Self-Esteem

Research on Self-Esteem

Baumeister, R. F., Campbell, J. D., Krueger, J. I., & Vohs, K. D. (2003). Does high selfesteem cause better performance, interpersonal success, happiness, or healthier lifestyles? Psychological Science in the Public Interest, 4, 1-44.

Summary: Self-esteem has become a household word. Teachers, parents, therapists, and others have focused efforts on boosting self-esteem, on the assumption that high self-esteem will cause many positive outcomes and benefits— an assumption that is critically evaluated in this review. 

Appraisal of the effects of self-esteem is complicated by several factors. Because many people with high self-esteem exaggerate their successes and good traits, we emphasize objective measures of outcomes. High self-esteem is also a heterogeneous category, encompassing people who frankly accept their good qualities along with narcissistic, defensive, and conceited individuals. 

The modest correlations between self-esteem and school performance do not indicate that high self-esteem leads to good performance. Instead, high self-esteem is partly the result of good school performance. Efforts to boost the self-esteem of pupils have not been shown to improve academic performance and may sometimes be counterproductive. Job performance in adults is sometimes related to self-esteem, although the correlations vary widely, and the direction of causality has not been established. Occupational success may boost self-esteem rather than the reverse. Alternatively, self-esteem may be helpful only in some job contexts. Laboratory studies have generally failed to find that self-esteem causes good task performance, with the important exception that high self-esteem facilitates persistence after failure. 

People high in self-esteem claim to be more likable and attractive, to have better relationships, and to make better impressions on others than people with low selfesteem, but objective measures disconfirm most of these beliefs. Narcissists are charming at first but tend to alienate others eventually. Self-esteem has not been shown to predict the quality or duration of relationships. 

High self-esteem makes people more willing to speak up in groups and to criticize the group's approach. Leadership does not stem directly from self-esteem, but selfesteem may have indirect effects. Relative to people with low self-esteem, those with high self-esteem show stronger in-group favoritism, which may increase prejudice and discrimination. 

Neither high nor low self-esteem is a direct cause of violence. Narcissism leads to increased aggression in retaliation for wounded pride. Low self-esteem may contribute to externalizing behavior and delinquency, although some studies have found that there are no effects or that the effect of self-esteem vanishes when other variables are controlled. The highest and lowest rates of cheating and bullying are found in different subcategories of high self-esteem. 

Self-esteem has a strong relation to happiness. Although the research has not clearly established causation, we are persuaded that high self-esteem does lead to greater happiness. Low self-esteem is more likely than high to lead to depression under some circumstances. Some studies support the buffer hypothesis, which is that high self-esteem mitigates the effects of stress, but other studies come to the opposite conclusion, indicating that the negative effects of low self-esteem are mainly felt in good times. Still others find that high self-esteem leads to happier outcomes regardless of stress or other circumstances. 

High self-esteem does not prevent children from smoking, drinking, taking drugs, or engaging in early sex. If anything, high self-esteem fosters experimentation, which may increase early sexual activity or drinking, but in general effects of self-esteem are negligible. One important exception is that high self-esteem reduces the chances of bulimia in females. 

Overall, the benefits of high self-esteem fall into two categories: enhanced initiative and pleasant feelings. We have not found evidence that boosting self-esteem (by therapeutic interventions or school programs) causes benefits. Our findings do not support continued widespread efforts to boost self-esteem in the hope that it will by itself foster improved outcomes. In view of the heterogeneity of high self-esteem, indiscriminate praise might just as easily promote narcissism, with its less desirable consequences. Instead, we recommend using praise to boost self-esteem as a reward for socially desirable behavior and self-improvement.

The Cognitive Model

Cognitive behavioral therapy (CBT) holds that our emotions and behaviors are determined by our beliefs and that the best way to help someone with emotional/behavioral problems is to help them change their beliefs. For example, someone might be sad and withdrawing from friends because they believe they're worthless and that nobody could like them; CBT would fight this sadness and isolating behavior by challenging that person's beliefs. 

Beck (1995) writes that CBT is based on the cognitive model, which states that our life experiences give rise to our beliefs. The cognitive model categorizes beliefs three ways: core beliefs, our underlying axioms about ourselves, others, and the world; intermediate beliefs, attitudes, rules, and assumptions; and automatic thoughts, the words are images that seem to be constantly popping into our minds. For most people, these beliefs are usually unconscious. The cognitive model can be depicted as follows: 

Experiences

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Core Beliefs

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Intermediate Beliefs

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Situation ⇨ Automatic Thoughts ⇨ Reactions

