Cognitive Behavioural Therapy (Brilliant Business) 1st Ed.

10. Boosting self-esteem

‘Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us. We ask ourselves, Who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be…? Your playing small does not serve the world.’

Marianne Williamson

example

‘I told you I would stuff up’

Elizabeth has worked at Marston and Sons, a northern clothing manufacturer, for the past 15 years. Her highly conscientious attitude to her work was spotted and she was promoted to the position of floor supervisor seven years ago. Her manager believes that Elizabeth is talented and has pushed her to apply for a fast-track, management-training programme.

Despite her reservations, Elizabeth now stands in front of the interview panel about to give a presentation as part of the application process. Her mouth is dry and her hands are trembling. Trying to mask her nerves she switches on the overhead projector to put up her first slide. To her horror she suddenly realises that the slide on the screen is not the first in the sequence. Elizabeth is appalled. What an idiot! She was up half the night checking through the presentation and can’t believe she has been so stupid. What are they going to think of her now? Clearly that she is incompetent – which she evidently is. She is definitely the very last person in the world anyone should ever give a management job to.

In her mind’s eye Elizabeth can see her stepmother’s disappointed face as she turns away from her, shaking her head reproachfully. She was stupid to try for this anyway. She should know her place. They told her at school that she was best suited to manual work. If only she had checked through them one more time, however tired she was… ‘Practise makes perfect, Elizabeth!’ That’s what Mrs Jenner would say.

Elizabeth is aware that her face has turned bright red with embarrassment. She tries to speak, to apologise for the mess she has made, but no words come out. She looks blankly at the interview panel and sees nothing but stony, judgemental faces. What did she expect? Her notes drop to the floor. Unable to bear it any longer, Elizabeth bursts into tears and rushes headlong for the door.

Understanding the cycle of low self-esteem

The unfortunate Elizabeth demonstrates some of the classic traits and habits of someone with low self-esteem. You can see the way a simple mistake triggers a cascade of critical self-talk that rapidly incapacitates her both physically and mentally, unleashing overwhelming feelings of shame and worthlessness.

Elizabeth’s negative self-evaluation becomes self-fulfilling. Her fixed belief that she must perform to the highest possible standard at all times to qualify for any sense of self-worth has prompted her to stay up late into the night until, exhausted, she made the error with her slides.

Having made the mistake, her persecutory thinking makes it almost impossible for her to recover. In her panic she starts to behave incompetently in front of the panel, merely confirming to herself that the critical voices from the past were right about her.

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Breaking the rules

As far as the CBT model is concerned, the reason that people who suffer from a poor self-image are so vulnerable is because they cling rigidly to a set of fixed beliefs about the conditions under which they are allowed to feel okay about themselves.

When these rules are broken the individual is laid open to the full emotional consequences of latent core beliefs that they are bad, helpless or unlovable. Trying to stick to the rules is actually a safety behaviour designed to safeguard them from a toxic cocktail of distressing feelings.

However, the rules themselves are invariably so rigid and so extreme that the poor person concerned has little realistic chance of living up to their demands. When they fail to do so, they feel demoralised, ashamed and depressed and often end up behaving in ways that further damage their self-image and reinforce those negative core beliefs.

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Take a few minutes to see whether you can identify any unhelpful rules of your own. Sometimes such rules are not obvious but hidden in our assumptions and moral values. They can often be detected by the presence of the words ‘should’, ‘ought’ and ‘must’ but this is not always the case. They will be closely associated with your sense of right and wrong and often reflect the expectations of other people.

This is not, of course, to suggest that all moral principles and values should be thrown out as dysfunctional assumptions… The rules that cause problems for us tend to be:

·        Rigid Such rules are absolutes. They don’t take into account our individual needs or circumstances. They are usually the product of polarised thinking.

·        Inherited Often unhelpful rules are imported wholesale from key figures in childhood. Such rules, assumptions and values have often never been examined or evaluated.

·        Unrealistic People often impose standards on themselves that, with the best will in the world, it is not possible to uphold. You might aspire to be a kind person, but no one is kind all the time. If you have rules that insist that you are, then it is inevitable that you will fall short.

