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Cited by 4Art Therapy and Mental HealthDigital Mental Health InterventionsPsychotherapy Techniques and Applications

Recent developments in bibliotherapy for adolescent depression

Open access
Liao, Fei, Liang, Jiaquan, Zhang, Meng, Liang, Wenting, Zhang, Chunguo, Yun, Xuan·2025·Frontiers in Psychiatry
DOI 10.3389/fpsyt.2025.1681462PMC PMC12740898
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Abstract

Objective: This review systematically examines the current research on bibliotherapy for adolescent depressive disorders, emphasizing its efficacy and potential as a non-pharmacological intervention, while also considering the variations across different types of bibliotherapy and inherent limitations of the intervention itself. Methods: A narrative review of the literature was conducted to explore the therapeutic mechanisms of bibliotherapy—including emotional resonance, cognitive restructuring, and social support—and to analyze various application models, such as guided versus unguided formats, creative versus self-help bibliotherapy, group reading, individualized interventions, and emerging digital approaches. Results: Evidence indicates that bibliotherapy can effectively reduce depressive symptoms in adolescents across diverse intervention strategies. Both creative and self-help bibliotherapy, as well as group-based and individualized formats, have shown promising outcomes, particularly when integrated with structured discussion or other therapeutic approaches like CBT and mindfulness. However, the intervention’s effectiveness can be moderated by factors such as text selection, reader characteristics, and cultural context. Potential limitations include emotional triggering from certain narratives, variability in individual engagement, and inconsistent long-term efficacy, especially among adolescents. Existing studies are further constrained by small sample sizes, brief intervention periods, and a lack of standardized material selection criteria. Conclusion: Bibliotherapy represents a valuable, accessible intervention for adolescent depression, yet its application requires careful implementation to mitigate potential drawbacks. Future research should focus on large-scale, multicenter trials, further investigation of neuroscientific mechanisms, development of personalized reading programs, establishment of practitioner training systems, and cross-cultural adaptation. Efforts should also address ethical and privacy concerns, particularly within digital platforms, and explore creative integration with complementary therapeutic methods to enhance overall efficacy and safety.

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review examines bibliotherapy for adolescent depression, describing mechanisms such as emotional resonance, cognitive restructuring, and social support, and formats including guided/unguided, creative/self-help, group, and digital approaches. It concludes bibliotherapy is a promising accessible non-pharmacological intervention, but evidence is limited by small samples, short interventions, inconsistent long-term efficacy, and potential harms.

Key findings

  • A meta-analysis by Yuan et al. reported a standardized mean difference of –0.52 (95% CI: –0.89 to –0.15) for depression and anxiety in children and adolescents, with high acceptability and low dropout, making bibliotherapy particularly suitable for mild to moderate depression.
  • In a large randomized controlled trial by Rohde et al., after two-year follow-up, new-onset depression incidence was 3% in the bibliotherapy group, versus 14% in group CBT and 23% in controls; bibliotherapy did not significantly improve initial depressive symptoms, and cost was approximately $8 per participant.
  • A systematic review by Gualano et al. found that among eight long-term randomized controlled trials, all adult studies reported symptom reductions, whereas four adolescent trials failed to show significant effects, suggesting unstable long-term efficacy in adolescents.
  • Bibliotherapy may work through emotional resonance, cognitive restructuring, and social support; guided formats with structured support, integration with CBT or mindfulness, and group or digital delivery show promise, but effects are moderated by text selection, reader characteristics, and cultural context, with potential emotional triggering from certain narratives.

Methods

  • Narrative review of the literature, not a systematic review or meta-analysis; no formal search strategy, inclusion criteria, or primary data are reported.
  • Examines therapeutic mechanisms—emotional resonance, cognitive restructuring, and social support—and application models including guided versus unguided, creative versus self-help, group reading, individualized interventions, digital bibliotherapy, and integration with CBT and mindfulness.
  • Synthesizes selected prior studies, including meta-analyses and randomized controlled trials, to discuss efficacy, feasibility, limitations, and future directions.

Limitations

  • Stated: existing studies have small sample sizes, brief intervention periods, weak clinical support systems, lack of standardized material selection criteria, and inconsistent long-term efficacy in adolescents; effectiveness is moderated by text selection, readers’ comprehension abilities, and cultural differences.
  • Stated: potential downsides include emotional triggering or maladaptive responses, especially from illness-centered narratives; digital platforms raise ethical and privacy concerns.
  • Evident from the text: as a narrative review, it does not systematically appraise study quality or provide new pooled effect estimates beyond citing prior meta-analyses, and it reports no primary adolescent sample or new empirical data.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3389/fpsyt.2025.1681462

Cites

89 of 89 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

43 of 96 cited sources checked · 11 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    Many non-pharmacological techniques for adolescent depression (e.g., transcranial magnetic stimulation, art or music therapy) require specialized equipment or settings.