Cognitive Model of Low Self-Esteem

Fennell (1997) adapted the cognitive model to explain low self-esteem. According to this model, negative experiences (usually things that happened in childhood) cause us to have negative core beliefs about ourselves, or in other words, low self-esteem. In order to convince ourselves that these core beliefs are false, we adopt rules for living (in other words, intermediate beliefs), which are rules that, if followed, help us to feel that our negative core beliefs are false. Everything might seem fine until a triggering situation occurs, that is, a situation which threatens to prevent us from meeting the demands of our rules for living. The belief that we might not be able to meet these demands leads to anxiety. The belief that we in fact failed to meet these demands leads to depression. Low self-esteem is maintained by biases in thinking, specifically biased perceptions and biased interpretations (pp. 297-299). Biased perceptions occur when we "notice anything that is consistent with the negative ideas" we have about ourselves and ignore anything that is inconsistent with these ideas. Biased interpretations occur when something does not go well and we "use this as the basis for a global, overgeneralized judgment" of ourselves (Fennell, 2016). Fennel's model can be depicted as follows:

Negative Experiences

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Negative Core Beliefs

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Rules for Living

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Triggering Situations

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Situation ⇨ Core Beliefs Activated ⇨ Reactions 

Fennel (2016) gives several examples of this model at work. Briony. Core Belief: "I am bad." Rules for Living: "If I allow anyone close to me, they will hurt and exploit me. I must never let anyone see my true self." Triggering Situations: "Situations where she felt her true self had been exposed." Jesse. Core Belief: "I am not good enough." Rules for Living: "Unless I always get it right, I will never get anywhere in life. If anyone criticizes me, it means I have failed." Triggering Situation: "Situations where he feared he might be unable to meet the high standards he had set himself, or where he encountered criticism." Kate. Core Belief: "I am unlovable." Rules for Living: "Unless I do everything people expect of me, I will be rejected. If I ask for what I need, I will be disappointed." Triggering Situation: "Being unable to do what was expected of her; having to ask for help." 

CBT for Low Self-Esteem

Overview. 

Fennel (1997) states that the goal of CBT for low-self esteem is to weaken negative core beliefs about the self and to "establish and strengthen more positive, realistic new beliefs about the self" (p. 299). Since low self-esteem is maintained by biased perceptions and biased interpretations, the therapy sets out to achieve its goal by modifying these perceptions. One modifies biased perceptions by:

• Directing attention to positive qualities, assets, skills, strengths.
• Keeping regular written records of examples of positive qualities, etc. on a day-to-day basis.
• Seeking evidence (past and present) which is inconsistent with negative core beliefs about the self. 
• Recording incidents inconsistent with negative core beliefs about the self.
• Acting against the old belief and observing the results (behavioural experiments).

One modifies biased interpretations by:

• Re-evaluating the evidence (past and present) that apparently supports the old belief.
• Questioning associated negative automatic thoughts (e.g. self-criticism) on a daily basis.
• Testing negative predictions through regular and frequent behavioural experiments.
• Breaking down black-and-white thinking through continuum work.
• Re-evaluating dysfunctional assumptions and formulating more realistic and helpful alternatives. (p. 299)

The therapist must make modifications when treating clients with personality disorders (p. 300). 

Fennel (1997) writes that clients will respond will to short-term therapy if they possess the following characteristics: 

• Acceptance of the cognitive model of emotional disorder as relevant to their own experience. 
• Belief that change is at least theoretically possible, and acceptance of the possibility of alternatives to their negative views.
• Ability to recognise and describe thoughts and feelings with minimal training.
• Low to moderate level of disability.
• Willingness to try out cognitive-behavioural methods in practice, and to experiment with new ways of thinking and behaving, both within therapy sessions and in between-session self-help assignments.
• Ability to form an equal, collaborative therapeutic alliance. (p. 300)

Anxious Predictions

Fennel (2016) writes that when a triggering situation occurs, we worry that we won't be able to meet the demands of our Rules for Living. As a consequence we often make anxious predictions that "contain biases which feed into the sense of uncertainty and dread" -- e.g., we might "overestimate the chances that something bad will happen," underestimate our ability to deal with the situation if something bad in fact happens. In response to these predictions, we often take precautions which "actually prevent [us] from discovering whether [our] anxious predictions have any true foundation and so keep low self-esteem going."

Fennel (2016) recommends taking the following steps. First, becoming aware -- that is, becoming aware of our anxious predictions and the precautions we take. Use the "Predictions and Precautions Record Sheet," which consists of five columns: (a) Date/Time, (b) Situation (What were you doing when you began to feel anxious?), (c) Emotions and Body Sensation (anxious, panicky, tense, heart racing, rate 0-100 for intensity), (d) Anxious Predictions (What exactly was going through your mind when you began to feel anxious, e.g., thoughts in words and images, rate 0-100% for degree of belief), (e) Precautions (What did you do to stop your predictions from coming true?, e.g., avoid the situation, safety-seeking behavior). Second, questioning our anxious predictions by asking questions such as the following:

• What is the evidence to support what I am predicting?
• What is the evidence against what I am predicting? 
• What alternative views are there? What evidence is there to support them? 
• What is the worst that can happen? 
• What is the best that can happen? 
• Realistically, what is most likely to happen? 
• If the worst happens, what could be done about it?

