This contribution reviews both theoretical and empirical research on the effects of absorbed reading and bibliotherapy on subjective psychological well-being, paying special attention to the possible influence of digitization on this relationship. Reading on tablets, for example, could prove counter-productive for obtaining a state of absorption and thus modern-day tablet-readers may miss out on potential health benefits that absorbed reading of literature might provide. On the other hand, the connection that tablets provide to online reader communities and thus online bibliotherapeutic resources, might prove even more beneficial than obtaining a state of absorption during reading.
Absorbed reading and well-being
Bibliotherapy in the age of digitization
The feeling of getting lost in a book, blissfully unaware of your surroundings and daily worries is familiar to a large number of people. This experience is called narrative absorption — or immersion, transportation, or narrative engagement — and it involves sustained attention to and open reflection on the world of the story (Kuijpers, 2014; Kuiken and Douglas, 2017; Kuijpers, et al., 2018). Absorbed reading leaves the reader unaware of their surroundings, their bodies, and the passage of time (Nell, 1988). Often, such reading experiences involve a sense of being transported to the world of the story, accompanied by an intense emotional engagement with the characters inhabiting that world and vivid visual imagery of what that world looks like (Gerrig, 1993; Green and Brock, 2000). And most importantly, absorbed reading usually feels effortless to the reader and is generally considered to be an enjoyable experience (Green, et al., 2004).
In addition to being an intrinsically enjoyable experience, absorbed reading facilitates other positive effects on a person’s sense of well-being, such as, for example, the opportunity for meaningful contemplation (Oliver and Raney, 2011). The shift away from the immediate environment and the self is what releases a reader’s psychological constraints — such as self-awareness — and facilitates a so-called transcendent experience. This in turn provides the reader with room to ponder meaningful questions and encourages a focus on “higher-order needs”, such as a feeling of autonomy, competence and relatedness (Oliver and Raney, 2011; Oliver, et al., 2017).
Furthermore, absorption in a book has been argued to provide escape (Green, et al., 2004), enhance empathic abilities (Kidd and Castano, 2013), provide catharsis for people who experienced trauma (Khoo and Oliver, 2013; Koopman, 2015, 2013), offer a better understanding of self and other (Kuiken, et al., 2012; Kuiken and Douglas, 2017), and facilitate identification with characters that are going through similar experiences, say of heartache or other problems, providing readers with the very comforting notion that they are not alone in their pain (Troscianko, 2018).
To sum up, reading narrative fiction, especially absorbed reading of narrative fiction, is good for people’s mental health. Building on this relationship between absorbed reading and well-being is the practice of bibliotherapy, which can be roughly defined as the use of books as or in an intervention strategy to prevent certain behaviors (e.g., bullying, cf., Gregory and Vessey, 2004, or Wang, et al., 2015; recidivism in ex-offenders, cf., Colvin, 2015; alcohol dependence, cf., Rus-Makovec, et al., 2015), alleviate certain situations and conditions (e.g., neurological conditions, cf., Latchem and Greenhalgh, 2014), or in general help people deal with the challenges of life.
A distinction is often made between cognitive bibliotherapy, which involves the use of self-help books or other non-fictional texts in traditional therapeutic settings, and creative bibliotherapy which involves using (literary and genre) fiction (cf., Troscianko, 2018). In this article, the term bibliotherapy exclusively refers to creative bibliotherapy and thus the use of fiction texts in therapeutic ways and contexts. The practice of bibliotherapy can take many forms, such as book clubs, shared reading groups, or actual therapy using reading recommendations (cf., The Novel Cure by Elderkin and Berthoud, 2013). In all cases, though, bibliotherapy involves reading plus talking about reading and thus you could say that this practice doubles up on what literature has to offer. The act of reading a novel can be beneficial in itself as illustrated above, but the act of talking about what you have read is adding an extra layer of mental health benefits.
However, as pointed out in other papers in this issue, with the rise of digitization, media habits have developed that are not favorable to long-form reading (Kovač and van der Weel, 2018). People nowadays seem to prefer short-form to long-form texts, and short-form texts are not conducive to getting into a state of absorption. In addition, the quality of attention has deteriorated (Newman, 2010), which is something that seems to directly oppose the possibility of getting lost in a book.
On the other hand, however, the rise of digitization has also brought with it massive online reader platforms and communities such as Goodreads and Wattpad where people can talk about their favorite novels with other avid readers. These platforms are freely available and thus provide people with low-cost, low-risk opportunities to engage in bibliotherapeutic activities. As of yet, however, we do not know what is more important. What is more conducive to people’s mental health: frequently engaging in absorbed reading, to which paper might be more conducive, or frequently engaging in talking about reading, which is perhaps better facilitated by the digital substrate. The connection that the rise of digitization has provided to online reader communities and thus online bibliotherapeutic resources, might prove even more beneficial to people’s mental health than obtaining a state of absorption during reading.
