A systematic review and meta-analysis of CBT interventions based on the Fennell model of low self-esteem

Ageism and Type D Personality: The Protective Role of Self-Esteem and Perceived Social Support

Background: This study examined the relationship between Type D personality and ageism in young adults, and evaluated the role of protective and risk factors. Methods: Two hundred and forty-seven community volunteers (M age = 31.8 years) reported online on age-related attitudes, Type D personality, and on measures of well-being. Results: A significant correlation was found between ageist attitudes and the tendency toward Type D personality. Both Type D personality and ageism correlated negatively with all the well-being measures. Perceived social support (PSS) partially down-mediated the association between Type D personality and ageism. A three-way interaction was found among individuals with Type D personality. Low PSS and low self-esteem were associated with an elevation of ageism compared to those with low PSS and high self-esteem. Discussion: The current research suggests that self-esteem and PSS are protective against ageism, and might be good targets for psychological interventions in order to mitigate ageism, particularly among individuals with Type D personality.

Exploring Mental Health Services for Youth Experiencing Homelessness in East Asian Pacific Regions: A Systematic Scoping Review

BACKGROUND

Youth experiencing homelessness (YEH) in East Asian Pacific (EAP) regions represent one of the most at-risk populations due to cultural and geographical factors. Effective mental health interventions, primarily researched in Western contexts, may not fully apply to YEH in EAP. Their lack of stable shelter, disrupted social networks, and limited access to mental health services elevate their susceptibility to adverse mental health, making urgent interventions essential to address their needs.

OBJECTIVE

The objective of this study is to explore and systematically search the types of mental health services and interventions available for YEH in EAP and their impact on overall quality of life and wellbeing.

METHODS

Electronic databases (e.g., Medline, PsycINFO, PubMed, Scopus) were systematically searched (publication dates between 1 January 1990 and 13 May 2023), as well as additional online resources specific to homelessness. Articles were screened, and a critical appraisal assessed the quality of the included studies.

RESULTS

Eight studies with different interventions were identified in Indonesia (n = 2), Malaysia (n = 1), South Korea (n = 3), and the Philippines (n = 1). These were thematically clustered into six categories: art, cognitive behavioural therapy, life skills education, resilience enhancement, family strengthening, and government interventions/services.

CONCLUSIONS

This review highlights effective mental health interventions' positive impact on YEH mental health outcomes and quality of life in EAP, stressing the urgent need to implement socio-culturally sensitive services. Future research should address knowledge gaps through comprehensive studies covering diverse EAP regions and populations, prioritising socio-culturally specific psychological measures.

Stigma and self-esteem in facial burn patients: A correlation study

BACKGROUND

A considerable number of burn patients have greater psychological stress due to the special trauma site. In clinical practice, it is found that medical staff pay more attention to the rehabilitation of physical function, while the mental health status of patients is greatly neglected. In contact with patients, we found that attention should be paid to the levels of stigma and self-esteem. However, there are few studies on stigma and self-esteem in patients with facial burns. Therefore, this study aimed to describe the stigma and self-esteem levels of facial burns, investigate the relationship between these two variables, and explore the influencing factors of stigma in patients with facial burns, in order to provide evidence for follow-up interventions to improve this population.

METHODS

From August 2020 to June 2021, we recruited patients with facial burns who met the inclusion criteria in one burn specialist clinic and three burn units of a tertiary A hospital in Guangzhou, China. The survey tools of this study include sociodemographic and disease-related information questionnaires, the Chinese version of the Social Impact Scale, and the self-esteem scale (these scales were validated). SPSS 25.0 software was used for data analysis through t test, analysis of variance, correlation analysis, multiple linear regression method for data statistics.

RESULTS

The total stigma score of facial burn patients was (58.01 ± 7.57), which was at a medium level; the self-esteem score was (19.72 ± 2.43), which was at a low level. Correlation analysis showed that there was a positive correlation between the self-esteem score and the total score of stigma (r = 0.286, P < 0.01). The family per capita monthly income, education level, way of medical expenses expenditure, and self-esteem of facial burn patients were the influencing factors of their stigma, and these factors explained 33.7% of the variation in stigma (F=8.659, P＜0.01).

CONCLUSIONS

Patients with facial burns have low levels of stigma and self-esteem, which requires our efforts. In particular, there is a positive correlation between stigma and self-esteem, and self-esteem is an independent risk factor affecting stigma. Our findings suggest that interventions aimed at enhancing self-esteem have the potential to positively impact the reduction of stigma in this patient population.

Enhancing self-esteem in adults with body dysmorphic symptoms: experimental testing and initial evaluation of a brief internet-based training

BACKGROUND

Low self-esteem is an important factor associated with body dysmorphic concerns. In treatment, self-esteem cannot always be adequately addressed. Internet-based interventions offer a low-threshold and cost-efficient possibility for treating body dysmorphic disorder (BDD).

AIMS

For this reason, we conducted two studies to explore the effectiveness of an internet-based intervention targeting improving self-esteem in adults with BDD symptoms.

METHOD

The first study investigated the differential effects of a 1-week self-esteem training compared with a 1-week attention-focus training. Two hundred twenty adults with elevated body dysmorphic symptoms were randomly assigned to one of the two trainings. Our second study (n = 58 adults with body dysmorphic symptoms) evaluated an extended 2-week stand-alone self-esteem training.

RESULTS

In the first study, self-esteem in different domains (appearance, performance and social), self-focused attention, and BDD symptom severity improved in both groups. Other-focused attention only increased in the attention training group. Participants' overall adherence was high. In the second study we observed significant improvements in self-esteem, BDD symptom severity, and other secondary outcomes, with additional improvements in most outcomes in the second week. Adherence was again high.

CONCLUSIONS

Together, these findings show that a brief internet-based intervention may be a highly accepted and effective way of improving self-esteem in people suffering from BDD symptoms.

Transdiagnostic Ecological Momentary Intervention for Improving Self-Esteem in Youth Exposed to Childhood Adversity: The SELFIE Randomized Clinical Trial

Importance

Targeting low self-esteem in youth exposed to childhood adversity is a promising strategy for preventing adult mental disorders. Ecological momentary interventions (EMIs) allow for the delivery of youth-friendly, adaptive interventions for improving self-esteem, but robust trial-based evidence is pending.

Objective

To examine the efficacy of SELFIE, a novel transdiagnostic, blended EMI for improving self-esteem plus care as usual (CAU) compared with CAU only.

Design, Setting, and Participants

This was a 2-arm, parallel-group, assessor-blinded, randomized clinical trial conducted from December 2018 to December 2022. The study took place at Dutch secondary mental health services and within the general population and included youth (aged 12-26 years) with low self-esteem (Rosenberg Self-Esteem Scale [RSES] <26) exposed to childhood adversity.