Third, set up experiments to check out anxious predictions. This is done by (a) clearly stating your prediction, (b) decide what you will do to avoid take precautions, and (c) observe what happened. Use the "Checking Out Anxious Predictions Record Sheet," which consists of six columns: (a) Date/Time, (b) Situation, (c) Emotions and Body Sensation (rate 0-100 for intensity), (d) Anxious Predictions (rate belief 0-100%), (e) Alternative Perspectives (use the key questions to find other views of the situation, rate belief 0-100%), (f) Experiment (What did you do instead of taking your usual precautions? What were the results?)

Combating Self-Criticism

Fennel (2016) writes that when experience seems to confirm our core beliefs, self-criticism follows, which in turn can lead to depression and reinforce our low self-esteem. Fennel (2016) proposes three ways to combat self-criticism: (1) Become aware of self-critical thoughts, (2) Question self-critical thoughts, and (3) Set up experiments to disprove self-critical thoughts. 

In order to (1) Become aware of self-critical thoughts, use the "Spotting Self-Critical Thoughts" record sheet, which consists of five columns: (a) Date/Time, (b) Situation (What were you doing when you began to feel bad about yourself?), (c) Emotions and body sensations (e.g., sad, guilty, angry) (rate each 0-100 for intensity), (d) Self-critical thoughts (What exactly was going through your mind when you began to feel bad about yourself?) (e.g., thoughts in images, words) (rate 0-100% for degree of belief), (e) Self-defeating behavior (What did you do as a consequence of your self-defeating thoughts?). 

The point of writing this down: Many people find that "writing thoughts down encourages distance from them. It takes them out of your head (so to speak), where it is difficult to question their truth because they seem so much a part of you, and puts them 'out there' on paper, where you can start to stand back from them, take a good look at them and gain a different perspective." When you can stop writing them down: "When you feel you have reached the point where noticing them and observing their impact has become fairly automatic." 

In order to (2) Question self-critical thoughts, use the "Combating Self-Critical Thoughts" record sheet, which consists of five columns: (a) Date/Time, (b) Situation, (c) Emotions and body sensations (rate each 0-100), (d) Alternative perspectives (use the key questions to find other perspectives on yourself, rate belief in each 0-100%), (e) Outcome (now that you have found alternatives to your self-critical thoughts, how do you feel 0-100%, what can you do). The Key Questions:

• What is the evidence? (Am I confusing a thought with a fact? What is the evidence for/against what I think about myself?)
• What alternative perspectives are there? (Am I assuming that my perspective is the only one possible? What evidence do I have to support alternative perspectives?)
• What is the effect of thinking this way about myself? (Are these self-critical thoughts helpful, or are they getting in my way? What perspective might be more helpful to me?)
• What are the biases in my thinking about myself? (Am I jumping to conclusions? Am I using a double-standard? Am I thinking in all-or-nothing terms? Am I condemning myself as a total person on the basis of a single event? Am I concentrating on my weaknesses and forgetting my strengths? Am I blaming myself for things which are not really my fault? Am I expecting myself to be perfect?)
• What can I do? (How can I put a new, kinder perspective into practice? Is there anything I need to do to change the situation? How can I experiment with acting in a less self-defeating way?)

Enhancing Self-Acceptance

Step #1. To enhance appreciate for yourself, start by make a list of your talents and strengths. Questions to help you identify your good points:

• What do you like about yourself, however small and fleeting? 
• What positive qualities do you possess?
• What have you achieved in your life, however small? 
• What challenges have you faced? 
• What gifts or talents do you have?
• What skills have you acquired? 
• What do other people like or value in you?
• What qualities or actions that you value in others do you share? 
• What aspects of yourself would you appreciate if they were aspects of another person? 
• What small positives are you discounting? 
• What are the bad things you are not? 
• How might another person who cared about you describe you? 

After writing the list, "Pause and dwell on each quality you have recorded. Let it sink in. When you have read slowly and carefully through the list, go back to the top again. Now, as you consider each item, bring to mind a particular time when you showed that quality in how you behaved. Take time to make the memory as clear and vivid as you can." As you do this, "You should find your mood lifting, and a sense of self-acceptance and confidence creeping in." 

