A Cognitive Behavioural Bibliotherapy for People with Depressive Symptoms: A Pilot Study

Monday, 22 July 2013

Sally Wai-Chi Chan, PhD, MSc, BSc, RN, RMN
Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
Ziqiang Li, RN, RMN, BS
Nursing Training, The Joanna-Briggs Institute-Institute of Mental Health (Singapore) Centre for Evidence-Based Practices in Mental Health Care: an affiliate centre of the Joanna Briggs Institute, Institute of Mental Health, Singapore, Singapore

Learning Objective 1: The learner will be able to learn the use and effectiveness of self-help intervention in the field of Depression.

Learning Objective 2: The learner will be able to learn nursing expanded role in using self-help intervention in helping people with depression.


The aim of the overall research is to develop and test the feasibility of a Cognitive Behavioural Bibliotherapy (CBB) for adults with depressive symptoms.

The objectives are:

1. To adopt, translate and validate a CBB manual ‘The Good Mood Guide (GMG)—A Self-Help Manual for Depression’;

2. To implement and test the feasibility of the CBB manual as: i) outcomes of participants (level of depression, resilience, and distress); and ii) participants’ satisfaction with the intervention (usefulness, acceptability, and areas for improvement).


The GMG manual was adopted, modified, and validated for cultural relevance through experts’ group review and participants’ opinion. A pilot study was conducted with 16 participants from outpatient department of one of the acute hospitals in Singapore. The pilot study evaluated the intervention with pretest-posttest design. A convenience sample of 16 participants were recruited, who were having mild to moderate depression. Participants completed the GMG manual in 8 weeks, and three assessments at pre-intervention, post-intervention and two-month follow-up. Repeated measure ANOVA was used to analyse participants’ outcomes.


At 2-month follow up, participants reported significant reduction in depression score measure by the CES-Depression Scale (F(1.40, 21.05)=19.971, p<0.001). Participants reported significant improvement in coping with distress which was measured by Kessler Psychological Distress scale (K-10) (F(2, 30)=24.80, p<0.001). Participants also reported significant improvement in their resilience levels measured by the Resilience Scale (F(2, 30)=18.45, p<0.001).


The pilot study outcomes provided evidence to support the effectiveness of the GMG. Further rigorous RCT will be conducted to provide more conclusive evidence on its effectiveness.