Interventions

A novel blended EMI (3 face-to-face sessions, email contacts, app-based, adaptive EMI) plus CAU or CAU only.

Main Outcomes and Measures

The primary outcome was RSES self-esteem at postintervention and 6-month follow-up. Secondary outcomes included positive and negative self-esteem, schematic self-beliefs, momentary self-esteem and affect, general psychopathology, quality of life, observer-rated symptoms, and functioning.

Results

A total of 174 participants (mean [SD] age, 20.7 [3.1] years; 154 female [89%]) were included in the intention-to-treat sample, who were primarily exposed to childhood emotional abuse or neglect, verbal or indirect bullying, and/or parental conflict. At postintervention, 153 participants (87.9%) and, at follow-up, 140 participants (80.5%), provided primary outcome data. RSES self-esteem was, on average, higher in the experimental condition (blended EMI + CAU) than in the control condition (CAU) across both postintervention and follow-up as a primary outcome (B = 2.32; 95% CI, 1.14-3.50; P < .001; Cohen d-type effect size [hereafter, Cohen d] = 0.54). Small to moderate effect sizes were observed suggestive of beneficial effects on positive (B = 3.85; 95% CI, 1.83-5.88; P < .001; Cohen d = 0.53) and negative (B = -3.78; 95% CI, -6.59 to -0.98; P = .008; Cohen d = -0.38) self-esteem, positive (B = 1.58; 95% CI, 0.41-2.75; P = .008; Cohen d = 0.38) and negative (B = -1.71; 95% CI, -2.93 to -0.48; P = .006; Cohen d = -0.39) schematic self-beliefs, momentary self-esteem (B = 0.29; 95% CI, 0.01-0.57; P = .04; Cohen d = 0.24), momentary positive affect (B = 0.23; 95% CI, 0.01-0.45; P = .04; Cohen d = 0.20), momentary negative affect (B = -0.33; 95% CI, -0.59 to -0.03, P = .01, Cohen d = -0.27), general psychopathology (B = -17.62; 95% CI, -33.03 to -2.21; P = .03; Cohen d = -0.34), and quality of life (B = 1.16; 95% CI, 0.18-2.13; P = .02; Cohen d = 0.33) across postintervention and follow-up. No beneficial effects on symptoms and functioning were observed.

Conclusions and Relevance

A transdiagnostic, blended EMI demonstrated efficacy on the primary outcome of self-esteem and signaled beneficial effects on several secondary outcomes. Further work should focus on implementing this novel EMI in routine public mental health provision.

Trial Registration

Dutch Trial Register Identifier:NL7129(NTR7475).

Resilience resources, life stressors, and postpartum depressive symptoms in a community sample of low and middle-income Black, Latina, and White mothers

Resilience resources refer to factors that protect against the physical and mental health effects of stress exposure. This study used a cross-sectional design to test whether three individual-level resilience resources-mastery, self-esteem, and perceived social support-moderated associations between prenatal major life stressors and postpartum depressive symptoms at approximately 8 weeks postpartum. Participants were 2510 low- and middle-income women enrolled after the birth of a baby in a multi-site study of five communities in the United States. At approximately 8 weeks postpartum, participants were interviewed in their homes to assess the three resilience resources, symptoms of depression, and major life stressors that had occurred during the pregnancy. The results of path analyses revealed that mastery and self-esteem moderated the positive association between prenatal life stressors and postpartum depressive symptoms adjusting for race/ethnicity, partner status, years of education, and household income. Perceived social support was associated with fewer postpartum depressive symptoms but did not moderate the association between life stressors and depressive symptoms. Higher levels of two personal resilience resources, mastery and self-esteem, attenuated the association between prenatal life stressors and early postpartum depressive symptoms in a large, predominantly low-income multi-site community sample. These findings highlight the protective nature of individual-level resilience resources in the early postpartum period when maternal adjustment shapes parent and child health outcomes.

Self-esteem in new light: a qualitative study of experiences of internet-based cognitive behaviour therapy for low self-esteem in adolescents

BACKGROUND

Low self-esteem is common and can be impairing for adolescents. Treatments that primarily target low-esteem are lacking. Internet-delivered cognitive behaviour therapy (ICBT) is a treatment that can be used for adolescents but ICBT is yet to be evaluated for low self-esteem using qualitative methods. The aim of this study was to investigate experiences of participating in a novel ICBT treatment for adolescents suffering from low self-esteem.

METHOD

Fifteen adolescent girls who had received ICBT consented to participate in a semi-structured qualitative telephone interview at post-treatment. Data were analysed and categorised using inductive Thematic Analysis.

RESULTS

Four overarching themes were identified; (1) Increased awareness and agency in difficult situations, (2) Enhanced self-image, (3) Unique but not alone, and (4) Widened understanding and new perspectives. Participants reported positive changes in their thinking and behaviour, as well as helpful learning experiences in relation to themselves and their self-esteem. For instance, participants described a more self-accepting attitude, learned how to manage negative thoughts, and experienced an increased sense of connection to others.

CONCLUSION

The results suggest that ICBT is experienced as helpful and will inform further use and development of ICBT for low self-esteem. Future studies should validate and further evaluate experiences of ICBT for low self-esteem in other settings and in particular for boys as the study only include female participants.

Low self-esteem: a refined cognitive behavioural model

Melanie Fennell's (1997) seminal cognitive approach to low self-esteem was published in Behavioural and Cognitive Psychotherapy. The current paper proposes a refined model, drawing on social theories, and research with people with socially devalued characteristics. This model emphasises how self-esteem relates to perceptions of one's value in the eyes of others. It is proposed that core beliefs typical of low self-esteem relate to one's value in relation to personal adequacy (e.g. having worth or status) and/or to social connection (e.g. being liked, loved, accepted or included). In each of these value domains, beliefs about both the self (e.g. 'I am a failure', 'I am unlovable') and others (e.g. 'Others look down on me', 'Others don't care about me') are considered important. The model suggests that everyone monitors their value but in people with low self-esteem, cognitive biases associated with underlying beliefs occur. In the context of trigger situations, this results in a greater likelihood of negative appraisals of perceived threat to one's value. Such appraisals activate underlying negative beliefs, resulting in negative mood (e.g. low mood, anxiety, shame, disgust) and other responses that maintain low self-esteem. Responses which can be used excessively or in unhelpful ways include (a) corrective behaviours; (b) compensatory strategies; (c) increased value monitoring; (d) safety-seeking behaviours; (e) rumination; (f) unhelpful mood regulation responses. These responses can adversely impact daily functioning or health, having the counterproductive effect of maintaining negative beliefs about one's value. Examples are provided for low self-esteem in lesbian, gay and bisexual individuals.