    “While techniques such as transcranial magnetic stimulation and art or music therapy has shown promise, many require specialized equipment or settings (8–11).”
    Quote in the paperSubstantial claim2 of 4 sources checked
    • cites [8] Lee, 2017, Transcranial direct current stimulation: considerations for research in adolescent depression, Front Psychiatry source

      The Concurrent and State-Dependent Interventions section describes tDCS as low-cost and portable, potentially allowing use at home. The Safety in Children and Adolescents section mentions TMS, but our copy does not say that TMS, art therapy, music therapy, or many other techniques require specialized equipment or settings. Searches for those therapies and for equipment or setting requirements did not establish the attributed claim. (LLM, conf=0.73)

      Experimental — accuracy not yet measured
    • cites [9] Magavi, 2017, A review of repetitive transcranial magnetic stimulation for adolescents with treatment-resistant depression, Int Rev Psychiatry source
    • cites [10] Belski, 2022, Review: The effectiveness of musical therapy in improving depression and anxiety symptoms among children and adolescents - a systematic review, Child Adolesc Ment Health source
    • cites [11] Zhang, 2025, The effect of the art therapy interventions to alleviate depression symptoms among children and adolescents: a systematic review and meta-analysis, Clinics (Sao Paulo) source

      The Introduction (page not provided) describes art therapy as non-pharmacological and reports evidence that art and music therapy may reduce depressive symptoms in young people. It does not say that these therapies require specialized equipment or settings, and it does not address transcranial magnetic stimulation. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Study design and conductcitation

    Baseline differences among groups in the Rohde et al. RCT may have influenced the outcomes.

    “Moreover, baseline differences among groups may have influenced the outcomes (45).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [45] Stice, 2010, Efficacy trial of a brief cognitive-behavioral depression prevention program for high-risk adolescents: effects at 1- and 2-year follow-up, J Consult Clin Psychol source
  • Premisecitation

    Evidence suggests that group-based bibliotherapy may have superior long-term preventive effects on depression incidence compared to group CBT and psychoeducational pamphlet controls in adolescent populations.

    “Although RCTs specifically evaluating this format remain limited, evidence suggests that the bibliotherapy group may be demonstrated superior long-term preventive effects on depression incidence compared to both group CBT and psychoeducational pamphlet controls, thereby potentially underscoring the added value of group-based delivery for adolescent populations (24, 56).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [24] Redman, 2024, The impact of school-based creative bibliotherapy interventions on child and adolescent mental health: a systematic review and realist synthesis protocol, Syst Rev source

      The Background > Creative bibliotherapy section reports a small-to-moderate positive effect on child behaviour in a review of creative-bibliotherapy trials. It does not report adolescent depression incidence or a long-term comparison with group CBT or pamphlet controls. Background > Mechanisms of change also says the extent to which the group setting drives change has not been scrutinized. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [56] Arslan, 2022, Benefits of positive psychology-based story reading on adolescent mental health and well-being, Child Indic Res source

      The Results (Primary Analyses; page not supplied) report reduced depressive symptoms in the adolescent story-reading group compared with a control group. The study measured symptoms over five weeks, not long-term depression incidence, and did not compare story reading with group CBT or psychoeducational pamphlets. The Method (Participants; page not supplied) also says assignment was not random. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Premisecitation

    Bibliotherapy might have potential for long-term depression prevention.

    “While the study suggests that bibliotherapy might have potential for long-term depression prevention and may be cost-effective (approximately $8 per participant), it did not show significant improvement in initial depressive symptoms.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [45] Stice, 2010, Efficacy trial of a brief cognitive-behavioral depression prevention program for high-risk adolescents: effects at 1- and 2-year follow-up, J Consult Clin Psychol source
  • Premisecitation

    Bibliotherapy did not show significant improvement in initial depressive symptoms in the Rohde et al. RCT.

    “While the study suggests that bibliotherapy might have potential for long-term depression prevention and may be cost-effective (approximately $8 per participant), it did not show significant improvement in initial depressive symptoms.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [45] Stice, 2010, Efficacy trial of a brief cognitive-behavioral depression prevention program for high-risk adolescents: effects at 1- and 2-year follow-up, J Consult Clin Psychol source
  • May combine two claims. 34
  • Classified as probably not a substantial claim. 20

  • May combine two claims.

    Premisecitation

    In adolescent cancer patients, mobile app-based psychological interventions have shown good acceptability and preliminary effectiveness, highlighting high engagement levels with digital bibliotherapy among youth.

    “For instance, in adolescent cancer patients, mobile app–based psychological interventions have shown good acceptability and preliminary effectiveness, highlighting high engagement levels with digital bibliotherapy among youth (81).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [81] Lau, 2024, Mobile app promoting resilience in stress management for adolescents and young adults with cancer: protocol for a pilot randomized controlled trial, JMIR Res Protoc source

      The Introduction says psychosocial mHealth interventions had not yet been evaluated or implemented among adolescents and young adults with cancer. The Discussion describes this study as an ongoing pilot designed to test acceptability and explore engagement, not one reporting demonstrated effectiveness or high engagement. It does not report digital-bibliotherapy results. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Adolescent depression is characterized by chronicity and high recurrence, often accompanied by severe functional impairment and increased risks of self-harm and suicide.

