Bibliotherapy for Stress Management: A Wellness Intervention for First-Year Medical Students

Objectives: Bibliotherapy, or reading for therapeutic effect, is traditionally deployed in a clinician or librarian-led community self-help context, usually taking the form of a book club or reading group. While medical students report high prevalence of emotional exhaustion and a greater likelihood of depression, their schedules, duties, and the COVID-19 pandemic all place significant barriers on regular attendance and participation in meetings or discussion groups. This study examines if replacing conventional bibliotherapy models with librarian-selected short readings and an independent, self-directed structure influences subjects’ overall levels of stress and anxiety.

Methods: The study is an Interrupted Time Series (ITS) with four small concluding focus groups. 30 subjects were recruited from the MD class of 2024 in November 2020, and data collection began in January 2021. Data points are derived from the 10-item Perceived Stress Scale (PSS-10), a validated instrument widely used to assess subjects’ global perceived stress. The PSS-10 was administered three times prior to intervention and three times following the intervention. The intervention was delivered in March 2021, consisting of three short readings that each participant selected from a list of six. The readings were a mix of fiction and non-fiction, focused on themes of plague and pandemic. All subjects received the intervention, and all who successfully completed the surveys and intervention were invited to participate in a small focus group.

Results: Data collected from the PSS-10 were analyzed for overall trends throughout the six months of the study and to determine any significant differences in pre-and-post intervention scores. Focus groups were conducted via Zoom and recorded, and the resulting transcripts corrected and coded by the research team. Qualitative data were analyzed using the constant comparison method.

Conclusions: This ITS did show lower PSS-10 post-intervention (p = .410, 95% CI [-2.19, .90]), but was constrained by one academic semester and did not achieve statistical significance; however, this study serves as a proof-of-concept for further exploration of bibliotherapy modalities in an academic health sciences library setting. Analysis of focus group transcripts revealed a very positive overall reaction to a wellness intervention offered by librarians rather than medical school administrators, an interest in a variety of “readers’ advisory” service for topical non-curricular reading, and a strong sense of engagement in and concern for overall personal wellbeing among study subjects. Shortcomings of the study were also noted, particularly a desire to engage in deeper and more frequent discussion and analysis of the intervention readings with fellow subjects.