Absorbed reading and well-being
“Successful art invites and sustains absorption in form and quality, a giving-in to their force” . In his aesthetic theory on individual form, Beardsley describes the experience of absorption as involving firmly fixed attention on a perceptual object which goes hand in hand with a feeling of freedom from concerns outside that object, a sense of discovery, a sense of integration of the self with the object, and notable affect detached from practical ends .
Before Beardsley’s aesthetics the term absorption was used by Brecht (1964) to denote a similar experience. He used it, by contrast, to describe a type of theatre that was highly undesirable, as it was assumed to make the recipients passive, uncritical human beings. Since Beardsley, opinion on the value of absorbing experiences with art has been divided (see for example: Appel, 2008; Hakemulder, 2000; Oatley, 1999). Some scholars suggest that the only positive consequence of absorption is that it potentially provides a person with temporary relief from daily worries (i.e., escapism) (Green, et al., 2004). Others argue, however, much like Beardsley, that an absorbing experience with art can offer a better understanding of self and other (Kuiken, et al., 2012; Kuiken and Douglas, 2017), a meaningful experience in and of itself (Oliver and Bartsch, 2011, 2010), and even catharsis (Khoo and Oliver, 2013; Koopman, 2015, 2013).
The latter argument is in line with the idea that reading literature allows individuals to Temporarily Expand the Boundaries Of The Self (i.e., TEBOTS; see Slater, et al., 2014). In seeking a theoretical foundation for understanding the appeal of stories, Slater, et al. formulated the following:
When we become absorbed or transported into a narrative, when we become emotionally and imaginatively identified with a character or characters, we are momentarily relieved of the task of maintenance of our personal and social identity. We are no longer confined to the roles, unrealized potentials, or limitations of that identity. We have temporarily expanded the boundaries of the personal and social self. 
Troscianko argues along similar lines, when discussing the bibliotherapeutic process, that “... if a reader is transported into a narrative world, he or she becomes correspondingly distanced from the real world in which the trauma exists, and this may create the potential for more critical engagement with real-world avoided stimuli and associated responses.” .
We might argue that the experience of absorbed reading shares communalities with flow experiences and mindfulness (Csikszentmihalyi, 1988; Deci and Ryan, 1985), with respect to the clarity and focus of attention. They differ from one another by the fact that attention within absorption is focused on a text world outside ourselves diminishing our awareness of the world around us, whereas attention within mindfulness is focused on what is occurring around us and within us, leading to a sharpened awareness of the feelings within us. Still, absorption could benefit readers in ways similar to the ways mindfulness benefits meditators: 1) providing them with a vivid experience that is 2) intrinsically rewarding, and 3) disengaging them from automatic thoughts and habits; all of these have been associated with increased well-being (Ryan and Deci, 2000; Brown and Ryan, 2003), and as Troscianko (2018) explains can benefit therapeutic treatment.
Thus, absorption seems to have a complicated, multi-faceted, but positive relationship with well-being. However, this assumption is based mainly on empirical findings on related experiences, such as flow and mindfulness. Empirical studies specifically investigating absorption during reading and its relationship to well-being are needed to be able to confirm this assumption. Nevertheless, there is a wealth of empirical research on the relation between narrative media consumption in general and enhanced subjective well-being.
Recently, there has been increased interest in this relationship, culminating in the publication of The handbook of media and well-being (Reinecke and Oliver, 2017). This umbrella term of subjective well-being refers to “a person’s cognitive and affective evaluations of his or her life as a whole”  and can be understood to comprise three distinct types: (1) hedonic well-being, involving positive affect, absence of negative affect, and life satisfaction; (2) eudaimonic well-being, pertaining to autonomy, environmental mastery, personal growth, self-acceptance, and purpose in life; and (3) social well-being, connected to social acceptance, social actualization, social coherence, social contribution, social integration, and positive relationships with others (Gallagher, et al., 2009).
Research on the beneficial effects of fiction reading on subjective well-being, has been abundant in the last two decades (e.g., Appel, 2008; Green, 2005; Hakemulder, 2004; 2000; Koopman, 2015; 2013; Kuiken, et al., 2004; Kuijpers and Hakemulder, 2018). For example, empirical literary studies have shown positive effects of reading literature on empathic skills and pro-social behavior (Mar, et al., 2006; Kidd and Castano, 2013; Panero, et al., 2016). Reading fiction compared to expository texts (Mar, et al., 2006) or popular fiction (Kidd and Castano, 2013) leads to an increase in theory of mind abilities, and this, it has been hypothesized can lead to more openness, tolerance, and positive relationships. In this respect, it is very likely that reading fiction has a positive effect on social well-being.