    “Adolescent depression is characterized by chronicity and high recurrence, often accompanied by severe functional impairment and increased risks of self-harm and suicide (3, 4).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [3] Ryan, 2005, Treatment of depression in children and adolescents, Lancet source
    • cites [4] Spruit, 2020, The relation between attachment and depression in children and adolescents: A multilevel meta-analysis, Clin Child Fam Psychol Rev source

      The “Depression in Youth” section (page not provided) describes suicide-related thoughts and behavior, poor academic and work performance, and difficulties with family and friends, supporting the claim’s risk and impairment components. It does not describe adolescent depression as chronic or highly recurrent, and it does not specifically address self-harm apart from suicide-related behavior. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Mindfulness helps reduce rumination and enhances self-regulation.

    “This method helps reduce rumination and enhances self-regulation (70).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [70] Saarinen, 2022, School-based mindfulness intervention for depressive symptoms in adolescence: For whom is it most effective, J Adolesc source

      The paper describes mindfulness and rumination as partly opposite and says rumination and emotion regulation may change during mindfulness interventions (Abstract; Discussion, §4; page numbers unavailable). It measured those traits only at baseline, so it does not establish that the intervention reduced rumination or enhanced self-regulation. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Simple mindfulness meditation before reading can enhance concentration, clear mental distractions, and improve emotional engagement with the text.

    “In practice, simple mindfulness meditation before reading can enhance concentration, clear mental distractions, and improve emotional engagement with the text (77, 78).”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [77] Tavallaei, 2018, Mindfulness for female outpatients with chronic primary headaches: an internet-based bibliotherapy, Eur J Transl Myol source

      The Materials and Methods describe an eight-week mindfulness-based bibliotherapy program, and the Results and Discussion report improvements in headache-related outcomes. Neither section addresses meditation before reading or its effects on concentration, distractions, or emotional engagement with a text; searches for those reading-related effects found no supporting passage. Page numbers were not available in our copy. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [78] Yu, 2021, Chinese adolescents’ mindfulness and internalizing symptoms: The mediating role of rumination and acceptance, J Affect Disord source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    NICE guidelines recommend bibliotherapy at Step 2 of the stepped care model for individuals with mild to moderate depressive symptoms.

    “According to the National Institute for Health and Care Excellence (NICE) guidelines, bibliotherapy is recommended at Step 2 of the stepped care model for individuals with mild to moderate depressive symptoms.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [59] Williams, 2022, Online cognitive behavioral therapy (CBT) life skills program for depression: pilot randomized controlled trial, JMIR Form Res source

      The Introduction > Background (page unavailable) says NICE guidelines use a stepped-care model and place bibliotherapy among Step 2 low-intensity interventions. It does not specify that this recommendation is for individuals with mild to moderate depressive symptoms; it says treatment choice takes severity and other factors into account. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    The development of self-identity plays a crucial role in reducing depressive symptoms and enhancing psychological resilience.

    “The development of self-identity plays a crucial role in reducing depressive symptoms and enhancing psychological resilience (43, 44).”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [43] Zhou, 2015, Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis, World Psychiatry source

      The Outcome measures and Results sections assess psychotherapies by changes in depressive symptoms, not by self-identity development or psychological resilience. Searches for self-identity, identity development, and resilience found no passage linking self-identity to either claimed outcome. Page numbers were not available in the indexed passages. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [44] Yuan, 2018, Comparative efficacy and acceptability of bibliotherapy for depression and anxiety disorders in children and adolescents: a meta-analysis of randomized clinical trials, Neuropsychiatr Dis Treat source

      The Introduction describes self-help bibliotherapy, and the Discussion reports improvements in depression, but neither links those improvements to the development of self-identity. Searches for self-identity, resilience, and their connection to depressive symptoms found no passage addressing the claim; page numbers were not available in our copy. (LLM, conf=0.74)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Bibliotherapy at Step 2 is typically implemented as CBT-informed self-help books and grouped with iCBT and group CBT as part of early psychological support strategies.

    “It is typically implemented in the form of CBT-informed self-help books and is grouped with internet-based CBT (iCBT) and group CBT as part of early psychological support strategies (59).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [59] Williams, 2022, Online cognitive behavioral therapy (CBT) life skills program for depression: pilot randomized controlled trial, JMIR Form Res source

  • May combine two claims.

    Premisecitation

    Bibliotherapy demonstrated high acceptability and low dropout rates in the meta-analysis by Yuan et al.

    “Additionally, the therapy demonstrated high acceptability and low dropout rates, making it particularly suitable for adolescents with mild to moderate depression (44).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [44] Yuan, 2018, Comparative efficacy and acceptability of bibliotherapy for depression and anxiety disorders in children and adolescents: a meta-analysis of randomized clinical trials, Neuropsychiatr Dis Treat source

      The Conclusion describes bibliotherapy as a potentially acceptable treatment for depression in adolescents. However, the Discussion says all-cause discontinuation in bibliotherapy groups remained high, contrary to the claim of low dropout. The cited passages also do not establish particular suitability for mild to moderate depression. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In a large-scale RCT by Rohde et al., after a two-year follow-up, the incidence of new-onset depression was 3% in the bibliotherapy group, lower than in the group CBT (14%) and control (23%) groups.