Self-Esteem and Self-Compassion: A Narrative Review and Meta-Analysis on Their Links to Psychological Problems and Well-Being

The present review addressed the relationship between two self-related concepts that are assumed to play a role in human resilience and well-being: self-esteem and self-compassion. Besides a theoretical exploration of both concepts, a meta-analysis (k = 76, N = 35,537 participants) was conducted to examine the magnitude of the relation between self-esteem and self-compassion and their links to indices of well-being and psychological problems. The average correlation between self-esteem and self-compassion was strong (r = 0.65, effect size = 0.71), suggesting that - despite some distinct features - the overlap between both self-related constructs is considerable. Self-esteem and self-compassion displayed relations of a similar magnitude to measures of well-being and psychological problems, and both concepts accounted for unique variance in these measures once controlling for their shared variance. Self-esteem and self-compassion can best be seen as complementary concepts and we invite researchers to look more at their joint protective role within a context of well-being and mental health as well as to their additive value in the treatment of people with psychological problems.

The Lexical Association Technique: A randomized controlled trial with breast cancer patients

Low self-esteem is a vulnerability factor for depressive disorders, and the prevention of psychological disorders is essential in cancer patients. The enhancement of self-esteem in breast cancer patients may therefore be an appropriate clinical target. Previous studies have shown the efficacy of the Lexical Association Technique to enhance self-esteem in healthy subjects. This study aims to test the clinical efficacy and acceptability of the Lexical Association Technique on the self-esteem of cancer patients. A double-blind randomized controlled trial was conducted on 63 breast cancer patients during their radiotherapy treatment. Global self-esteem measures were taken using the Rosenberg Self-Esteem Scale before and after the Lexical Association Technique and 1 month after its end. The results showed a significant improvement in global self-esteem in patients immediately after performing the Lexical Association Technique compared to an active control group. However, the positive effects did not last 1 month. These results confirm the efficacy and suitability of the Lexical Association Technique for cancer patients. Avenues of research are proposed to extend the effects of the technique and increase its transdiagnostic applicability.

Self-esteem and its relationship with depression and anxiety in adults with intellectual disabilities: a systematic literature review

BACKGROUND

In the general population, low self-esteem has been linked with poorer mental and physical health. This systematic literature review aimed to summarise and evaluate the findings of studies that examined self-esteem in adults with intellectual disabilities and links with mental health outcomes.

METHOD

A systematic search of PsycINFO, Web of Science and CINAHL was conducted to identify studies published between 1990 and 2021. The studies were appraised using the QualSyst tool.

RESULTS

Twenty-six articles were identified of which two studies were removed from the review due to low quality. Studies reported mixed evidence regarding levels of self-esteem compared with the general population. Engagement in activities appeared to be linked with positive self-esteem, and perception of negative interpersonal life events as having a negative impact was associated with lower self-esteem. There was evidence of co-occurrence of low self-esteem and depression, but no studies examined the relationship between self-esteem and anxiety.

CONCLUSION

Reviewed studies provided mixed evidence on levels of self-esteem in this population, suggesting that factors such as engagement in life were related to higher self-esteem and demonstrating the co-occurrence of low self-esteem and depression. However, clear causal links have yet to be identified, and more research is needed using longitudinal designs to answer questions about trajectory.

Effect of psychotherapy for adult depression on self-esteem: A systematic review and meta-analysis

BACKGROUND

There is emerging evidence to suggest that Cognitive Behavioral Therapy for depression may have a secondary effect on self-esteem, but less is known about non-CBT based interventions. To examine this, we had two main aims; (1) to meta-analyze psychotherapy effects on (i) depression and (ii) self-esteem, and (2) to investigate the relationship between reductions in depression symptoms and improvements in self-esteem.

DESIGN

A systematic review and meta-analysis.

METHODS

Following the PRISMA guidelines, we conducted a meta-analysis of randomized control trials of psychotherapy for adult depression, which included a self-esteem outcome at post-treatment. Nineteen studies with a total of 3423 participants met the inclusion criteria. For each comparison between psychotherapy and a control condition, we calculated Hedges' g both for depression and self-esteem and pooled them in two separate meta-analyses. Furthermore, meta-regression was used to explore the association between the effect of psychotherapy for depression and its effect on self-esteem.

RESULTS

The effects on depression were large and significant (Hedges' g = -0.95; [95 % CI: -1.27, -0.63]). We found evidence of smaller, albeit still moderate, effects on self-esteem (Hedges'g = 0.63; [95 % CI:0.32, 0.93]), with sustained effects at 6-12 months (Hedges'g = 0.70; [95 % CI: -0.03, 1.43]). We also found a strong inverse association between the effects of psychotherapy for depression and self-esteem (β = -0.60, p < 0.001).

LIMITATIONS

Heterogeneity was very high (I² = 97 %), and out of 19 trials, only 6 trials were rated as having a low risk of bias.

CONCLUSIONS

The results suggest that psychotherapy for depression may improve self-esteem to a moderate degree.

Reasons for living, positive psychological constructs and their relationship with suicide ideation in people with moderate to severe traumatic brain injury: A cross-sectional study

Positive psychological constructs such as reasons for living, self-esteem and resilience have previously been shown to act as protective psychological barriers against negative psychological outcomes, including suicide ideation in both clinical populations and the general population. This study aims to explore the positive psychological constructs of reasons for living, self-esteem, resilience and their relationship with suicide ideation and predictors of suicide ideation (depression, hopelessness) for N = 50 people who have a severe TBI and are currently receiving community rehabilitation at Liverpool Brain Injury Rehabilitation Unit (LBIRU), NSW. Results indicated good reliability for the use of the RFLI with people who have TBI, with the most frequently endorsed subscale (range 0-5) being "survival and coping beliefs" (4.7 ± 1.0) and the least frequently being "fear of suicide" (2.2 ± 1.1). The shortened version of the RFLI (BRFLI) also displayed good reliability. Positive psychological constructs (reasons for living, resilience, self-esteem) were all significantly inversely associated with suicide and suicide predictors (depression, hopelessness). This study suggests that positive psychological constructs can act as a buffer against suicide ideation after moderate to severe TBI.

Internet-based CBT for adolescents with low self-esteem: a pilot randomized controlled trial

Low self-esteem is a common problem among adolescents and is related to psychiatric problems such as depression and anxiety. However, effective and available interventions primarily targeting low self-esteem are scarce, in particular for youths. To address this gap, the aim of this pilot study was to evaluate a novel internet-based Cognitive Behavioral Therapy (ICBT) program for low self-esteem in adolescents using a randomized controlled design. Fifty-two participants (15-19 years) were recruited and randomly allocated to seven weeks of therapist-supported ICBT (n=26) or to a waitlist control condition (n=26). The primary outcome was the Rosenberg Self-Esteem Scale (RSES). Secondary outcomes measured domain-specific aspects of self-esteem, self-compassion, quality of life, depression and anxiety. The treatment group showed significantly higher levels of self-rated self-esteem compared to the control group at post-treatment, with a large between-group effect-size (RSES, d = 1.18). Further, the treatment had significant positive impact on secondary measures of self-esteem, self-compassion, quality of life, depression and anxiety. The results of this pilot-RCT suggest that ICBT can be effective for treating low self-esteem in adolescents, decrease depression and anxiety levels, and increasing quality of life. Replication of the results in larger samples is needed.