Furthermore, a recent study has even found positive associations between book reading and longevity (Bavishi, et al., 2016). For people who read books versus people who do not read or only read periodicals, a 20 percent reduction in mortality was observed. Although the study did not specify what types of books people read and did not use an experimental design (which means that causal relationships cannot be drawn), the researchers did control for relevant intervening variables, such as gender, education, and wealth, and therefore its findings are promising. What the authors did not consider was whether reading leads to any other health benefits that make a longer life more enjoyable.
Bibliotherapy in the age of digitization
A charitable enterprise launched this year, ReLIT [the Foundation for Bibliotherapy] is dedicated to the therapeutic value of mindful reading. The underlying proposition is that attentive immersion in great literature can help relieve, restore, and reinvigorate the troubled mind — and can play a part in alleviating stress and anxiety, as well as other conditions. 
As this quote from the founders of ReLIT — the Foundation for Bibliotherapy from the U. K. — shows, the therapeutic qualities of absorbed reading have been recognized and integrated in a number of recent initiatives to help people ‘deal with the challenges of life’ through the power of books. In some ways, the therapeutic effects of reading have long been recognized. Already, the ancient Greeks would name their libraries “Healing-places for the Soul” (Bate and Schuman, 2016), and since then many a philosopher or writer, from Plato to Michel de Montaigne to Alberto Manguel, has talked of the healing powers of great literature. In most of these examples, though, the advocates of reading were talking about ‘unsupported bibliotherapy’ (helping yourself by just reading a book on your own).
There is a rapidly growing number of supported bibliotherapy initiatives that actively aim towards integration of bibliotherapy in traditional therapeutic settings or towards using bibliotherapy as a treatment in its own right. One of the examples is ReLIT, as mentioned earlier, an organization devoted to finding scientific evidence for the efficacy of different forms of bibliotherapy and offering courses and workshops on the therapeutic effects of mindful reading of poetry and prose (ReLIT, 2018). Others include national programs, mostly in the U. K., such as ‘Mood-Boosting Books’, or ‘Reading Well Books on Prescription’; which are programs that make lists of books available to general practitioners to recommend to their patients, as well as make them available in public libraries for people to browse through. There is also more targeted bibliotherapy and bibliotherapy research such as The Reader Organization’s ‘Get into Reading’ scheme, which offers shared reading facilities to vulnerable groups such as people suffering from depression or female prisoners (Billington, et al., 2010; Billington, 2011).
There is little empirical evidence, however, to support the efficacy of these programs. As Troscianko eloquently puts it “... bibliotherapy with fiction, drama or poetry is often practiced and rarely researched. Assumptions about the inevitable edifying nature of art are frequent, and realistic acknowledgements of the complexity of both literature and human beings are oddly rare.”  One thing that is still a mystery, for example, is in what way the different components of ‘bibliotherapy’ contribute to well-being: in a shared reading group, is it the reading aloud that benefits the readers, the reading together, or the discussion of what is being read and thus the direct transference of what is read to the participants’ daily struggles? There is some evidence that unsupported bibliotherapy already can have modest positive effects, but not for every sample of participants.
On the other hand, there is evidence of the harmful effects of unsupported bibliotherapy in the case of people with eating disorders, for example (Troscianko, 2018). More systematic empirical research is needed on the effects — both positive and negative — of different forms of bibliotherapy in different samples, both healthy and those suffering from different types of mental illnesses. So far, research on the use of bibliotherapy in psychological treatment focuses mostly on non-fiction “self-help” books (Gregory, et al., 2004; Moldovan, et al., 2013). In contrast, the potential health benefits of fiction material are largely ignored. In addition, even though the positive effects of fiction reading have been tentatively associated with increased well-being (Brown and Ryan, 2003), the actual relationship between fiction reading and an enhanced sense of well-being has not been empirically investigated. Let alone, the potential role that absorption plays in this relationship.
For example, creative bibliotherapy advocates often underline the importance of choosing the right text, which commonly leads to the use of books exclusively from the literary canon. A case can be made, however, for using genre fiction — such as fantasy, young adult or science fiction — over the literary canon, as they seem to be genres more conducive to absorption. At this point, however, we do not know what is most beneficial to a reader: a feeling of absorption, a feeling of identification with a character and thus necessarily a close match between book and reader, the literary quality of the text that is read, or the reflection on what was read, either in a group or as a solitary act. In other words, more empirical research on the effects of bibliotherapy is much needed, especially in the age of digitalization: “... more work is needed to establish whom bibliotherapy might best target, especially as self-help interventions move from traditional book to online formats, some with multimedia, discussion forum and mobile components.” 
