Step 1: Conduct an Assessment and Provide Education
The first step in the CBT treatment of self-esteem problems is to conduct an assessment. This will help determine both the cause of the problem and the ways in which a person can respond to the problem. For some people, their self-esteem levels might vary according to the situation they’re in. For example, they might feel confident about their abilities at work but have low self-esteem when they come home to their families. For other people, their self-esteem might be generally low in all aspects of their lives. Treatments for these two groups of people often incorporate different strategies, so a thorough assessment can improve the chances that the treatment will work. Self-assessment tools, such as a self-concept inventory, can also be helpful. It’s also important for the person to understand that CBT is an active form of treatment that requires him or her to do work outside of the therapy session.
Step 2: Refute the Self-Critic
The self-critic is the judgmental inner voice that tells people they’re incompetent or valueless. The self-critical voice often replays messages such as “You’ll always be alone,” “You always screw up,” and “You’ll never be happy.” Messages like these are the driving force of low self-esteem. One of the first steps of the CBT treatment is to identify these pathological, self-critical messages and confront them. It’s very important to understand where these messages come from, how they affect the person’s life, how they are strengthened over time. Based on this information, the person can begin confronting these messages with a number of different techniques, such as talking back to the self-critic.
Step 3: Challenge Cognitive Distortions
Cognitive distortions are unhelpful thinking styles that often cause people to make automatic judgments about themselves, others, and the world. For example, overgeneralizing involves making broad negative conclusions about life based on limited situations, and minimizing and maximizing involve discounting the positive and enlarging the negative aspects of life. Another cognitive distortion is mind reading, where people assume they know what others are thinking about them. All of these cognitive distortions need to be successfully challenged in order to remove the power of the self-critic.
Challenging these distortions begins with identifying when they are used and then making a strong rebuttal statement every time they are noticed. For example, a person who uses mind reading might challenge that distortion by thinking, “Stop it; it’s impossible for me to know what anyone else is really thinking.”
Step 4: Develop Compassion for Self and Others
Compassion for oneself and others is an essential part of healthy self-esteem. People struggling with low self-esteem often think very poorly of who they are and what they do, even though no one is perfect and everyone struggles with self-doubts at times. What differentiates people with low self-esteem from others is that they criticize themselves more frequently than do people with healthy self-esteem.
The most important step in developing compassion is to cultivate a sense of acceptance. Simply put, acceptance is the ability to stop fighting things that cannot be changed. For example, many people would like to look different, be smarter, have a different family, or find a different job, but these things aren’t always possible. People who struggle against things that can’t be changed get very angry and frustrated. Acceptance acknowledges the facts of what can and can’t be changed, while the final step, forgiveness, releases oneself and others from judgments and criticisms.
There are many techniques people can use to develop compassion for themselves and others, such as cultivating a peaceful state of mind, understanding true self-worth, and learning to communicate without making judgments.
Step 5: Combat the “Shoulds”
The “shoulds” are powerful rules that many people live by that often cause great frustration and low self-esteem. Examples of powerful “should” statements include “I should do everything perfectly,” “I should always be helping others,” and “I should be completely competent.” The truth is, no one is right all the time or perfect in everything he or she does. We all make mistakes.
The key to combating the “shoulds” is to develop healthy values that are flexible and realistic and allow for mistakes. A person with low self-esteem might need to reassess his or her values to determine their true worth, and possibly redefine those values in order to make them healthier and more compassionate.
Step 6: Learn to Handle Mistakes
People with healthy self-esteem are often more compassionate toward themselves when they make mistakes and don’t continue to blame themselves for mistakes after they’ve occurred. It’s far healthier to learn from one’s mistakes than to endlessly blame oneself for them. Mistakes can be reframed as events from which a person can learn, or they can be viewed as warnings that something needs to change. In addition, mistakes can sometimes be avoided by developing a greater awareness of the benefits and disadvantages of ones actions.
Step 7: Learn to Respond to Criticism
Learning to respond to criticism from others is a very important step in the cognitive behavioral treatment of low self-esteem. It begins by recognizing that other people can be critical for many reasons, many of which don’t reflect directly on the person being criticized. For example, a person might be in a bad mood and take out his or her frustration on others. Sometimes it helps to probe the other person’s criticism to determine what he or she really wants. Then it often helps to respond with assertive communication skills. Learning to be assertive can help people ask for what they want, learn to say no, and respond to criticism in a healthy way.
Step 8: Use Visualization and Self-Hypnosis Techniques
Visualization skills use the power of the imagination to help people achieve their goals. These skills often begin with relaxation techniques and then proceed to imagining doing a difficult task successfully, interacting with others in effective ways, or successfully achieving a goal. These are the same techniques that many musicians, actors, and athletes use to prepare themselves for successful performances. Visualization skills prepare people for successful action by imagining that success happening.
Similarly, self-hypnosis techniques can be equally powerful. In many ways, people with low self-esteem have been brainwashed into believing that they are failures. Many of their beliefs in this regard are very old and resistant to change, but this is where self-hypnosis can be a powerful tool. Self-hypnosis techniques can help people reprogram themselves with positive, empowering messages to overcome old habits and develop self-acceptance.
Step 9: Challenge Core Beliefs
As the work on challenging cognitive distortions continues, people usually begin to notice common themes among their thoughts. These themes often point to deeper, more firmly entrenched core beliefs about one’s self that make a person more vulnerable to low self-esteem. These core beliefs, often called schemas, include thoughts like “I’m a failure,” “I’m worthless,” and “I’m unlovable.” When these core beliefs are encountered, they too need to be challenged and modified using an evidence log and tests of those beliefs.
Step 10: Prevent Relapse
Challenging one’s beliefs and improving self-esteem can be difficult. There are likely to be successes and difficulties during the process. The key to developing long-term, healthy self-esteem is to continue using the skills described in this section and to seek professional help when needed.
