Cognitive-Behavioral Therapy in the Treatment of Low Self-Esteem - Article Example

Cognitive Behavioural Therapy in the Treatment of Low Self-esteem al affiliation All the schools of psychotherapy acknowledge the influence of cognitive processes over emotional and behavioural patterns. These processes may give rise to a variety of mental disorders. The correlation between cognitions, emotions, and behaviour was often explained with the help of rather complicated abstract theories. They made this correlation difficult to understand and evaluate. Cognitive behavioural therapists avoid such kind of abstractions. Instead, they prefer to focus their attention on certain thoughts, known as automatic, which may be called a determining factor of human behaviour. However, methods of cognitive behavioural therapy do not return to the traditional insight-therapy. As opposite to traditional approaches, cognitive behavioural therapy investigates and categorises cognitive processes of a patient. In addition, its aim is to find out how they correlate with emotions and behaviour. Low self-esteem, a frequent symptom of many mental disorders, should be treated together with the disorder a patient suffers. To improve self-esteem would mean to help patients get rid of many problems. The aim of cognitive behavioural therapy is also to teach patients specific skills which would help them solve their peculiar problems. Patients with low self-esteem are offered a number of specific techniques in order to improve it. That is why cognitive behavioural therapy may be regarded a training course, but not as treatment. It is especially important for clients who prefer not to be called patients. Key words: cognitive behavioural therapy, emotional and behavioural patterns, cognitive processes, automatic thoughts, low self-esteem, mental disorders. Cognitive Behavioural Therapy in the Treatment of Low Self-esteem Low self-esteem is a widely-spread problem which often makes people suffer many inconveniences and disappointments in their lives, or sometimes even gives rise to serious psychological disorders, such as depression or anxiety. It presupposes constant usage of defence mechanisms – people with low self-esteem lack self-confidence, that is why they prefer to choose strategies of guaranteed success. In other words, they tend to choose those aims which may be achieved without any risk of failure. Such aims very often do not correspond to true abilities of a person. Such people are passive both at study and work. They prefer to remain unnoticed just because they are afraid to make a mistake, but not because their abilities are insufficient indeed. Their success rate is generally average, but constant. People with predominantly low self-esteem sometimes tend not to notice their failures. Their position is the following – it is all right if I fail to do something, I did not want it indeed. People with such a type of self-esteem possess too high level of pretension. They choose too stretch goals, and of course they eventually fail to achieve them. Even more, they usually do not even expend any efforts. However, it is also possible to come across stubborn individuals who tend to choose the tasks they are unable to perform because of low level of training. They just do not take into considerations their true abilities and knowledge. This is also an example of low self-esteem – total unawareness of own strengths and potential makes people choose random goals. The progress in studies or professional activities is quite poor and unstable. At the same time, these people prescribe their failures and mistakes to various external factors – other people, unjust authority, untoward circumstances, or even coincidences. Low self-esteem is one of the most frequent symptoms of numerous psychological disorders. Almost all the patients admit they would like to improve their self-esteem, regardless of their peculiar problems and diagnosis. Dr Milton Spett, a cognitive behavioural psychologist of New Jersey, states “If we just alleviate low self-esteem, many psychological problems will diminish substantially or disappear completely” (Milton 2004). However, it is impossible to treat only symptoms, but not cause. That is why low self-esteem should be treated alongside with the peculiar psychological disorder of a patient. Cognitive behavioural therapy is known to be one of the most effective approaches in this process. The aim of this approach is to change certain mental images, thoughts, and cognitive patterns in order to help patients overcome their emotional and behavioural problems. According to the theory this therapy is based on, human behaviour and emotions are partially predetermined by certain cognitions and cognitive processes, which can be modified if a person possesses appropriate knowledge and skills. Traditional methods of mental therapy always acknowledged the important role of cognitions while shaping of behavioural and emotional patterns. Cognitive behavioural therapy is different from the preceding insight-oriented approaches since it takes