"I'll Worry About It Tomorrow" - Fostering Emotion Regulation Skills to Overcome Procrastination

Procrastination remains an omnipresent phenomenon impeding especially students' academic performance and well-being. Preliminary findings suggest that procrastination emerges due to dysfunctional emotion regulation efforts to regulate aversive emotions. This study's objective was to clarify whether the enhancement of general adaptive emotion regulation skills reduces subsequent procrastination. For the purpose of this study, data from a two-armed randomized controlled trial (RCT) with (N = 148) university students, comprising an active intervention (IG) and a passive wait-list control (WLC) group, was collected. Participants of the intervention group were provided with an online emotion regulation training over a period of 9 weeks. The results showed that the enhancement of general emotion regulation skills significantly reduced subsequent procrastination behavior within the IG as compared to the untreated WLC. Moreover, subsequent mediation analyses revealed that the reduction of procrastination was significantly mediated by the increase in general ER skills. The present results suggest that trainings which enhance general ER skills are an appropriate measure to reduce procrastination behavior among university students. The practical value of ER training interventions, particularly for student populations, is discussed.

A cognitive behavioural intervention for low self-esteem in young people who have experienced stigma, prejudice, or discrimination: An uncontrolled acceptability and feasibility study

OBJECTIVES

Stigma has been found to be associated with lower self-esteem, which increases the risk of difficulties across life domains including vulnerability to mental health problems. There are no previous studies of interventions for people experiencing low self-esteem in the context of different stigmatized characteristics. This study evaluated feasibility, acceptability, and preliminary outcomes of an intervention targeting low self-esteem in stigmatized people aged 16-24 years.

DESIGN

An uncontrolled study with repeated measures.

METHOD

People with a range of stigmatized characteristics, who had low self-esteem and associated impaired daily functioning, were recruited from the general population. The individual six-session cognitive behavioural intervention had modules chosen according to participants' formulations. The CBT included compassion-focussed therapy methods and was informed by stigma research. Feasibility was assessed in relation to recruitment, retention, and protocol adherence. Acceptability was assessed through participant feedback. Questionnaires assessing self-esteem, functioning impairments, depression, anxiety, self-criticism, self-compassion, and responses to prejudice and discrimination were administered at baseline, pre-, mid-, post-intervention, and two-month follow-up.

RESULTS

Forty-four people completed screening; 73% were eligible. Of these, 78% consented and 69% (N = 22) started the intervention. Eighteen (82%) participants completed, and four dropped out. Follow-up measures were completed by all treatment completers. Treatment completers reported the intervention was useful, improved their self-esteem and coping, and would recommend it. Ratings of usefulness and frequency of use of intervention components were high at post-treatment and follow-up.

CONCLUSIONS

The intervention was feasible and highly acceptable to treatment completers. This suggests the intervention warrants investigation in a randomized-controlled trial.

PRACTITIONER POINTS

Young people with low self-esteem whom have been negatively affected by stigma may wish to access support and be willing to engage in psychological interventions. Cognitive behavioural therapy may be helpful for young people with low self-esteem who have experienced stigma, prejudice, or discrimination. Cognitive behavioural techniques such as self-compassionate thought records and behavioural experiments were considered acceptable and helpful by young people whose self-esteem has been affected by stigma. Addressing responses to stigma in therapy, such as rumination, avoidance, and perfectionism, appears to be feasible and acceptable.

The Influence of Perfectionism, Self-Esteem and Resilience on Young People's Mental Health

The current study explored whether maladaptive perfectionism and low self-esteem constituted reliable risk factors of student mental illness, as well as determining whether resilience moderates these predictive relationships. 434 University undergraduate students were recruited. Depression and anxiety were measured using the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Assessment (GAD-7). Perfectionism, self-esteem and resilience were analyzed in relation to the PHQ9 and GAD-7 scores via a regression analysis. Perfectionism discrepancy, self-esteem and resilience all significantly predicted depression and anxiety. Hierarchical regression analysis revealed a statistically significant amount of additional variance to be explained by resilience for depression and anxiety, than for perfectionism and self-esteem alone. Maladaptive perfectionism and low self-esteem predispose an individual to depression and anxiety, though resilience may act as a protective factor against development of mental illness.

A New Technique to Increase Self-Esteem by Reading and Mental Visualization: The Lexical Association Technique

Introduction: Self-esteem is central to human well-being, quality of life, and mental health. Therefore, it is important to propose preventive and therapeutic techniques to deal with decline in self-esteem. Different interventions have been proposed and their efficacies have been validated. However, they present certain constraints such as a cognitive and/or emotional cost, which limit some clinical applications. Method: Based on contributions from cognitive, social, and clinical psychology, we propose to test the efficacy of a new technique for self-esteem enhancement using brief lexical associations and mental visualization (six sessions of five minutes) for a stimulation of episodic and semantic self-perceptions. Results: Comparing the Lexical Association Technique to a control technique and using a double-blind pre-post design, two studies show the efficacy of this new technique on global self-esteem in two samples of students (nStudy1 = 36; nStudy2 = 89), as well as a sustained effect up to 5 days after the technique is stopped. Discussion: The mechanisms underlying the efficacy of this technique are discussed. Further studies are needed to precise the clinical applicability of the Lexical Association Technique on patients.