    “After a two-year follow-up, the incidence of new-onset depression in the bibliotherapy group was 3%, lower than in the group CBT (14%) and control (23%) groups.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [45] Stice, 2010, Efficacy trial of a brief cognitive-behavioral depression prevention program for high-risk adolescents: effects at 1- and 2-year follow-up, J Consult Clin Psychol source

  • May combine two claims.

    Premisecitation

    Digital bibliotherapy can be effective and well-accepted in addressing emotional problems such as depression and anxiety.

    “Existing studies suggest that this format can be effective and well-accepted in addressing emotional problems such as depression and anxiety (79, 80).”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [79] De Jesús-Romero, 2022, Willingness to use internet-based versus bibliotherapy interventions in a representative US sample: cross-sectional survey study, JMIR Form Res source

      The Introduction’s “Self-help Interventions” section reports evidence that print bibliotherapy and digital mental health interventions can reduce depression. It treats them as separate formats, however, and does not establish the effectiveness of digital bibliotherapy for anxiety. The Results (“Overall Preference”; page unavailable) found greater willingness to use print media than digital interventions, so the claim that the digital format is well-accepted is not established by this study. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [80] Franz, 2022, Digital bibliotherapy as a scalable intervention for suicidal thoughts: A randomized controlled trial, J Consult Clin Psychol source

  • May combine two claims.

    Premisecitation

    In the meta-analysis by Yuan et al., participants receiving bibliotherapy showed significant reductions in depression scores, with effects maintained during follow-up.

    “The analysis also found that participants receiving bibliotherapy appeared to showed significant reductions in depression scores, with effects maintained during follow-up.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [44] Yuan, 2018, Comparative efficacy and acceptability of bibliotherapy for depression and anxiety disorders in children and adolescents: a meta-analysis of randomized clinical trials, Neuropsychiatr Dis Treat source

      The Results (Subgroup analysis) report significantly lower depression symptoms with bibliotherapy than with controls in studies of depressive patients. But Results (Study selection and characteristics) says there were insufficient follow-up data to examine long-term effects, so the claim that the effects were maintained during follow-up is unsupported. (LLM, conf=0.92)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Mindfulness, as an effective emotional regulation strategy, can significantly improve adolescents' emotional states and may reduce the incidence of depression, anxiety, and related psychological issues.

    “Research has shown that mindfulness, as an effective emotional regulation strategy, can significantly improve adolescents’ emotional states and may reduce the incidence of depression, anxiety, and related psychological issues (68).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [68] Kato, 2022, Effectiveness of school-based brief cognitive behavioral therapy with mindfulness in improving the mental health of adolescents in a Japanese school setting: A preliminary study, Front Psychol source

      The Conclusion (page unavailable) says the mindfulness-based brief cognitive behavioral therapy program reduced depression and anxiety and enhanced emotional regulation in Japanese junior high school students. But the claim generalizes from that combined program to mindfulness alone and says it may reduce the incidence of psychological issues; the paper measures symptoms, not new cases or incidence (Measures, page unavailable). (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Emotional connectedness and social support are regarded as fundamental components in the recovery of mental well-being.

    “Moreover, engaging in shared reading experiences with others (as in group bibliotherapy) facilitates emotional connectedness and social support, both of which are regarded as fundamental components in the recovery of mental well-being (41).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [41] Leamy, 2011, Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis, Br J Psychiatry source

  • May combine two claims.

    Premisecitation

    CBT has been shown to be effective in adolescents, outperforming both no intervention and other talk-based therapies.

    “CBT has been shown to be effective in adolescents, outperforming both no intervention and other talk-based therapies (61, 62).”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [61] Oud, 2019, Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis, Eur Psychiatry source

      Section 3.5.2.1 reports that CBT reduced depressive symptoms compared with waitlist/no treatment, supporting that part of the claim for youth with depression. The Introduction says interpersonal psychotherapy has not been shown to be more effective than CBT, but that does not establish that CBT outperforms other talk-based therapies. Section 4.1 also notes evidence that a brief psychosocial intervention can be as effective as CBT. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [62] Uebelacker, 2023, Assessing feasibility and acceptability of yoga and group CBT for adolescents with depression: A pilot randomized clinical trial, Clin Child Psychol Psychiatry source

      The Introduction describes CBT as an established, efficacious treatment for adolescent depression, and the Results report decreased depression symptoms in the CBT group. The paper compares CBT with yoga, not with no intervention or other talk-based therapies, so it does not support the claimed superiority over those comparators (page numbers unavailable). (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    In eating disorders, reading novels or memoirs unrelated to the illness generally had neutral or positive effects on readers' emotions, self-esteem, body perception, and behavior, whereas narratives centered on illness experiences were often reported to have a "significant negative impact".