into consideration only those cognitions which are manifested at the given moment of a patient’s life. Advocates of cognitive behavioural therapy pay much more attention to these cognitions in comparison to the adherents of other psychotherapeutic approaches. They use principles of modification in order to recognise the existing cognitions and define those ones which cause problems. Behavioural techniques are used in order to remove unwanted cognitions. The aim is also to provide new mental patterns and ways of dealing with problems. Finally, the task is to reinforce recently elaborated cognitions. Thus, the first step is to discover the existing cognitions and find out reasons why they had appeared. After this it is possible to start modelling new cognitions. It is also necessary to make a patient imagine how new cognitions may be correlated with the desirable behaviour and emotional patterns. Finally, new cognitions should be used in practice of real-life situations. They are supposed to become a habitual thought pattern of a patient. The cognitions which are supposed to be changed include separate opinions, judgments, thoughts, and images. The range of cognitive processes of people include the way how information about themselves and external environment is evaluated and organized. Cognitive processes also predetermine the ways this information is processes in order to adapt for life circumstances and emerging troubles. Finally, these processes include the ability to forecast and estimate future events. The theoretical foundation of cognitive behavioural therapy was elaborated by Aaron Beck and Albert Ellis, the founders of rational emotive behavior therapy. One of the key concepts of this approach lays in the assumption that people on their own are sources of all the problems they suffer. In other words, they suffer not because of any external factors. Problems occur as a result of certain thoughts, opinions, evaluation of the own worth, and estimation of others. People have certain cognitive schemes (for example, someone may think “real men do not act like this”) and cognitive biases (people may think they are capable to forecast future or read thoughts of others). People also have automatic thoughts, which may provoke negative emotions. The process of cognitive behavioural therapy means that a patient and a therapist investigate the way the patient thinks. The therapist may carry out different experiments and ask patients various questions, sometimes also captious or funny ones, in order to find out their prejudices, irrational logic, and false beliefs. Patients often tend to consider their mistaken opinion to be true. Therapists try to make their patients doubt them. The main idea is that the unwanted reaction of a patient arouses because of the way he or she perceives it, but not because of situation itself. In other words, the reaction depends on the way patients estimates themselves in the given moment. It may also be influenced by the estimation of the surrounding environment and other people. The results of this process may sometimes turn into disadaptive and harmful beliefs. It means they do not help patients adapt for real life and other people. On the contrary, they encourage people to keep isolated from others. Such beliefs do not help anyone, though they may seem to be genuine. They do not only make self-esteem even lower, but may also cause depression, anxiety, phobias, and so on. In the course of cognitive behavioural therapy patients are given an opportunity to observe their misconceptions from the outside. It may help them make a decision whether to believe or to refuse from them. The aim of a cognitive behavioural psychologist is to make a patient reconsider such misconceptions and misbeliefs. Such a reconsideration of personal convictions not only let patients improve their self-esteem but also helps them cope with depression, anxiety, self-distrust, and many other problems. Thus, according to the advocates of cognitive behavioural therapy, human behaviour is predetermined by perception and estimation of external environment. The way people perceive and estimate themselves, others, and life in general depends on the way they think, or their cognitive processes. The process of thinking is in its turn predetermined by the way a person was taught to think. That is why it is sometimes incorrect to say that cognitive behavioural psychologists treat their patients. It is more appropriate to say they teach them. Patients are taught to use those cogitative patterns which would have them improve self-esteem and quality of life in general. Aaron Beck wrote that human thoughts predetermine emotions, and consequently behavioural patterns. At the same time, behaviour of a person influences the position he or she occupies in society. In other words, our thoughts shape the world around us. However, the reality people believe in is rather subjective and quite often has nothing in common with the objective one. Aaron Beck always said that everything around us is not so bad indeed. That is just