·        Restrictive CBT ultimately enshrines a humanistic value system that holds growth, freedom and personal development as fundamental rights of every human being. If your rules stand in the way of such objectives you might want to question their role in your life. Always ask yourself: ‘Are my beliefs helping me?’

As you begin to unearth your rules and values, consider each one in the light of these criteria. Here are a few examples of such rules and assumptions to stimulate your thinking:

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Now see whether you can add a few of your own…

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So how do you change the rules?

There are three things you can do to start with:

1.     Remind yourself that your rules are based on beliefs and values that other people may not share so they are not set in stone. Our rules are aspects of a personal meaning system that can never be objectively ‘true’. As this book has hopefully shown you by now, beliefs and meanings can be changed and adapted to better suit your needs.

2.     Systematically review the evidence as to whether your rules are helpful for you and test them against the criteria listed above.

3.     Conduct behavioural experiments to look at the consequences of alternative rules or see what happens if you deliberately allow yourself to break your current ones. Do the anticipated consequences always follow? What does it actually feel like to live according to different principles? Can you list the personal advantages or disadvantages of alternative positions?

tip

Choose your own values

Avoid using the words ‘should’, ‘must’ and ‘ought’. Substitute them with phrases like ‘I prefer to…’, ‘I choose to…’ and ‘I want to…’ (providing, of course, that this is actually the case!). This will help expose implicit rules that you may wish to reconsider and help you identify the values that you do want to uphold.

example

No more Mr Nice Guy!

Daniel was the most mild-mannered individual you could hope to meet. He came across as a bumbling clown of a man with a shy, bashful air about him. The son of a violent, alcoholic father, Daniel had spent his childhood never knowing what mood his dad would be in when he came home from the pub. He had learnt from an early age the importance of placating his father and had subsequently generated a number of rules about how he must always defer to others that he still lived by as an adult.

Daniel’s low self-esteem had made him quite depressed and as part of an effort to galvanise his activity levels he agreed to join the local amateur dramatics society. The group was due to put on a production of Robin Hood as the annual pantomime, and when another actor fell sick, Daniel had to step into the part of the evil Sheriff of Nottingham at the last minute. He was a huge success in the role, but more impressive was the change the experience produced in Daniel.

‘You’ve no idea how weird it is for me to get inside the head of someone who just takes what he wants and doesn’t give a stuff about anyone else,’ he told me later. ‘That’s so different to how I’ve trained myself to be – the Dan who’s always keeping the peace, always thinking about how everyone else feels… It was just the best thing. Don’t get me wrong: I don’t want to be a villain in real life, but it’s made me realise that perhaps I’ve gone a little bit too far in the other direction.’

Abandoning his life-long rules, even just for a couple of hours on stage, had given Daniel an insight into a brave new world of exciting possibilities.

The origins of low self-worth

People who feel bad about themselves usually do so because they have been programmed with negative messages about themselves from an early age. These messages are not always explicit: sometimes the way children are treated drives them to conclusions about their lack of value just as surely as if someone was telling them directly to their face. It is worth briefly examining some of the ways in which negative core beliefs are laid down, because understanding their origins can equip us better to tackle them.

Neglect

Nothing says ‘You’re worthless’ quite like ignoring your basic needs. And basic needs for children include affection and warmth as well as a roof over their heads and food on the table. Children who feel unloved or uncared for invariably conclude at some level that they are bad because otherwise surely their carers would be motivated to look after them? Because of their vulnerability and dependence upon the adults in their world – however negligent those adults might be – it is usually safer for a child to hold themselves responsible for their poor treatment rather than acknowledge that their carers are incapable or unwilling to do the job properly.

Associated beliefs:

‘I don’t count.’

 

‘I am unlovable.’

 

‘I am not good enough to be looked after.’