    “Troscianko et al. found in the field of eating disorders that reading novels or memoirs unrelated to the illness generally had neutral or positive effects on readers’ emotions, self-esteem, body perception, and behavior, whereas narratives centered on illness experiences were often reported to have a “significant negative impact” (87).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [87] Troscianko, 2018, Literary reading and eating disorders: survey evidence of therapeutic help and harm, J Eat Disord source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Reading engages the prefrontal cortex and amygdala and also modulates other regions involved in emotional and cognitive processing, such as the hippocampus and the cingulate gyrus.

    “Findings indicate that reading not only engages the prefrontal cortex and amygdala but also modulates other regions involved in emotional and cognitive processing, such as the hippocampus and the cingulate gyrus (93, 94).”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [93] Davis, 2018, Amygdala sub-regional functional connectivity predicts anxiety in children with reading disorder, Dev Sci source

      The Discussion links reading impairment in children with reading disorder to resting-state connectivity between the amygdala and medial prefrontal cortex. It does not establish that reading itself engages those regions: the authors call for future imaging during reading tasks. Our copy also provides no finding that reading modulates the hippocampus or cingulate gyrus. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
    • cites [94] Al Dahhan, 2020, Understanding the biological basis of dyslexia at a neural systems level, Brain Commun source

      The Results (Neural activation during task performance; Effect of task manipulations on brain activation in ROIs; page not provided) report activation of the dorsolateral prefrontal and anterior cingulate cortices during naming tasks, and greater amygdala and hippocampal activation for letter than object naming. The claim generalizes these task-specific findings to reading broadly; the paper does not establish that reading modulates these regions through emotional processing. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationnone given

    Existing studies on bibliotherapy for adolescent depression are constrained by small sample sizes, brief intervention periods, and a lack of standardized material selection criteria.

    “Existing studies are further constrained by small sample sizes, brief intervention periods, and a lack of standardized material selection criteria.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    Bibliotherapy can cause emotional triggering from certain narratives.

    “Potential limitations include emotional triggering from certain narratives, variability in individual engagement, and inconsistent long-term efficacy, especially among adolescents.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    Individual engagement in bibliotherapy varies.

    “Potential limitations include emotional triggering from certain narratives, variability in individual engagement, and inconsistent long-term efficacy, especially among adolescents.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Depression is one of the most common psychological disorders among adolescents, with its prevalence increasing more rapidly in this group than in adults.

    “Depression is one of the most common psychological disorders among adolescents, with its prevalence increasing more rapidly in this group than in adults (1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Miller, 2021, Depression in adolescents, N Engl J Med source

  • May combine two claims.

    Premisecitation

    When adolescents encounter storylines that mirror their own experiences, they may feel understood and accepted, which could significantly ease their feelings of loneliness.

    “Research has found that when adolescents encounter storylines that mirror their own experiences, they may feel understood and accepted, which could significantly eases their feelings of loneliness (42).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [42] Wu, 2025, Effects of bibliotherapy on emotional distress, coping strategies, and resilience in adolescents with cancer: A pilot randomized controlled trial, Eur J Oncol Nurs source

  • May combine two claims.

    Interpretationcitation

    The long-term efficacy of bibliotherapy in adolescents may be unstable and could be susceptible to factors such as developmental stage, intervention format, or sample characteristics.

    “This contrast suggests that the long-term efficacy of bibliotherapy in adolescents may be unstable and could be susceptible to factors such as developmental stage, intervention format, or sample characteristics.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Bibliotherapy serves as a valuable tool that uses narratives and character experiences to help adolescents better understand complex emotional states, thereby potentially fostering empathy and emotional regulation through story immersion.

    “Within this framework, bibliotherapy serves as a valuable tool that uses narratives and character experiences to help adolescents better understand complex emotional states, thereby potentially fostering empathy and emotional regulation through story immersion (72).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [72] Hazlett-Stevens, 2017, Effectiveness of mindfulness-based stress reduction bibliotherapy: A preliminary randomized controlled trial, J Clin Psychol source

  • May combine two claims.

    Interpretationreasoning

    These cognitive operations facilitate the detection of maladaptive thought patterns and the generation of more balanced interpretations.

    “These cognitive operations facilitate the detection of maladaptive thought patterns and the generation of more balanced interpretations.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The structured discussion feature is particularly relevant for under-resourced educational settings where access to individual psychotherapy may be limited.

    “This feature is particularly relevant for under-resourced educational settings, such as public middle and high schools, where access to individual psychotherapy may be limited.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The group-based bibliotherapy model emphasizes peer support and collaborative reflection to enhance adolescents’ abilities in emotional expression and cognitive restructuring.
    • Rests on an assumption: The structured discussion component creates a psychologically safe, shared space that encourages emotional disclosure and mutual understanding among participants.

  • May combine two claims.

    Premisecitation

    Emotional engagement enables individuals to confront unexamined or unhelpful beliefs, gaining new insights through immersion in fictional experiences and learning to understand others' situations from alternative viewpoints.

    “Simultaneously, emotional engagement enables individuals to confront unexamined or unhelpful beliefs, gaining new insights through immersion in fictional experiences and learning to understand others’ situations from alternative viewpoints (65).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [65] Oatley, 1999, Meetings of minds: Dialogue, sympathy, and identification, in reading fiction, Poetics source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The transportation effect may lead to real-world belief and behavior change.