the way we perceive it. In other words, situations and events are not emotionally coloured. Thus, thoughts of people may predetermine their emotions and actions. On the other hand, thoughts is just an interpretation of what people see. Any interpretation presupposes certain degree of freedom. A therapist may help a patient change his or her negative interpretation into a positive and more constructive one, which would not be harmful for self-esteem. All the opinions and judgments people possess are born in the course of an endless dialogue they conduct with themselves. These thoughts are fugitive, but sometimes sufficient enough to provoke the strongest emotions. Albert Ellis called these thoughts an inner dialogue, while Aaron Beck preferred to call them automatic. Beck’s terms seems to be more precise since it emphasises how mechanical and involuntary they are. Such an inner dialogue is generally non-harmful, but sometimes certain thoughts may pose serious threat for self-esteem and factor into the development of different mental disorders. Automatic thoughts of such kind may be suppressed. This is one of the main skills which a patient of cognitive behavioural therapy is supposed to learn. The search for automatic thoughts cannot be regarded as treatment – it is just a first step of all the cognitive behavioural therapy training programs. However, many patients may feel how effective it is, even if the situation seems to worsen at the beginning. It is proven that the more a patient practices to distinguish his or her automatic thoughts, the better is the result. It can be compared to any other activity such as dancing, skiing, or singing – skills come with experience. The ability to notice automatic thoughts is the first step to obtain control over negative emotions. Therapists sometimes offer their patients to keep a register of their thoughts. Patients are offered to write down what they feel every time they suffer some negative emotion. This register has its special format, which should be kept. It also helps patients understand the role of automatic thoughts in their lives. The second step is to help patients change the patterns of limited thinking. One of the most widely-spread patterns of limited thinking is known as personalization. It means that people tend to relate everything around to themselves. As a rule, it gives rise to painful feelings, since the interpretation of the surrounding is often wrong. At the same time, people still act in accordance to this mistaken interpretation. One of the most effective ways to resist limited thinking is to elaborate balanced alternative statements. It may help a person get rid of depression, anxiety, and consequently improve self-esteem. According to Matthew McKay, a professor of psychology, it is possible to distinguish 8 patterns of limited thinking. Each of them may influence self-esteem in its own way, but in general the effect is rather harmful. If to talk about filtering, the first patterns, it means that a person focuses attention on negative details only. All the positive aspects of a situation remain unnoticed. In other words, people pay no attention to the results they have achieved. Even small mistakes may make them feel frustrated. Polarized thinking means that people can distinguish only the extreme characteristics. Something may be either good or bad. Self-esteem of such people is really vulnerable – they think they must always remain perfect. Otherwise it is impossible to avoid failure. Overgeneralization, the third pattern, makes people come to hasty conclusions on the basis of a single case or fact. That is why an occasional phrase of a strange person may seriously damage their self-esteem. Mind reading is referred to those who are sure they know why other people act and feel in a particular way. They are also sure they understand what others think about them. Catastrophizing, pattern number five, means that people always wait for something bad to happen. A remarkable event, even if it is common for all the people, may exert serious influence over self-esteem. People may think it is going to turn into a disaster and set themselves up for a failure. Magnifying means that a person tends to exaggerate the significance of all the unpleasant events. It makes a person feel depressed and esteem themselves even lower. Pattern number seven, personalization, was already mentioned above. People compare themselves to others and try to find out who is more beautiful, successful, competent, and so on. As a rule, people with low self-esteem come to the conclusion that they are worse than somebody else even if it is not true. It is a serious threat to their self-esteem as well. Finally, the last pattern is shoulds. People may possess certain set of inviolable rules. They feel frustrated and guilty if they fail to follow these rules. If a patient fails to learn how to distinguish patterns of thinking, there is an alternative method. The search for arguments against automatic thoughts may help a patient understand his or her own experiences clearer. This