Associations Between Maladaptive Perfectionism and Life Satisfaction Among Chinese Undergraduate Medical Students: The Mediating Role of Academic Burnout and the Moderating Role of Self-Esteem

Empirical research has shown that maladaptive perfectionism may lead to lower life satisfaction. However, the relationship between maladaptive perfectionism and life satisfaction among medical students and the mechanism underlying this relationship still need to be further explored. The present study used a large sample of undergraduate medical students to examine the associations between maladaptive perfectionism and life satisfaction and to explore the mechanism underlying the associations. Specifically, the present study tried to probe the mediating role of academic burnout and the moderating role of self-esteem in the relationship between maladaptive perfectionism and life satisfaction in medical students. We invited 1628 undergraduate medical students from two medical universities in Northeastern China to participate in the survey. Among the students recruited, 1377 medical students (response rate: 84.6%) completed questionnaires including the Frost Multidimensional Perfectionism Scale (FMPS) maladaptive perfectionism subscales, the Chinese College Student Academic Burnout Inventory (CCSABI), the Satisfaction With Life Scale (SWLS), the Rosenberg Self-Esteem Scale (RSES) and demographic information. Results show that maladaptive perfectionism was significantly negatively related to life satisfaction among medical students and academic burnout played a significant mediating role (β = -0.10, BCa 95%CI: -0.12, -0.07) in this relationship. Moderated mediation analyses reveal that the mediating effect of maladaptive perfectionism on life satisfaction via academic burnout was moderated by self-esteem. Maladaptive perfectionism exerted a stronger effect on life satisfaction via the mediating role of academic burnout for medical students with high self-esteem [β = -0.026, SE = 0.009, 95%CI = (-0.047, -0.011)] than for medical students with low self-esteem [β = -0.019, SE = 0.009, 95%CI = (-0.038, -0.001)]. Medical institutions can implement effective interventions to decrease medical students' maladaptive perfectionism levels and academic burnout levels, and increase their self-esteem levels in order to enhance their life satisfaction.

The Effectiveness of Self-Esteem-Related Interventions in Reducing Suicidal Behaviors: A Systematic Review and Meta-Analysis

Suicide is a serious social issue and is often treated using psychological interventions. The current systematic review and meta-analysis aimed to investigate the effectiveness of self-esteem-related interventions on suicidal behaviors. A systematic literature search for randomized controlled trials (RCTs) including a self-esteem component was conducted on 29 May 2021 and updated on 4 April 2022. In total, 12 studies were included in the systematic review and five studies were included in the meta-analysis. Small effect sizes were found for suicidal ideation at post intervention [g = -0.24, 95% CI (-0.48, 0.00)] and a 3-month follow-up [g = -0.36, 95% CI (-0.62, -0.11)]. However, these results should be interpreted cautiously due to the limited number of included studies and varied sample population. In conclusion, the current review suggests that future intervention studies should incorporate self-esteem enhancement in the treatment of suicidal behaviors, especially for suicidal ideation.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=250882.

A transdiagnostic model of low self-esteem: pathway analysis in a heterogeneous clinical sample

BACKGROUND

Low self-esteem (LSE) has been associated with several psychiatric disorders, and is presumably influenced by transdiagnostic factors. Our study was based both on investigations of the relationship between depression and LSE (vulnerability, scar, reciprocal models) and on theories of cognitive factors contributing to the development and maintenance of LSE, such as Melanie Fennell's model, the catalyst model and the Self-Regulatory Executive Function model.

AIMS

Based on the theories above, in our cross-sectional study we aimed at understanding more specifically the transdiagnostic factors that can maintain LSE in a heterogeneous clinical sample.

METHOD

Six hundred and eleven out-patients were assessed by SCID-I and self-report questionnaires. The model was tested by structural equation modelling.

RESULTS

Based on the fit indices, the hypothesis model did not fit the data; therefore, a modified transdiagnostic model was emerged. This model made a good fit to the data [χ2 (12, n=611)=76.471, p<.001; RMSEA=.080, CFI=.950, TLI=.913] with a strong explanatory power (adj R2=.636). Severe stressful life events and depressive symptoms lead to LSE indirectly. Self-blame, perfectionism, seeking love and hopelessness have been identified as mediating factors in the relationship between depressive symptoms and LSE. Although there was a significant correlation between state-anxiety and LSE, as well as LSE and rumination, these two factors did not fit into the model.

CONCLUSIONS

The new transdiagnostic model of LSE has great potential in the treatment of various mental conditions and may serve as a guide to developing more focused and more effective therapeutic interventions.

The role of self-evaluation in predicting attitudes toward supporters of COVID-19-related conspiracy theories: A direct and a conceptual replication of Cichocka et al. (2016)

We examined the role of people’s self-evaluation in predicting their attitudes toward supporters of COVID-19-related conspiracy theories by replicating and extending the findings of a study by Cichocka et al. (2016, Study 3) in two preregistered studies (total N = 1179). Study 1, a direct replication, confirmed that narcissism and self-esteem—two different sources of people’s self-evaluation—differentially predicted their beliefs in a series of well-known conspiracy theories (not related to COVID-19), and served as mutual suppressor variables. Specifically, narcissism was positively related and self-esteem was negatively related to conspiracy beliefs, especially when the respective other predictor was controlled for. Study 2 extended Cichocka’s and our Study 1’s findings by testing the differential role of self-esteem and narcissism in predicting a COVID-19-specific criterion. Specifically, we focused on people’s rejection of supporters of COVID-19 conspiracy theories, a criterion we deem particularly important in curtailing the spread of these theories. Results were generally in line with previous findings, but effects were substantially weaker. As suggested by exploratory analyses, this might be due to the fact that the overall rejection of supporters measure comprises not only items capturing rejection of supporters but also items capturing low beliefs in conspiracy theories. These two distinct components differentially related to self-esteem and narcissism: the differential role of self-esteem and narcissism could only be replicated for the “low belief” subcomponent (thus replicating findings from the original study and from Study 1) but not for the “rejection of supporters” subcomponent. The present work thus contributes to recent research suggesting that low belief in conspiracy theories and the rejection of their supporters might be qualitatively different responses with unique antecedents.

The Associations of Common Psychological Problems With Mental Disorders Among College Students

Psychological problems like procrastination, perfectionism, low self-esteem, test anxiety and stress are common among college students. There are evidence-based interventions available for these problems that not only have direct effects on these problems, but also indirect effects on mental disorders such as depression and anxiety disorders. Targeting these psychological problems may offer new opportunities to prevent and treat mental disorders in a way that is less stigmatizing to students. In this study we examined the association of five psychological problems with five common mental disorders (panic, generalized anxiety, bipolar, major depressive, and substance use disorder) in a sample of 2,449 students from two Dutch universities. Psychological problems were measured with one item for each problem and mental disorders were measured with the Composite International Diagnostic Interview Screening Scales. Associations were examined with Poisson regression models as relative risks (RR) of the disorders as a function of the psychological problems. The population attributable fraction (PAF) indicates by what percentage the prevalence of the mental disorder would be reduced if the psychological problem was addressed successfully by an intervention. Especially generalized anxiety disorder was strongly associated with psychological problems (strong associations with stress and low self-esteem and moderately with test anxiety). The group with three or more psychological problems had a strongly increased risk for generalized anxiety (RR = 11.25; 95% CI: 7.51-16.85), and a moderately increase risk for major depression (RR = 3.22; 95% CI: 2.63-3.95), panic disorder (RR = 3.19; 95% CI: 1.96-5.20) and bipolar disorder (RR = 3.66; 95% CI: 2.40-5.58). The PAFs for having any of the psychological problems (one or more) were considerable, especially for generalized anxiety (60.8%), but also for panic disorder (35.1%), bipolar disorder (30.6%) and major depression (34.0%). We conclude that common psychological problems are associated with mental disorders and with each other. After adjustment, psychological problems are associated with different patterns of mental disorders. If the impact of the psychological problems could be taken away, the prevalence of several mental disorders would be reduced considerably. The psychological problems may provide a promising target to indirectly prevent and intervene in psychopathology in hard to reach college students with mental disorders.