    “Scholars suggest that this form of transportation “may lead to real-world belief (and behavior) change” (39).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Green, 2006, Narratives and cancer communication, J communication source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The digital approach of e-bibliotherapy is particularly appealing to adolescents who are digital natives.

    “This digital approach is particularly appealing to adolescents who are digital natives (28).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Septiana, 2023, Self-help digital bibliotherapy to support the emotional well-being of patients in a recovery session, J Public Health (Oxf) source

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The relative ease of implementation and scalability makes group-based bibliotherapy well-suited for widespread mental health promotion initiatives in youth populations.

    “Moreover, the relative ease of implementation and scalability makes this intervention format well-suited for widespread mental health promotion initiatives in youth populations.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: In recent years, school- and community-based interventions have increasingly adopted group reading combined with structured discussion as a practical and scalable bibliotherapy format.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    E-bibliotherapy leverages e-books, mobile applications, and online reading platforms to enhance accessibility and interactivity.

    “In recent years, the rise of digital technology has led to the emergence of e-bibliotherapy, which leverages e-books, mobile applications, and online reading platforms to enhance accessibility and interactivity.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Septiana, 2023, Self-help digital bibliotherapy to support the emotional well-being of patients in a recovery session, J Public Health (Oxf) source

  • May combine two claims.

    Interpretationreasoning

    Reading helps adolescents explore their identity, comprehend their emotions and experiences, and thereby enhance their self-efficacy and confidence.

    “Additionally, reading helps adolescents explore their identity, comprehend their emotions and experiences, and thereby enhance their self-efficacy and confidence.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The core mechanism of bibliotherapy may involve guiding individuals to read texts that align with their psychological state, thereby eliciting emotional resonance, promoting self-reflection, and facilitating cognitive restructuring to support emotional regulation and psychological recovery.

    “Studies have shown that the core mechanism of bibliotherapy may involves guiding individuals to read texts that align with their psychological state, thereby eliciting emotional resonance, promoting self-reflection, and facilitating cognitive restructuring to support emotional regulation and psychological recovery (34).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Pardeck, 1994, Using literature to help adolescents cope with problems, Adolescence

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Such texts offer a channel for emotional catharsis and provide strategies for coping with personal emotions.

    “Such texts not only offer a channel for emotional catharsis but also provide strategies for coping with personal emotions.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Creative literary works possess the capacity to evoke profound emotional engagement.

  • May combine two claims.

    Interpretationreasoning

    Reading provides emotional support and promotes self-understanding and self-acceptance.

    “In this way, reading not only provides emotional support but also promotes self-understanding and self-acceptance.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Reading materials with mindfulness-related themes allow adolescents to observe characters facing emotional challenges and learn how to respond to their own emotions with openness and acceptance, which helps reduce fear of negative emotions.

    “Reading materials with mindfulness-related themes allow adolescents to observe characters facing emotional challenges and learn how to respond to their own emotions with openness and acceptance, which helps reduce fear of negative emotions (76).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [76] Restrepo, 2021, Addressing psychosocial work-related stress interventions: A systematic review, Work source

  • May combine two claims.

    Premisecitation

    Bibliotherapy facilitates self-reflection, emotional resonance, and cognitive restructuring.

    “It facilitates self-reflection, emotional resonance, and cognitive restructuring, and can be applied outside clinical environments (12, 13).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [12] Shah, 2023, The use of Bibliotherapy as a therapeutic intervention by mental health professionals, Int J Indian Psychȯlogy

      Not checked in the free run.

    • cites [13] Yu, 2024, Examining the emotional healing process through bibliotherapy in adolescents with cancer: A qualitative descriptive study, Eur J Oncol Nurs source

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Bibliotherapy utilizes narrative and character experiences to draw readers into emotionally resonant stories, fostering empathy and deepening emotional understanding.

    “Building on these findings, bibliotherapy utilizes narrative and character experiences to draw readers into emotionally resonant stories, fostering empathy and deepening emotional understanding.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Current research and practice in creative bibliotherapy are insufficient in understanding its mechanisms of action.

    “Troscianko further pointed out that current research and practice in creative bibliotherapy are still insufficient in understanding its mechanisms of action (27).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Troscianko, 2018, Fiction-reading for good or ill: eating disorders, interpretation and the case for creative bibliotherapy research, Med humanities source

  • May combine two claims.

    Premisecitation

    Cognitive processing of fictional and non-fictional texts differs significantly, with distinct neural networks activated in each case.

    “Research indicates that the cognitive processing of fictional and non-fictional texts differs significantly, with distinct neural networks being activated in each case (37).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] Tribe, 2021, It just gives people hope”: a qualitative inquiry into the lived experience of the Harry Potter world in mental health recovery, Arts Psychother source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Bibliotherapy operates in a way similar to therapist-led interventions, as books or manuals incorporate psychotherapeutic principles aimed at increasing awareness of negative emotions, providing coping strategies, and encouraging practical application.