It is important to reach a better understanding of bibliotherapy in the digital age, as there is, as of yet, no consensus about the possible negative or positive effects of digitalization on reading and communication about reading. On the one hand, there are researchers who argue that digitalization and especially the pervasiveness of social media and smartphones in our daily lives has detrimental effects on our cognitive abilities and by extension our sense of well-being (e.g., Carr, 2010; Greenfield, 2009; Kahneman, 2011; Sherman, et al., 2013; Wolf, 2007). On the other hand there are those that emphasize the positive potentials of social networking for specific purposes, such as increasing reading pleasure and motivation (e.g., Howard, 2008; Merga, 2015; Pitcher, et al., 2007).
Particularly pertinent to the points made in this paper, are the arguments of those that warn against the harmful effects of digitalization on our attention span or our ability to concentrate in general. For example, Kovač and van der Weel suggest that people have poorer quality of attention when reading from screen than when reading from paper, which, as they rightly point out in their contribution to this special issue, undermines “the immersion and sustained attention required for in-depth reading”. What is unclear, however, is whether exposure to screens in general also has a detrimental effect on the quality of people’s attention or whether this is only true when actually reading from a screen. Again, this would be especially important to know if we find that absorption plays an important role in mediating the potential beneficial effects of reading on mental health and overall subjective well-being.
If on the other hand, it turns out that the ‘shared’ component of bibliotherapeutic treatments has the strongest effect on well-being, digitalization may well have positive effects on this same relationship. Over the last decades, with technological advancements, growing digitalization and the development of social media, the act of reading has transformed into a more social interaction (Cordón García, et al., 2013; Merga, 2015), or rather has returned to its once social origins (Nation, 2018). Social media platforms like Goodreads are online environments where millions of people come to share their love for the written word. Members come together to discuss what they read, what they classify as good or bad literature, and they recommend books to one another or even try their hand at writing fan fiction.
Mental health care is quite expensive and still not freely available to everyone. Online platforms such as Goodreads provide an opportunity for an enormous number of people to engage in bibliotherapy completely free of charge. The ultimate goal of the line of research set out in this paper, should be to first extensively test the possible merits and pitfalls of bibliotherapy — and the effects of reading literature on psychological well-being in general; and second, to integrate, on the basis of this research, bibliotherapy applications in online social media platforms such as Goodreads or Wattpad, that are focused on shared reading and writing. I believe this could have compelling large-scale health benefits of a preventive nature that are relatively inexpensive.
Other than expanding the empirical research on the effects of bibliotherapy on mental health in a systematic way, there are some areas where we can improve research into the effects of reading on well-being in general. For example, most empirical studies so far only use short stimulus materials (i.e., short stories, poems, or fragments of novels), often selected by the experimenter and/or manipulated to target the effects of specific text features on specific outcomes (e.g., Cohen, 2001, on identification; Green and Brock, 2000, on narrative persuasion; Kidd and Castano, 2013, on theory of mind). Furthermore, absorbed reading has never been studied in daily life, which leaves the field of absorption research with a considerable lack, as absorption is an experience that is hard to simulate in a lab. Finally, experimenters have focused on short-term effects (i.e., how people feel immediately after reading a text) or made claims about long-term effects based on correlational analyses using self-report measures of “lifetime print exposure” (Mar, et al., 2006; Panero, et al., 2016). In sum, research on the long-term effects of absorbed fiction reading on subjective well-being in a natural context is greatly needed.
Researchers in the field of empirical literary studies are asking the right questions, but so far few of their results have been extrapolated to practical applications. Part of this is probably due to the fact that they need to work in close collaboration with clinical psychologists and/or psychiatrists to test their questions. However, I believe that they have an important role to play in bringing together different disciplines into a ‘medical humanities’ context to investigate the possibilities set out above and develop practical applications based on empirical evidence. This is especially relevant now that the question of bibliotherapy’s efficacy is evolving into the digital age, which could either hinder or help its aim of providing solace, companionship, comfort, and insight through the power of reading a good book.
About the author
Moniek M. Kuijpers is a Postdoctoral Fellow at the Digital Humanities Lab of the University of Basel (Switzerland).
E-mail: moniek [dot] kuijpers [at] unibas [dot] ch
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Received 3 September 2018; accepted 7 September 2018.
Copyright © 2018, Moniek M. Kuijpers. All RIghts Reserved.
Bibliotherapy in the age of digitization
by Moniek M. Kuijpers.
First Monday, Volume 23, Number 10 - 1 October 2018