Compassion-focused therapies for self-esteem: A systematic review and meta-analysis

PURPOSE

To identify whether compassion-focused therapy (CFT) or compassion-based interventions are effective in improving self-esteem.

METHODS

Databases (CINAHL, MEDLINE, and PsycINFO) were searched, along with OpenGrey literature. Experts were also contacted and handsearching of reference lists and citing articles undertaken. To be eligible, papers had to include an intervention identified as being compassion-based and mention 'self-esteem' as a variable or outcome. Papers were quality appraised using the Mixed Methods Appraisal Tool. Data were analysed using a random-effects meta-analysis model, with sensitivity analysis conducted in relation to the quality of studies.

RESULTS

Ten eligible papers were identified. Within-group analysis of data from eight studies demonstrated a medium, significant overall effect size (g = 0.56, 95% CI [0.19-0.93], z = 3.54, p < .001), which increased slightly and remained significant (g = 0.61, 95% CI [0.05-1.17], z = 2.82, p = .005) when the lowest quality studies were removed.

CONCLUSIONS

Compassion-focused therapy or compassion-based interventions may be effective in improving self-esteem. However, there is large clinical and methodological heterogeneity amongst studies making further conclusions difficult.

PRACTITIONER POINTS

CFT/compassion-based interventions appear to be effective in improving self-esteem. Transdiagnostic concepts (such as low self-esteem and compassion-focused therapy) should be considered in supporting people with their mental health.

Self-esteem in individuals at ultra-high risk for psychosis: A systematic review and meta-analysis

AIM

Low self-esteem (LSE) has been reported among individuals with psychosis and is hypothesized to act as a risk and maintenance factor for the disorder. However, the extent to which LSE also characterizes individuals deemed at ultra-high risk (UHR) for psychosis (who present features consistent with the prodromal phase of illness), has yet to be quantified using meta-analysis. This is important given that LSE is a potentially modifiable target for early intervention services aiming to reduce the risk of psychosis transition in this population.

METHODS

We searched Medline, Embase, PsycINFO and Web of Science Core Collection for studies examining self-esteem in UHR and healthy individuals. Random-effects models were used to examine group differences in self-esteem (Hedges'g) with exploratory meta-regression analyses employed to investigate the effect of study characteristics (mean age of UHR group, the proportion of male participants in the UHR group and study quality) on standardized mean differences.

RESULTS

Six studies were eligible for inclusion. Significant differences in self-esteem were observed, with individuals at UHR showing reduced self-esteem relative to healthy controls (g = -1.33 [-1.73 to -0.94] P < .001).However, there was evidence of substantial heterogeneity (I²  = 75%). Exploratory meta-regression analyses indicated a significant effect of the mean age of the UHR group on effect sizes (B = -0.26, P = .02).

CONCLUSIONS

UHR youth present with lower levels of self-esteem than healthy individuals, a difference that appears to be more pronounced with advancing age. We discuss clinical implications and provide recommendations for future studies.

The effect of cognitive behavior therapy on body image and self-esteem in female adolescents: a systematic review and meta-analysis

Low self-esteem and negative body image expose girls to many risks and damages. Cognitive-behavior counseling is one of the ways of improving body image and self-esteem. The aim of this systematic review was to determine the effects of cognitive-behavior therapy on body image and self-esteem of adolescent girls. The English (Cochrane library, Web of sciences, EBSCO, PubMed, Google Scholar) and Persian (SID, MagIran) databases were searched without any time limit. The quality of included studies in terms of risk of bias was assessed using Cochran handbook and the quality of evidence was evaluated through Grading of Recommendations Assessment, Development and Evaluation (GRADE). Meta-analysis was performed using RevMan software. Heterogeneity of studies was analyzed by index I ². Subgroup analysis was performed on the basis of outcome evaluation intervals (after intervention, one month and two months later). A total of 2,664 articles were accessed in different databases of which 2,655 articles were excluded and finally nine studies were systematically reviewed. Meta-analysis results on seven studies (228 participants) showed that the group receiving cognitive-behavior counseling was significantly better than the control group regarding body image (Standardized Mean Difference [SMD]: 13.01; 95% CI: 10.68 to 15.34; I²=26.1%). Likewise, meta-analysis results on two studies (50 participants) showed that self-esteem was not significantly different between the group receiving cognitive-behavior counseling and the control group (SMD: 1.13; 95% CI: -0.7 to 2.32, I²=73%). Meta-analysis results of this study represent effectiveness of cognitive-behavior therapy on body image of adolescent girls; however, since the number of studies in the field of self-esteem is low, more trials in this field with stronger designs are suggested.

Relationship between childhood physical abuse and clinical severity of treatment-resistant depression in a geriatric population

Introduction

We assessed the correlation between childhood maltreatment (CM) and severity of depression in an elderly unipolar Treatment-Resistant Depression (TRD) sample.

Methods

Patients were enrolled from a longitudinal cohort (FACE-DR) of the French Network of Expert TRD Centres.

Results

Our sample included 96 patients (33% of the overall cohort) aged 60 years or above, with a mean age of 67.2 (SD = 5.7). The majority of the patients were female (62.5%). The Montgomery and Asberg Depression Rating Scale (MADRS) and Quick Inventory Depression Scale-Self Report (QIDS-SR) mean scores were high, 28.2 (SD = 7.49) [MADRS score range: 0–60; moderate severity≥20, high severity≥35] and 16.5 (SD = 4.94) [IDS-SR score range: 0–27; moderate severity≥11, high severity≥16], respectively. Mean self-esteem scores were 22.47 (SD = 6.26) [range 0–30]. In an age- and sex-adjusted model, we found a positive correlation between childhood trauma (CTQ scores) and depressive symptom severity [MADRS (β = 0.274; p = 0.07) and QIDS-SR (β = 0.302; p = 0.005) scores]. We detected a statistically significant correlation between physical abuse and depressive symptom severity [MADRS (β = 0.304; p = 0.03) and QIDS-SR (β = 0.362; p = 0.005) scores]. We did not observe any significant correlation between other types of trauma and depressive symptom severity. We showed that self-esteem (Rosenberg scale) mediated the effect of physical abuse (PA) on the intensity of depressive symptoms [MADRS: b = 0.318, 95% BCa C.I. [0.07, 0.62]; QIDS-SR: b = 0.177, 95% BCa C.I. [0.04, 0.37]]. Preacher & Kelly’s Kappa Squared values of 19.1% (k² = 0.191) and 16% (k² = 0.16), respectively for the two scales, indicate a moderate effect.