    “It operates in a way similar to therapist-led interventions, as books or manuals incorporate psychotherapeutic principles aimed at increasing individuals’ awareness of negative emotions, providing effective coping strategies, and encouraging the practical application of these methods in daily life (18, 19).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [18] Campbell, 2003, Integrating self-help books into psychotherapy, J Clin Psychol source
    • cites [19] Bilich, 2008, Effectiveness of bibliotherapy self-help for depression with varying levels of telephone helpline support, Clin Psychol Psychotherapy: Int J Theory Pract source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    CBT is widely recognized as an effective psychological intervention for treating depression.

    “In recent years, CBT has been widely recognized as an effective psychological intervention for treating depression.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] Beck, 2020

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Bibliotherapy is a legitimate and cost-effective method of behavioral intervention.

    “These findings are consistent with earlier reviews which identified bibliotherapy as a legitimate and cost-effective method of behavioral intervention (67).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [67] Glasgow, 1978, Behavioral bibliotherapy: a review of self-help behavior therapy manuals, Psychol Bull source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Bibliotherapy is a low-cost, flexible intervention using literature for emotional and psychological healing.

    “In this context, bibliotherapy—a low-cost, flexible intervention using literature for emotional and psychological healing—offers distinct advantages.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [12] Shah, 2023, The use of Bibliotherapy as a therapeutic intervention by mental health professionals, Int J Indian Psychȯlogy

      Not checked in the free run.

    • cites [13] Yu, 2024, Examining the emotional healing process through bibliotherapy in adolescents with cancer: A qualitative descriptive study, Eur J Oncol Nurs source

  • May combine two claims.

    Interpretationreasoning

    Identification with characters can enhance adolescents' sense of social connectedness and help reduce the occurrence of depressive symptoms.

    “This identification can enhance adolescents’ sense of social connectedness and help reduce the occurrence of depressive symptoms.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    Bibliotherapy can effectively alleviate depressive symptoms in adolescents by fostering emotional resonance, promoting cognitive restructuring, and providing social support.

    “By fostering emotional resonance, promoting cognitive restructuring, and providing social support, it can effectively alleviate depressive symptoms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Existing studies of bibliotherapy for adolescent depression face several limitations, including inadequate research design, short intervention periods, and weak clinical support systems.

    “Although bibliotherapy has shown promising potential in the intervention of adolescent depression, existing studies still face several limitations, including inadequate research design, short intervention periods, and weak clinical support systems.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The effectiveness of bibliotherapy can be influenced by multiple factors such as text selection, readers' comprehension abilities, and cultural differences.

    “The effectiveness of bibliotherapy can also be influenced by multiple factors such as text selection, readers’ comprehension abilities, and cultural differences.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Reading is a continuous and gradual process, making it difficult to accurately assess therapeutic outcomes within a fixed time frame.

    “Moreover, reading is a continuous and gradual process, making it difficult to accurately assess therapeutic outcomes within a fixed time frame.”
    Quote in the paperNot a substantial claim
48 of 48

  • The paper relies on this without support.

    Pharmacological treatments for adolescent depression are often limited by unpredictable side effects and developmental vulnerability, creating a need for safer, more accessible non-pharmacological interventions.

    “Pharmacological treatments for adolescent depression are often limited by unpredictable side effects and developmental vulnerability, creating a need for safer, more accessible non-pharmacological interventions.”

  • The paper relies on this without support.

    Bibliotherapy has been widely applied in the treatment of adolescent depression, particularly in the area of cognitive restructuring.

    “Bibliotherapy has been widely applied in the treatment of adolescent depression, particularly in the area of cognitive restructuring.”

  • The paper relies on this without support.

    Through carefully selected literary works, adolescents are exposed to a range of emotional experiences and values, enabling cognitive reshaping.

    “Through carefully selected literary works, adolescents are exposed to a range of emotional experiences and values, enabling cognitive reshaping.”

  • The paper relies on this without support.

    The challenges and triumphs experienced by characters in certain stories can prompt adolescents to reflect on their own situations, leading to a shift in their negative perceptions of themselves and the world around them.

    “For example, the challenges and triumphs experienced by characters in certain stories can prompt adolescents to reflect on their own situations, leading to a shift in their negative perceptions of themselves and the world around them.”

  • The paper relies on this without support.

    Reading allows adolescents to experience others’ emotions and struggles in a safe environment.

    “Moreover, reading allows adolescents to experience others’ emotions and struggles in a safe environment, and this development of empathy is also a key component of cognitive restructuring.”

  • The paper relies on this without support.

    Development of empathy is a key component of cognitive restructuring.

    “Moreover, reading allows adolescents to experience others’ emotions and struggles in a safe environment, and this development of empathy is also a key component of cognitive restructuring.”

  • The paper relies on this without support.

    Creative literary works possess the capacity to evoke profound emotional engagement.

    “Creative literary works possess the capacity to evoke profound emotional engagement, guiding readers into a narrative realm that is both aesthetically pleasing and psychologically enlightening.”