Trauma and abuse

When bad things happen to us it is very natural to assume we are being punished in some way, or conclude that we were not worth protecting. These assumptions can form even when we can satisfy ourselves that we have just been unlucky or that the misfortune we have suffered is not our fault. Trauma can also leave us feeling powerless, overwhelmed and unable to cope – all experiences that are at odds with a healthy self-concept.

Associated beliefs:

‘I am weak and vulnerable.’

 

‘I deserve bad things to happen to me.’

 

‘No one kept me safe. Perhaps I don’t matter.’

Failing to live up to expected standards

We have already illustrated how for some people breaking their internalised rules can precipitate a crisis of confidence about their self-worth. However, sometimes these unrealistic standards are programmed into us from an early age. Parents who place excessive expectations on their children, either in terms of their morality or performance, can put their self-esteem under enormous pressure. If they fail to meet these standards children feel (or are made to feel) bad. Even if they succeed then their self-worth is likely to feel contingent on future performance, which means ultimately it is conditional.

Associated beliefs:

‘I just let everyone down.’

 

‘If I don’t do what others want then I am worthless.’

Sustained criticism

Whatever you may feel about the merits of over-praising children, developmental psychologists have known for a long time that an environment of constant criticism erodes self-esteem more reliably than almost anything else. If you allow yourself to tune into your internal critic – and we all have one – you will most likely hear the voice of a disapproving parent. The inner monologue of people with low self-esteem is constantly reproving and condemning. If, as a child, you were constantly being taken to task then you are likely to have internalised negative attributions that, if left unchecked, can continue to damage your self-image in the present. If your carers backed up their disapproval with displays of anger or withdrawal the impact is likely to be particularly pronounced.

Of course it is not only our parents who can pass judgement upon us. People who belong to minority groups may well end up feeling judged by society as a whole. Growing up gay, disabled or in an ethnic minority is still far from easy in today’s world and sadly members of such groups often struggle with self-esteem issues as a result of other people’s perceptions of them.

Associated beliefs:

‘Something’s wrong with me.’

 

‘However hard I try I will never be good enough.’

 

‘I am unworthy.’

Reworking formative memories

All the standard CBT approaches are relevant to dealing with core beliefs linked to self-esteem, but in addition it may be helpful to imagine setting up some kind of dialogue between yourself when you were younger and the adult you have now become.

Retrospectively changing the meaning of key past experiences is not always easy – but it is possible. You are usually dealing with the interpretations and conclusions reached by a child with far less life experience and insight than you have as an adult, so it can be helpful to think not only about how the original conclusions were drawn but whether they were valid or balanced.

Pick out some of the key experiences that moulded the child’s beliefs. Having put yourself into a relaxed state try to picture the scene in as much detail as you can.

1.     Run the scene through a couple of times in your imagination, trying to experience it from the child’s point of view. What were the prominent features of the scene? What did the child feel at the time? What was he or she most aware of? Can you recall any thoughts or images that passed through your head back then or snatches of dialogue that seem especially significant? What sense did the child make of those experiences?

2.     Now run the scene through again, this time trying to put yourself in the position of other key characters in the scene. What were they thinking and feeling? What insights can you gain into why they acted as they did?

3.     Using what you have learnt, the next step is to write down three things you would have wished the child could have appreciated or understood at the time. Keep your message brief and try to keep it in the present tense. Perhaps you need the child to grasp that he or she was not responsible for what happened, or expose some of the things he or she was told and believed as untrue? Perhaps you will simply need to affirm the child’s value at a time when he or she was left feeling ashamed or stupid.

4.     Finally, replay the scene one more time, but this time imagine your adult self standing at the child’s side. Picture yourself explaining to the child what you now know. In your mind’s eye imagine the child assimilating any new information or insights and processing the implications of your message.

example

Jemima was using this technique to reprocess a memory of being left with her grandparents in the UK while her mother and father went abroad to try to clear out their farm in Uganda before it was taken over by Idi Amin’s troops. She remembered feeling desolate – not understanding why her parents had left her behind when her older brother went back home to Africa with them. She recalled how the experience had fed her insecurity about whether she was dispensable to her family. As an adult she knew rationally that the decision had been made because her parents had feared for her safety in the uncertain political climate of Uganda. However, not until she imagined herself communicating this to the seven-year-old Jemima did she begin to weaken the force of latent beliefs that she was ‘unwanted’ and an ‘outsider’ in the family. When she came round from the exercise, Jemima was slightly tearful. When asked whether she was okay she replied: ‘Yes… it’s just that Young Me gave Old Me a message too... I feel a bit embarrassed to say… She said she was glad that one day she would grow up to be a lady with a big handbag and pretty make-up like mine.’

