(PS5-59) What’s in a Children’s Book?: A Systematic Review of Children’s Storybooks for Anxiety Disorders and Recommendations for Improving Accessibility of Evidence-based Practices

The inclusion of children’s books in mental health treatment (i.e., bibliotherapy) has demonstrated success in addressing social, emotional, and behavioral concerns with children (Heath et al., 2017). Bibliotherapy involves the guided reading of a book with a child and therapist to address therapeutic needs and is often based on foundational principles of cognitive and behavioral therapies (CBT) (Mendel et al., 2016). Bibliotherapy is effective for treating children’s internalizing and externalizing behaviors both as a stand-alone treatment (Yuan et al., 2018) and as an adjunct to enhance and support treatment-as-usual (Montgomery & Maunders, 2015). Through bibliotherapy, children experience validation when they read about characters in similar situations with similar feelings; explore painful or challenging topics; and learn problem-solving strategies (Mendel et al., 2016). These interventions are vital in efforts to reduce the prevalence of childhood anxiety disorders—such as specific phobias—that affect approximately 10% of all children in the United States (Centers for Disease Control and Prevention, 2024). Unfortunately, even with the existence of comprehensive evidence-based practices (EBPs), children often lack access to them—up to half of youth with mental health disorders do not receive mental health services (Merikangas et al., 2010, 2011). As bibliotherapy continues to evolve, it is imperative to understand how EBPs are presented throughout available bibliotherapy interventions.

The goal of the study was to systematically review and assess children’s storybooks about anxiety and specific phobias to determine how often they include EBPs indicated for these disorders. Books were searched for via Google’s search engine and APA’s Magination Press. Some search keywords included: children’s books for anxiety, children’s books for phobias or fears, and therapeutic storybooks for fears. Inclusion criteria included books for children ages 7 to 12 and at least one EBP in the book narrative. Books were excluded if they exceeded the age range, were chapter or self-help books, or did not include at least one EBP within the text. EBPs sought amongst the narratives included: psychoeducation, relaxation, coping thoughts, problem-solving, contingency management, encouraging approach, and post-approach processing (Werntz et al., 2022). In addition, exposure, labeling of feelings, and labeling of bodily sensations were other EBPs examined. This search retrieved a total of 33 books—10 titles were excluded due to being chapter books or not being age appropriate and 10 titles were excluded due to not meeting the minimum number of EBPs. The final review consisted of 13 titles that, on average, contained 3.5 EBPs. The most common EBPs present were exposure, relaxation, and coping thoughts. Visual imagery and contingency management were incorporated the least. Assessing books for use of EBPs can inform clinicians’ decisions on which to recommend for children and encourage future authors to incorporate EBPs within children’s storybooks. Storybooks that include EBPs can also increase the accessibility of CBT principles via a behavior (i.e., reading books) that is familiar to children across demographic and socioeconomic groups.