Conclusion

To our knowledge, this is the first study conducted in a geriatric TRD population documenting an association between childhood trauma (mainly relating to PA) and the intensity of depressive symptoms.

Higher Negative Self-Reference Level in Patients With Personality Disorders and Suicide Attempt(s) History During Biological Treatment for Major Depressive Disorder: Clinical Implications

Objective: The aim of the study was to identify clinical variables associated with changes in specific domains of self-reported depression during treatment by antidepressant and/or repetitive Transcranial Magnetic Stimulation (rTMS) in patients with Major Depressive Disorder (MDD).

Methods: Data from a trial involving 170 patients with MDD receiving either venlafaxine, rTMS or both were re-analyzed. Depressive symptoms were assessed each week during the 2 to 6 weeks of treatment with the 13-item Beck Depression Inventory (BDI₁₃). Associations between depression changes on BDI₁₃ domains (Negative Self-Reference, Sad Mood, and Performance Impairment), treatment arm, time, and clinical variables were tested in a mixed linear model.

Results: A significant decrease of self-reported depressive symptoms was observed over time. The main characteristics associated with persistent higher depressive symptomatology on Negative Self-Reference domain of the BDI₁₃ were personality disorders (+2.1 points), a past history of suicide attempt(s) (+1.7 points), age under 65 years old (+1.5 points), and female sex (+1.1 points).

Conclusions: Early cognitive intervention targeting specifically negative self-referencing process could be considered during pharmacological or rTMS treatment for patients with personality disorders and past history of suicide attempt(s).

An evaluation of a group-based cognitive behavioural therapy intervention for low self-esteem

BACKGROUND

Self-esteem is a common factor in many mental health problems, including anxiety and depression. A cognitive behavioural therapy (CBT)-based protocol called 'Overcoming Low Self-Esteem' is available; the use of this protocol in a group format has been associated with improvements in self-esteem. However, it is unclear whether improvements persist after the end of a group-based version of this programme.

AIMS

We aimed to assess whether changes in self-esteem, anxiety and depression persist 3 months after the end of a group version of the Overcoming Low Self-Esteem programme.

METHOD

Using data from the National Health Service in Fife, Scotland, we analysed whether there were improvements on self-report measures of self-esteem, anxiety and depression from the beginning of the group to the end of the group and at a follow-up session 3 months later.

RESULTS

Significant improvements in self-esteem, anxiety and depression are maintained at 3 months follow-up.

CONCLUSIONS

The Overcoming Low Self-Esteem group seems to be associated with improved self-esteem, anxiety and depression. However, further research from randomised controlled trials is needed to establish a causal link between the programme and improved psychological outcomes.

Cognitive-behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis

BACKGROUND

Cognitive-behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive-behavioural therapy systematic reviews suggested that cognitive-behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials.

OBJECTIVES

This project was undertaken to map the quality and gaps in the cognitive-behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive-behavioural therapy.

DATA SOURCES

The overview was designed with cognitive-behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019.

REVIEW METHODS

Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive-behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive-behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I2 < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality.

RESULTS

A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive-behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive-behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.05 to 0.50, I2 = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval -0.28 to 0.88, I2 = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.28 to 0.74, I2 = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions.

LIMITATIONS

Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them.

CONCLUSION

Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive-behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes.

FUTURE WORK

Future research should focus on how the modest effect sizes seen with cognitive-behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42017078690.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 9. See the NIHR Journals Library website for further project information.

Universal and selective interventions to promote good mental health in young people: Systematic review and meta-analysis

Promotion of good mental health in young people is important. Our aim was to evaluate the consistency and magnitude of the efficacy of universal/selective interventions to promote good mental health. A systematic PRISMA/RIGHT-compliant meta-analysis (PROSPERO: CRD42018088708) search of Web of Science until 04/31/2019 identified original studies comparing the efficacy of universal/selective interventions for good mental health vs a control group, in samples with a mean age <35 years. Meta-analytical random-effects model, heterogeneity statistics, assessment of publication bias, study quality and sensitivity analyses investigated the efficacy (Hedges' g=effect size, ES) of universal/selective interventions to promote 14 good mental health outcomes defined a-priori. 276 studies were included (total participants: 159,508, 79,142 interventions and 80,366 controls), mean age=15.0 (SD=7.4); female=56.0%. There was a significant overall improvement in 10/13 good mental health outcome categories that could be meta-analysed: compared to controls, interventions significantly improved (in descending order of magnitude) mental health literacy (ES=0.685, p<0.001), emotions (ES=0.541, p<0.001), self-perceptions and values (ES=0.49, p<0.001), quality of life (ES=0.457, p=0.001), cognitive skills (ES=0.428, p<0.001), social skills (ES=0.371, p<0.001), physical health (ES=0.285, p<0.001), sexual health (ES=0.257, p=0.017), academic/occupational performance (ES=0.211, p<0.001) and attitude towards mental disorders (ES=0.177, p=0.006). Psychoeducation was the most effective intervention for promoting mental health literacy (ES=0.774, p<0.001) and cognitive skills (ES=1.153, p=0.03). Physical therapy, exercise and relaxation were more effective than psychoeducation and psychotherapy for promoting physical health (ES=0.498, p<0.001). In conclusion, several universal/selective interventions can be effective to promote good mental health in young people. Future research should consolidate and extend these findings.

A Scoping Review of Constructs Measured Following Intervention for School Refusal: Are We Measuring Up?

Reviews of the effectiveness of interventions for school refusal (SR) rely upon well-conducted primary studies. Currently there are no guidelines for those conducting primary studies about the measurement of outcome following intervention for SR. Most people would agree that it is important to measure school attendance as an outcome but there has been little discussion about other constructs that warrant measurement. To facilitate this discussion and support the development of guidelines, we conducted a scoping review of constructs measured in studies evaluating intervention for SR. We screened the title and abstract of 3,213 publications found in peer-reviewed journals between 1980 and 2019. After full text review of 271 publications, 50 publications describing 51 studies were included. Results address the frequency with which constructs were measured, along with instruments used, informants, and time-points for measurement. Based on the results, we offer guidelines for choosing constructs to measure following intervention for SR and considerations for how to measure the constructs. Guidelines can increase consistency across primary studies, with benefits for future meta-analyses and international comparisons. They also provide support for practitioners contemplating routine evaluation of their interventions for SR. Ultimately, a core outcome set for SR can be developed.

