Cognitive behaviour therapy for low self-esteem: A preliminary randomized controlled trial in a primary care setting Polly Waite a, * , Freda McManus b, 1 , Roz Shafran a, 2 a University of Reading, Department of Psychology, Whiteknights Road, Earley Gate, Reading, RG6 6AL, UK b Oxford Cognitive Therapy Centre & University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, OX3 7JX, UK article info Article history: Received 1 November 2011 Received in revised form 16 April 2012 Accepted 26 April 2012 Keywords: Cognitive behaviour therapy Low self-esteem Randomized controlled trial Fennell Transdiagnostic treatment abstract Background and Objectives: Low self-esteem (LSE) is associated with psychiatric disorder, and is dis- tressing and debilitating in its own right. Hence, it is frequent target for treatment in cognitive behav- ioural interventions, yet it has rarely been the primary focus for intervention. This paper reports on a preliminary randomized controlled trial of cognitive behaviour therapy (CBT) for LSE using Fennell’s (1997) cognitive conceptualisation and transdiagnostic treatment approach (1997, 1999). Methods: Twenty-two participants were randomly allocated to either immediate treatment (IT) (n ¼ 11) or to a waitlist condition (WL) (n ¼ 11). Treatment consisted of 10 sessions of individual CBT accompanied by workbooks. Participants allocated to the WL condition received the CBT intervention once the waitlist period was completed and all participants were followed up 11 weeks after completing CBT. Results: The IT group showed significantly better functioning than the WL group on measures of LSE, overall functioning and depression and had fewer psychiatric diagnoses at the end of treatment. The WL group showed the same pattern of response to CBT as the group who had received CBT immediately. All treatment gains were maintained at follow-up assessment. Limitations: The sample size is small and consists mainly of women with a high level of educational attainment and the follow-up period was relatively short. Conclusions: These preliminary findings suggest that a focused, brief CBT intervention can be effective in treating LSE and associated symptoms and diagnoses in a clinically representative group of individuals with a range of different and co-morbid disorders. Ó 2012 Elsevier Ltd. All rights reserved. 1. Introduction Self-esteem has been defined as the “conviction that one is competent to live and worthy of living” (Branden, 1969; p.110) and is a term used to reflect a person’s overall evaluation or appraisal of his or her own worth. It can be seen as a schema, in that it is a broad, pervasive theme or pattern, comprised of memories, emotions, cognitions and bodily sensations regarding oneself and one’s rela- tionships with others, developed during childhood or adolescence and is elaborated throughout one’s lifetime (Young, Klosko, & Weishaar, 2003). Evidence suggests that the majority of people with mental health problems suffer from low self-esteem (LSE) (Silverstone & Salsali, 2003), in that they evaluate their competence and worthiness negatively. However, due to difficulties operation- alizing and evaluating the concept of self-esteem (Mruk, 1999), it has been inadequately studied. Although LSE is not a psychiatric diagnosis, it has been shown to have far-reaching consequences. It is associated with dropping out of school (Guillon, Crocq, & Bailey, 2003), self-harm and suicidal behaviour (Kjelsberg, Neegaard, & Dahl, 1994) and teenage preg- nancy (Plotnick, 1992). It also has a negative impact on economic outcomes, such that those with LSE experience greater unem- ployment and lower earnings (Feinstein, 2000). LSE has been associated with and cited as an etiological factor in a number of different psychiatric diagnoses including depression (Brown, Bifulco, & Andrews, 1990), psychosis (Hall & Tarrier, 2003), eating disorders (Gual, Perez-Gaspar, Martinez-Gonzallaz, Lahor- tiga, & Cervera-Enguix, 2002), obsessive compulsive disorder (Ehntholt, Salkovskis, & Rimes, 1999), substance abuse (Akerlind, Hornquist, & Bjurulf, 1988; Brown, Andrews, Harris, Adler, & Bridge, 1986; Button, Sonuga-Barke, Davies, & Thompson, 1996) and chronic pain (Soares & Grossi, 2000). * Corresponding author. Tel.: þ44 118 378 5534; fax: þ44 118 378 6665. E-mail addresses: p.l.waite@reading.ac.uk (P. Waite), freda.mcmanus@ psych.ox.ac.uk (F. McManus), r.shafran@reading.ac.uk (R. Shafran). 1 Tel.: þ44 1865 613145; fax: þ44 1865 738817. 2 Tel.: þ44 118 378 5534; fax: þ44 118 378 6665. Contents lists available at SciVerse ScienceDirect Journal of Behavior Therapy and Experimental Psychiatry journal homepage: www.elsevier.com/locate/jbtep 0005-7916/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.jbtep.2012.04.006 J. Behav. Ther. & Exp. Psychiat. 43 (2012) 1049e1057