Assessing and Treating Low Self-Esteem

This part of the report is based on Dr. Sokol’s books as well as her Dec. 2, 2018 presentation to NJ-ACT.

By Lynn Mollick and Milton Spett

Step 1: Begin treatment by applying the self-esteem model to the patient’s experiences:

1. Determine if low self-esteem arises from issues with desirability, competence or both.
2. Explain to patients how their low self-esteem developed from experiences with parents and peers. Historical explanations provide motivation to change.
3. Identify internal or external situations that activate low self-esteem.
4. Identify low self-esteem emotions and cognitions that are elicited.
5. Identify the low self-esteem driven behavior.
6. Explain to patients that low self-esteem driven behavior and low self-esteem cognitions about the self are reciprocal causes of each other. For example, if patients don’t think anyone will like them at a party, they will behave awkwardly, and, as a result, they won’t have many conversations, confirming their cognition that they are unlikeable.
7. Avoidance is an important component of low self-esteem. Identify the avoidance cognitions and behaviors patients employ such as psychoactive substance misuse and procrastination. For example, “If I avoid parties, I won’t experience rejection/failure.” The avoidance behaviors strengthen low self-esteem cognitions and low self-esteem cognitions increase avoidance.
8. Identify other negative cognitions: “I am a valuable person only if I work hard and succeed.” “If someone gets angry at me, I am not a worthwhile person.”

Step 2: Assess low self-esteem cognitions and emotions in specific situations.
Follow Beck’s cognitive approach:
A = Activating situation – can be external or internal (a thought or feeling).
B = Bodily response – sensations
C = Cognitions (thoughts and interpretations) – what runs through your head?
D = Are the self-criticisms sociotropic or autonomous?
E = Negative emotions
F = Facts – is the self-criticism realistic or unrealistic?

Step 3: Assess thinking errors. Does the patient:
1. Dichotomize, thinking only in terms of good or bad
2. Reason from emotions and say, “I feel it so it must be true”
3. Anticipate negative outcomes
4. Catastrophize about negative outcomes
5. Use nasty name-calling to relieve feelings of hurt and rejection?
6. Demand that situations be as they wish by using shoulds and musts.

Step 4: Assess low self-esteem behaviors in specific situations. Does the patient:
1. Avoid and evade
2. Quit, give in, give up
3. Control, do too much, do everything themselves
4. Please, make everyone else happy and ignore their own needs
5. Defend, angrily explain, attack, and provoke others
6. Delegate, pass on responsibility, and avoid the possibility of error
7. Distract from self-esteem issues with TV, alcohol, drugs, or activity
8. Be perfectionistic and work excessively
9. Worry because worry blunts emotion

Step 5: Use CBT techniques to change dysfunctional cognitions and behaviors. Emotional change will follow:
1. Perform behavioral experiments to disprove low-self-esteem cognitions.
2. Think of all the people who are not as successful as you but seem to happy anyway.
3. Write new, functional cognitions. “I am competent, so I don’t have to be perfect or work so hard.” “I am a worthwhile person, so it’s OK to say no or take care of my own needs.”
4. Weaken self-critical beliefs by replacing them with self-confident ones. Look for evidence to support the self-confident belief. Collect additional information:
— ask for objective feedback from a colleague or friend
— pretend you are a job applicant and imagine being their evaluator
— make a list of stressors you’ve handled in the past
— review confidence-building flashcards throughout the day
5. Set self-esteem-enhancing goals.
6. Act competent even when you don’t feel competent.
7. Keep a self-esteem log listing successes, compliments, and experiences of others wanting to talk to you or be with you.
8. When experiencing low self-esteem cognitions and emotions, stop and reflect on their validity before acting on them.
9. Be especially vigilant in stressful situations because stress can reactivate low self- esteem.