Self-esteem, symptom severity, and treatment response in adolescents with internalizing problems

BACKGROUND

Adolescents with low self-esteem often experience internalizing psychopathology (i.e., anxiety, depression). Self-esteem may therefore be a clinically relevant construct for assessment and treatment outcomes. We examined whether general and domain-specific (family, peer, academic) self-esteem are related to adolescents' internalizing symptom severity and response to cognitive behavioural therapy (CBT).

METHOD

Participants were 89 adolescents ages 14 to 18 years (M = 16.3, 70% females) from an outpatient clinic who were referred for CBT. Adolescents completed measures of self-esteem at baseline and measures of internalizing symptoms at baseline and at the end of a manualized group CBT intervention.

RESULTS

Lower peer and family self-esteem, but not academic self-esteem, were associated with more internalizing symptoms at baseline, after controlling for general self-esteem. However, only higher general self-esteem, and not any of the specific self-esteem domains, predicted lower internalizing symptoms at posttreatment. Follow-up analyses revealed differential associations between family and peer self-esteem domains and anxious and depressive symptoms.

LIMITATIONS

Only self-report measures were used. The relatively small sample size may have limited power to detect small effects.

CONCLUSIONS

Self-esteem in domains regarding family and peer relationships may be important in the evaluation of adolescents with internalizing problems. Adolescents with low general self-esteem may benefit less from CBT than other adolescents. Addressing negative self-perceptions may be necessary to reduce internalizing symptoms for adolescents with low self-esteem.

Protective and Vulnerability Factors in Self-Esteem: The Role of Metacognitions, Brooding, and Resilience

The aim of the current study was to explore protective (resilience) and vulnerability factors (dysfunctional metacognitions and brooding) for self-esteem. A total of 725 participants were included in a cross-sectional study. A path analysis revealed five paths to self-esteem. The three main paths were as follows: (1) symptoms −> metacognitions −> brooding −> self-esteem, (2) symptoms −> resilience −> self-esteem, and (3) a direct path from symptoms. The first path corresponds with the metacognitive model of psychopathology and suggests that triggers in the form of anxiety and depression symptoms lead to the activation of metacognitive beliefs, which in turn activates brooding in response to these triggers. When a person engages in brooding, this makes the person vulnerable to experiencing low self-esteem. The second path suggests a protective role of resilience factors. The overall model explained 55% of the variance in self-esteem. Regression analysis found that unique predictors of self-esteem were female sex, symptoms of anxiety and depression, brooding, and resilience. These findings have possible clinical implications, as treatment may benefit from addressing both protective and vulnerability factors in individuals suffering from low self-esteem.

[Mediators of Problematic Social Media Use in Adolescence as Possible Mechanisms of Change in Psychotherapy]

Mediators of Problematic Social Media Use in Adolescence as Possible Mechanisms of Change in Psychotherapy Social media are omnipresent in the lives of adolescents. Problematic use of social media has been linked to adverse mental health outcomes including depression, anxiety, suicidality, self-harm, body dissatisfaction and eating pathology. Preliminary evidence suggests that interventions aiming at reducing the amount of time spent in social media and changing dysfunctional beliefs about social media use are promising. However, the mechanisms of change of these interventions with regard to mental health remain unclear. Therefore, this review first provides an overview of the association between social media and mental health and then identifies mediators of this relationship as potential mechanisms of change of interventions targeting problematic media use in adolescents. The identified mediators encompass social comparison, decreased self-esteem, fear of missing out, sleep problems and increased rumination. Future studies should apply a longitudinal design, should investigate additional confounding variables (e. g. age, level of psychopathology) and should also focus on positive effects of social media use on mental health. Thereby, this line of research has the potential to improve our understanding how social media use exerts its effects and based thereupon to develop new or optimize current interventions on problematic social media use to improve mental health in adolescents by targeting the identified mediators.

Superior knee self-efficacy and quality of life throughout the first year in patients who recover symmetrical muscle function after ACL reconstruction

PURPOSE

The aim of this study was to (1) describe psychological outcomes during the first year after an anterior cruciate ligament (ACL) reconstruction and (2) compare psychological outcomes in patients who recover symmetrical muscle function with patients who do not.

METHODS

The included patients had undergone a unilateral ACL reconstruction. Patients with a re-rupture and contralateral ACL injury were excluded. Three groups, based on the results from 5 tests of muscle function 12 months after reconstruction, were created. Three validated questionnaires (the Knee Self-Efficacy Scale; the Knee injury and Osteoarthritis Outcome Score subscale "Quality of Life"; the ACL Return to Sport after Injury scale) and a single question "Have you achieved your goal with rehabilitation?" were analysed in 4 different follow-ups after ACL reconstruction (10 weeks, 4, 8 and 12 months). Means and standard deviations were analysed with standard t tests and reported with 95% confidence intervals.

RESULTS

A total of 328 patients (120 men, 37%), mean age 27.8 ± 10 years, were included. Patients who did not recover symmetrical muscle function (n = 56; 17%) at the 12-month follow-up reported inferior knee-related self-efficacy and quality of life than patients who recovered symmetrical muscle function (n = 96; 29%) at all follow-ups, except quality of life at 4 months. The proportion of patients who stated they achieved their rehabilitation goal at 12 months was 17% for the entire cohort, 24% for patients who recovered muscle function and 5% for patients who did not recover muscle function.

CONCLUSION

Patients who recovered strength and hop symmetry 12 months after ACL reconstruction had superior knee-related self-efficacy and greater quality of life during the whole first year after ACL reconstruction. These results can aid clinicians in the decision-making process by providing knowledge of patients who might need further attention during rehabilitation.

LEVEL OF EVIDENCE

III.

A metacognitive model of self-esteem

BACKGROUND

In the current study, we aimed to test a metacognitive model of self-esteem grounded in the Self-Regulatory Executive Function model of psychopathology.

METHOD

A convenience sample of 346 community participants were recruited and completed a battery of online questionnaires that measured self-esteem, self-criticism, self-critical rumination, metacognitions about self-critical rumination, generic metacognitions and negative affect. Initially, we tested a series of hypotheses to establish the relationships between the study variables. We then conducted a path analysis to test a metacognitive model of self-esteem, where the process of self-critical rumination and its associated metacognitive beliefs was hypothesized to mediate the relationship between affect and self-esteem.

RESULTS

Self-critical rumination and its associated negative metacognitions, levels of depression and self-criticism independently predicted self-esteem. However, the multicollinearity between rumination and metacognitions suggests that one might not exist without the other. Additionally, a path analysis revealed that the study data was a very good fit to the proposed metacognitive model of self-esteem.

CONCLUSION

The metacognitive model of self-esteem presented in this paper may be used to generate novel interventions to improve self-esteem and decrease self-critical rumination.