Further techniques to repair your self-image

As the CBT expert Judith Beck points out, the kind of negative core beliefs that damage self-esteem can be grouped under two main headings – beliefs about being helpless and beliefs about being worthless. The interventions that CBT practitioners use when addressing low self-esteem tend to target these two basic areas.

Look after yourself

Whatever their background, people who suffer from low selfworth tend to neglect themselves in important areas of their lives. Their behaviour follows naturally on from their belief that they have little or no value: think about how you treat an expensive new car compared with your rusty old banger! Conversely, because of the two-way street principle in CBT, if you start to treat yourself as if you did have value then you will begin to steer your thinking processes and your emotions in a similar direction.

Individuals with low self-worth may not look on the surface as if they are neglecting themselves. They may even present a well-groomed appearance to the outside world, but often there will be significant areas of unmet need in the way they live their lives. Perhaps they don’t prioritise rest and relaxation because they are spending all their time doing things for others. Maybe they are secretly starving or overfeeding themselves. If you are serious about tackling your self-esteem issues you need to start treating yourself as if your wellbeing mattered, even if you don’t currently feel that way.

·        Diet, exercise and adequate sleep are all part of the equation. If your wardrobe is shabby invest in some new clothes. Just don’t bankrupt yourself doing so because that is not looking after yourself either! Pay attention to personal grooming, not to conform to other people’s aesthetic standards but to give yourself the message that, as the corny advert would tell you, ‘You’re worth it…’.

·        Cut back on the habits and indulgences that feel comforting but actually constitute a veiled form of self-harm: smoking, over-eating, starving yourself, spending hours in front of the telly all need to be addressed. If you really liked yourself would you be doing quite so much of any of these?

·        Find healthy and constructive alternatives that give you pleasure. Lose yourself in a dance class, or treat yourself to a professional massage. Go for a walk in the countryside and listen to your favourite music. Make time to do the things you enjoy and that make you feel good.

Become an assertive communicator

Developing assertive communication skills is an important step for people with self-esteem issues. Expressing yourself clearly and directly is in itself an affirmation of self-worth. Whatever the content of your communication you are saying, in effect, that you believe that what you have to say is worth listening to, while letting the other person hog the floor or ‘suffering in silence’ is not the act of someone with a very strong self-belief.

Key strategies for more effective communication

·        When you want to sound assertive keep it clear and concise. Less is more. Don’t waffle or be tentative. This will make you sound deferential and weaken the impact of what you are saying.

·        Don’t be afraid to use the first person. Under-confident people are often loathe to say ‘I’ but owning your wishes, feelings and beliefs directly makes you sound confident and strong. Moreover no one can directly challenge you because only you are in a position to pronounce authoritatively on the contents of your own heart and mind. ‘I would like to think through the proposal for a few days’ is a strong, assertive statement, whereas ‘Perhaps, all things considered, it would be better to think things through for a while’ invites the possibility of dissent. Perhaps it wouldn’t be better? Maybe it would be better to decide here and now?

·        When making requests of other people use the following three-point formula:

1.     Describe the situation as you see it.

2.     Request the change you want.

3.     State any action you intend to take or consequences that will ensue if your request is not met.

For example (after several polite attempts earlier in the evening):

1.     ‘I can hear the music from your flat really loudly and it is now past midnight.’

2.     ‘I would like you to turn it down now please.’

3.     ‘If you don’t I will be lodging a complaint with the council.’

·        Practise using a strong, clear voice. Don’t use a whiny tone or mumble your words.

