Self-help may be delivered through a variety of formats, including books or online, and is a widely applied treatment modality (Mains & Scogin, 2003).
Surprisingly, there is a lack of research regarding the efficacy of such methods, and that which does exist, tends to use a range of formats and populations. This means that the conditions whereby self-help is most effective is unknown
(Newman, Erickson, Przeworski & Dzus, 2003).
Self-help approaches have been criticised because of the social isolation associated with self-directed learning (Botella, Garcia-Palacios, Banos & Quero, 2009), and the absence of a responsive therapist (Segal, Williams & Teasdale, 2013). Limitations of self-help approaches include the lack of contact between the client and therapist, and a lack of support for some individuals who may struggle. However, self-help does not necessarily have to be viewed as a compromised format.
There are numerous benefits of self-help approaches, for example, they are relatively inexpensive and resource efficient due to their low intensity (Butryn et al., 2011) and so may make a valuable contribution to addressing emotional eating. They are also accessible and promote self-efficacy (which is considered critical within the common factors literature; Grencavage &
Norcross, 1990). Regarding the latter, one argument of employing a self-help approach is that it relies on the individual’s drive and so it is a good way of building mastery and self-efficacy allowing the individual to make the necessary changes.
163 Self-help approaches have also been considered an effective treatment modality (Coull & Morris, 2011; Sysko & Walsh, 2008) with recovery rates comparable to interventions delivered by professionals. For example, in the area of eating disorders, self-help has been found to be effective for binge eating (Bailer et al., 2004; Peterson et al., 2001). Furthermore, in a recent systematic review, fifteen RCTs exploring the effectiveness of self-help
acceptance-based approaches were found to be more beneficial than TAU for a range of psychological difficulties (Cavanagh, Strauss, Forder & Jones, 2014).
Three ACT self-help books which were included within this review demonstrated positive outcomes. However, on this basis alone, it cannot be concluded that all ACT self-help materials are helpful (Jeffcoat & Hayes, 2012). Furthermore, these studies did not assess the mechanisms of change, so further research is warranted. This is especially important considering that each individual may have a different response to a particular self-help approach, thus making generalisability difficult (Menchola, Arkowitz & Burke, 2007).
Although ACT self-help interventions may not have poor attrition rates, self-help interventions for disordered eating specifically do in comparison, and attrition rates are similar to those offered face-to-face interventions (Winzelberg, Luce & Taylor, 2008). However, briefer interventions have been considered to promote engagement and increase compliance rates with this population (Ghaderi, 2006). Arguably the shame and stigma associated with disordered eating and poor weight management may explain why some individuals may not come forward for treatment, however offering a self-help therapeutic modality may be a way around such obstacles (Garner & Garfinkel, 1997), particularly if it is brief. The evidence regarding guided self-help versus pure self-help is mixed, with some researchers claiming that guided self-help is more effective than self-help alone (Richards & Richardson, 2012). However, the differences between the two modalities have not always been significant (Ghaderi & Scott, 2003).
1.12 SCED
1.12.1 Rationale for adopting a SCED over a RCT. As a means of improving care, therapies supported by RCTs are high on the research agenda (Macey, Clarke & Gologani-Moghaddam, 2015). Due to the negative
consequences associated with the obesity epidemic, there is an increased need
164 to prove the quality and cost-effectiveness of interventions (Petermann &
Muller, 2001; Withrow & Alter, 2011; Scarborough et al., 2011). Although RCTs are a good way of confirming the efficacy of ACT, they are limited when it comes to determining individual evaluation and outcome (Davies, Howells &
Jones, 2007). Although ACT processes have been considered effective in relieving distress (Hayes, 2004), there is a lack of research exploring how such processes may interact in creating change, how they apply to emotional eating and more broadly weight management. Although previous studies in this area have made important advances (e.g., Lillis et al., 2009; Forman et al., 2012;
Katterman et al., 2014), design limitations renders it impossible to determine the mechanisms of change. Moreover, the generalisability of RCTs to other
contexts may be challenging, for example, participants recruited to RCTs may not be representative of individuals who suffer with eating and weight-related difficulties (Morley, Williams & Hussain, 2008). In addition to this, although RCTs are used as evidence of efficacy, they do not establish the effectiveness of an intervention (Barkham & Mellor-Clark, 2003).
In order to overcome this limitation, the present study adopted a SCED which lends itself to attribute change to the introduction of the intervention and determine whether or not the ACT self-help intervention impacts on the
processes under investigation. This is in line with the research agenda
advocating the use of SCED to allow a fuller evaluation of the effectiveness of the ACT model by determining the specific mechanisms of change (e.g., Gaudiano, 2011). This is particularly important as mediational studies are needed to establish whether theorised processes precede changes. Given the novelty of this intervention a case series design is an appropriate and useful means of building evidence.
1.12.2 Benefits of SCEDs. SCEDs involve repeated measurement of the target variable in order to monitor change (Barker, Pistrang & Elliott, 2002).
Ultimately SCEDs allow one to establish; (a) whether change has occurred; (b) whether any change is significant and meaningful; (c) whether the change is stable or variable, and; (d) what caused the change (Davies et al., 2007).
SCEDs have been considered central to the scientist practitioner model (Jones, 2010) and are an important part of clinical practice for a number of reasons.
Firstly, they provide evidence allowing for accountable practice amongst
165 clinicians (Bloom, Fisher & Orme, 2003). Secondly, they stimulate the
generation of new hypotheses, particularly in relation to new interventions (Turpin, 2001). Thirdly, other benefits of SCEDs include the identification of slight changes which may not be picked up in larger studies. Fourthly, SCEDs enable the identification of iatrogenic effects of interventions which is important to inform our learning and practice (Jones, 2007; Davies et al., 2007).