When are self-help programs “helpful”?

Srini Pillay, MD
Srini Pillay, MD, Contributor

Follow me on Twitter @srinipillay

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.

Comments:

  1. Liz Tebb

    Not everyone is in the frame of mind to implement strategies. N

  2. Alok Varshney

    Dr Srini

    Thanks for the insight I gained on combination of intuition and critical research for designing appropriate and best practices for vocational skilling and employment support for individual marginalised unemployed youth in India . This should help in raising effectiveness of our skill programs in India and other countries .

    Cheers

    Alok Varshney

    • Sara Marshall

      My problem with the Harvard posts are they usually aim at selling their books and products. I really object to the so-called social support popping up with insurance companies AARP MDX is the worst I’ve seen. They dust off old articles and barrage people with mail that is useless.

  3. John M. Lind

    Some of us need very serious help in a certain area. The problem is with chemical exposure (OPs + etc.) resulting in neurological and respiratory illness among employees in pesticide manufacturing, agriculture, and airline aircrew members. As an airline risk management professional, a nurse friend and I are seeking ways to reduce the airline health exposure that is causing death, disability and grounding of pilots and flight attendants. Less so among passengers because they do not live in this environment.
    I have emails from the neurologically disabled desperately seeking help from alternative sources. They spend huge sums in this haphazard effort.
    We will value any direction you can give us!!!!

  4. Helen

    One other essential criterion is not mentioned in this article: weighing the potential benefits against the actual or potential costs. How much, if any, harm will result if the method does not succeed for a given individual? Even if only a small percentage of individuals succeed with a given method, it might still be worth a try if there is little or nothing to lose. On the other hand, a high success rate does not necessarily make a method worth trying if a failed attempt would be physically, financially, or emotionally devastating.

  5. Jay Yudof, MS, Certified Psychiatric Rehabilitation Practitioner

    Sounds like a good framework to evaluate self-help toolsets. I also encourage folks to consider whether they are looking at the toolset for closing a skills or treatment gap (e.g., upon onset of a condition) versus supporting entertainment (e.g., cueing and reinforcing coping strategies).

    For the latter, peer support groups are often a good resource. Good programs do not claim to replace professional psychotherapy or skills training programs, but often help people normalize and strengthen our own learned or innate coping capabilities. Expect a support group to offer 1)practical advice from your peers, 2)a non-judgmental environment, a leader trained in the model, but also trained not to give advice, 4)a sense of empathy, mutual aid, and mutuality, and 5)a chnace to help others (the “helper therapy” effect).

  6. MCE Conferences

    Good Post… I believe that a combination of the two is most valuable, and critical thinking applied to both “intuition” and “research” will help all of our interventions get better.

  7. Erica

    This article, despite it’s pneumonic, doesn’t offer folks a way to use research but leaves one to judge if a program ‘feels’ right, feels trustworthy and offers little guidance on how to use research nor how to vett expertise. Probably because these are difficult to do for a generic person as you say.

    Dr. Pillay, you have highlighted the need for collaboration between practioners and researchers. As a teacher I have a lot of gut instincts, built up over decades of teaching, about which intervention will help which child and family. My instincts would benefit from a researchers careful attention and insights. A researcher would benefit from my more nuanced grouping of the populations being studied and paired with interventions. I suspect many self-help strategies have good and bad mingled. Researchers could begin with self-helpers, teachers, and practioners that they “feel are trustworthy” as “clincial experts” and co-design investigations that probe those instincts to hep caring people separate the best of their services for those they serve.
    If you’d like to explore this idea by pairing a research scientist with my innvotive programs for social/language goals, I’d be delighted. -Erica, Learning Seeds Brookline

    • Srini Pillay

      Thanks for your perspective, Erica. Yes, this article is not meant to be about how to use research. but rather, about how to think about the self-help that you are receiving. As you imply, research is the cornerstone of traditional medicine, and very valuable indeed. However, as you also point out, intuitive decisions also play a role because controlled trials do not necessarily reliably represent every person and there is no real way to tell if they do. I believe that a combination of the two is most valuable, and critical thinking applied to both “intuition” and “research” will help all of our interventions get better. Mostly, I think that both extremes—a blind overemphasis on the research, and no research at all—can both be problematic. My intention in writing this article was to provoke thinking about this. I have tremendous respect for teachers, and agree that intuition and research go well together in that context as well. I wish you all the best in finding a research scientist for your programs, and if I come across any helpful sources, I’ll mention them here. Thanks again for being a part of this discussion!