program itself references well-controlled trials, and that more than one study backs up the claim. This is rare, but certainly, by checking the references or endnotes in a book or program, you can get a sense of whether the recommendations are research-based or not.
And here’s why you should care about the research. Scientists use statistical analyses to help determine whether an intervention works significantly better than placebo for a majority of people. Yet, even if an intervention is better than placebo for 80% of people in a study, there is no way to actually tell if you are likely to fall into that 80% or whether you are more likely to be one of the 20% of people for whom that intervention did not work. In fact, many scientists now recognize that because there is such variation in humans, the only truly valuable study would be one that was conducted for the specific human being planning to use that intervention. This is close to impossible. The onus then falls back on you, and on how you interpret the data presented to you. Scientific research is certainly one factor to consider, but not the only one.
Is the self-help program a good match for you?
All study results pertain to a “generalized person” and not specifically to you. “Individualized medicine” aims to target interventions to a specific group of people. For example, scientists may test a drug or therapy on people who share the same genetics. However, it is not only our genes that make us different. Gender, race, personality, and even our beliefs in whether an intervention will work or not, all help determine whether or not a particular self-help program will benefit you. Being more deliberate in thinking about whether an approach is relevant to you may help.
Is the person who developed the program “qualified” — and does it matter?
Guided self-help interventions can certainly help you navigate your way toward alleviating depression or anxiety. But providing such help is a responsibility that is quite complex, and training gives professionals perspectives that untrained people do not have. So, understanding whether an author is qualified may help you decide whether or not to follow his or her advice. Clinical experts offer the advantage of having worked with large numbers of individuals, and not just promoting isolated, sensational outcomes that give you a false sense of hope. Yet, as with research, even an expert’s experience is limited to the types of people that person sees. Other factors such as religion, cultural sensitivity, and spirituality may all play a role in helping you decide whether to follow the advice of an “expert.” While focusing on qualifications may help you avoid the charlatans, there is something to be said for the wisdom of people who share their personal experiences too. One red flag should be someone claiming to have a “cure for all” or “known methods that always work.” Distinguishing your desperation from random inspiration is helpful.
So how do you decide?
Given such variability in the quality of research, the meaning of research, the qualifications and experience of “experts,” and in the people who respond to interventions, there is no “one size fits all” solution. Eventually, the decision to use self-help (or any treatment, for that matter) will be yours. To help you decide, I’ve created a mnemonic that you can use to assess the value of a suggested self-help intervention: REST.
- Is the claim based on high-quality Research?
- What is the Expertise of the person handing out the advice?
- Does this advice feel Self-applicable — to you, and to your genetics and circumstances?
- How Trustworthy is the advice? Is the advice-giver appropriately humble, or too hyped up about the advice?
When you realize the complexity of self-help interventions, it will help you become a more discerning customer and make it more likely you will find something that could work for you.