  • The paper relies on this without support.

    In recent years, school- and community-based interventions have increasingly adopted group reading combined with structured discussion as a practical and scalable bibliotherapy format.

    “In recent years, school- and community-based interventions have increasingly adopted group reading combined with structured discussion as a practical and scalable bibliotherapy format.”

  • The paper relies on this without support.

    The group-based bibliotherapy model emphasizes peer support and collaborative reflection to enhance adolescents’ abilities in emotional expression and cognitive restructuring.

    “This model emphasizes peer support and collaborative reflection to enhance adolescents’ abilities in emotional expression and cognitive restructuring.”

  • The paper relies on this without support.

    RCTs specifically evaluating group-based bibliotherapy remain limited.

    “Although RCTs specifically evaluating this format remain limited”

  • The paper relies on this without support.

    The structured discussion component creates a psychologically safe, shared space that encourages emotional disclosure and mutual understanding among participants.

    “The structured discussion component plays a key role by creating a psychologically safe, shared space that encourages emotional disclosure and mutual understanding among participants.”

  • The paper relies on this without support.

    Adolescents show a high level of adaptability and acceptance toward digital interventions.

    “adolescents—being a population highly engaged with mobile devices and the internet—show a high level of adaptability and acceptance toward digital interventions.”

  • The paper relies on this without support.

    Several factors influence adolescents’ engagement with digital bibliotherapy, among which design and user experience are particularly critical.

    “Several factors influence adolescents’ engagement with digital bibliotherapy, among which design and user experience are particularly critical.”

  • The paper relies on this without support.

    There is a close relationship between user experience and treatment adherence.

    “There is a close relationship between user experience and treatment adherence.”

  • The paper relies on this without support.

    The flexibility in timing and location offered by digital platforms aligns well with the lifestyle of adolescents, contributing to improved adherence.

    “The flexibility in timing and location offered by digital platforms also aligns well with the lifestyle of adolescents, contributing to improved adherence.”

  • The paper relies on this without support.

    High-quality digital experiences may support sustained engagement over time.

    “High-quality digital experiences not only attract initial interest but may also support sustained engagement over time.”

  • The paper relies on this without support.

    Differences in cultural background, geographic location, and psychological conditions may influence adolescents’ acceptance of digital interventions.

    “Differences in cultural background, geographic location, and psychological conditions may influence adolescents’ acceptance of digital interventions.”

  • The paper relies on this without support.

    Neurobiological research specifically focused on bibliotherapy remains limited.

    “However, neurobiological research specifically focused on bibliotherapy remains limited.”

  • The paper relies on this without support.

    Cultural factors play a critical role in shaping the acceptance and efficacy of bibliotherapy.

    “Cultural factors play a critical role in shaping the acceptance and efficacy of bibliotherapy.”

  • The paper relies on this without support.

    The digitalization and remote delivery of bibliotherapy is becoming increasingly common due to the growing prevalence of digital reading platforms and mental health apps.

    “With the growing prevalence of digital reading platforms and mental health apps, the digitalization and remote delivery of bibliotherapy is becoming increasingly common.”

  • The paper relies on this without support.

    Adolescents are particularly sensitive to the protection of their personal information, especially when it involves mental health data.

    “Adolescents are particularly sensitive to the protection of their personal information, especially when it involves mental health data.”
21 of 21

Cites

Flagged first, then by citations

Research works printed but not linked: 6

  1. Shah, 2023, The use of Bibliotherapy as a therapeutic intervention by mental health professionals, Int J Indian Psychȯlogy, 11
  2. Hicks, 2006, An audit of bibliotherapy/books on prescription activity in England
  3. David, 1980, Feeling good: The new mood therapy
  4. Lewinsohn, 2010, Control Your Depression, Rev’d Ed
  5. Billington, 2010, An investigation into the therapeutic benefits of reading in relation to depression and well-being
  6. Beck, 2020, Cognitive behavior therapy: Basics and beyond

Cited by

Still being checked.

Authors
Liao, F., Liang, J., Zhang, M., Liang, W., Zhang, C., & Yun, X.
Corresponding author
  • Zhang, Chunguo
  • Yun, Xuan
ORCID
Venue
Frontiers in Psychiatry
Publisher
Frontiers Media SA
Published
2025-12-12
Volume
16
Pages
1681462-1681462
ISSN
1664-0640 (ISSN-L)
DOI
10.3389/fpsyt.2025.1681462
PMC
PMC12740898
OpenAlex
W4417263130
Semantic Scholar
9bb428e1fbd378561e81ee09e97fe4d7d011fc38
Cited by
4
References
89
Citations by year
2026: 4
FWCI
20.52
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychiatry (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • PubMed Central (submittedVersion, cc-by)
Topics
  • Social Sciences › Arts and Humanities › Conservation › Art Therapy and Mental Health
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
bibliotherapy, adolescent depression, non-pharmacological treatment, shared reading, cognitive restructuring, emotional resonance, social support, text selection, cultural context, reader engagement, long-term efficacy, cross-cultural adaptation, practitioner training

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Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-27.

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