Can digital fiction be therapy?

Media is a powerful tool that shapes the world. Through circulating influential images and narratives, media sells products and instills in us the desire for certain ways of being, appearing, and relating to others. Literature and films not only reflect values of the societies and communities they are formed in, but also play a part in shaping them. The internet has created a participatory culture of media, where anyone and everyone can be a creator and a critic, and the lines between online and offline ‘reality’ become increasingly blurred.

There is evidence that the use of the internet, including social media, is linked to depression, anxiety, negative self evaluation, and body dissatisfaction (e.g. Kelly et al., 2018; Keles, McGrae & Grealish, 2019; Mingoia et al., 2017). Modern media consistently bombards us with unrealistic and narrow perceptions of the ideal, unattainable body, to the point where body dissatisfaction has become a norm, rather than an exception, in Western society. With regards to young women especially, more time spent scrolling social media is associated with greater self-objectification, appearance comparison, and body surveillance (e.g., Brown & Tiggemann, 2016; Cohen et al., 2017; Fardouly, Willburger & Vartanian, 2018;).The frequency with which people use social media, coupled with the way in which their interaction with visual culture exacerbates our social comparison tendencies, makes it particularly detrimental to self- esteem, in particular, body image (Tiggemann & Miller, 2010). While there is growing evidence that online media is harming us, we need to move the focus toward creating research and creative solutions that reimagine the stories being told online.

‘Bibliotherapy’ can refer to any sort of therapeutic reading. In order to understand how it can apply practically in a digital world, it is helpful to first break down how to classify it. Most research on bibliotherapy focuses on non-fictional texts. Self-help style books are often employed in the course of psychotherapy, where clients are given reading materials to work through on their own as an adjunct to or in lieu of traditional talk therapy. However, bibliotherapy can also be conducted with creative texts, giving readers the chance to analyse and accept their emotions and thoughts with relation to a fictional character. The bibliotherapy process involves readers progressing through stages of recognition, examination and insight into issues and feelings, and acceptance and problem solving (Pardeck, 2014). Given the fact that reading and discussing a piece of fiction is a relatively low-cost, accessible intervention, bibliotherapy has the potential to reach many people for whom other forms of psychological intervention are inaccessible or inappropriate.

Bibliotherapy is also a tool that can be used widely outside professional healthcare settings, for example in education or in community groups. There is evidence that it can increase mental health literacy and emotional coping skills amongst children (Mumbauer & Kelchner, 2018). Studies have assigned fictional reading to children in schools and found moderate improvements in intercultural attitudes, reduced prejudice, and reduced social anxiety (e.g., Betzalel & Schectman, 2010; Vezzali, Stathi & Giovanni, 2012). Despite the clear potential for the use of literature and creative work to positively influence behaviour and psychological wellbeing, there is little research that examines the use of fictional bibliotherapy. The more frequently utilised and researched genre of ‘self-help’ books have been critiqued as being problematically gendered, focusing on individual flaws women are responsible for fixing in themselves, whilst not addressing the underlying social context which perpetuates insecurity (Riley et al., 2019). Fictional bibliotherapy is an area where more research could have huge benefits. By bringing together healthcare practitioners and researchers with artists and creators, we can start to bring better stories to people at a time when they desperately need them.

Given the increasingly screen-based reality we find ourselves in, creating a relevant and accessible text for the purpose of bibliotherapy may be better suited to a digital media form, rather than a traditional print book. Furthermore, audio-visual media can express emotional subtleties that are difficult to express in words and create higher recognition and relevance for people accustomed to postmodern media forms (Gustaffson, 2019). The use of smartphone apps and internet-based interventions are already being taken up within the field of psychotherapy more broadly, including in body-image interventions. For example, research has been conducted on new apps that can be used to apply the principles of approach/avoidance training to decrease body dissatisfaction (Kollei et al., 2017), or to encourage positive body image through mood tracking and journaling (Rodgers et al., 2018). Due to the general paucity of research in this area, there is no clear evidence as to which formats, mediums, or genres may be suited for different target groups, or to address different psychological or social issues. Creating new narratives specifically for digital narrative or bibliotherapy is needed to gain further clarity.

‘Writing New Bodies’ (WNB; SSHRC IG 435-2018-1036), a research and design project funded by the Social Sciences and Humanities Research Council of Canada, aims to fill this gap by blending bibliotherapy with digital media and by creating a digital fiction centred on body image concerns. Digital fictions are a medium representing a fusion of story and game and are typically non-linear and interactive – like a choose your own adventure book, but with a digital interface and the accompanying audio-visual elements. WNB utilises participant co-design based on the principles of Feminist Participatory Action Research (FPAR, Gustafson, Parsons, & Gillingham, 2019) to inform both the content and the narrative design elements for a digital fiction. The target population for this work is young women wholly or partially identified and gender non-conforming people, and a community sample from this population has been involved at multiple stages of the research process. In the initial stages of research, participants were involved in discussion forums to identify key body image concerns; their discussions centred around a variety of themes, such as bodily autonomy and consent, self-objectification, perception from others, and body acceptance. Participants also discussed the narrative and generic conventions they would like to see in this new digital fiction ‘story’ or app, for example, expressing a preference for an invisible or shapeless protagonist so that users can project their own experiences onto the story and not be limited by the relatability of any set character. Based on the experiences and viewpoints of the participants, the writer and developer of the digital fiction, Christine Wilks, is creating a choice-based interactive narrative that dramatizes a struggle with a range of body image issues (although it foregrounds body size and shape). The digital fiction will be available as a responsive web app for mobile devices as well as larger screens.

A ‘digital fiction’ focused on helping people address their own view of their bodies through interactive stories is just one example of all the possible ways with which we can use the intersection of storytelling and new media to improve psychological wellbeing. Creative texts even in traditional book form have not been subject to proper evaluation in a therapeutic context, and as more books start to be published which champion diversity, social progress, and holistic views of health, we should perhaps look to better understand how they can affect us collectively and individually. Recent books like More than a Body (Lindsay & Lexie Kite, 2021), and Her Body Can (Katie Krenshaw, Ady Meschke & Li Liu, 2020) exemplify the move towards comprehensive understandings of body image and could also be evaluated for their potential to target body image and attitudes on an individual and therapeutic level. Beyond books, there is potential for popular modern media forms such as podcasts, audiobooks, film, videogames, and even content on popular platforms like Tiktok, Instagram, and Twitter, to focus on more nuanced and representative content that supports rather than harms people’s wellbeing. Creative bibliotherapy represents a unique intersection between the worlds of health, psychology, and science, and that of storytelling in all its modalities, by providing a chance for people to engage with different psychosocial and emotional issues through reading/watching/playing a story.

References:

Betzalel, N., & Shechtman, Z. (2010). Bibliotherapy treatment for children with adjustment difficulties: A comparison of affective and cognitive bibliotherapy. Journal of Creativity in Mental Health, 5(4), 426-439.

Brown, Z., & Tiggemann, M. (2016). Attractive celebrity and peer images on Instagram: Effect on women's mood and body image. Body image, 19, 37-43.

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