method was elaborated by Albert Ellis and now is known as rational emotive behavior therapy. However, “hot” thoughts of such a kind are always irrational (McKay, Davis, & Fanning 2011). Attention should be paid to the way how to disprove them. That is why this method seems to be inconvenient. There is one more strategy of search and analysis of the required evidences. It was elaborated by Christine Padesky on the basis of Beck’s researches. Padesky does not consider hot thoughts to be completely irrational. Instead, she offers to analyse all the available evidences and distinguish some balanced position. Finally, patients should be encouraged to test their core beliefs. A core belief may be regarded as the profound opinion of people about themselves. They predetermine whether a person consider himself or herself to be beautiful (smart, strong, or anything else) or not. Core beliefs are usually formed in the childhood and influence over almost all the person’s actions. People tend to create certain rules, regulating their behaviour, on the basis of these beliefs and concepts. If these beliefs are positive, people shape realistic and flexible rules. On the contrary, negative concepts shape negative rules, which are often based on restrictions and fears. Core beliefs and rules exert such a profound influence over personality that many people are not even aware of them. At the same time, they may predetermine each aspect in life. They also exert large impact upon automatic thoughts. In general, core beliefs may be considered a basis of personality. They predefine what a person may do (rules) and how he or she may interpret the surroundings (automatic thoughts). That is what actually shapes self-esteem of a person. Unfavourable beliefs may be a reason of low self-esteem. However, negative core beliefs may be changed. The one who has been treated cruel as a child comes through a crisis. Such people may suffer addictions, lack motivation, and have severe low self-esteem. A cognitive behavioural psychologist may help them transform their core beliefs and make their lives better. Therefore, positive thinking may be regarded one of the crucial points when it is necessary to improve and maintain self-esteem. However, it does not mean that a person is just persuaded that everything is all right. It does not also mean that people are to adapt for inconvenient and negative situations in life. People are not supposed to remain passive. Instead, the approach is oriented on active changes. Patients are taught not to build up illusive hopes or underestimate the seriousness of certain problems. It may lead to self-deception, disappointment, and frustration. Patients are to pay attention to the changes which are possible to implement. They should learn how to evaluate resources and capabilities they possess and how to use them properly. And of course, patient should know how to learn from their life experience. Thus, cognitive behavioural therapy is one of the most widely-spread approaches of psychotherapeutics in the USA, Germany, and many other countries. Methods of behavioural modelling are easy to practice in community settings. Cognitive behavioural therapy is problem-oriented and often referred to as training course, but not treatment. It attracts clients who prefer not to be called patients. This therapy encourages people to cope with their problems on their own. It is especially important for patients with borderline personality disorders, often based on infantilism. Many methods, used in cognitive behavioural therapy, may be regarded as coping-strategies, which help people gain skill to adapt for the external environment. References Beck, J. & Beck, A. (2011). Cognitive Behavior Therapy, Second Edition: Basics and Beyond (2nd ed.). New York, NY: The Guilford Press. Craske, M. (2010). Cognitive-Behavioral Therapy (Theories of Psychotherapy). Washington: American Psychological Association. Hofmann, G., Sawyer, A., & Fang, A. (2010). The Empirical Status of the "New Wave" of Cognitive Behavioral Therapy. Psychiatric Clinics of North America 33 (3): 701–10. Longmore, J. & Worrell, M. (2007). Do we need to challenge thoughts in cognitive behavior therapy?. Clinical Psychology Review 27 (2): 173–87. McKay, M. & Fanning, P. (2000). Self-Esteem: A Proven Program of Cognitive Techniques for Assessing, Improving, and Maintaining Your Self-Esteem (3rd ed.). Oakland, CA: New Harbinger Publications. McKay, M., Davis, M., & Fanning, P. (2011). Thoughts and Feelings: Taking Control of Your Moods and Your Life (4th ed.). Oakland, CA: New Harbinger Publications. Rachman, S. (1997). The evolution of cognitive behaviour therapy. Oxford: Oxford University Press. Riggenbach, J. (2012). The CBT Toolbox: A Workbook for Clients and Clinicians. Dublin: Premier Publishing & Media. Spett, Milton. (2004). Cognitive-Behavioral Treatment. Retrieved from http://www.nj-act.org/self.html Tolin, F. (2010). Is cognitive–behavioral therapy more effective than other therapies? A meta-analytic review. Clinical Psychology Review 30 (6): 710–20. Read More