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Samia Khoury Dietitian

Tuesday, October 18, 2011

Low self-esteem is associated with many mental health problems

They can feed off each other in a vicious circle; the more depressed or anxious you become the lower your opinion of yourself and your abilities, the more you avoid activities that could help to build-up esteem and address depression or anxiety. Even if you don’t have a mental health diagnosis, you will recognise the impact that your view of yourself has on your mood and nerves.

Most of the research on low self-esteem has been done by psychologists and the most promising treatment outcomes have been with cognitive-behavioural therapy (a process that helps you to identify how you think interacts with how you feel and what you do as a result).
One of the pioneers is Melanie Fenell, a Clinical Psychologist at the Oxford Cognitive Therapy Centre. Dr Fenell has developed a model of how low self-esteem occurs, is maintained and interacts with depression and anxiety. A simplified version of the model looks like this:
Graph illustrating how low self-esteem occurs
This diagram may look daunting but can be understood if you have low self-esteem yourself and can provide valuable insight.

Early experiences

Most self-esteem problems start with an early experience (which could be as late as teenage years) of either failing at some highly valued task, or more tragically by being told that you are not measuring up. Recognising this is valuable and might be helpful for putting the experience into more realistic perspective; but dwelling on it can also make things worse.

Foundation beliefs

The early experience will have been interpreted and its meaning taken deeply to heart as one of your foundational beliefs about yourself, usually concerning your general incompetence; it gets translated into a set of assumptions about how you will fail to cope in specific situations.

Trigger of assumptions

Each of these assumptions about failing to cope is like a little trap waiting to go off when it hits the right trigger, usually a situation that has similarities with the early experience. You immediately expect the worst and all the emotions that come with it, usually anxiety.

Vicious circles

A vicious circle begins with you painfully aware of how much your anxiety about the situation is interfering with your ability to deal with it.
At this point you either withdraw to avoid the trigger; or the anxiety has such an impact that things do go as badly as predicted and your foundation beliefs, assumptions and expectation of the worst are all made stronger. You can see even less of a chance of a way out of the problem and so become depressed and the whole process is repeated when you come across another trigger of assumption.
You may think this cycle cannot be broken, even with this insight, but this isn’t so. The first step is to take the model and put together a version that is unique to you. It helps to get a notebook and draw out something similar to the diagram above, but give yourself a page per box. Sit down and ask yourself a lot of questions, but don’t expect to get it done quickly. You might want to keep a diary over a week or a month to be really clear. If you feel too overwhelmed or too distressed, then stop. You may want to consult your GP and ask to be referred for further help with discussing the issue.
Start by clearly listing your trigger situations first and be really clear about them. Is the trigger:
  • A place
  • A task
  • A person
  • A combination of all three
  • Is there one situation you do manage to muddle through?
  • Is there another you cannot even thinking about facing?
Try to arrange them in order.
Now ask yourself:
  • What is it that you are expecting?
  • Why does this affect you so badly?
  • What happens when you are experiencing anxiety?
  • Are you more aware of racing thoughts of disaster or of physical sensations?
  • What actually happens in the situation?
  • Are you always right to expect the worst?
  • How often do you just withdraw?
  • What are you not doing as a result and how much does this contribute to your depression?
Try not to make this a list of your life failings and include challenging situations that you do deal with and note how they differ from the difficult situations.

It‘s easy to write down these instructions but they can be harder to follow.

Take your time. You‘re the only person this has to be ‘good enough’ for. If you feel it has to be done perfectly you might start looking at challenging some of your assumptions; if not you might look for some common themes in the triggers and expectations and see if they point to any assumptions that you make about yourself. The key is to establish new assumptions.

To do this, try a series of experiments. First take one of your less difficult situations write down your expectation of the worst and ask how strongly you believe this on a scale of one to ten?

Then ask if there is an alternative way of dealing with the situation and how strongly you believe it between one and ten. Question the thoughts that race through your head, stand back and decide if they are accurate.

Try using some of the anxiety management strategies and try to put yourself in the situation and observe yourself; does the worst happen? If so try to find an easier situation to work on; if not rerate your beliefs in your expectations, have they changed and what are the implications for your assumptions if they have.

By slowly working on the triggers changing your expectations and establishing new assumptions about yourself you can begin to work on improving your self-esteem.

Track the changes in your notebook; and remember there will be some setbacks but they are not the end of the story, and if it gets too difficult seek help through your family doctor.


Samia Khoury Dietitian

Yalla I am waiting for you to help you lose weight or consult you on health issues at my clinic in Lebanon or over the web wherever you live! Just contact me at 00 961 3 48 31 86 or via email to take an appointment.


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