·        Check your body language. Make good eye contact and plant your feet firmly on the floor. Don’t fold your arms or you will look defensive. Drop your shoulders and hold your head up. The aim is to hold yourself relaxed but upright. Under-confident speakers often stoop or appear to be collapsing under the force of gravity.

·        When being criticised you can often disarm your critic by not jumping to defend yourself but finding something in her comments that you can agree with, even if only in principle. This technique is called fogging.

·        When negotiating try to work towards solutions that yield some kind of pay-off for both parties. You will get much further.

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Remember: assertiveness is not the same thing as aggression. Truly assertive communication is respectful of the self-esteem of everyone involved.

Don’t allow yourself to be thwarted

Researchers have found that heaping praise on children is not the most effective way to promote their self-esteem. What really counts is having opportunities to experience themselves as effective and competent people. Self-esteem is synonymous with self-efficacy. On the other hand, if you allow yourself to become helpless and convince yourself you lack the resources to get your needs met, your self-esteem will suffer.

Negative beliefs about helplessness are a recurring theme for people with low self-worth. Once established, they can encourage passive and defeatist attitudes that only make the situation worse. Many people with poor self-images sit on their dreams and aspirations because they allow their critical inner voices to rob them of the possibility of turning dreams into reality. This leads to a further sense of frustration and futility that reinforces how powerless the individual has become. To break this cycle:

1.     Make a comprehensive inventory of past achievements and current skills. You will use this to bolster your confidence and counter negative beliefs such as self-critical affirmations that you ‘are incapable of ever achieve anything worthwhile’ when working towards new goals becomes difficult.

2.     Set yourself some goals and plan steps towards achieving them. Are there projects, large or small, you have always wanted to embark on but have talked yourself out of? What would you be doing if only you had the confidence? Make a list of at least five and select two objectives that you are going to work on.

3.     Break your goals into a series of smaller subgoals. If you wanted to take up fishing your subgoals might include a trip to the library to get out some related reading and a phone call to the friend at work who offered to take you along to the local trout farm one day.

4.     Set yourself a realistic time scale and schedule for achieving your subgoals. Don’t forget to incorporate regular review points so you can monitor how your progress is coming along, factor in any new subgoals, and take action if your plans are going astray.

5.     Think about any obstacles that might present themselves (e.g. general inertia, other people’s demands on your time, your impending house move) and make specific contingency plans about how such obstacles might be managed and overcome.

6.     When you have reached your goal take time to celebrate. This is a way of consolidating your sense of achievement and logging an experience that can be used as an effective counter to future negative thoughts about being ineffectual or powerless.

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Reframe your ‘failures’ in a more positive light

If your self-esteem is fragile it is easy to get discouraged when things don’t go according to plan. However, psychologist Carol Dweck writes persuasively about the ‘growth mindset’ as being characterised by a preparedness to welcome mistakes and apparent failures of all kinds as a natural, valuable and inevitable part of learning. Develop the attitude of Thomas Edison, the American inventor, who was once heard to remark: ‘I haven’t failed. I’ve just found 10,000 ways that don’t work.’

Try a little tenderness

As we have seen, people who suffer from low self-esteem often develop a highly critical inner voice that leaves them prone to feelings of inadequacy and shame. One of the best antidotes to these problems has turned out to be deliberately cultivating specifically compassion-based cognitions that can be highly effective in counteracting your hostile internal commentary.

Dr Paul Gilbert has found that by deliberately concentrating on generating feelings of compassion towards oneself and other people impressive changes can be achieved. In a study conducted in a high-security psychiatric hospital, a group of patients reported significant improvements in their self-esteem and the lifting of depressive symptoms after just a few weeks of compassion-based meditation.

Developing a compassionate stance towards oneself and others depends on cultivating three main attitudes:

·        A willingness to be mindful and open to one’s own distress rather than trying to shut it down prematurely.

·        Adopting a kind and non-judgmental stance towards self and others.

·        Developing an awareness of sharing feelings of suffering with others, rather than concentrating on feelings of isolation or shame.

