low-self-esteem counselling, how low-self-esteem develops

Self-esteem might not be as simple as our perception of our ability to achieve life goals and our overall self-liking (more on this later), but overall high self-esteem is associated with a generally positive self-evaluation, and low self-esteem arises from a more negative self-perception.

What causes low self-esteem

Sometimes our self-esteem depends on external factors, and we only feel good about ourselves when things are going well. Conversely, if things get tough, we will feel down. This may lead to mental health problems if external circumstances, beyond our control, lead to failure or rejection. In this case, pursuing high self-esteem means wanting to get everything perfect around is, which is impossible, leading to further mental health problems (such as perfectionism).

As we alluded to, self-esteem is likely not just a single dimension but a two-dimensional construct, combining self-competency and self-liking. Simply chasing “high self-esteem” might not even be possible.

In this sense, fragile self-esteem is dependent on daily events outside of us (and sometimes outside of our control). Things often fluctuate around us day to day, and so does a fragile self-esteem. On the other hand, secure high self-esteem is generally more stable and unconditional – this comes from us, and not swayed too much by daily events. People with secure high self-esteem think that just because something didn’t work out, it does not mean they are worthless.

Is low self-esteem a mental health issue?

Low self-esteem is widely recognised for its negative consequences, leading to and associated with several mental illnesses. Interestingly, low self-esteem itself is not a mental disorder on its own, even though it is linked to more than 20 emotional and personality disorders, such as depression, anxiety, anorexia nervosa, bulimia nervosa, sexual dysfunction, and avoidant personality disorder (according to the Diagnostic and Statistical Manual of Mental Disorders, DSM-5).

How self-esteem develops

Some models of low self-esteem suggest it is a deep schema, developed based on our past experiences, influencing how we process incoming information later (the Fennell model). When this early schema is more negative, it can lead to self-defeating behaviours, self-criticism, and a cycle of negative thinking and low mood. Some of these behaviours, such as withdrawal, self-focus or reassurance seeking, reinforce the already negative schemas about how the person is “bad” or “worthless”.

This negative cycle is well recognised in psychology, and we know that anxiety and depression both contribute to and are the results of low self-esteem. In other words, low self-esteem may cause or make anxiety and depression worse (vulnerability model), and anxiety and depression can also negatively affect our self-esteem (scar model).

Interestingly, improving self-esteem has been integrated as part of depression treatment, meaning that treating low self-esteem and treating depression might be the same. We do not even need to separate them if we know self-esteem is both a cause and a result of depressive symptoms.

How do you fix low self-esteem?

Cognitive Behavioural Therapy (CBT) is a well-known therapeutic approach used to change how we feel by changing our thoughts and behaviours: changing emotions directly is almost impossible, but changing the thoughts that drive these emotions is achievable.

CBT has the potential to address the instability of self-esteem, external contingency of self-worth, and levels of self-criticism. For example, CBT can help individuals become more accepting and realistic of their shortcomings (flaws), rely more on and acknowledge their positives (strengths), and develop a sense of control and efficacy by engaging in new activities and resuming activities before low self-esteem develops.

CBT is widely studied, especially for depressive and anxiety disorders. If low self-esteem is linked to these disorders, we can expect that CBT, aiming to help with anxiety and depressive symptoms, would help with low self-esteem as well.

Self-esteem counselling

Research found, as expected, that weekly sessions of CBT self-esteem counselling significantly increase our self-esteem (effect size of 1.12), while significantly decreasing symptoms of depression (effect size of -1.20). 

What was interesting is that even one-day workshops help with self-esteem: the effects were smaller compared to therapy, but still meaningful, with self-esteem showing an effect size of 0.34 and depression an effect size of -0.47, even three months after the intervention. That is an impressive, lasting change! Overall, CBT therapy has a measurable impact on increasing self-esteem and reducing depression symptoms, particularly when delivered through weekly individual self-esteem counselling sessions. 

Self-esteem, confidence, and depression

Given the above data and effect sizes, interventions specifically designed to target self-esteem might be similar (or the same?) as standard CBT interventions that address depression symptoms. The effect sizes suggest that both types of treatments are equally effective at reducing depression symptoms and increasing self-esteem and confidence at the same time. 

How to increase self-esteem – is it possible?

For people meeting the criteria for a depressive disorder, the effect sizes are typically promising – another study also showed 0.84 for self-esteem and -1.13 for depression, and these gains persisted for up to two years post-treatment. We know that self-esteem counselling works.

However, for the non-depressed people, the effect sizes were almost zero (0.07 and 0.09, respectively). This suggests that while low self-esteem is linked to depressive symptoms, once we treat the disorder, we cannot keep increasing self-esteem. In other words, it is a good idea to stop therapy after the depressive or anxious symptoms disappear, as self-esteem cannot just keep increasing.

The complexity of self-esteem

To date, it is still debated whether self-esteem is just stable or unstable, externally or internally contingent, and implicit (how one feels about oneself) or explicit (what one thinks about oneself). Regardless of how exactly we define it, it is almost certain that seeing self-esteem as a simple binary classification of “High” or “Low” is not very accurate. Some argue if we only take one aspect of self-esteem into account, we should consider measuring it between “Secure” and “Fragile”, rather than high or low.

Rumination, over-thinking, and self-esteem

Rumination, described as the persistent dwelling on one’s feelings and problems, is a thinking process that can not only lead to but also maintain low self-esteem. Our inclination to obsess over self-critical thoughts (“Why am I so bad?”), along with the negative thoughts about these thoughts (“Why do i hate myself?”), likely play a role in maintaining low self-esteem.

Next steps

At Personal Psychology, we provide CBT and self-esteem counselling to help with low self-esteem, anxiety, and depression. Whenever you are ready, we are here for you.

Please note that this blog post by Personal Psychology is not intended to provide professional advice. If you or someone you know is experiencing mental health difficulties, it is important to seek help from a qualified healthcare professional.