What Is Low Self-Esteem And What Keeps It Going?

Low self-esteem is a common issue, but it isn't always the main reason people seek therapy. Sometimes, low self-esteem results from other issues, such as obsessive compulsive disorder (OCD) or post-traumatic stress disorder (PTSD). Alternatively, it can make individuals more vulnerable to developing certain difficulties, like eating disorders. While low self-esteem isn’t formally described in diagnostic manuals, it is an important issue that can be addressed in therapy. An effective treatment for low self-esteem is cognitive behavioral therapy (CBT).

What is low self-esteem?

People with low self-esteem do not hold themselves in high regard; in fact, they tend to see themselves in a very negative and critical light.

At the core of low self-esteem are negative beliefs or judgments about oneself that seem to persist despite contradictory evidence. Sometimes these beliefs are easy to articulate (e.g., “I am unacceptable” or “I’m unlovable”), at other times they may manifest as a more general sense of inadequacy.

Some people with low self-esteem are aware that they treat themselves harshly, while others hold onto their negative beliefs so strongly that they feel like unquestionable facts. Self-esteem also exists on a spectrum: some people find that low self-esteem affects them only in specific situations, while others experience a pervasive lack of self-confidence that colors everything they do.

Low self-esteem can impact people in many ways, influencing how they think, feel, and act. For instance, someone with low self-esteem might:

• Think negatively about themselves, worry that they won’t be able to cope, or blame themselves when things go wrong.

• Feel sad, deflated, ashamed, hopeless, or anxious much of the time.

• Avoid situations that make them anxious, struggle to assert themselves, or overcompensate in some way (e.g., by trying to please other people or do things perfectly).

What keeps low self-esteem going? A CBT perspective:

Melanie Fennell (1997, 1998) identified several key components that help explain why people struggle with low self-esteem. These maintaining factors are sometimes presented as a self-maintaining ‘vicious cycle’ that perpetuates these difficulties.

Negative beliefs

At the core of low self-esteem are negative beliefs or judgments about the self. People with low self-esteem come to believe negative things about themselves, such as being a failure, unlovable, or not good enough. Additional information that relates to these negative beliefs is subject to perceptual and interpretational biases. For example, information that is consistent with a person’s negative beliefs tends to be readily accessible and easily processed, whereas data that is inconsistent with these beliefs is “screened out” (perceptual bias). Moreover, ambiguous data tends to be interpreted negatively, and positive or neutral data is distorted to fit the belief (interpretation bias).

Maladaptive ‘rules for living’

When a person believes that their core belief is true, they may try to overcompensate in some way by adhering to dysfunctional assumptions or problematic ‘rules for living’ – ground rules for operating in the world given the apparent truth of their negative belief (e.g., “If I do everything perfectly, I will be acceptable”, “I must make people happy”). These assumptions can help the person to function while their terms are met, but they do not change the underlying negative belief. In addition, they are often strict and inflexible, which can set the individual up for failure. When these rules seem to have been broken (or if there is a risk that they might be broken), a person with low self-esteem is likely to feel very anxious.

Threatened rules, safety behaviors, and unintended consequences

The negative beliefs associated low self-esteem are often maintained and strengthened in a sequence. First, these beliefs become activated in situations where the individual’s rules for living are threatened. This leads to negative predictions, biased expectations, and anxiety, which prompts the individual to avoid the situation or use ‘safety-seeking behaviors’ - actions aimed at stopping the worst from happening. For example, an individual might over-prepare to avoid making mistakes or try to appear extra-nice so they don’t upset anyone. Unfortunately, avoidance and safety behaviors can prevent the person from discovering that their worst predictions are untrue. In addition, these ways of behaving may (unintentionally) seem to confirm the core belief and strengthen it in the long term.

Why positive experiences fail to change the belief

Unfortunately, information processing biases place individuals with low self-esteem in a “no win” situation. If their negative predictions turn out to be accurate, their negative beliefs are reinforced (e.g., “I knew no-one liked me”). Conversely, if their predictions are proven wrong, they are likely to ignore or discount this contradictory evidence (e.g., “They said they enjoyed talking to me, but I could tell they were just being polite when they mentioned that”). This explains why low self-esteem tends to persist despite success, achievements, and positive feedback.

Self-criticism

As a result of the above factors, a person with low self-esteem is likely to interpret events as more evidence that their negative view of themselves is true, regardless of what actually happens. When events are seen in this way, it can trigger a cascade of self-critical thoughts that lead to low mood. Low mood can, in turn, reinforce the cycle: when individuals feel depressed, negative predictions and self-critical thoughts often become more frequent and convincing. This keeps the underlying negative self-belief active, making it harder for the person to distance themselves from these thoughts.

Conclusion

Melanie Fennell’s seminal work shows that low self-esteem is maintained by several interconnected cognitive, emotional, and behavioral processes. Negative core beliefs are activated when a person's rules for living are broken or threatened. This leads to negative predictions, avoidance, and/or the use of safety behaviors. The information processing biases and self-critical thinking that follow reinforce the negative core belief, perpetuating it and contributing to anxiety and low mood.

In this way, the cognitive behavioral model helps clients and therapists identify the mechanisms that fuel low self-esteem and identify important targets for therapy, such as anxious predictions, unhelpful behaviors, self-critical thinking, and problematic rules for living. Most importantly, cognitive behavioral treatments based on this model appear to be effective (e.g., Kolubinski et al., 2018).

References

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

• Fennell, M. J. (1998). Cognitive therapy in the treatment of low self-esteem. Advances in Psychiatric Treatment, 4(5), 296-304.

• Kolubinski, D. C., Frings, D., Nikčević, A. V., Lawrence, J. A., & Spada, M. M. (2018). A systematic review and meta-analysis of CBT interventions based on the Fennell model of low self-esteem. Psychiatry Research, 267, 296–305.