Many of these ideas have much in common with the Mindfulness approach already being used in the treatment of a variety of mental health problems with considerable success. An important element is the preparedness to accept negative thoughts and feelings when they arise, stand back and observe them, and then allow them to subside. In Compassion Focused Therapy the techniques of CBT are used to normalise suffering and challenge assumptions that such states are intolerable or damaging. Examples of the sorts of compassion-based response we are talking about include alternative thoughts like the following:

Negative automatic thoughts

Compassion-based responses

‘I can’t stand this pain inside…’

‘Emotional pain is an unavoidable part of life that we all must share. It is unpleasant but normal. It feels bad now but it will pass in due course. If I can accept it rather than struggle against it, it will hurt me less.’

‘What I’ve done is unforgivable. I’m just scum.’

‘I can always choose to love and forgive myself, no matter what I have done or how I have acted in the past. We are all human and we all make mistakes. Although I choose to face the consequences of my actions, including how they make me feel right now, I recognise that there will come a time when I need to wipe the slate clean and start afresh.’

‘I’ve come to the end of the road. I can’t face going on anymore…’

‘Right now I feel desperate, and I choose to stand back and observe my feelings, reminding myself that however terrible they may be they don’t have to control me. Part of me is separate from them, just noticing them. It’s a good, strong, wiser part of me that remains unaffected, whatever I may be experiencing right now.’

The science behind Compassion Focused Therapy claims that when we rehearse self-critical and negative thoughts, we activate the subsystem of our brains designed to help us deal with threat and unwittingly prime a state of arousal that primes us for fight or flight. The techniques of CFT are designed to persuade the threat-response system to stand down, by actively cueing a separate subsystem designed to soothe us and restore a sense of equilibrium by producing feelings of reassurance, comfort and safety and releasing oxytocin and endorphins into our bloodstream.

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Be careful how you speak to yourself

Gilbert was interested in why many people using CBT techniques reported that while rationally they were convinced by their alternative thoughts, they often lacked emotional conviction. It was ‘head knowledge’ but it didn’t seem to connect with what they felt inside. What Gilbert discovered was that often such people were using CBT to reason with themselves in quite a harsh, critical or detached way, as if they were blaming themselves for their thinking errors or simply commanding themselves to think differently. Once he persuaded them to start imagining delivering the alternative thoughts in a kind, gentle and soothing tone, many of his subjects reported finding them much more effective. This makes sense in terms of Gilbert’s model: it looks as if the very thoughts that were supposed to be an antidote to negative cognitions were being administered in such a way as to trigger the threat-response system!

There are many aspects to Gilbert’s Compassion-based therapy model that lie beyond the scope of this brief introduction. If you are interested in acquainting yourself further with Paul Gilbert’s theories and methods, I would recommend his book The Compassionate Mind. However, the notion that fostering attitudes of kindness and self-acceptance directly may be just as important in boosting our sense of self-efficacy is an important one for anyone who suffers from the symptoms of low self-esteem.

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You can try out a CFT technique for yourself. Seek out a quiet place where you won’t be interrupted. Find a comfortable position and close your eyes. Allow yourself to imagine the most compassionate, wisest version of yourself possible. Imagine yourself sitting in a pool of beautiful pure light. Decide for yourself what colour best represents for you the quality of pure compassion and tint the light beam accordingly. In your mind’s eye let the light wash over you, soaking into every fibre of your being, and gathering in your core where it grows stronger and sweeter and brighter. Notice how the light makes you feel safe, accepted, and secure. You feel completely at peace. Now imagine that the light entering you is also flowing through you and out towards the world, reaching out towards other people, irrespective of who they are or the mistakes they have made. And as the light touches them you watch them changing. Their faces soften. Their postures relax. Their movements become more fluid. They look lighter, happier, bathed in the glow of this constant stream of loving energy that finds no fault with any of them and touches the heart of each, just as surely as it calms and settles your own. Take a moment to enjoy a profound feeling of deep acceptance and connection. See yourself sitting there with the light streaming into you and out through you, connecting you to every living thing.



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