Step #2. Next "begin recording examples of your good points every day, as they occur, just as you have been recording examples of anxious predictions and self-critical thoughts. Your objective is to reach the point where you automatically notice good things that you do." Once you reach this point, you can stop with these writings. For each notebook entry, write down what you did and what quality it exemplifies. "At the end of each day, perhaps just before you go to bed, make time to relax and be comfortable and review what you have recorded. Look over what you have written, and recreate the memory of what you did in vivid detail. Let it sink in, so that it affects your feelings and your sense of yourself." 

Step #3: Adding pleasure to your life (which will lift your mood, which in turn will make it easier to fight self-criticism) and giving yourself credit for your achievements. You first need to learn how you spend your days and how much pleasure you experience and how good you are at acknowledging your achievements. You can keep a Daily Activity Diary: record what you did, how much you enjoyed what you did (P0 = no enjoyment, P10 = total enjoyment), and to what extent you mastered each activity (M0, M1, etc.) (e.g., getting up to exercise when you're tired might be a real achievement, an M10). Once you better understand how you're spending your time, you need to make changes to add pleasure to your life and give yourself credit for your achievements. 

Changing the Rules

Fennel (2016) writes that rules for living can take the form of "should," "must," or "ought."
Rules can also take the form of "If...then..." or "Unless...then..." Such rules "describe what you think will happen if you act (or fail to act) in a certain way." For example:

• If I allow anyone close to me, [then] they will hurt and exploit me.
• If someone criticizes me, [then] it means I have failed.
• Unless I do everything people expect of me, [then] I will be rejected.
• Nothing I do is worthwhile unless it is recognized by others (i.e. Unless what I do is recognized by others, [then] it is not worthwhile). 

How do we identify our rules for living? We often know we have broken a rule for living if we have a strong emotional reaction. "You feel depressed or despairing, not sad. You experience rage, not irritation." And so on. Rules for living can be found in:

1. Automatic thoughts.
2. Themes -- e.g., identifying situations that normally make you doubt yourself
3. Your judgments of yourself and others -- "Jesse, for example, noticed that he was always impatient with people who took a relaxed attitude to their work, allowed themselves lunch breaks and went home at a reasonable hour."
4. Family mores -- ask what did your family tell you that you should and shouldn't do, what were you criticized and praised for, praise for, etc.
5. Following the opposite -- that is, pondering the times that you felt really good about yourself and asking what rule you were following. 
6. Downward arrow -- think of something which makes you feel upset with yourself and then ask, "Supposing that were true, what would it mean to me?"

To change a rule, complete the following summary: 

• My old rule is: _____. 
• This rule has had the following impact on my life: _____. 
• I know the rule is in operation because: _____. 
• It is understandable that I have this rule because: _____. 
• However, this rule is unreasonable because: _____. 
• The payoffs of obeying the rule are: _____. 
• But the disadvantages are: _____. 
• A more realistic and helpful rule would be: _____. 
• In order to test-drive the new rule, I need to: _____. 

Put the summary somewhere easily accessible. Maybe write them down on a flashcard. And then of course start to experiment with your new rule. 

Changing Core Beliefs

Research

Research has shown Fennel's program to be effective at treating low self-esteem, anxiety, and depression. McManus, Waite, & Shafran (2009) used this program to treat an individual over 12 sessions and found at one-year follow-up that the client had a significantly higher self-esteem and lower levels of anxiety and depression. Waite, McManus, & Shafran (2012) treated 11 individuals with the program over 10 sessions and at the end of treatment had higher self-esteem and lower depression than 11 individuals placed on a waitlist. Pack & Condren (2014) treated 50 participants in a group format and at three-month follow-up found that they had higher self-esteem and lower levels of anxiety and depression.

Notes

Beck, J.S. (1995). Cognitive therapy: Basics and beyond. New York: The Guilford Press. DeRubeis, R.J., Webb, C.A., Tang, T.Z., & Beck, A.T. (2010). Cognitive therapy.

Fennell, M. J. (1997). Low self-esteem: A cognitive perspective. Behavioural and cognitive psychotherapy, 25(1), 1-26.

Fennell, M. (2016). Overcoming low self-esteem: A self-help guide using cognitive behavioral techniques. [Kindle version.]

McManus, F., Waite, P., & Shafran, R. (2009). Cognitive-behavior therapy for low self-esteem: A case example. Cognitive and behavioral practice, 16(3), 266-275.

Pack, S., & Condren, E. (2014). An evaluation of group cognitive behaviour therapy for low self-esteem in primary care. The cognitive behaviour therapist, 7.

Waite, P., McManus, F., & Shafran, R. (2012). Cognitive behaviour therapy for low self-esteem: A preliminary randomized controlled trial in a primary care setting. Journal of behavior therapy and experimental psychiatry, 43(4), 1049-1057.