The effectiveness of creative bibliotherapy for internalizing, externalizing, and prosocial behaviors in children: A systematic review

• The effectiveness of creative bibliotherapy for children (aged 5–16) is reviewed.
• Outcomes considered are internalizing, externalizing and prosocial behaviors.
• Creative bibliotherapy has small to moderate effect on these behaviors.
• It is hypothesized that the interventions work on cognitive behavioral mechanisms.

IntroductionCreative bibliotherapy is the guided reading of fiction and poetry relevant to therapeutic needs. Experiencing stories is hypothesized to act on the same mechanisms as cognitive behavioral therapy (CBT). This systematic review assesses the efficacy and effectiveness of creative bibliotherapy for the prevention and treatment of internalizing and externalizing behaviors, and the strengthening of prosocial behaviors in children (aged 5–16).MethodAn electronic search in seven major databases was conducted along with hand searches of key journals and bibliographies. Only randomized or cluster-randomized trials were included. Primary outcomes: internalizing behavior (e.g., anxiety and depression), externalizing behavior (e.g., aggression), and prosocial behavior (e.g., behavioral intentions and attitudes towards others). Secondary outcomes: parent–child relationship, peer relationship, educational attainment and reading ability.Results9180 records were located after removing duplicates. 9134 were excluded prior to screening. Of the 46 full-text articles assessed for eligibility, eight met the inclusion criteria and 38 were excluded. Meta-analysis was inappropriate due to study heterogeneity. Overall results suggest that creative bibliotherapy has small to moderate effect for internalizing behavior (δ range: 0.48–1.28), externalizing behavior (δ range: 0.53–1.09), and prosocial behavior (δ range: 0–1.2).ConclusionCreative bibliotherapy can have a small to moderate positive effect on child behavior. Although no definitive model of creative bibliotherapy emerges from the included studies, to some extent all interventions reflected CBT mechanisms. Further research is required to: 1) model the change processes taking place when children experience stories; 2) develop and pilot an intervention; 3) assess subgroup effects by gender, age, modality and literacy.